14_TOP_21_Section_L_Amd_1_10-1-19.docx

L.1. PROVISIONS.

FAR 52.204-7 System for Award Management (Oct 2018)

FAR 52.204-16 Commercial and Government Entity Code Reporting (Jul 2016)

FAR 52.204-22 Alternative Line Item Proposal (Jan 2017)

FAR 52.215-1 Instructions to Offerors—Competitive Acquisition (JAN 2017)

FAR 52.215-16 Facilities Capital Cost of Money (JUN 2003)

FAR 52.215-20 Requirements for Certified Cost or Pricing Data and Data Other Than Certified Cost or Pricing Data—Alternate IV (OCT 2010)

a. Submission of certified cost and pricing data is not required.

b. Offerors shall provide the information described in paragraph L.8. Volume IV, Price Proposal (Factor 3).

(End of Provision)

FAR 52.215-22 Limitations on Pass-Through Charges—Identification of Subcontract Effort (OCT 2009)

FAR 52.216-1 Type of Contract (APR 1984)

The Government contemplates award of a single award, predominately fixed-price, indefinite delivery/indefinite quantity (IDIQ) services contract.

(End of Provision)

FAR 52.222-24 Pre-award On-Site Equal Opportunity Compliance Evaluation (FEB 1999)

FAR 52.222-56 Certification Regarding Trafficking in Persons Compliance Plan (MAR 2015)

FAR 52.233-2 Service of Protest (SEP 2006)

(a) Protests, as defined in section 33.101 of the Federal Acquisition Regulation, that are filed directly with an agency, and copies of any protests that are filed with the Government Accountability Office (GAO), shall be served on the Contracting Officer by obtaining written and dated acknowledgment of receipt from the Contracting Officer, address in Block 7 of the Standard Form 33.

(b) The copy of any protest shall be received in the office designated above within one day of filing a protest with the GAO.

(End of Provision)

FAR 52.252-1 Solicitation Provisions Incorporated by Reference (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at the web address http://www.acquisition.gov/browse/index/far.

(End of Provision)

FAR 52.252-5 Authorized Deviations in Provisions (Apr 1984)

The use in this solicitation of any Federal Acquisition Regulation (48 CFR Chapter 1) provision with an authorized deviation is indicated by the addition of “(DEVIATION)” after the date of the provision.

(End of Provision)

DFARS 252.215-7008 Only One Offer (JUN 2019)

DFARS 252.225-7003 Report of Intended Performance Outside the United States and Canada—Submission with Offer (OCT 2015)

DFARS 252.226-7001 Utilization of Indian Organizations, Indian-Owned Economic Enterprises, and Native Hawaiian Small Business Concerns (APR 2019)

DHA PROCEDURES GUIDANCE AND INFORMATION (PGI) 233.103-90, AGENCY LEVEL PROTESTS NOTICE OF AVAILABILITY OF INDEPENDENT REVIEW (April 14, 2014)

An interested party filing a protest with Defense Health Agency (DHA) has the option of requesting review by either the Contracting Officer (CO) or an independent review official (IRO), who is a DHA official at a level above the CO. Alternatively, an interested party may request IRO review as an appeal of the CO’s protest decision.

Where applicable, an interested party must clearly state in the protest that IRO review is requested, and must specify the nature of the independent review sought – whether as an alternative to the CO review or as an appeal of the CO’s decision.

Regardless of which review is requested, all protests must be complete and submitted to the CO within the timeframes specified in FAR 33.1.

L.2. GENERAL INSTRUCTIONS.

L.2.1. This section provides general guidance for preparing proposals as well as specific instructions on the format and content of the proposal. Offerors are cautioned to follow the instructions provided in this section carefully to ensure that the Government receives consistent information in a format that will facilitate proposal evaluation. The offer shall be compliant with the requirements as stated in the solicitation and applicable attachments. Nonconformance with the instructions provided in the solicitation and this section may result in an unfavorable proposal evaluation or rejection of the proposal. The written proposal shall be clear, concise, and include sufficient detail for effective evaluation and for substantiating the validity of stated claims.

L.2.2. The Government will evaluate proposals based on the written information submitted by offerors. The Government reserves the right to award without discussions. Therefore, the offeror’s initial offer should contain the offeror’s best terms from a price and technical standpoint. The CO may find the proposal unacceptable, which could make the offeror ineligible for award, if an offeror:

(1) fails or refuses to assent to any of the terms and conditions of the solicitation,

(2) proposes additional terms and conditions of this solicitation excluding those permitted in paragraph L.6.1.3,

(3) fails to submit any of the information required by this solicitation.

Offerors shall submit only one proposal. If an offeror submits more than one proposal, the Government will not evaluate any proposal from that offeror.

L.2.2.1. Sections L and M apply to the solicitation phase only and will not be part of the resulting contract. Section K, Representations and Certifications, shall be incorporated into the contract by reference per FAR 52.204-19.

L.2.2.2. The contract will be updated to reflect the actual period of performance dates prior to award.

