AP040_MTF_eMSM_Optimization_Support_Plan_02.04.16.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

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D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

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REQUIRED

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12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

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15. TOTAL

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A. CONTRACT LINE ITEM NO.

DD FORM 1423‐1, FEB 2001 Page ___ of ___ Pages

16. REMARKS (Continued)

CONTRACT DATA REQUIREMENTS LIST

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C. CATEGORY:

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B. EXHIBIT

Frequency: Annual Plan (Option Period) Reporting Period Start Date: Start of service delivery Due Date: 60 calendar days before start of reporting period

SUBSEQUENT SUBMISSION: SAME AS FIRST SUBMISSION

PHI/PII: No FILE FORMAT: No specific file format required

CONTENT DETAILS:

The contractor shall submit an annual MTF/eMSM Optimization Support Plan for review and approval through the TRICARE Regional Office (TRO) to the Contracting Officer (CO) in accordance with TRICARE Operations Manual (TOM), Chapter 15, Section 2 and 3 to document the internal process and procedures for administering the TRICARE Resource Sharing Program and other contracting tools including Clinical Support Agreements (CSAs), while promoting cooperation and open communication between MCSC, the TRO, Enhanced Multi-Service Markets (eMSMs), and the Military Treatment Facilities (MTFs). The plan should include at a minimum:

- Table of contents

- Introduction

- Plan Overview

- Program Benefits. Describe how programs in this plan will benefit the Military Health System (MHS).

- Plan Administration and Management. Describe structure, membership, functional responsibilities and meeting frequency.

- Contingency Plans. Discuss policies and procedures for recruiting and backfilling of contract staff, and access to care for beneficiaries during emergencies.

- Optimization of Healthcare Services within the Direct Care System. Discuss optimization approach and strategies (TOM, Ch.15 Sec. 1 and Addendum A, Operational Annexes, Annex K-MTF/eMSM Optimization).

- Accommodating Changes in MTF Capability and Capacity. Discuss approach proposed response to potential MTF changes.

- Authorized Contract Vehicles. Discuss strategies for identifying and implementing optimization opportunities.

- External Resource Sharing Agreements. Discuss the general approach and methods for facilitating the identification of resource sharing opportunities throughout the region. Address privileging, licensing, contract liability, management, record keeping and termination procedures.

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- Clinical Support Agreements. Discuss in detail the procedures and the process for administering and reporting the CSAs which adhere to the CSA Program guidelines at TOM Chapter 15 Section 3. Discuss program goals, roles and responsibilities, personnel, supervision, invoice processing, record keeping and reporting.

The TRO shall review the plan and make recommendations for revision, if necessary, within 30 days of submission (including subsequent submissions), or provide written approval through the CO. The contractor shall provide a revised plan addressing the recommendations within 15 business days to the appropriate reviewing office, which will provide written approval of the plan through the appropriate CO within 15 calendar days if there are no recommendations or upon receipt of a revised plan which addresses the recommendations.