TDP_Draft_RFP_Responses_to_Industry_FBO.docx

1. (16) Section A Part 1 – The Schedule Page 1, Supplies or Services and Prices/Cost. Will the Government consider modifying the CLIN structure to allow for adjustments to prices in Option Years 4-6?

Government Response: No. Option prices will be set prior to contract award.

2. (10) Section B Transition-Out and Phase-Out CLINs; C.4.3 Transition - What is the difference between the scope of work to be estimated within the Transition-Out CLINs associated with each contract year period of performance and the scope of work to be estimated separately under the contract Phase-Out CLINs?

Government Response: As stated in Section J, Attachment J-11, paragraph 3.0, the term “Transition-Out” is the last option period in which the outgoing contractor is still providing dental care, but is transferring data to the incoming contractor (CLIN X014). The term “Phase-Out” (CLIN 600X) is the option period in which the outgoing contractor is no longer providing dental care, but is processing claims and providing customer service for care that was delivered in the previous option period. Phase-out follows the Transition-Out period.

Paragraph 3.10 states, the outgoing contractor shall complete processing of its claims, adjustments, written correspondence, telephone inquiries, appeals, and grievances related to services under this contract within the contractually established standards until the end of the Phase-Out period (i.e., the option period following the Transition-Out period).

The only difference in scope of work between the two CLINs is the contractor will not be providing dental care in the Phase-Out period.

3. (34) Section B - CLINs X010 and X011 Please clarify why these CLINS are optional and under what circumstances would they be exercised.

Government Response: All CLINS past the base period of performance are considered Option Line Items. CLINS will be exercised based on Government’s need for the service to be performed. See Section J, Attachments J-6a and J-12

4. (42) Under C.3 Performance Requirements, subsection C.3.1 States “The Contractor shall sustain or increase enrollment percentage for eligible beneficiaries” (Page C2 of C12).

Q: What is the percentage used for increased enrollment and what is the disincentive for not sustaining/increasing enrollment?

Government Response: The percentage will be the previous year’s total enrolled divided by the current year’s total enrolled. There is no disincentive for this requirement other than being documented in the annual Contractor Performance Assessment Review (CPAR).

5. (49) Section C.3 Performance Requirements – We recommend that the Performance Requirements be expanded to include the following: “Establish and maintain enrollee and provider satisfaction at the highest level possible through the delivery of a high quality dental care program meeting or exceeding all standards identified in this contract.”

Government Response: Customer satisfaction is a requirement of the RFP, per the standard 95% overall customer satisfaction with TDP stated in Section C.3.3.7. Meeting or exceeding all standards identified in this contract supports the overall customer satisfaction.

6. (3) Sections C.3.1, C.4.10.1 - The incumbent contractor has an advantage in modeling the enrollments and utilization based on their experience performing the current contract. To ensure adequate competition, please provide the historical data on enrollments as a percentage of the total number of TDP-eligible beneficiaries that were enrolled during each year of the current TDP contract.

Government Response: As stated in Section J, Attachment J-16, we intend to provide a listing of eligibles and also the following enrollment data pertaining to the current TDP contract. Offerors will be able to determine the percentages.

CONUS Enrollment Data.

· By month per option period

· By single/family plan type

· Current enrollments, additions and disenrollments

· Total covered lives

· Data collected May 2012 through Dec 2014

. OCONUS Enrollment Data.

· By month per option period

· By single/family plan type

· Current enrollments, additions and disenrollments

· Total covered lives

· Data collected May 2012 through Dec 2014

7. (43) Under Subsection C.3.3.2a Performance Standards, the AQL states “95% of enrollees shall have access to a general dentist within 35 driving miles and 21 days of requesting an appointment” (Page C4 of C12). However, on Page H3 of H3 Subsection H.4.1.1 Network Provider Access Standard states “Ninety Nine (99) percent of enrollees shall have access to a network general dentistry provider within 35 driving miles of their primary residence, and be able to obtain an appointment within 21 calendar days of requesting an appointment.

Q: Please clarify as to the percentage used regarding Network Provider Access Standards.

Government Response: H.4.1 and H.4.1.1 should both reflect an access standard of 95%. Section H will be corrected.

8. (44) Section C.3.3.2 – Network Access Performance Standards. Per the proposed change in Attachment J-5 – 9.3. Non-network Reimbursement additional network access standards are recommended. It is critical to maintain high contractual standards for the Contractor’s network size and broad geographic accessibility to preserve the beneficiary access to providers and minimize beneficiary dissatisfaction that could result from network disruption. Since, in most instances, non-network reimbursement will be based on the network maximum allowable charges, stringent network access standards are required. If a contractor’s network does not include sufficient provider access, TDP beneficiaries may be forced to seek care out of network and be subject to significantly higher out of pocket costs which can greatly decrease beneficiary satisfaction. Such network access standards should include differing levels of access to varying numbers of general dentist(s) and driving miles, as well as a network depth component to ensure a certain level of availability to all dentists. The network access standards could be constructed along the lines of the following:

i. (x)% of enrollees with access to (y) general dentist(s) within 35 driving miles and 21 days of requesting an appointment

ii. (x)% of enrollees with access to (y) general dentist(s) within 20 driving miles and 21 days of requesting an appointment

iii. Network Depth Standard – (x)% of all enrollees will have network access to (y)% or more of all available dentists in their zip code area.