L.2.2.3. The CO has determined there is a high probability of adequate price competition in this acquisition. After receipt of proposals, if the CO determines adequate price competition exists, no additional cost information will be requested; and offerors will not be required to provide certification under FAR 15.406-2. However, if the CO determines adequate price competition does not exist, the CO may require offerors to submit information to the extent necessary for the CO to determine the reasonableness of the proposed prices.

L.2.3. The proposal should not simply rephrase or restate the Government's requirements, but it shall provide clear explanation that demonstrates understanding of the requirements and addresses how the offeror intends to meet the requirements. Offerors shall assume the Government has no prior knowledge of their facilities, capabilities and experience. The Government will base its evaluation on the information presented, plus any additional past performance information or data the Government obtains from other sources.

L.2.4. ORGANIZATIONAL CONFLICTS OF INTEREST.

L.2.4.l. The offeror's attention is directed to FAR 9.5, Organizational and Consultant Conflicts of Interest.

L.2.4.2. For the purpose of these provisions, the term offeror means the offeror, its subsidiaries, affiliates, partners, marketing consultants, as defined by FAR 9.501, or any of its successors or assignees.

L.2.4.3. The offeror is hereby notified that an actual or potential conflict of interest may exist with Covered DoD officials, as defined by DFARS 252.203-7000. The offeror shall not knowingly provide compensation to a Covered DoD official within 2 years after the official leaves DoD service, without first determining that the official has sought and received, or has not received after 30 calendar days of seeking, a written opinion from the appropriate DoD ethics counselor regarding the applicability of post-employment restrictions to the activities that the official is expected to undertake on behalf of the offeror. In addition to the requirements stated in DFARS Clause 252.203-7000, the offeror shall disclose all intended employees participating on the proposal that are potential Covered DoD Officials, and get approval from the CO prior to the involvement of Covered DoD Officials in the development of a response to the solicitation or a mitigation plan.

L.2.4.4. The offeror shall represent in writing within Volume I of the proposal 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 9.5. In the event an actual or potential organizational conflict of interest exists, the offeror shall submit an organizational conflict of interest plan to the CO that effectively demonstrates how the offeror will avoid, neutralize, or mitigate any actual or potential organizational conflict of interest while supporting this contract and any other DHA contract. The offeror shall also provide the CO with information of previous or ongoing work that is in any way associated with this solicitation.

L.2.4.5. The CO will review all organizational conflict of interest plans to determine whether award to the offeror is consistent with FAR 9.5. If the CO determines that no conflict would arise or that the organizational conflict of interest plan adequately protects the interest of the Government, the offeror will be eligible for award. If the CO determines that the organizational conflict of interest plan is inadequate, the CO will consider remedial actions, such as eliminating the offeror from the solicitation process, terminating related contract efforts already awarded, or negotiating the organizational conflict of interest plan.

L.2.4.6. The offeror shall include the above restrictions in all subcontracts, teaming arrangements, and other agreements calling for performance of work which is subject to the organizational conflict of interest restrictions identified in these provisions.

L.2.4.7. The offeror acknowledges the full force and effect of these provisions. The Government reserves the right, in case of a breach, misrepresentation or nondisclosure, to terminate the resultant contract, disqualify the offeror from subsequent related contractual efforts, or pursue any remedy permitted by law, regulation or the terms and conditions of this solicitation.

L.2.5. Offerors shall use their legal name and not a shortened version that could be confused with a parent company or other corporation. Use of an acronym is permissible after the first usage of the full legal name in each of the four Volumes. The offeror shall clearly state in its proposal whether it is speaking of itself, its parent company, or a subsidiary.

L.2.6. Offerors shall submit their proposals to the CO at the address indicated below. Offerors shall submit proposals in electronic and hard copy format (See paragraph L.4.). Hardcopies and CDs shall be submitted to:

Ms. Margaret Zancanella, Contracting Officer Defense Health Agency ATTN: MC-CD Ref: Solicitation HT940219R0001 16401 East Centretech Parkway Aurora, CO 80011-9066

Each CD label and the outside cover page of each hardcopy volume shall be marked as follows:

OFFEROR’s COMPANY NAME, e.g., XYZ Corporation

HT940219R0001

TRICARE Overseas Program Volume Number CD number (e.g., 1 of 3) Identify if the data is protected information. Date the CD was created.

Software and version used.

L.3. GENERAL INFORMATION.

L.3.1. The CO is the official point of contact for this solicitation. The CO has assigned one or more contract specialists to coordinate with offerors for solicitation questions, receive past performance questionnaires, and proposal deliveries. All solicitation documents for this requirement are available on the Federal Business Opportunities (FBO) website at http://www.fbo.gov unless noted otherwise. Potential offerors are encouraged to register on FBO to receive e-mails regarding Government notifications on the FBO.gov website.

The CO encourages offerors to submit questions regarding the solicitation or other concerns via email to the CO and Contract Specialist identified in Block 10 of the Standard Form 33 no later than 10 business days after the CO issues the solicitation. Questions submitted later than 10 business days after the solicitation issue date will not be considered. The CO will provide the answers to questions via the FBO website at http://www.fbo.gov.

