TOP_21_Section_M.docx

SECTION M

EVALUATION FACTORS FOR AWARD

M.1. 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 option(s).

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M.2. BASIS OF EVALUATION.

M.2.1. General. This is a full and open competitive source selection and will be conducted in accordance with the Federal Acquisition Regulation (FAR) 15. Source Selection, as supplemented. The Government has established a Source Selection Evaluation Board (SSEB) to evaluate proposals submitted in response to this solicitation. The SSEB will evaluate proposals using the evaluation factors and subfactors identified below. The Source Selection Advisory Council (SSAC) will provide a recommendation to the Source Selection Authority (SSA). The SSA will determine which proposal represents the best value to the Government.

M.2.2. The Government anticipates award of a single fixed-price, indefinite delivery/indefinite quantity (IDIQ) health care services contract to the responsible offeror whose proposal represents the best value to the Government. The Government may make tradeoffs among the first three factors (Technical Approach, Past Performance, and Price) when determining which offer represents the best value to the Government, provided the offeror is rated “Acceptable” in Factor 4, Small Business Participation. This may result in selection of other than the low priced offer.

M.2.2.1. To be eligible for award, offerors are required to meet the solicitation requirements, including but not limited to Instructions to Offerors, terms and conditions, technical requirements, and the evaluation factors and criteria below. Failure to comply with the terms and conditions of the solicitation may result in the offeror being removed from consideration for award.

M.3. EVALUATION FACTORS AND RELATIVE VALUES.

M.3.1. The Government shall evaluate each proposal against the following factors and subfactors. Each proposal will be evaluated separately and will be evaluated solely on its own merits.

Factor 1–Technical Approach Subfactor 1–Optimal Beneficiary Experience of Care Subfactor 2–Clinical Quality/Provider Networks Subfactor 3–Efficient and Integrated Overseas Health Care Delivery Factor 2–Past Performance Factor 3–Price Factor 4–Small Business Participation

M.3.2. Relative Importance of Factors. Among the four factors, Factor 1, Technical Approach, and Factor 2, Past Performance, are the most important factors. Factors 1 and 2 are equal in importance. Each is more important than Factor 3. Factor 4, Small Business Participation, is the least important factor. When Factors 1 and 2 are combined, they are significantly more important than Factor 3, Price. Factor 4 will be rated Acceptable/Unacceptable as described in paragraph M.7.1. Within the Technical Factor, all subfactors are of equal importance.

M.4. EVALUATION OF FACTOR 1—TECHNICAL APPROACH.

M.4.1. The Government will evaluate each subfactor under Factor 1, Technical Approach, to determine a separate technical rating and a technical risk rating for each subfactor. The Government will consider the technical merit and technical risk ratings in determining the best value to the Government. The Government will evaluate proposals on the basis of how well an offeror’s proposed procedures, methods, and delivery of services meet or exceed the Government’s minimum standards and/or requirements. The Government will consider whether an aspect of an offeror’s proposal which has merit or exceeds specified performance or capability requirements will be advantageous to the Government. Except for enhancements to the standards and requirements identified in paragraph M.4.5., if the Government finds an aspect of the proposal to be advantageous, the Government may assign a strength. If the Government deems any part of the proposal to be a strength, the strength will be credited to only one subfactor. 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 will evaluate proposals to identify and assess strengths at its sole discretion. The Government will have the sole discretion in determining which subfactor the strength best fits. The following definitions will apply when assigning technical and technical risk ratings:

· “Strength” is an aspect of an offeror’s proposal that has merit or exceeds specified performance or capability requirements in a way that will be advantageous to the Government during contract performance.

· “Weakness” means a flaw in the proposal that increases the risk of unsuccessful contract performance. See FAR 15.001.

· “Significant Weakness” is a flaw in the proposal that appreciably increases the risk of unsuccessful contract performance. See FAR 15.001.

· “Deficiency” is a material failure of a proposal to meet a Government requirement or a combination of significant weaknesses in a proposal that increases the risk of unsuccessful contract performance to an unacceptable level. See FAR 15.001.

M.4.1.1. Technical Rating.

