39_TCRS_Section_M_11_10_16.pdf

SECTION M, EVALUATION FACTORS FOR AWARD

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1.0 SOLICITATION PROVISIONS

52-217-5 EVALUATION OF OPTIONS (JUL 1990)

Except when it is determined in accordance with FAR 17.206(b) not to be in the Government’s best interests, the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. Evaluation of options will not obligate the Government to exercise the options(s).

(End of Provision)

2.0 BASIS FOR AWARD

2.1 General: This is a full and open competitive source selection, using the Lowest Price

Technically Acceptable (LTPA) source selection process in accordance with Federal Acquisition

Regulation (FAR) 15.3, Source Selection, as supplemented by the Defense FAR Supplement

(DFARS). The Contracting Officer (CO) intends to award a single contract to the offeror whose proposal is the LPTA offer.

2.2 To be eligible for award, an offeror’s proposal shall meet all solicitation requirements, including but not limited to, instructions to offerors, terms and conditions, technical requirements, and the evaluation factors and criteria below. If an offeror fails to meet a solicitation requirement, the CO may reject the proposal as “non-responsive” and ineligible for award. The Government will not evaluate non-responsive proposals.

2.3 LPTA Evaluation Approach. The Government will evaluate the lowest priced proposal first. If the Government determines the proposal is technically acceptable, the Government will not evaluate any other proposals because the LPTA proposal represents the best value to the

Government. The Government will award the contract to that offeror without further evaluation of any other proposals.

2.3.1 If the Government determines the lowest priced proposal is not technically acceptable, the

Government will evaluate the next lowest priced proposal, and the process will continue in order until the Government determines a proposal is technically acceptable or until it evaluates all proposals. The Government will evaluate the acceptability of the offeror’s proposal and will not rank based on non-price factors/subfactors. To be eligible for award, an offeror must receive an

“acceptable” rating in every non-price factor/subfactor, as discussed below and have a total evaluated price that determined to be fair and reasonable, with no unbalanced pricing.

3.0 EVALUATION FACTORS

3.1 The Government shall evaluate each proposal against the following factors and subfactors.

There are two Non-Price Factors: Factor 1, Technical Approach; and Factor 2, Past Performance

3.1.1 Factor 1, Technical Approach

Subfactor 1, Staffing/Program Management;

Subfactor 2, Quality Control;

Subfactor 3, Transition-In;

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Subfactor 4, Compliance Reviews;

Subfactor 5, Focus Studies/Medical Reviews

3.1.2 Factor 2, Past Performance

3.1.3 Factor 3, Price

4.0 EVALUATION OF FACTOR 1, TECHNICAL APPROACH

4.1 The Government will evaluate each subfactor under Factor 1 to determine if each is technically acceptable. The Government will evaluate the offeror’s technical proposal against evaluation criteria relating to the requirements of the solicitation and assign a rating of either

Acceptable or Unacceptable. If an offeror fails to address or demonstrate the ability to meet one or more requirements, the Government will rate the subfactor “Unacceptable” which would render the Factor itself as “Unacceptable.” The Government will evaluate the proposal on the basis of whether or not an offeror’s proposed procedures, methods, and delivery of service meet the Government’s minimum requirements. The government will evaluate the proposal solely on its own merits.

4.1.1 The Government will use the technical ratings in Table A below to rate subfactors 1-5.

Table A. Technical Ratings

Rating Description

Acceptable Proposal clearly meets the minimum requirements of the solicitation.

Unacceptable Proposal does not clearly meet the minimum requirements of the solicitation.

4.2. Subfactor 1, Staffing/Program Management

4.2.1 The Government will evaluate if each offeror’s proposal provides acceptable evidence of a team (i.e. corporate and staff) possessing experience with meeting the requirements of the

Performance Work Statement and the solicitation, to include the amount of relevant corporate experience the offeror possesses, as well as the relevant experience possessed by the proposed personnel.

4.2.1.1 The Government will evaluate the proposed experience and staffing to determine the offeror’s current capabilities for assuring performance of the requirements, and consider the relevant corporate experience of the offeror, supporting subcontractors, consultants, and business partners.

4.2.1.2 The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach to ensure that all personnel performing assigned duties are qualified by education, training, experience, and when appropriate, are credentialed.