L.3.2. The remarks, explanations, and answers provided by Government representatives whether orally, or in writing, shall not change or qualify any of the terms or conditions of the solicitation. The solicitation can only be changed by a written amendment issued by the CO.

L.3.3. Offerors may order historical data files containing aeromedical evacuations, customer service, enrollment, translation, referrals, medical capability reports, dental claims, and detailed medical claims at no cost. Offerors shall refer to Attachments L-1, Ordering Instructions for Data, L-1a, List of Data Files, L-1b, Detail Level Claims Data Fields, L-1c, Non-Disclosure Agreement, and L-1d, Business Associate Agreement to request historical data.

L.3.4. The applicable TRICARE Manuals are incorporated in Section C and are the current versions for the purposes of this solicitation. There are two exceptions: Section J, Attachment J-17, Draft TRICARE Operations Manual (TOM) Chapter 24 and Section J, Attachment J-18, Draft TRICARE Policy Manual Chapter 12. Any revisions, changes, or updates to these manuals may be incorporated in an amendment or after contract award.

L.4. PROPOSAL PREPARATION.

L.4.1. The offeror’s proposal shall consist of four physically separated parts/volumes, individually titled as indicated below. Hard copies of each part/volume shall be contained in a separate three-ring binder and submitted to the CO with the appropriate number of copies. The total number of copies includes the original (e.g., 5 copies = original + 4 copies).

Table L-1, Volume Copies

· Organization Chart (L.4.8.)

· Organizational Conflict of Interest statement (L.2.4.4.)

· Complete SF33 (L.5.1.1)

· Completed Section B (L.5.2., L.8.)

· Completed Price Proposal Template (L.8.)

· Completed CDRLs listed in Section J, Exhibit A (L.5.2.)

· Completed Section K, Certs & Reps (L.5.1.)

· Completed Section G, paragraph G.2.3. (L.5.2.)

· Completed Section H, paragraph H.7.4. (L.5.2.)

· Reported performance outside of the U.S. and Canada, DFARS 252.225-7003(L.5.4.)

· Wage Determinations or Collective Bargaining Agreements (CBAs) (L.5.5.2.)

· DCMA Form 1620 04-04 Guaranty Agreement for Corporate Guarantor (L.5.7.)

· Financial Data (L.5.8.)

· Subcontracting Plan and Small Business Participation (L.5.3., L.9.)

4/2

Financial Data Only: 0/3

· Organization Chart (L.4.8.)

· Technical Proposal (L.6.)

10/2

· Organization Chart (L.4.8.)

· Past Performance Summary Narrative (L.7.2.)

· Past Performance Summary Description of Each Largest Contract (L.7.3.)

· Past Performance Questionnaires, Attachment L-2 (L.7.5.)

· Completed Attachment L-3, Sample Teaming Partner/Subcontractor’s Consent (L.7.5.2.)

· Completed Attachment L-4, Client Authorization Letter for each client POC for each contract (L.7.5.3) 8/2

· Copy of Section B, Supplies or Services and Prices/Costs (L.5.2, L.8)

· Section L, Attachment L-5, Price Proposal Excel Template (L.8.)

· Organization Chart (L.4.8.)

8/2

· Complete Volume Set (L.4.2.1) 1 electronic (PDF OCR Format)

L.4.2. Electronic Copies. The electronic portion of the offeror’s proposal shall be submitted on virus-free CD-ROMs that are compatible with Microsoft Office 2003 or later applications. The set may be submitted on one CD if size permits. For the electronic copies listed above, excluding the Complete Volume Set I-IV, the documents shall be either in Microsoft Word or Excel format. If this is not possible, then a PDF document in Optical Character Reader (OCR) format is acceptable for all volumes. Each CD shall be labeled as stated in paragraph L.2.6. In addition, each CD must be made final. Final is a recording option that renders the CD totally used so no other data tracks can be added. Offerors shall not use compressed file formats. Offerors shall use separate files to permit rapid location of all portions, including exhibits, annexes, and attachments, if any. Electronic versions shall be exact duplicates of the paper copy proposals in both content and format. All portions of the electronic documents, including the body of text, tables, charts, and graphs shall be in a format that enables the Government to perform electronic searches of the documents. Note: Joint Photographic Experts Group (JPEG or JPG) images and similar formats containing text, tables, diagrams and charts are graphics files which are NOT searchable. If a picture or screen shot is the only way to provide the information, then the offeror shall place it within a chart or table that contains a title or such narrative that would allow the Government to find it in a word search. If tables, charts, etc. are used within Volumes II and III, the offeror shall ensure that the information is captured within the narrative portion of the proposal. The information does not need to be duplicated in its entirety in multiple locations, but the narrative should reference the tables and charts. No part of a volume shall incorporate by reference portions of other volumes of the proposal (e.g., Volume IV Pricing shall not be referenced in Volume III Technical). Offerors may reference information within the same volume rather than duplicating the information within that volume.