The Government will assign a technical rating to each Factor 1 subfactor. The purpose of the technical rating is to assess the offeror’s proposed approach for each subfactor and determine the degree to which the proposed approach meets or exceeds the requirements based on the evaluation criterion in paragraphs M.4.2. through M.4.4. In evaluating the offeror’s proposal, the Government will review the offeror’s compliance with the requirements, whether the offeror demonstrated it understands the requirements and whether the offeror demonstrated a sound approach to accomplish the requirements. The Government will use the technical ratings listed in Table M.1, Technical Ratings.

Table M.1. Technical Ratings.

M.4.1.2. Technical Risk Evaluation.

In addition to the technical rating evaluation, the Government will assign a separate technical risk rating for each of the Factor 1 subfactors. The Government will assess the level of risk based on the degree to which the offeror’s proposed technical approach may cause the potential for disruption of schedule, increased costs, degradation of performance, the need for increased Government oversight, and/or the likelihood of unsuccessful contract performance. The Government will use the technical risk ratings listed in Table M.2, Technical Risk Ratings.

Table M.2. Technical Risk Ratings.

cause disruption of schedule, increased cost or degradation of performance. Normal contractor effort and normal Government monitoring will likely be able to overcome any difficulties.

weaknesses which may potentially cause disruption of schedule, increased cost or degradation of performance. Special contractor emphasis and close Government monitoring will likely be able to overcome difficulties.

weaknesses which is likely to cause significant disruption of schedule, increased cost or degradation of performance. Is unlikely to overcome any difficulties, even with special contractor emphasis and close Government monitoring.

weaknesses that increases the risk of unsuccessful performance to an unacceptable level.

M.4.2. Subfactor 1—Optimal Beneficiary Experience of Care.

M.4.2.1. The Government will evaluate all aspects of the offeror’s approach to creating an optimal beneficiary experience of care. Areas of evaluation include, but are not limited to customer service interfaces, approach to performing health care finder functions, and providing assistance for navigating the purchased-care system.

M.4.2.2. The Government will evaluate the offerors approach to ensuring all aspects of its beneficiary experience of care program are fully operational at the start of health care delivery.

M.4.3. Subfactor 2—Clinical Quality/Provider Networks.

M.4.3.1. The Government will evaluate all aspects of the offeror’s approach to providing quality, right sized provider networks. Areas of evaluation include, but are not limited to, the offeror’s approach for establishing a provider network to support access to care for TOP Prime/Prime Remote enrollees on a cashless, claimless basis and mitigating areas of network inadequacy.

M.4.3.2. The Government will evaluate the effectiveness of the offeror’s proposed approach to ensure its network is in place in all required locations prior to the start of health care delivery.

M.4.3.3. The Government will evaluate all aspects of the offeror’s methodology for optimizing clinical quality. Areas of evaluation include, but are not limited to, developing and utilizing clinical quality metrics, establishing a clinical quality rating system for providers, maximizing the use of providers that produce the best quality clinical outcomes, and medically managing TOP Prime and Prime Remote patients.

M.4.3.4. The Government will evaluate the offeror’s approach to ensuring its clinical quality program is fully operational at the start of health care delivery.

M.4.4. Subfactor 3—Efficient and Integrated Overseas Health Care Delivery.

M.4.4.1. The Government will evaluate all aspects of how the offeror proposes to provide efficient and integrated overseas health care delivery. Areas of evaluation include, but are not limited to, the offeror’s approach to integrating direct care and purchased care systems, accurately processing claims, directing care to an appropriate network or non-network provider, processing referrals, and negotiating reduced rates for healthcare provided by purchased-care network providers in identified countries.

M.4.4.2. The Government will evaluate the offeror’s approach to ensuring its claims and referral/authorization systems are fully operational at the start of health care delivery.

M.4.5. The Government will not assess a strength for proposing to exceed the following:

· Claims Processing Cycle (TOM Chapter 1, Section 3, paragraph 1.6.)

· Claims processing timeliness (Draft TOM Chapter 24, Section 9, paragraph 12.22)

· TEDS Timeliness: 100% of initial submission vouchers transmitted to DHA within five calendar days (TOM Chapter 1, Section 3, paragraph 1.7.)