Government Response: Offerors may propose more stringent network access standards. If more stringent standards are proposed, they will be incorporated into the contract. If network access standards are not met, then the network access disincentive will be applied to the contractor. In addition, if an area is deemed as non-compliant the beneficiary is protected while the contractor will pay out-of-network rates (see Section J, Attachment J-5 paragraph 5.2).

9. (17) C.3.3.2 Performance standards Page C4 of C12. Requirement: The contractor shall provide and maintain access to general and specialty network providers for enrollees. Question/Comments

a) The current language in this section pertains to general dentistry. Are there specific requirements for specialty care that will be added, or can it be clarified that the general requirements also apply to specialty care?

Government Response: The performance standards at C.3.3.2 only apply to general dentistry. The Government has not specified a standard for specialty providers. Offerors may propose a specialty provider standard if they wish.

b) As part of the access requirement, there is a 21- day appointment requirement. Is there a standard for urgent/emergent care? Will the government provide detail on the appointment survey criteria and calculation methodology?

Government Response: Per 32 C.F.R. 199-13(f)(5), participating providers must accept within one day of a request for appointment, beneficiaries in need of emergency palliative treatment. Offerors are responsible for developing and proposing their methods of verifying access standards are being met.

c) Will the government consider making a full census file available prior to the RFP being issued?

Government Response: The Government will provide eligibility files as described in Attachment J-15.

d) Based on the access standards definition provided in Appendix B, will the government consider varying the AQL for general dental care of"35 driving miles" to also allow for differences in Suburban and Rural geographies?

Government Response: The minimum standard is 95% of all enrolled beneficiaries must have access to a network provider within 35 driving miles.

10. (18) C.3.3.3. All Page C5 of C12. Requirement: The contractor shall develop agreements with TRICARE OCONUS Preferred Dentists (TOPDs). Question/Comments

a) Will a list of currently contracted TOPD providers be made available for use in responding to RFP? Will the Government consider making this list of TOPD providers available prior to the RFP being issued?

Government Response: A list of TOPD Locations by City and Country will be released with the data set. It will not include provider names. A complete list including providers will be released after award.

b) Will the list indicate the utilization of each provider; will the list include provider identification information?

Government Response: In addition to the TOPD locations, offerors will receive raw claims data which will specify the zip code/country code where care was rendered, but individual provider names will not be listed.

c) For OCONUS network development and relations, will shared effort/coordination with the DHA facilities and/or offices that are located OCONUS be subject to clarification through an MOU between the parties?

Government Response: Please refer to Attachment J-6a for information regarding OCONUS TAO relations. The Government has no requirement for an MOU.

d) Can you clarify the key requirements for each of the following:

a. Contractual/ Agreement Language Requirements

Government Response: TOPD Agreements shall comply with Section J, Attachment J-6a, paragraph 4.1.

b. Credentialing Requirements

i. Tricare Standards

ii. OCONUS Standards

Government Response: TRICARE credentialing requirements specify that beneficiaries may seek covered services from any provider who is fully licensed and approved to provide dental care or covered anesthesia benefits in the state where the provider is located. Please refer to 32 C.F.R.199.13 for information. OCONUS providers must be credentialed in accordance with local nation laws. In addition, Section J, Attachment J-5, paragraph 8 states, “Prior to the payment of any claim for dental services, the contractor shall ensure that the provider has complied with the licensure requirements established by 32 CFR 199.6 or the OCONUS locality (e.g., state, country, territory, etc.) in which the services were rendered, including national and/or lower level requirements and Canadian federal and/or provincial requirements, as appropriate.”

c. Credentialing Standards

i. Required turnaround times for credentialing

Government Response: This is at the discretion of the contractor. Minimum access standards must be met.

e) Does the 35-mile radius and 21-day appointment access standard for CONUS also apply to OCONUS?

Government Response: No. There are no requirements for a network in OCONUS locations.

11. (35) Section C.3.3.7 In the Government-provided data file list (Attachment J-16), please consider including the current customer satisfaction levels so offerors can adequately respond to the requirement to maintain 95% overall customer satisfaction with the TDP.

Government Response: This information will not be released. The Government considers the threshold to be appropriate and rely on offerors to determine how to maintain the minimum level of satisfaction.

12. (19) C.4.7.1.1. Par 1 Page C9 of C12. The contractor shall develop and implement a QCP IAW the TOM, Chapter 1 Section 4 (excluding paragraph 2.2, 2.3, 2.4, 3.1, 3.2, 3.4 and 4.0). The contractor shall maintain a QCP that ensures that services are performed in accordance with the contract. The contractor shall develop and implement procedures to identify, prevent, and correct problems for the duration of the contract. Question: Section C excludes paragraph 4.0 (Quality Control) of Chapter 1, Section 4 of the TOM. Will there be a quality control audit requirement under the TRICARE Dental Program?