L.4.2.1. In addition to the electronic copies stated above the offeror shall submit one set of Volumes I through IV documents in PDF Optical Character Reader (OCR) format. The set may be submitted on one CD if size permits. The CD shall be labeled as stated in L.2.6 to include stating it is in OCR format.

L.4.3. Paper Copies. Paper copy proposals shall be exact duplicates of the electronic versions in both content and format. In instances where the paper copy differs from the electronic copy, the paper copy shall prevail. Paper copies shall be separated by volume, each in a 3-ring binder and identified with the offeror’s name, volume number, volume title, proposal date and solicitation number. A separate binder is required for each volume. All paper copy proposal narrative material shall be submitted on white paper with at least 1 inch margins on all sides. The font for both CD ROM and paper submissions shall be 12-point Times New Roman. However, offerors may use Times New Roman, 10-point font for illustrations, organization charts, supporting data exhibits/tables, report listings, or labels on process flows. Elaborate brochures or documentation, binding, detailed artwork, or other embellishments shall not be submitted. Proposals shall be printed double-sided, double-spaced, with non-duplicative, sequential page numbers at the bottom of each printed page. Double spacing does not apply to the table of contents, illustrations, organization charts, supporting data exhibits, report listings, or labels on process flows. Each page will also include the offeror’s name, and solicitation number.

L.4.4. Page Limitations. Page limitations shall be treated as maximums. A single sheet of paper printed on both sides equals two pages. If exceeded, the Government will not consider the excess pages in the evaluation of the proposal. The Government will destroy the excess hard copy pages without review. The Government will not review excess electronic pages. The Table L.2. Page Limitations, provides offerors with the page limitations cross-referenced to the specific paragraph of Section L. If a paragraph is not listed in this table, but there is a requirement for information to be submitted in the proposal, then a page limitation does not apply.

Table L.2. Page Limitations

Applicable to:

L.4.8. Organization Chart

L.4.5. If an offeror believes that the requirements in these instructions contain an error, omission, or are otherwise unsound, the offeror shall notify the CO in writing with supporting rationale not later than 15 calendar days before the proposal due date.

L.4.6. An offeror’s proposal will not be incorporated into the awarded contract as a whole. However, the Government may incorporate portions of the proposal.

L.4.7. In accordance with FAR 4.8, Government Contract Files, the agency’s contracting office will retain one copy of all unsuccessful proposals. The agency’s contracting office will destroy extra copies of unsuccessful proposals.

L.4.8. Organization Chart. The offeror shall submit its anticipated organizational structure and shall include the prime contractor and first-tier subcontractors as defined in paragraph L.7.1. In the case of a joint venture or other business structure (e.g., subsidiary relying upon its parent corporation and/or relying on other corporate subsidiaries of its parent), the offeror shall disclose a clear description of the organizational relationships. A copy shall be placed in each volume of the proposal. The organization chart shall not exceed 3 pages and will not count against any of the other page limitations indicated in paragraph L.4.4.

L.5. VOLUME I—EXECUTED OFFER.

L.5.1. Volume I shall contain the signed original of all documents requiring signature of the offeror. Use of reproductions of the signed original is authorized in the copies. Offerors shall commit in writing to fulfilling the terms and conditions of the contract. All certifications and representations, to include Section K, required by the solicitation shall be completed and provided in Volume I. The offeror shall submit a completed Section K, FAR 52.204-8, Annual Representations and Certifications, with the proposal. An online Representations and Certifications Application is available at https://sam.gov/SAM

L.5.1.1. Offerors shall complete, sign, and date their offer at blocks 12 through 18 of the Standard Form 33. The Government anticipates evaluation of offers will require up to 180 calendar days to complete. As a result, the offeror shall enter a minimum of 180 calendar days in the Item 12. Minimum Acceptance Period of the Standard Form 33.

L.5.2. Offerors shall submit a completed Section B, Supplies or Services and Prices/Costs, in Volume I and include a copy in Volume IV. Offerors shall enter their proposed price for each CLIN in Section B in accordance with L.8. Offers received in other than U.S. dollars and cents shall be rejected. Quantities identified by the Government are estimates based on TRICARE historical data and shall be used for evaluation purposes. However, the Government does not guarantee that future workload will match the historical data provided.

L.5.2.1. Performance Guarantee Amounts. Offerors shall propose a dollar amount that is no lower than two percent (2%) of the offeror’s proposed administrative price for all priced CLINs except CLINs X007 and X008 (Claims Processing-TRICARE and Medicare eligible) for each OP as the total performance guarantee. The offeror shall insert these amounts in Section H, paragraph H.7.4., and provide a copy of Section H, paragraph H.7.4. in Volume I and Volume IV.

L.5.3. The offer shall include in Volume I the requirements for Factor 4 – Subcontracting Plan and Small Business Participation (see paragraph L.9).

L.5.4. Offerors shall report any intended performance outside the United States and Canada. The offeror shall complete the provision at paragraph L.1, DFARS 252.225-7003, Report of Intended Performance Outside the United States and Canada—Submission with Offer, and submitted it in Volume I.

