Section_L_TMEP_FINAL_rev_2_08_22_2019.docx

SECTION L

INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

L.1. CLAUSES

FAR 52.204-7 -- SYSTEM FOR AWARD MANAGEMENT (OCT 2018)

FAR 52.204-18 -- COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE (JUL 2016)

FAR 52.211-7 -- ALTERNATIVES TO GOVERNMENT -- UNIQUE STANDARDS (NOV 1999)

FAR 52.211-14 -- NOTICE OF PRIORITY RATING FOR NATIONAL DEFENSE EMERGENCY PREPAREDNESS AND ENERGY PROGRAM USE (APR 2008) Any contract awarded as a result of this solicitation will be [ ] DX rated order; [X] DO rated order certified for national defense, emergency preparedness, and energy program use under the Defense Priorities and Allocations System (DPAS) (15 CFR 700), and the Contractor will be required to follow all of the requirements of this regulation.

(End of Provision)

FAR 52.215-1 -- INSTRUCTIONS TO OFFERORS -- COMPETITIVE ACQUISITION -- ALTERNATE I (OCT 1997)

FAR 52.216-1 -- TYPE OF CONTRACT (APR 1984)

The Government contemplates award of a Fixed-Price contract resulting from this solicitation.

FAR 52.222-24 -- PREAWARD ON-SITE EQUAL OPPORTUNITY COMPLIANCE EVALUATION (FEB 1999)

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 (addressed as follows) by obtaining written and dated acknowledgment of receipt from:

Mr. Todd Young, Contracting Officer

TMEP, HT940219R0003

DHA, Managed Care Contracting Division (MC-CD) 16401 East Centretech Parkway Aurora, CO 80011-9066

(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 (CO) 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. The full text of a solicitation provision may be accessed electronically at this address:

http://farsite.hill.af.mil

(End of Provision)

FAR 52.252-5 -- AUTHORIZED DEVIATIONS IN PROVISIONS (APR 1984)

(a) 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.

(b) The use in this solicitation of any Defense Acquisition Regulations System, Department Of Defense (48 CFR Chapter 2) provision with an authorized deviation is indicated by the addition of “(DEVIATION)” after the name of the regulation.

(End of Provision)

DFARS 252.215-7008 -- ONLY ONE OFFER (OCT 2013)

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

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

b. 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 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.

Note: Any subsequent DHA appellate review of the initial agency–level protest shall not provide an extension of time to file a protest with the Government Accountability Office. The subsequent independent review does not extend the GAO’s timeliness requirements for subsequent protest of the initial adverse agency action (FAR 33.103(d)(4) and 4 CFR 21.2(a)(3)).

L.2. GENERAL INSTRUCTIONS

L.2.1. To assure timely and equitable evaluation of proposals, offerors must follow the instructions contained herein. Offerors are required to meet all solicitation requirements, including terms and conditions, representations and certifications. To be considered for award, offerors must submit proposals with program terms, commitments, and contract terms demonstrating a basic level of competence and an understanding of the complexity and risks of TRICARE Medicare Eligible Program (TMEP). Proposals must be complete, self-sufficient and respond directly to the requirements of this solicitation. Proposals must also be prepared in accordance with the instructions set out in this Section L. If it is determined that a proposal is substantially not in conformance with the instructions in Section L or fails to be submitted in accordance with the Request For Proposal (RFP) requirements, the Government may deem that proposal to be unacceptable, not subject to further evaluation and removed from consideration for contract award. Although failure to provide pricing information in accordance with Section B and L may result in a rejection of a proposal, an offeror’s evaluated proposed price will not, itself, form the basis for rejection of a proposal under the instructions of this paragraph.

L.2.1.1. The CO will determine whether the apparent successful offeror is responsible in accordance with FAR 9.1. A determination of non-responsibility will result in the rejection of an offer and that offer may not be considered for award.

L.2.1.2. Award without Discussions. The Government may award a contract without discussions. Therefore, the offeror’s initial proposal should contain the offeror’s best terms from a price, technical, past performance, and small business standpoint.

L.2.1.2.1. The Government reserves the right to conduct discussions if the CO determines they are in the Government’s best interests. The Government may reject any or all offers if such action is in the public interest, accept other than the lowest price offer, and waive informalities and minor irregularities in offers received. The Government cautions offerors not to leave solicitation items blank, including the Standard Form (SF) 33 blocks or offer any item requiring the offeror’s response. If an item is not applicable to the offeror, the offeror shall state “not applicable” or “NA.” The CO may consider the offer to be unacceptable and ineligible for contract award if an offeror (1) fails or refuses to assent to any of the terms and conditions of the RFP, (2) proposes additional terms and conditions of this RFP (excluding those permitted under L.6.) or (3) fails to submit any of the information required by this RFP. The offeror is reminded the Government reserves the right to award this effort based on the initial proposal received without discussions.