Government Response: Government quality assurance will be completed in accordance with FAR 52.246-4, Inspection of Services—Fixed Price and Contract Section C.4.7.

13. (20) C.4.7.1.2. All Page C9 of C12. The contractor shall also provide a Web based dental health plan report card that monitors outcome measures for the program. This report card will, at a minimum, monitor access and satisfaction, use of services, effectiveness of care, utilization, membership, utilization of prophylaxes of pregnant and diabetic enrollees, utilization of scaling and root planning of diabetic enrollees, and utilization of the dental accident coverage. The data will be updated on a monthly basis and summarized quarterly. Questions:

a) Can you clarify parameters for conditions to be monitored (for example, diabetic enrollees and dental accident coverage)?

Government Response: The report card will summarize and report the volume of care delivered in a manner that will provide the Government with quantified data to evaluate program effectiveness. The minimum requirements regarding conditions to be monitored are contained in C.4.7.12.

b) Please provide more detail regarding determinations for dental accident coverage.

Government Response: The contractor must report quantified data on care delivered in response to an accident resulting in damage to dentition. See Section J, Attachment J-2, paragraph 3 for additional information on accident coverage.

c) Can you also clarify how benefits are to be coordinated between plans and, specifically, dental accident coverage and regular dental benefits?

Government Response: TRICARE is secondary payer to other dental health plans (see Section J, Attachment J-5, paragraph 9.4). If the care needed is determined to be caused by an accident then the dental accident coverage will pay before regular dental benefits. Please refer to Section J, Attachment J-2 for further guidance regarding dental accident coverage.

d) How will diagnostic information be made available/accessed, or will contractors be limited to the diagnosis noted on the dental claim form?

Government Response: Claim data from participating providers is submitted in accordance with the contractor’s network agreement. Nonparticipating providers may be required to submit additional information necessary to validate the claim.

14. (21) C.4.9.2. All Page C10 of C12. Potential Fraud and Abuse Cases. The contractor shall refer to DHA potential cases that involve more than a $10,000 loss to the Government or cases with any loss where patient harm has occurred. See TOM, Chapter 13, Section 2 for further requirements. Question: Will there be a minimum number of cases to be referred to the Government?

Government Response: No. Refer all cases that meet the specified criteria.

15. (22) C.4.10.1. All Page C10 of C12. The contractor shall provide the Government with access to their full TDP data set including, but not limited to network providers, non-network providers, enrollment information, claims processing, claims payment, enrollee care and service data.. Questions/Comments:

a) Please define the level of access that will be required for the full TDP data (e.g., read-only access, online access, near real-time access).

Government Response: The Government requires read-only access, with download capability for data manipulation purposes. Access shall be on-line, and as near real-time as possible. Clarification will be added to C.4.10.1.

b) Please provide further definition of the level of access required

Government Response: Access is required for the DHA Dental Care Office, Contracting Officer, Contract Specialist, Contracting Officer’s Representative, and the Tri-Service Center for Oral Health Studies (TSCOHS).

c) Is the contractor required to provide all training to Government personnel?

Government Response: Yes. Clarification will be added to C.4.10.1.

d) Will the government provide in the RFP how many user access accounts will be needed, and for what type of entities?

Government Response: The Government will likely need 10-15 user accounts. Clarification will be added to C.4.10.1.

16. (23) C.4.10.2.1. All Page C11 of C12. The contractor shall submit the claims and provider data in accordance with the ICD and Section J, Attachment J-10. Questions/Comments Please provide further details regarding the ICD and its data fields.

Government Response: Please refer to Section J, Attachment J-10 for a description of data fields. This document will be further developed by the Government and the contractor during the transition period to accommodate both the Government’s data requirements and the contractor’s data systems.

17. (24) F.2.2. All Page F1 of F3. F.2.2. Options 1 through 6 (if exercised) will be : Option Period l: 02/01/2017 to 01 /31/2018, Option Period 2: 02/0l/2018 to 0l/31/2019, Option Period 3: 02/01/2019 to 01/31/2020, Option Period 4: 02/01/2020 to 01/31/2021, Option Period 5: 02/01/202l to 02/01/2022 Option Period 6: 02/01/2022 to 01/31/2023. Question Will the CLIN Structure in Section B, be updated to provide for a 6th Option Period (i.e., CLlNs 6001 - 6012)?

Government Response: No; the Government has revised the language in F.2.2 and added Par F.2.3 to reflect Option Period 6 Phase-Out performance period of performance. Following is F.2.3. addition “ Phase out, CLINs 6001- 6005: There will only be one phase-out CLIN exercised in the performance of this contract. The phase out CLIN period of performance will be one year and follow the last period of dental care delivery.

18. (37) Section H.3.1.1 H.3.1.1 contains suggested dental CDT codes for an enrollee annual utilization measure. Evidence-based guidelines recommend clinical evaluations with a regular recall schedule. Recent activity of the Dental Quality Alliance (CMS-sponsored and ADA-administered) and the National Quality Forum regarding dental quality measures uses a similar philosophy of assessing examination utilization; however both those measures only include codes D0120, D0145 and D0150. They do not use the emergency/problem focused codes to assess annual utilization. We recommend that the incentive follow the emerging national guidelines.