L.5.5. The services for which the Government is contracting include benefit management, building and managing a provider network, claims processing and customer services. The Service Contract Act applies to this solicitation for those categories of labor that are defined as service employees in FAR 22.001. “Service employee” means any person engaged in the performance of a service contract other than any person employed in a bona fide executive, administrative, or professional capacity, as those terms are defined in Part 541 of Title 29, Code of Federal Regulations. The term service employee includes all such persons regardless of any contractual relationship that may be alleged to exist between a contractor or subcontractor and such persons. See Section I, FAR Clauses 52.222-41, Service Contract Act of 1965; 52.222-42, Statement of Equivalent Rates for Federal Hires; and 52.222-43, Fair Labor Standards Act and Service Contract Act-Price Adjustment (Multiple Year and Option Contracts).

L.5.5.1. In accordance with FAR 22.1009 and 29 CFR 4.4(a)(3)(i), where the place of performance of a contract for services subject to the Service Contract Act is unknown at the time of solicitation, the solicitation does not need to contain a wage determination.

L.5.5.2. Because the offeror’s place of performance is unknown to the Government at the time of solicitation, the offeror shall obtain the applicable wage determination(s) under the Department of Labor website, http://www.wdol.gov. When selecting a wage determination, each offeror shall use the pull down menus for the place of performance of said service employees based upon their place of performance: proper state and proper county using the odd number wage determinations (even numbered wage determinations are not applicable to this solicitation). The offeror shall submit the applicable wage determination(s) in Volume I. If the offeror’s employees are covered by a Collective Bargaining Agreement (CBA), the offeror shall submit the CBA rates in place of the wage determination(s). The CO will incorporate the appropriate wage determination(s) and/or CBA rates in the resultant contract. The wage determination(s) shall be applicable to all work performed regardless of whether the successful contractor subsequently changes the place(s) of contract performance.

L.5.6. The offeror shall include the offeror’s point of contact information required for Section G, paragraph G.2.3 in Volume I.

L.5.7. The offeror shall include a guarantee from the offeror’s holding or parent company, or owner(s), if applicable, indicating their willingness to guarantee complete and faithful performance of the offeror and to provide the offeror all necessary and required resources, including financing, which are necessary to assure the full, complete and satisfactory performance of the contract. The format to be used for this guarantee is found at Section J, Attachment J-14, DCMA Form 1620 04-04 Guaranty Agreement for Corporate Guarantor. The offeror shall include a signed original in Volume I. Failure to provide this guarantee, if applicable to the offeror, may result in the CO determining the offeror is not responsible and is thus ineligible for award. The CO shall consider the results of this review in the responsibility determination.

L.5.8. Financial Viability. The offeror must demonstrate adequate financial resources to perform the prospective contract or demonstrate an ability to obtain adequate financial resources. The CO will consider the offeror’s submitted financial information or other information available in making a financial responsibility determination. If an offeror fails to submit the required financial information, the CO could determine the offeror is not responsible. Offerors shall submit this information a CD or DVD only; a hard copy is not required.

L.5.8.1. The offeror shall submit financial statement data for the 3 most recent and complete fiscal years and the most recent interim accounting period, if applicable. The offeror shall submit these data on the parent corporation, on the subsidiary offeror, and on any recent or prospective significant merger candidates.

L.5.8.2. The offerors shall clearly label all financial statements as audited or not audited, and include the date last audited, name and organization of the auditor, and the date, if applicable, of any certification of the financial statements by the responsible company official. The offeror shall disclose and explain all off-balance sheet arrangements and related party transactions.

L.5.8.3. The following financial statements are required:

· Annual Reports for the offeror’s 3 most recent fiscal years (including audit opinions)

· Balance Sheets and Income Statements

· Statements of Retained Earnings

· Statements of Cash Flow

· Statements of projected quarterly cash flows for a 1-year period beginning with the start of the contract (i.e., transition-in).

· The most recent Dun and Bradstreet (D&B) Comprehensive Report, or if not available, another rating company report that is essentially equivalent to D&B (e.g., A.M. Best Company).

L.5.8.4. Offerors shall submit copies of adverse financial items uncovered in the last 3 years of State Insurance Department audits, if applicable. Offerors shall provide a supporting narrative, including a brief description of anomalies. The offeror shall submit State Insurance Department audits, if applicable. Offerors shall provide a supporting narrative, including a brief description of anomalies in the submitted financial data and a brief description of any projected increases and decreases in the offeror’s business base.

L.5.8.5. An offeror that is a start-up company or otherwise does not have annual reports shall provide historical documents (e.g., tax returns), projected income statements and balance sheets, and narrative documentation supporting its ability to obtain financial resources to perform the contract.

L.6. VOLUME II—TECHNICAL PROPOSAL.