· Filing (TOM Chapter 1, Section 3, paragraph 2.1)

· Availability of Information (TOM Chapter 1, Section 3, paragraph 2.2.)

· Telephone Inquiries (TOM Chapter 1, Section 3, paragraph 3.4.)

· Grievances (TOM Chapter 1, Section 3, paragraph 5.0.)

· Network provider ability to speak/write English or provide translation at time of service (Section C, paragraph C.11.12)

· Establish/Operate an Internal Quality Management/Quality Improvement Program (Section C, paragraph C.8.3)

M.5. EVALUATION OF FACTOR 2—PAST PERFORMANCE.

M.5.1. The Government will evaluate past performance information provided in accordance with Section L and other sources, to determine how well an offeror has performed in the past on recent and relevant work. The Government will only consider relevant past performance information for ongoing contracts and contracts concluded within the last three years as defined in Section L, paragraph L.7.1.1. The Government will consider the entire period of performance of the contract to include the transition-in and transition-out periods. The past performance evaluation will result in an assessment of the offeror’s probability of meeting the solicitation requirements. The Government will assign one performance confidence assessment rating in Table M.4. Past Performance Confidence Ratings after evaluating each offeror’s past performance.

M.5.2. The Government will evaluate recent past performance to determine relevancy in terms of scope and the magnitude of effort and complexities as it relates to the requirements for this solicitation and will assign a relevancy rating listed in Table M.3. Past Performance Relevancy Ratings, to each recent contract the offeror provides

M.5.2.1. The Government will assign a relevancy rating for each recent contract the offeror submitted in accordance with Section L, L.7.3. Summary Description of Each Contract. The Government will examine the scope, magnitude of effort, and complexities of each identified contract to see how closely its performance history relates to the requirements for this solicitation. The Government will base its assessment of relevancy based on those functions the contractor or subcontractor will perform for this solicitation. For example: the Government will only assess the relevancy of scope on providing network services if that is the only function a subcontractor will be providing. For example: the past performance information will only be assessed as it relates to providing network services if that is the only function the contractor or subcontractor will be providing.

M.5.2.2. The Government will determine magnitude of effort based upon annual number of claims processed and covered lives. The current TOP contract processes approximately 470,000 claims annually and covers 300,000 lives.

M.5.2.3. The Government will use the past performance relevancy ratings listed in Table M.3. Past Performance Relevancy Ratings.

Table M.3. Past Performance Relevancy Ratings.

M.5.3. Once the Government assigns a relevancy rating, the Government will review the offeror’s past performance information to determine the quality of the offeror’s performance, execution of subcontracting plan, and general trends for consideration in the overall performance confidence assessment. If the Government determines an individual contract is "not relevant," the Government will not review the quality of the offeror’s performance. The Government will identify any positive and/or negative findings noted during the review. If the Government identifies any negative findings during the review to 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 opportunity to provide comments on these negative findings.

M.5.4. The Government will then assign a performance confidence rating relative to the offeror’s ability to successfully perform the requirements of this solicitation. The Government will use the offeror’s description of its past performance (both the 10-page summary narrative and the individual 4-page specific descriptions for the largest contracts), the questionnaires completed by the offeror’s clients, and any information developed by the Government to assign a performance confidence rating. If there is insufficient information on a past performance questionnaire or in the offeror’s proposal to adequately support information provided, the Government may conduct a telephone interview with the point(s) of contact the offeror provided. The Government will document every telephone interview conducted and create a record of the questions asked and the responses received. The Government may also utilize information obtained from the clients listed in the proposal, other customers, Contractor Performance Assessment Reporting System (CPARS), Federal Awardee Performance and Integrity Information System (FAPIIS), Electronic Subcontract Reporting System (eSRS), FFATA Subaward Reporting System (FSRS), and other sources that may have useful and pertinent information (subject to recent definition as defined in M.5.1.). The Government may also utilize its own internal records and sources for past performance information concluded within the last 3 years as defined in Section L, paragraph L.7.1.1. and paragraph M.5.1.