Government Response: DHA’s research indicates that emergency/problem focused codes are still being used in assessing annual utilization; therefore the incentive measures will remain unchanged.

19. (45) Section H.4.1.1 - Network Access Negative Incentive – Similar to the comments regarding network access performance standard, because a Contractor has no inherent financial incentive to continuously build their TDP network when their claim costs are the same in network versus out-of-network, there is a significant risk they may provide a network that meets the minimum contractual requirements but is actually rather limited in terms of accessibility and possibly quality. To be consistent with the stricter access standards as outlined in item 1 above, these negative incentives should be updated accordingly.

Government Response: The disincentive in Section H will be revised at award to coincide with the proposed network access standard. Payment to non-network providers in a network compliant area will be the lesser of (1) billed charges; or (2) the network maximum allowable charge for similar services in that same locality (region) or state (see Section J, Attachment J-5 paragraph 9.3). If the area is a non-compliant area the non-network provider will be reimbursed at the level of the provider’s usual fees less applicable enrollee cost-shares (see Section J, Attachment J-5 paragraph 5.2).

20. (25) H.4.1.1. All Page H3 of H3. Network Provider Access Standard: Ninety-nine percent of enrollees shall have access to a network general dentistry provider within 35 driving miles of their primary residence, and be able to obtain an appointment within 21 calendar days of requesting an appointment. The negative incentive will only be applied to the 99% standard. The other network access standards (see Section C.7.5.2) will be addressed under the monthly reporting requirements and the contractor Performance Assessment Reporting System (CPARS). If the contractor's percentage of Network Provider Access falls between the levels described below, the contractor shall reduce their following Option Period premiums as indicated in the chart below: Question/Comments

a) In the table embedded within H.4.l.l, a 95% access standard is indicated. Did the government intend to use the 95% standard in both H.4.1 and H.4.1.1 instead of 99%?

Government Response: H.4.1 and H.4.1.1 should both reflect an access standard of 95%. Section H will be corrected.

b) For areas where a general dentistry provider does not exist (community need) within 35 driving miles of a beneficiary's primary residence, how will geographic areas be counted? Will they be removed from the numerator and denominator?

Government Response: The minimum standard is 95% of all enrolled beneficiaries must have access to a network provider within 35 driving miles. All geographic areas will be counted in the calculation of the achieved network access standard.

c) If the only dentist within 35 miles is not able to take any more patients, would this be considered community need or not?

Government Response: This would be considered a non-compliant zip code.

d) Will a list of beneficiary addresses be provided in the RFP to allow for proposal development?

Government Response: No, a listing of beneficiary addresses will not be provided. Please see Attachment J-15 for the list of data that will be provided.

e) How will the "appointment within 21 calendar days of request" be measured? Will it suffice for providers to communicate that they are able to take a new patient within 21 days? Will there be a survey of beneficiaries? Is this measured by looking at the day the beneficiary is referred and then looking at the date of service for the dental appointment?

Government Response: The standard is measured from the date of the request to the date an appointment is available. The standard applies only to general dentists. There is no specific standard for specialists. Referrals do not apply to general dentists. The DHA Dental Care Office monitors the standard based on the contractor monthly reporting requirement and the feedback received from the enrollees.

21. (26) Section I FAR 52.216-19(a) Page 13 of I12. (a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $2,500 the Government is not obligated to purchase, nor is the contractor obligated to furnish, those supplies or services under the contract. Question/Comment Will the Government consider instituting a contract minimum dollar value for each option period under the contract?

Government Response: No. The Government contemplates an Indefinite Delivery Requirements Contract. There are no minimum contract guarantees for this type of contract. The minimum identified in this clause is an order minimum not a contract minimum.

22. (29) Attachment J-2 All Sections all pages. Utilization Management requirements and Exclusions & Limitations listed throughout document. Question. Can the contractor apply their own utilization management standards and/or exclusions and limitations that might be more or less restrictive?

Government Response: No, all offerors must propose on the same benefit as outlined in Section J, Attachment J-2. After award, the contractor may recommend changes when the Current Dental Terminology (CDT) codes are updated annually (see Section C.3.3.1).

23. (28) Attachment J-2 2. General Policies Page 1 of 32. Benefits, Limitations and Exclusions Question. Is the "not billable" statement limited to network providers only?

Government Response: Yes.

24. (14) Attachment J-2, Sections 2.1.2 and 5 - May the premium rates vary by CONUS vs OCONUS, by pay grade, active duty vs reserve, by geographic region, etc. or must all beneficiaries be offered the same premium rate?

Government Response: We are not able to locate your references stated for Section J, Attachment J-2. In response to the premium rates, the premium rates will not differ by status or geographic region. Premiums must be the same in all locations in order for the Uniformed Services Finance Centers to make timely beneficiary premium allotments and pay the Government’s share of the premium. In addition, retroactive enrollments are allowed in conjunction with corrective actions in the Defense Eligibility Enrollment Reporting System (DEERS). This and enrollee mobility would make the administrative task of ensuring correct premium payments on the part of the Government and enrollees extremely burdensome if the premium varied from one region to another. Section J, Attachment J-5, paragraph 2 states the premium payments must be the same for all single plans and the same for all family plans no matter their status. Clarification will be added to paragraph 2 to include geographic regions.