4.2.1.3 The Government will evaluate the feasibility of the offeror’s staffing approach for this effort to include the roles to be filled on the project, the labor categories used to staff them, and the rational for the approach. For example, support of the claims review process will be

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YYY with the critical skills of ZZZ. The contractor shall propose the roles that it believes best suit this effort and may propose multiple or partial FTEs to staff proposed roles. The

Government will also review position descriptions to include the list of relevant training, education, and certifications/credentials. To be Acceptable, the proposed staff approach shall:

a) Clearly demonstrate the offeror’s ability to provide the appropriate level of staffing, skill mix, experience, education and certification(s)/credential(s) equal to the minimums needed for successful task performance as stated in the solicitation and consistent with industry standards for (this is NOT an all-inclusive list):

Program/Project Management

Healthcare Claim Reviewers/Auditors

Medical Record Auditors/Coders

Information Assurance

Records Management

System Definition, Design and Development

Test and Evaluation

Data Analyst

System Security Administrator

b) Clearly describe positions and minimum qualifications and experience in relation to the tasks in the solicitation.

c) Demonstrate offeror’s capability to hire/maintain personnel with required Automated

Data Processing/Information Technology (ADP/IT) Level I or II clearance.

4.2.1.4 Demonstrate corporation/management staff have experience supervising and leading tasks similar to the tasks defined in the solicitation; and corporate/management staff have experience, education, credentialing needed to meet solicitation requirements for (This is NOT an all-inclusive list):

Program/Project Management

Healthcare Claim Reviewers/Auditors

Medical Record Auditors/Coders

Information Assurance

Records Management

System Definition, Design and Development

Test and Evaluation

Data Analyst

a) Demonstrate a clear, sound and logical rational for their approach and proposed labor categories and staffing levels to meet the requirements of the solicitation.

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b) Provide position descriptions that clearly meet all functional areas (for example

Healthcare Claims Reviewer/Auditor, Program/Project Management, etc.) and labor education, experience and certification levels as stated in the solicitation and consistent with industry standards.

4.2.2. The Government will evaluate whether the offeror’s Program Management Plan (PMP)

(CDRL AP020) demonstrates a technically acceptable approach to ensure accuracy and timeliness of services and products delivered. The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach for developing a training program and process that ensures the accuracy of compliance reviews. The Government will evaluate whether the offeror’s proposed risk management program demonstrates a technically acceptable approach for risk management and address how risks will be identified and avoided or mitigated to ensure the solicitation requirements are met.

4.2.2.1 The Government will evaluate whether the offeror’s management approach provides a clear, logical and comprehensive method for managing tasks; developing and maintaining auditing guidelines and instructions; acquiring and maintaining required pricing/grouping/editing software; managing and maintaining manual changes; developing and maintaining document management system; managing documentation requirements; acquiring and maintaining translation services; coordinating and developing required memorandums of understanding; and organization capabilities.

4.2.2.2 The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach through its integration, organizational structure, lines of authority, subcontractor management, and performance monitoring and reporting to include interfaces between the offeror and the Government, structure and sharing of personnel between and among business entities. The Government will evaluate the management effectiveness of any contract requirements that will be accomplished by each specific subcontractor. To be Acceptable, the offeror’s management approach shall:

a) Demonstrate a clear understanding and sound approach for meeting the requirements in the solicitation and the Program Management Plan;

Clearly demonstrate the offeror’s ability to provide appropriate management of the program and projects, the management and oversight of staff and subcontractors.

Demonstrates the offeror’s ability to manage tasks and timelines.

Provides a clear, logical and rational approach for the development and maintenance of a document management system capable of meeting requirements of the solicitation.

Provides a clear, logical and rational approach for developing and maintaining a comprehensive training program which ensures the accurate evaluations of healthcare claims under the TRICARE health benefits program.

Clearly addresses resolving key staffing issues such as hiring, retention, replacement, training and obtaining/maintaining ADP/IT clearance.

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4.3 Subfactor 2, Quality Control

4.3.1 The Government will evaluate whether the offeror’s proposal demonstrates technically acceptable processes for establishing and operating an Internal Quality Management Program

(IQMP) to ensure accuracy and timeliness of services and products delivered consistent with

DHA and healthcare standards and best practices.