M.5.4.1. An offeror with no relevant past performance may submit relevant past performance information from a predecessor company, parent organization, consortium member, key personnel or subcontractors. The Government will consider this information in assigning a performance confidence rating. The Government will base the rating on the relevance to providing the services required by this solicitation and the amount of involvement the parent organization or consortium member will have in the operations of the offeror. When an offeror submits past performance information on its key personnel as stated in Sections L.7.7 and L.7.8, the Government will evaluate the key personnel information and then determine to what extent, if any, it will affect the performance confidence rating. The Government will assign a past performance confidence rating based on considerations such as the employee’s role in the company, the nature and quality of the services delivered, and the relevant amount of past performance the employee had related to providing the TOP solicitation services. Regardless of whether the past performance data relates to a parent organization, consortium member, or an employee or group of employees, the Government may still assign a performance confidence rating of “neutral confidence” if adequate, convincing and relevant past performance information is not available.

M.5.4.2. If an offeror has no past performance history relevant to providing the TOP solicitation services, the Government will rate offeror’s past performance as “neutral confidence”.

M.5.4.3. The Government will assign to the offeror one of the following overall Performance Confidence ratings in Table M.4. Past Performance Confidence Ratings.

Table M.4. Past Performance Confidence Ratings.

The offeror may not be evaluated favorably or unfavorably on the factor of past performance.

M.5.5. The Government will consider the offeror’s past performance in compliance with FAR Clause 52.219-8, Utilization of Small Business Concerns; and FAR Clause 52.219-9, Small Business Subcontracting Plan, including all subcontracting goals and any contract monetary targets for Small Disadvantaged Business Participation Program, if any. The Government may analyze information provided by the offeror, information available within the Government, or information from other sources.

M.6. EVALUATION OF FACTOR 3—PRICE.

M.6.1. Total Evaluated Price. The total evaluated price is the sum of all CLINs in Section B (i.e., cumulative prices for the Base and Option Period CLINs)(with the exception of CLIN X014, Transition-Out), the highest proposed option period price for CLIN X014, and the Government’s calculated amount for the possible 6-month extension of services under FAR Clause 52.217-8, Option to Extend Services. The Government will multiply each offerors’ proposed price for Option Period 7 by 0.5 for the possible 6-month extension of services under FAR 52.217-8, Option to Extend Services.

M.6.2. Reasonableness. In accordance with FAR 15.404-1(b), the Government shall evaluate the offeror’s proposed total evaluation price for reasonableness.

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

M.6.4. Evaluation of Options. In accordance with FAR Clause 52.217-5, Evaluation of Options; and FAR Clause 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 Clause 52.217-8.

M.7. EVALUATION OF FACTOR 4—SMALL BUSINESS PARTICIPATION.

M.7.1. The Government will evaluate the subcontracting plan and participation of small businesses on an Acceptable/Unacceptable basis.

Acceptable–Proposal meets the minimum requirements of the solicitation. Strengths are not assessed for this evaluation.

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

M.7.1. Large Businesses. The Government will review the subcontracting plan submitted under Volume I for the requirements identified under FAR 19.702, Statutory requirements; FAR 19.704, Subcontracting plan requirements; FAR 52.219-8 Utilization of Small Business Concerns, FAR 52.219-9 Small Business Subcontracting Plan, and DFARS 252.219-7003, Small Business Subcontracting Plan (DoD Contracts).

M.7.2. The Government will assess how the offeror’s proposed subcontracting goals compared to the subcontracting goals below. If the offeror does not propose the subcontracting goals below, the Government will assess how well the offeror describes how and why the proposed goals are set at levels that are realistic and that the parties can reasonably expect will be met. The Government will assess the extent the offeror identifies businesses in the Plan and demonstrated good faith efforts or plans to meet the below goals using small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business (which includes historically black colleges and minority institutions in its goal), and women-owned small business subcontractors to the maximum extent practicable. The TOP subcontracting goals are:

· Small Business Subcontracting (SB) 8.0%

· Small Disadvantaged Businesses (SDB) 0.5%

· Women-Owned Small Businesses (WOSB) 5.5%

· Historically Underutilized Business Zone (HUBZone) Small Businesses 1.0%

· Veteran Owned Small Businesses (VOSB) 0.25%

· Service-Disabled Veteran-Owned Small Businesses (SDVOSB) 0.25%

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