25. (15) Attachments J-2 and J-5 - Attachment J-2, section 1.2 as well as Attachment J-5, sections 1.2.4 and 7.4 reference an annual deductible, however, Attachment 4 does not specify the dollar value of the annual deductible. Please clarify, what is any annual deductible amount is to be applied to the benefit?

Government Response: You are correct; the term “deductible” does not apply to this contract. It will be corrected in the final RFP.

26. (9) Attach J-4 (3); Attach J-5 Section 9.3. - These sections state that the non-network reimbursement is contingent on the final rule 32 CFR 199.13. Will this be finalized when the final RFP is released and if not should the bidders assume that it will be finalized and bid non-network cost as if it is?

Government Response: Offerors shall propose as if the final rule is published. Clarification will be added to Section L.4 of the RFP.

27. (5) Section J-5, Paragraphs 12.5, 12.6, and 12.7; Attachment J-6a, Section 5.0 Education, 5.1 and 5.2; Attachment J-11 Item 2.2; Attachment J-16 - Section J-5 discusses choice of how to receive communication materials: website, email, CD or US Mail. However other sections/references are specific to utilization of US Mail. This conflicts with current DHA policy to leverage email communications and reduce print.

Question Part A:

Please confirm our understanding that the Government's requirement and stated DHA policy guidance authorize contractors to use email as the primary method for transmission of program-specific educational materials and communications. If the answer to Part A of this question is "Yes," then we recommend the following discrepancies within the RFP be corrected:

- 12.6.1 – ‘…distribute a copy of the TDP benefits booklet to new enrollees/households within 15 calendar days…’ – does not contain reference to 12.5.1 as other citations in this section.

- 12.7 – ‘The contractor shall mail the TDP Benefits Brochure to the new eligibles that are identified on a quarterly file received by Defense Manpower Data Center (DMDC)’ – this file should contain email addresses in order to minimize mail costs for contractor and print costs for government.

- Attachment J-11 Item 2.2 does not identify ‘email’ as part of the name and address information on each household for education and communications listing. It only references ‘direct mail educational activities.’ The 1st and 2nd Eligibility Education and Communications Listing files need to include emails to be compliant with Attachment J Section 12.5.1, minimize costs to the government and be consistent with DHA/DMDC paperless policies

- Attachment J-16 should also reference email as part of data files

Government Response: Yes, DHA is trying to reduce printed materials; however beneficiaries and providers may choose the method they want to receive materials. Changes are being made in how the current enrollees will be notified about the new contract and benefit changes. For the next contract DMDC will notify the current enrollees to go to the TRICARE website to view the changes and that they should also notify the contractor of the method in which they want to receive materials.

The policy has not been finalized at this time for DMDC to release email addresses with the eligible list. It has been determined that only one Eligibility Education and Communications Listing will be provided during Transition-In as an updated list of eligibles will be provided quarterly throughout the contract.

Question Part B:

Please provide the quantity of current eligible AND enrollee household email addresses as compared to those with US Mail address only to ensure all bidders, and not just the incumbent contractor, can appropriately calculate education material fulfillment and postal costs.

Government Response: DHA does not have the ability to provide the requested data. The DHA/DEERS email policy has not been finalized yet. The current TDP contractor is still utilizing US Mail rather than email for the majority of its correspondence. Currently, only claims notifications are sent to enrollees via email to those who are registered on the contractor’s website. The contractor does not currently send any other system generated correspondence via email. As a reference there are approximately 85,000 registered users on the contractor’s website. There are approximately 1.9 million lives enrolled and approximately 800,000 contracts. When viewed by household for enrollee newsletter mailings, etc., the number of pieces mailed via U.S. mail is typically similar to the number of contracts.

28. (2) Attachment 5, Paragraph 1.2.3 Incapacitated Children - It appears the example of the 19-year-old child is incorrect. Please confirm our understanding of the Government's TDP Survivor benefit to mean that if a 19-year-old incapacitated child is not in a full-time course of study in a secondary school or institution of higher education, the TDP Survivor benefit would end when the dependent attains 22 years of age, per the Government's statement that the benefit is the greater of: a) Three years from the sponsor’s date of death, or, b) The date on which such dependent attains 21 years of age, or, c) The date on which the dependent attains 23 years of age if enrolled in a full-time course of study in a secondary school or in a full-time course of study in an institution of higher education (subject to TRICARE eligibility limitations). The greater of duration in this case would be three years from the sponsor's date of death.

Government Response: The example is correct, for the TRICARE eligibility limitations restrict the eligibility to age 21 years. We will add clarification to paragraph 1.2.3 to more clearly state the age limit.