L.6.1. The offeror shall submit a technical proposal which demonstrates the offeror’s understanding of the requirements, and provides an effective and efficient technical solution for the prospective contract. The proposal should clearly describe the technical solution and overall approach to the solicitation requirements and address all of the subfactors identified in Section L, which the Government will evaluate against the criteria specified in Section M.

L.6.1.1. The proposal shall not reflect a marketing or sales presentation. The Government does not desire unnecessarily elaborate proposals beyond those sufficient to present a complete and effective response to this solicitation. Note: The Government shall not be bound by an offeror’s assertion that a particular approach in its technical proposal is a “strength.” Not withstanding an offeror’s assertion of the strengths and benefits in its proposal, the Government, at its sole discretion, will evaluate proposals to identify and assess strengths.

L.6.1.2. The proposal may state information on the offeror’s experience (for this purpose, experience refers to what an offeror has done, not how well it was accomplished) in performing proposed processes and procedures. This information may be considered in the evaluation of specific technical approaches and related technical proposal risk. However, any such information in the technical proposal will not be considered for purposes of the overall past performance rating as described in Section M.5. The price/cost proposal, past performance information, and financial information shall not be addressed in the technical proposal volume, and no part of the technical proposal shall incorporate by reference to portions of other volumes of the proposal.

L.6.1.3. An offeror may propose standards that exceed the Government’s minimum standards or propose additional standards or requirements. The offeror shall commit to these in the proposal and shall state the proposed standard/requirement in contractual language which the Government could incorporate into the contract as stated. The proposal shall clearly describe and explain how the offeror will meet these proposed standards that either exceed the Government’s minimum standard, or are additional standards or requirements. The proposal must clearly describe and explain how the offeror will meet these proposed standards that either exceed the Government’s minimum standard or are additional standards or requirements. If the Government determines these proposed standards or requirements will be advantageous to the Government, beneficiaries and/or providers during contract performance, the Government, at its sole discretion, will incorporate these into the contract.

L.6.1.4. Offerors shall refer to Section M, paragraph M.4.5. for the list of performance standards/requirements for which the Government will not assess a strength if offerors propose to exceed.

L.6.1.5. The technical proposal shall not exceed 125 pages inclusive of the exhibits, illustrations, attachments, flow diagrams, data dictionaries, figures, charts, draft start-up plan, and any other non-narrative inclusion. The offeror may use cross-references to information contained within the technical volume rather than resorting to redundancies in the presentation (i.e., a cross-reference to another paragraph within the technical volume; cross-references to the other volumes is not allowed). The Government will count the pages upon receipt of proposals beginning with the first piece of paper of Volume II of the technical proposal, which shall be regarded as page one. The Government will destroy pages in excess of 125 (starting at page 126) without review. The Government will not count the Table of Contents and tabs separating sections of the volume as long as they do not contain proposal content.

L.6.2. Subfactor 1—Optimal Beneficiary Experience of Care.

L.6.2.1. The offeror shall describe its proposed approach to creating an optimal beneficiary experience of care.

L.6.2.2. The offeror shall describe its approach to establishing and maintaining call centers, Beneficiary Service Representative (BSRs), and beneficiary interfaces/tools (Section C, paragraph C.17.) which will facilitate an optimal beneficiary experience of care. This description shall include how the offeror will ensure the accuracy of responses to beneficiary inquiries with a knowledgeable, courteous, and responsive staff. The offeror shall not submit proposed beneficiary surveys.

L.6.2.3. The offeror shall describe its proposed approach for optimizing the beneficiary experience to include its approach for ensuring beneficiaries are able to navigate through the purchased care system to include communicating with the staff in host nation facilities. The offeror shall describe how it will ensure cultural health care differences are communicated to beneficiaries.

L.6.2.4. The offeror shall describe its approach for performing health care finder services to direct care to an appropriate network or non-network provider and providing assistance with making appointments.

L.6.2.5. The offeror shall describe its approach for ensuring all aspects of its beneficiary experience of care program are fully operational at the start of health care delivery.

L.6.3. Subfactor 2—Clinical Quality/Provider Networks.

L.6.3.1. The offeror shall describe how its purchased care sector provider network will be established in all required network locations (as identified in Section J, Attachments J-1 and J-2) prior to start of health care delivery such that TOP enrollees have access to quality care on a cashless, claimless basis at the start of health care delivery. The offeror shall describe the sizing model or other business approaches that will be utilized to ensure the network is sized to include only the number of high quality providers required to meet contract requirements.

L.6.3.1.1. The offeror shall describe how its oversight, data analysis and support systems are designed to monitor access to care, so that instances of network inadequacy will be promptly identified and addressed by the contractor.

L.6.3.1.2. The offeror shall describe how it will build a network which is sufficient to support access to care within TRICARE access standards for TOP enrollees in all required locations. For each location where a shortfall is projected, the offeror shall identify the barrier(s) to network development and describe how the offeror will implement a mitigation strategy or other business processes to overcome the network inadequacy.

L.6.3.2. The offeror shall describe its approach for ensuring the clinical quality of network providers.