4.3.2 The Government will evaluate the whether the offeror’s proposal demonstrates a technically acceptable approach for conducting internal quality assurance reviews to meet solicitation requirements. The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach for retraining staff, refining its training program, and correcting documentation and applications because of internal and external QA reviews consistent with DHA and healthcare standards and best practices (CDRLs R090–R150). To be

Acceptable, the offeror’s Internal Quality Management Program (IQMP) plan and approach shall:

Demonstrate a clear understanding and sound approach for establishing an IQMP plan meeting the requirements in the solicitation.

Clearly describe the proposed process for conducting internal quality assurance reviews that evaluate the performance and quality of compliance review performed by its staff and the proposed corrective action plan to mitigate errors detected during the QA reviews.

4.4 Subfactor 3, Transition-in

4.4.1 The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable plan of performance for 180 days of incoming transition activities as described in the solicitation, from award to full contract operations. The Government will evaluate the adequacy of the tasks, schedules, and key milestones related to recruitment, training, assignment of personnel, (including subcontractors) background checks, security clearance, acquisition, installation and deployment of all facilities, equipment, and systems necessary to meet the solicitation requirements as described in the offeror’s proposal and Draft Transition-In Plan

(CDRL R010). To be Acceptable, the proposed Draft Transition-In Plan shall:

Demonstrate a clear, logical, reasonable and comprehensive approach for accomplishing the transition in tasks described in the solicitation, within 180 days.

Demonstrate reasonable and realistic milestones for accomplishing self-sufficient operations in 180 days.

Clearly demonstrate the offeror’s approach for demonstrating the ability to review healthcare claims to meet Readiness Test solicitation requirements.

4.5 Subfactor 4, Compliance Reviews

4.5.1 The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach to manage and perform compliance reviews to meet the solicitation requirements. The Government will evaluate if the technical approach will yield the required

TCRS HT9402-17-R-0002, Section M Page M6 of M9 results. The Government will evaluate the offeror’s understanding of tasks to be performed as well as the technical approach, methodology, and flexibility that will be utilized in accomplishing the requirements.

4.5.2 The Government will evaluate the overall technical approach to perform compliance review services. The Government will evaluate whether the offeror’s approach is effective from the extraction of compliance review listings from the TED Audit (TA) application through the performance of compliance reviews to determine the accuracy of claims payment and payment record coding; documenting compliance review findings; updating of the audit application;

utilization of the appropriate version of TRICARE manuals; and all rebuttal procedures. To be

Acceptable, the offeror’s Compliance Review approach shall:

Demonstrate a clear, logical and rational approach for evaluating health care claims under the TRICARE program meeting the requirements under this solicitation.

Demonstrates a clear understanding of the TRICARE health benefits program, pricing methodologies and reimbursement requirements.

Provides a clear and logical approach for responding to rebuttal comments and developing analysis report to meet the requirements of the solicitation. (CDRLs R011-

R015, R160-R220, R230-R290, and R020-R080)

4.6 Subfactor 5, Focus Studies/Medical Record Reviews

4.6.1 The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach for conducting focus studies to meet the solicitation requirements. The

Government will evaluate if the technical approach will yield the required results. The

Government will evaluate the offeror’s understanding of tasks to be performed as well as the technical approach, and methodology that will be utilized in accomplishing the requirements.

4.6.2. The Government will evaluate the overall technical approach to perform focus studies and develop analysis reports. The Government will evaluate whether the offeror’s approach is effective and meets the requirements of the solicitation. To be Acceptable, the offeror’s Focus

Study approach shall:

Demonstrate a clear, concise and logical process for meeting all aspects of the solicitation requirements (i.e., evaluating claims, analyzing information across purchased care contracts, etc.).

Demonstrate the offeror’s capability to develop detailed and comprehensive technical analysis reports that address study findings. (CDRL R330)

4.6.3 The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach for conducting medical record reviews to determine the sufficiency of medical record documentation and health care benefit determinations, and the appropriateness and accuracy of medical record billing and coding.

4.6.4 The Government will evaluate whether the offeror’s proposal demonstrates a technically acceptable approach for ensuring complete, timely, and accurate medical record reviews by the appropriate qualified or credentialed medical professional consistent with healthcare best

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Demonstrate a sound approach for evaluating medical records that meets the requirements of the solicitation.

Demonstrate a sound approach to have medical records evaluated by qualified professionals with the appropriate knowledge, experience, education, training, and appropriate credentialing required to render a professional/expert opinion to the accuracy of medical record coding and completeness of medical record documentation.