29. (12) Attachment J-6, paragraphs 2.0 and 3.2 - The Government states, “The contractor shall develop a TRICARE Area Office (TAO) Relations Program to facilitate this interface.” The Government also describes the responsibilities of the TAO Dental Representative/Consultant. We understand this requirement to mean the contractor plays a facilitative role while the TAO Dental Representative/Consultant is not a TDP contractor-provided function/individual. Is this a correct interpretation of the requirement? If the Government's answer to this question is "no," then we respectfully ask the Government clarify the roles in Attachment J-6 in terms of: a) Government-provided, b) TDP contractor-provided, and/or c) other Government contractor provided functions.

Government Response: Your assumption is correct. In Section J, Attachment J-6, the contractor plays a facilitative role. If CLINs X0010 and/or X0011 are exercised, then the contractor shall follow Section J, Attachment J-12 requirements, in which the contractor essentially assumes the duties of the TAO Dental Representative/Consultant.

30. (13) Attachment J-6, paragraph 3.2.1; Section B CLIN tables - Please provide a travel and ODC CLIN cost estimate for evaluation purposes that all bidders must incorporate into their proposals to eliminate the competitive advantage the incumbent contractor has with respect to historical data on the total number of trips required, by location?

Government Response: DHA will provide the following with the data set:

OCONUS Support Services (CLINs X010 and X011)

· Provides estimated annual totals

· Total TRICARE OCONUS Preferred Dentists (TOPDs) site visits

· Eurasia/Africa/Latin America/Canada

· Pacific

· Total Non-Availability Referral Forms (NARFs)

· Eurasia/Africa/Latin America/Canada

· Pacific

· TOPD Locations by City and Country (does not include provider names)

31. (6) Attachment J-6a, Section 5.0 - The Government states "…DHA Communications office will develop and print provider reference materials…" This appears to be in conflict with 5.2 which states "Provider education and education materials…are the responsibility of the contractor." Please resolve this discrepancy by clarifying the responsibilities of the Government and the TDP contractor for the development and printing of provider materials.

Government Response: Section J, Attachment J-6a, Paragraph 5.1 will be deleted because the TRICARE Area Offices (TAOs) can now order their reference materials online from DHA Communications. The last sentence in paragraph 5.2 will be revised to state “The education materials that are required to facilitate participation as a TOPD, or to encourage provision of care to TDP enrollees, shall be developed by the contractor in coordination with the DHA Dental Care Office.”

32. (7) Attachment 11, Para 2.10.3- 2.10.3. The incoming contractor shall coordinate the transition of allotment data through DHA, Defense Finance and Accounting Service (DFAS), Public Health System (PHS), and U.S. Coast Guard (USCG) (see TSM, Chapter 1, Section 1.1). The incoming contractor shall submit a start allotment file to the Finance Centers approximately 30 to 40 days before the start of dental care delivery. The date will be mutually agreed upon between the incoming contractor, DHA and the Finance Centers. - Please confirm that PHS is no longer involved in this process?

Government Response: At this time the USCG has not assumed this responsibility for PHS TDP enrollees. PHS still processes the TDP allotments.

33. (58) Attachment J-11 – Section 3.0 under Note – Where CLIN X014 is indicated, we believe it should state X012.

Government Response: This will be corrected in the final RFP.

34. (54) Attachment J-16 – Ordering Instructions for Data Files - #8 – This currently states that data will be provided for Aug 1, 2009 – July 31, 2012. We assume that based on the date of the submission of these comments, claims data would be provided for May 2012 – November 2014.

Government Response: The dates will be corrected in the final RFP.

35. (30) Attachment J-16 Claims Data Page 3 of 10. Claims Data (provided from Government's system): Provides detailed claims data for Option Periods 1 through 3 (Aug 1, 2009 - July 31, 2012). The following information is provided for downloading purposes: This data is in a pipe-delimited text file format., The record length is ???, The line count is ????, The byte count is ???. The data does not include any pending claims and claims that have not been processed, or the amount paid. Question/Comments.

a) Does claims data include submitted, allowed, and paid claims and procedures by service month/date/contract period and by ADA procedure code? If not, can that be supplied?

Government Response: Please refer to Section J, Attachment J-10 for a list of the data that will be provided. A data dictionary will be supplied with each data file. Enrollee information will be encrypted. The data will not include provider identifiers other than a ZIP Code, pending claims, unprocessed claims, or any dollar amounts. The data does include the service date and procedure code, but the data does not specify by contract period.

b) Is claims data available by the same splits of data used for eligible/enrolled data (as shown below)? If not, can that be supplied?

· State/Country

· 5-digit zip code

· Age Group

· 0-1, 2-4, 5-18, 19 and up

· Sponsor Rank by

· E1-E4

· Other for all remaining ranks

· Status by:

· Active Duty family member

· Reserve Component (RC) member

· RC family member

· Survivor member

· Spouses

· Children

Government Response: Offerors will be able to derive this information from the raw claims data provided. See previous response to a) above.

c) Will claims data be provided to bidders with separation between CONUS and OCONUS claims?

Government Response: Offerors will be able to derive this information from the raw claims data provided. See previous response to “a” above.

d) Since member coinsurance varies by pay grade (per Attachment 4- Cost Shares), does this means that claims/eligibility/enrollment data will need to be split by these categories. Can that data be supplied?