L.6.3.2.1. The offeror shall describe its methodology for developing clinical quality metrics and how the metrics will be used to assess the quality of care rendered by purchased care sector providers.

L.6.3.2.2. The offeror shall describe its approach for utilizing international accreditation agencies to ensure the quality of network providers.

L.6.3.2.3. The offeror shall describe its approach for maximizing the use of institutional and individual network providers that produce the highest quality clinical outcomes.

L.6.3.2.4. The offeror shall describe its plan for establishing and deploying a clinical quality rating system. The offeror shall explain how provider’s clinical quality performance is accurately rated and compared to other providers using clinical quality data.

L.6.3.2.5. The offeror shall describe its approach to ensuring its clinical quality program is fully operational at the start of health care delivery.

L.6.3.3. The offeror shall describe its methodology for ensuring that quality care is provided during aeromedical evacuations. The offeror shall describe its processes for achieving the following:

· Methodology for quickly determining aeromedical evacuation availability

· Ability to obtain multiple quotes and activate missions

· Processes for reducing overall mission time

· Methods for ensuring that quality care is provided during aeromedical evacuations

L.6.3.4. The offeror shall describe its approach for medically managing TOP Prime and Prime Remote patients.

L.6.3.5. The offeror shall describe its process for ensuring consult reports are returned to the referring MTF within 30 business days after the appointment.

L.6.4. Subfactor 3—Efficient and Integrated Overseas Health Care Delivery.

L.6.4.1. The offeror will describe how it will respond to changing Government requirements and plan/develop/implement solutions to high priority changes in an expedited manner.

L.6.4.2. The offeror shall describe how its existing or proposed claims processing system and business rules will meet or exceed the Government’s requirements. At a minimum, this description shall include the offeror’s method(s) and/or process(es) for:

· Establishing, maintaining, and monitoring a single, automated claims processing system to include the receipt and transmission of HIPAA compliant transactions through claims history retention

· Receiving and controlling both paper and electronic claims

· Accurately translating claims documents when necessary

· Obtaining missing claim information and accomplishing claim development

· Verifying patient eligibility

· Ensuring that medical necessity has been established for a claimed service

· Ensuring that a claimed service is a covered TRICARE benefit (except for ADSM claims where a valid waiver for non-covered services has been obtained)

· Ensuring that specialty care for TOP enrollees has been properly authorized prior to paying the claim, and that only those services which are related to the authorization are covered

· Determining the appropriate allowable payment amount

· Correctly applying Other Health Insurance (OHI) processing rules

· Correctly applying deductible, co-pay/cost-share and catastrophic cap provisions

· Creating and distributing the Explanation of Benefits (EOB)

· Creating and disbursing beneficiary and provider payments in the appropriate currency

· Meeting or exceeding the Government’s standards for claims processing timeliness and accuracy

· Identification of billing that is substantially in excess of reasonable and customary charges for the provider’s locality

· Accurately coding claims and methodology for conducting internal audits of coding accuracy

The offeror will describe its approach for ensuring its claims processing system will be fully operational at the start of health care delivery.

L.6.4.3. The offeror shall describe its proposed approach to referral and authorization/preauthorization processing. Specifically, the offeror shall describe their method(s) and/or process(es) for:

· Receiving and controlling referrals for TOP Prime and TOP Prime Remote enrollees

· Determining whether a referral contains sufficient information for processing an authorization/preauthorization

· Ensuring that medical necessity has been established for referred service(s)

· Ensuring that a referred service is a covered TRICARE benefit (except for ADSM claims where a valid waiver for non-covered services has been issued)

· Ensuring accurate and timely issuance of authorizations/preauthorizations which clearly delineate the conditions and/or limitations to care (e.g., number and type of visits, specific procedures which are authorized, non-covered services, etc.)

· Accomplishing health care finder services to direct care to an appropriate network or non-network provider

· Providing assistance with making appointments upon beneficiary request

The offeror will describe its approach for ensuring its referral/authorization processing system will be fully operational at the start of health care delivery.

L.6.4.4. The offeror shall describe its proposed approach for negotiating reduced rates for healthcare provided by purchased-care network providers in the countries designated in Section J, Attachment J-12, Negotiated Rates Locations.

L.6.4.5. The offeror shall describe its proposed approach for facilitating and improving integration between the purchased and direct care systems.

L.7. VOLUME III—PAST PERFORMANCE INFORMATION FACTOR 2 —PAST PERFORMANCE.

L.7.1. This section applies to the prime offeror and its first-tier subcontractors, if any. For the purpose of submitting past performance information, the term “prime offeror” may be an individual company or an entity that is a consortium of entities. Also for purposes of submitting past performance information, a first-tier subcontractor is either a company with a direct contractual relationship with the offeror whose total contract price exceeds $50 million for all option periods or a company which performs claims processing or operates a call center. A first-tier subcontractor does not include network providers.

L.7.1.1. The offeror’s Volume III past performance information consists of two sections: Past Performance Narrative and Past Performance Summary Descriptions. The offeror shall submit relevant past performance information for ongoing contracts and contracts that have concluded within the last 3 years; the Government considers the entire period of performance to include transition periods. The “last 3 years” is defined as 3 years prior to the date the solicitation was issued (Block 9 of the SF 33, Solicitation, Offer and Award).