Demonstrate the offeror’s capability to develop detailed and comprehensive report detailing the medical record review findings. (CDRL R340)

5.0 EVALUATION OF FACTOR 2, PAST PERFORMANCE

5.1 The Government will evaluate past performance information, provided in accordance with

Section L and other sources, to determine if the Offeror has performed in the past on recent relevant work and has a record of satisfactory performance in supplying products and services that meet the contract requirements (See FAR 15.305 and DFARS 215.305). The Government will evaluate past performance information submitted by the offeror and any other past performance information that the Government has independently obtained.

5.2 The Government will evaluate an offeror’s past performance for recency and relevancy to this solicitation. To be considered recent, the work must have been performed within 3 years of the date in Block 9 of the SF 33, Solicitation, Offer and Award. Relevant past performance is present or past performance involving similar scope and magnitude of effort and complexities to the TCRS solicitation. The Government will evaluate the magnitude of the offeror’s past performance effort based on the number of claims reviewed annually. The TCRS reviews approximately 63,000 medical, dental and pharmacy claims annually.

5.2.1 The Government will assess an overall relevancy rating for each contract submitted for past performance as stated below:

The Government will review the offeror’s past performance effort based on the number of claims reviewed annually.

The Government will review the identified contracts’ effort to see how closely their performance history relates to the requirements for this solicitation. Assessment of relevancy will be based on those functions the contractor or subcontractor will be performing on this solicitation.

5.2.2 The Government will assign one of the following relevancy ratings to each contract provided by the offeror.

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Rating Description

Very Relevant Present/past performance effort involved essentially the same scope and magnitude of effort and complexities this solicitation requires.

Relevant Present/past performance effort involved similar scope and magnitude of effort and complexities this solicitation requires.

Somewhat Relevant Present/past performance effort included some of the scope and magnitude of effort and complexities that this solicitation requires.

Not Relevant Present/past performance effort included little or none fo the scope and magnitude of effort and complexities this solicitation requires.

5.3 Once a relevancy rating has been determined, the Government will review all available information regarding the quality of performance for each of the contracts. If an individual contract has been assessed as not relevant, no performance review will be conducted. The

Government will identify positive and/or negative findings noted during the review. If any negative findings are identified during the review in which the offeror has not had the opportunity to provide comments, the Government will notify the offeror of the findings and allow the offeror the option to provide comments on these negative findings.

5.4 After determining the past performance proposal’s recency, relevancy and quality, the

Government will rate the past performance proposal as “acceptable” or “unacceptable” using the rating descriptions below, in Table B.

Table B. Past Performance Evaluation Ratings

Rating Description

Acceptable Based on the offeror’s performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown. (See note below.)

Unacceptable Based on the offeror’s performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

Note: In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance (see FAR 15.305 (a)(2)(iv)). Therefore, the offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability, “unknown” shall be considered “acceptable.”

6.0 EVALUATION OF FACTOR 3, PRICE

6.1 Total Evaluated Price. The total evaluated price is the sum of all priced CLINs in Section

B, Supplies or Services and Prices/Costs, for the Transition-in Base Period and each of the

Option Years 1-5. The total evaluated price will include the offeror’s proposed price (Option

Period 5 multiplied by 0.5) for the possible 6-month extension of services under FAR

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52.217-8, Option to Extend Services (See Section L Exhibit L-7, Price Proposal Template, worksheet entitled “Summary by CLIN, Option Yr”). Offerors are advised that the evaluation of options shall not obligate the Government to exercise such options.

6.2 Reasonableness. The proposed Total Evaluated Price (TEP) shall be evaluated for reasonableness. Adequate price competition is expected. If so, price analysis will be the primary technique used in the Government’s price evaluation. If not, the Contracting Officer may require additional information to support the proposed price in accordance with FAR 15.4.

6.3 Unbalanced Pricing. The Government will evaluate each offeror’s price proposal for unbalanced pricing per FAR 15.404-1(g).

6.4 Evaluation of Options. In accordance with FAR 52.217-5, Evaluation of Options; and FAR

52.217-8, Option to Extend Services, the price evaluation is inclusive of the evaluation of options required for any extension of services resulting from the Government’s unilateral right to exercise FAR 52.217-8. The Government may choose to exercise the Extension of Services at the end of any performance period (base or option periods), utilizing the rates of that performance period.

(END OF SECTION)