Government Response: DHA does not collect the claims data by rank. In Section J, Attachment J-15 the TDP Eligible Report and the TDP Enrollee Report include E1-E4 and higher ranks are indicated by “other.” The CONUS and OCONUS Enrollment Data reports will be revised to include rank.

e) Does benefit coverage vary by class (per the definition in Attachment 7B - Dental Readiness Classification)? Can claims/eligibility/enrollment data be split by this classification?

Government Response: No, benefit coverage is the same for all enrollees. Dental Readiness Classification applies to Reserve Component members and specifies their level of oral health. The Dental Readiness Classification is included in the claims data that will be provided to the offerors.

f) Have there been any benefit changes during the experience period that may have affected claims utilization/payment patterns? If so, what were these changes and when did they occur?

Government Response: No, there have not been any benefit changes that would affect claims utilization/payment patterns.

g) Is any information available regarding in-network utilization versus out-of-network utilization? Is any information available regarding current network discounts?

Government Response: Offerors will be able to derive network utilization from the raw claims data provided. See previous response to a) above. Dollar amounts such as amount allowed or paid will not be released.

36. (31) Attachment J-16 Claims Data Page 3 of 10 and Draft RFP Section H.3.1.1. Enrollee Utilization Page H1 of H3. Positive Incentives. Question Does claims data include utilization data to determine history of annual exam utilization as defined in Section H.3.1.1? If not, can that be supplied?

Government Response: Offerors will be able to derive this information from the raw claims data provided.

37. (32) Attachment J-16 Claims Data Page 3 of 10 and Draft RFP Section H.3.1.2. Enrollee Prevention/Oral Prophylaxis Utilization. Positive Incentives. Question Does claims data include utilization data to determine history of oral prophylaxis utilization as defined in section H.3.1.2? If not, can that be supplied?

Government Response: Offerors will be able to derive this information from the raw claims data provided.

38. (11) L.2.4, paragraph L.2.4.4 - Where should the response to proposal instruction L.2.4.4 be presented in the proposal? For example, as a separate attachment within Volume 1?

Government Response: The first sentence of L.2.4.4 will be revised to state “The offeror shall submit in writing to the Contracting Officer, no later than 15 calendar days prior to the proposal due date that, to the best of the offeror's knowledge, there are no relevant facts or circumstances concerning any past, present, or potential contracts or financial interest relating to the work to be performed, which could give rise to an organizational conflict of interest, as described in FAR, Subpart 9.5.”

39. (27) L.2.4.8. All Page L4 of L17. L.2.4.8. Use of Former DoD/Defense Health Agency (DHA) Employees and Uniformed Service Members in Proposal Preparation: The involvement of a former DoD/DHA employee/member in an offeror's proposal preparation may give rise to an unfair competitive advantage or the appearance thereof, if the former DoD/DHA employee/ member acquired non-public, competitively-useful information in his or her former position. Such knowledge could include proprietary information of competitor's performance on past or current contracts with similar requirements or source selection sensitive information pertaining to this procurement. Consequently, the offeror must notify the Contracting Officer prior to the involvement in the proposal preparation by a former DoD/DHA employee/member reasonably expected to have had access to such information. Based on the notification, the Contracting Officer will make a determination whether involvement of the former DoD/DHA employee/member in proposal preparation could create an unfair competitive advantage or appearance thereof. The Contracting Officer will further determine whether any mitigation measures taken or proposed by the offeror are adequate to alleviate this concern or whether the offeror will be disqualified from the competition. Failure to comply with these procedures may result in the offeror's disqualification for award. Question/Comments

a) Could this clause be limited in time to relevant past performance data requested under the solicitation? For example, non-public performance information of current TRICARE Dental contractors learned in the last 3 years in accordance with Section L. 7 .1.1.

b) How is "competitively useful" defined? Is it limited to the items listed (a competitor's performance on past or current contracts with similar requirements or source selection sensitive information)?

c) Does a contractor's proposal preparation start at the release of the RFP?

d) How long does the Government's Contracting Officer have to respond with a decision related to a Contractor's use of former DoD/DHA employees and Uniformed Service Members?

e) Will policies prohibiting disclosure/use of third-party information be sufficient mitigation plans?

Government Response:

The TDP Procuring Contracting Officer (PCO) may disqualify an offeror if the offeror uses, in its proposal preparation, a former TMA or DHA employee that had access to non-public “competitively useful” information, i.e., the information could assist the offeror in obtaining the contract. Such disqualification is not dependent on a finding that the competitively useful information was actually used in the proposal preparation. The PCO must ensure the integrity of the process and has an obligation to avoid even the appearance of impropriety in the procurement. Thus, a mitigation plan that consists merely of the former employee signing a non-disclosure statement is generally inadequate to avoid an unfair competitive advantage situation.

With respect to former employees, the primary categories of information of concern are as listed in L.2.4.8—contractor proprietary information and source selection sensitive information. See FAR 9.505(b). General and in-depth knowledge regarding the TRICARE Program does not give rise to an unfair competitive advantage and is expected of offerors.