L.7.1.2. Relevancy of past performance shall be deemed relevant in terms of scope and the magnitude of effort and complexities as it relates to the requirements for this solicitation.

The Government will assess an overall relevancy rating for each contract submitted for past performance in accordance with Section M.5.

L.7.1.3. The Government may, at its option, obtain past performance data from any reasonably reliable source, including, but not limited to, the references listed in the proposal, other customers known to the Government, consumer protection organizations, and persons inside or outside the Government who may have useful information.

L.7.2. Past Performance Summary Narrative. The offeror shall provide a summary narrative, not to exceed 10 pages, of the past performance that the prime offeror and its first-tier subcontractor(s) have in performing work that is relevant to this solicitation as defined in Section M, paragraph 5.3, Evaluation of Factor 2, Past Performance. The offeror shall address all relevant past performance. The offeror shall explain what aspects of its past performance are deemed relevant in scope of services as it relates to the requirements for this solicitation in terms of the scope of services, magnitude of effort, and complexities. The offeror shall clearly demonstrate management actions employed to address the scope, magnitude, and complexity of its past performance. The offeror shall provide its company’s total number of covered lives and total annual number of claims processed for the most recent 12-month period available.

L.7.2.1. If this is a newly formed company, the totals shall be that of the entity in which they report. If the newly formed company reports directly to the parent company, then the offeror shall report the parent’s totals for the most recent 12-month period available.

L.7.2.2. The offeror shall address any negative information associated with submitted relevant past performance, to include resolution.

L.7.3. Past Performance Summary Description of Each Largest Contract. For itself and each of its first-tier subcontractors, the offeror shall identify its three largest contracts that are relevant to the services of this solicitation. The offeror shall identify its three most relevant contracts to the services of this solicitation in terms of scope, magnitude of effort, and complexity. The offeror and/or its first-tier subcontractor shall state if it has fewer than three contracts that are relevant to this solicitation. The offeror shall not include contracts from its own subsidiaries, subcontractors, or other team members. A separate description shall be provided for each contract not to exceed four pages per contract. For each contract, the offeror shall provide the following information regarding the contract:

· A verified point of contact for the contract (name, title, address, phone number, email address) that will be able to discuss the offeror’s performance and contract standards/requirements and functions with the Government

· Start and end dates of the contract

· Total dollar value of the contract (separate costs for administration and health care costs)

· Number of covered lives

· Number of claims processed annually (state if this is not applicable to the contract)

· A clear explanation of the functions performed and what aspects of the contract are deemed relevant to this solicitation as it relates to the requirements of this solicitation.

· A clear explanation of management actions employed in resolving problems, ability to promptly correct performance problems and the effects of those actions, in terms of improvements achieved or problems rectified.

L.7.3.1. The offeror shall explain the circumstance if any of the following occurred during the contract period of performance:

· Failure to meet the minimum performance standards in the referenced contract and actions taken to restore performance to an acceptable level.

· Contract option period was not exercised.

· Assessment of Liquidated Damages or other reduction against offeror.

· Termination of a contract.

· Withheld payments.

· A notice to cure, claim or lien against the offeror, or suspension of work due to offeror’s quality issues.

L.7.4. If the offeror or its first-tier subcontractor(s) was formed or is being re-organized for the purpose of proposing on this solicitation, and the parent corporation, affiliate, individual entity/entities of a joint venture, or consortium has relevant past performance and will be involved in the management and/or operations of the offeror, the offeror shall submit its largest three contracts for its parent organization or each member of the consortium and provide the same information that is required for the largest three contracts as described in paragraphs L.7.3 and L.7.5. The offeror shall document in its summary narrative (see paragraph L.7.2) how the past performance of the parent corporation or consortium is relevant to this solicitation and the amount of involvement the parent or consortium member will have in the operations of the offeror. When describing the parent or consortium member’s involvement, the offeror shall describe in detail what division/entity the three largest contracts report to and what involvement and commitment of resources these divisions/entities will have in the operations of the offeror. The offeror shall describe what resources of the three largest contracts, if any, will be shared with the offeror (e.g., claims processing, networks, customer service). Offerors shall demonstrate the connection or commitment of resources from the entity with relevant past performance to the entity that will be performing the work.

L.7.5. Past Performance Questionnaires.

L.7.5.1. The offeror and each of its first-tier subcontractor(s) shall submit a completed past performance questionnaire for each of the contracts identified in paragraph L.7.3. (see Attachment L-2, Past Performance Questionnaire). The offeror shall not submit questionnaires from its own employees or employees of its own subsidiaries, subcontractors, or other team members. The offeror shall not include contracts from its own subsidiaries, subcontractors, or other team members. It is the offeror’s responsibility to have the questionnaire completed by the most cognizant officer of the contract or, if it is a Government contract, the CO or CO’s Representative.