Whether information is competitively useful must be determined on a case-by-case basis. There are no specific cut-off dates for when information ceases to be competitively useful. This is fact specific. With respect to your question regarding when proposal preparation begins, that is in the hands of the offeror. Although the draft RFP is subject to change, if an offeror begins proposal preparation based on the draft RFP, the offeror will not be permitted to circumvent the principle stated above, by limiting use of former employees to proposal preparation prior to final RFP release.

If potential offerors have any questions regarding specific situations, in reference to L.2.4.8., you are strongly encouraged to submit a determination request to the PCO in advance of RFP release, and as soon as possible. The PCO will respond as expeditiously as possible.

40. (38) Section L.7.1 Please confirm that the definition of a first-tier subcontractor does not include the purchase of software application licenses in addition to providers, mobile dental clinics and related functions such as data entry or copying for core claims processing functions.

Government Response: The purchase of software application licenses are not considered first-tier subcontractors.

41. (41)Sections L.7.3 and M.5.2.1 Section L.7.3 requires offerors to identify its three largest contracts that are relevant to the services of this solicitation, based on the number of covered lives. Section M.5.2.1 states that the Government will assess the relevancy of size based on the number of claims processed annually or on the number of covered lives if claims are not processed. Given that the preference in the evaluation is based on the number of claims processed, should the three largest contracts submission also be based on the number of claims processed?

Government Response: The requirement for the offeror to identify its three largest contracts will be removed. The following revisions will be made to Section L and Section M.

First sentence in L.7.3. - For itself and each of its first-tier subcontractors, the offeror shall identify its three contracts that they believe are most relevant in accordance with Section M.5 and that are currently ongoing or have concluded in the last three years.

First sentence in first bullet under M.5.2.1. - The Government will examine scope and complexities by reviewing the identified contracts’ effort to see how closely their performance history relates to the requirements for this solicitation.

First sentence in second bullet under M.5.2.1. - The Government will assess the magnitude of effort based on the number of claims processed annually or on the number of covered lives. The Government will first look to the number of claims processed, and will only consider covered lives if the first does not apply.

42. (47) Section L.8 – Volume 4 – Price Proposal. Factor 3 – Price. We would recommend the addition of a separate CLIN in each option period for the health insurer fee (Fee) imposed under Section 9010 of the Affordable Care Act ("ACA"). The proposed regulation released by the Internal Revenue Service (IRS) clarifies that the Fee applies to "limited scope dental insurance." Additionally, per Section M.6 Evaluation of Factor 3 – Price and FAR 15.304, due to the varied impacts to Contractors and the fact that the Fee is paid to the Federal Government, MetLife would recommend this separate CLIN not be evaluated.

Government Response: The ACA fee will not be a separate CLIN. Section L.8.3 will be updated to reflect that all taxes and fees will be included in the administrative costs.

43. (4) Section L, Paragraph L.8.1, "Adequate price competition is anticipated, so offerors shall not provide certified cost and pricing data or information other than certified cost or pricing data." - This is a change in the Government's proposal instructions from previous TDP acquisitions, and we respectfully ask for the Government to confirm our understanding that it is the Government's intent that bidders not provide certified cost and pricing data or information other than certified cost or pricing data within their Volume 4 Price Proposal submission.

Government Response: Confirmed as stated in L.8.1.

44. (57) Section L.8.7 – Per L.8.9. and L.8.10., CLIN X005 and CLIN X006 are not part of the total evaluated price and as such they should be removed from L.8.7.

Government Response: The Section L instructions provide direction on each CLIN, and whether or not the CLIN is included in the total evaluated price. It is important that offerors understand what is included in each CLIN and how each CLIN will be considered in the total evaluated price. The administrative price including direct costs and indirect costs for Reimbursement for Cost in Excess of Allowable Charges for OCONUS Claims (CLIN X005) and Reimbursement for Cost Shares and Additional Allowable Charges for Orthodontic Costs Charge for OCONUS Claims (CLIN X006) will be included in the premiums for CLINS X001 and X002. Only the OCONUS claim cost reimbursed by the Government is excluded from the total evaluated price. The following clarification shown in bold will be added to the current L.8.7 language “The proposed premiums shall not include any OCONUS claim costs reimbursed by the Government (CLINs X005, X006) (see L.8.9 and L.8.10).”

45. (40) Sections M.4.1, M.4.4. and H.3.1.1 Section M.4.1 states that there will be a merit rating assigned for each subfactor. Section M.4.4 Subfactor 3 - Management Approaches, has three elements. The first two result in acceptable/non-acceptable ratings. Thus, the third element (Section M4.4.3) is the only component of Subfactor 3 that will be assigned a merit rating, which by default will result in being the overall Subfactor 3 merit rating. Therefore, the evaluation merit rating of just one element of this Subfactor will have the same evaluation weight as the total Subfactor 1 and 2 ratings. Would the Government consider additional Section L and M evaluation elements for Subfactor 3 in order to balance the three Technical Subfactor weights?

Consider including the following elements:

• The offeror shall describe how its transition-in activities will ensure that all services and systems are fully operational according to the contract requirements.

• The offeror shall describe how its transition-in activities will minimize disruption of services to beneficiaries and providers.

Government Response: Each subfactor will receive an overall merit rating and risk rating.