L.2.1.3. If an offeror submits more than one (1) proposal, the Government will not evaluate any proposal from that offeror, except for proposals submitted in accordance with FAR 52.204-22 -- Alternative Line Item Proposal.

L.2.1.4. The offeror shall not simply rephrase or restate the Government’s requirements in the proposal. The offeror shall provide convincing rationale that addresses how the offeror intends to meet or exceed the requirements. Offerors shall assume that the Government has no prior knowledge of offeror’s facilities, capabilities or experience. The Government will base its evaluation on the information presented. The Government may consider any additional past performance information obtained from other sources.

L.2.1.5. Discrepancies and Ambiguities. If an offeror believes the requirements in these instructions contain any errors, omissions, ambiguities, or are otherwise unsound, the offeror shall immediately notify the CO in writing with supporting rationale as well as any as remedies the offeror is asking the CO to consider related to the omission or error.

L.2.1.6. Electronic Reference Documents. 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 emails regarding Government notifications on the FBO website.

L.2.1.7. Contract Document. Sections K, L and M apply to the solicitation phase only and will not be part of the resulting contract.

L.2.1.8. The contract will be updated to reflect the actual Period of Performance dates prior to award.

L.2.1.9. Offerors should submit their anticipated organizational chart referenced in L.4.9. at least 10 calendar days prior to the proposal due date. The offeror shall include an address, telephone number, and email of a point of contact for issues regarding the organizational chart.. In the case of a joint venture or other business structure, a clear description of the organizational relationships must be disclosed. This organizational structure is to be emailed to the following: duane.a.foley.civ@mail.mil

L.2.2. ORGANIZATIONAL CONFLICTS OF INTEREST (OCI)

L.2.2.1. The offeror’s attention is directed to FAR 9.5, Organizational and Consultant Conflicts of Interest.

L.2.2.2. For the purpose of these provisions, the term “offeror” means the offeror, its subsidiaries, affiliates, partners, and marketing consultants (as defined by FAR 9.501), or any of its successors or assignees.

L.2.2.3. DHA has contractual relationships with multiple companies that due to the nature of the performance with DHA, have an actual or potential organizational conflict of interest, which must be avoided, neutralized or mitigated. It is the responsibility of each offeror to identify if any such actual or potential organizational conflict of interest exist with regards to their offer. If an actual or potential organizational conflict of interest is identified, the conflict shall be addressed in accordance with L.2.2.5.

L.2.2.4. The offeror is hereby notified that the nature of the work to be performed may create an actual or potential organizational conflict of interest in future acquisitions.

L.2.2.5. The offeror shall represent in writing within 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 exist, the offeror shall submit a plan to the Contracting Officer, no later than 15 calendar days prior to the proposal due date, that effectively demonstrates how the offeror will avoid, mitigate or neutralize any actual or potential organizational conflict of interest while supporting this contract and any other DHA contract. As a part of the proposal, the offeror shall provide the Contracting Officer with information of previous or ongoing work that is in any way associated with this solicitation.

L.2.2.6. The CO will review all plans in accordance with FAR 9.5 to determine whether it effectively avoids, neutralizes or mitigates a potential or actual organizational conflict of interest, if the CO determines that no conflict would arise or that the offeror’s plan adequately protects the interest of the Government, the offeror will be eligible for award. If the CO determines that the offeror’s plan is inadequate, remedial actions will be considered, including elimination from the solicitation process, termination of related contract efforts already awarded or negotiation of the offeror’s plan.

L.2.2.7. The above restrictions shall be included 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.2.2.8. The offeror acknowledges the full force and effect of these provisions. The above provisions may be modified or deleted at the discretion of the Government. 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 pursues any remedy permitted by law, regulation or the terms and conditions of this solicitation.

L.2.3. 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 proposal volumes. The offeror shall clearly distinguish information in its proposal that it attributes to itself (the offeror) its parent company, affiliate or subsidiary.

L.2.4. Offerors shall submit proposals to the CO at the address indicated below. The proposals are to be in electronic and hard copy format (see paragraph L.4.) in the quantities indicated in Table 1. Hardcopies and Compact Disc (CDs) shall be submitted to:

Mr. Todd Young, Contracting Officer

TMEP, HT940219R0003

DHA, Managed Care Contracting Division (MC-CD) 16401 East Centretech Parkway Aurora, CO 80011-9066

L.2.4.1. Each CD and hardcopy volume shall be marked as follows:

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

HT9402-19-R-0003

TRICARE Medicare Eligible Program (TMEP) Volume Number CD number (e.g., 1 of 3) Date the CD was created Software and version used (See paragraph L.4.2.)

L.2.4.2. Offerors shall apply all appropriate markings including those prescribed in accordance with FAR 52.215-1(e), Restriction on Disclosure and Use of Data; and FAR 3.104-4, Disclosure, Protection, and Marking of Contractor Bid or Proposal Information and Source Selection Information.

L.2.5. Personal Deliveries. If an offeror plans to have a representative deliver its proposal, the offeror shall coordinate the delivery with the Contract Specialist (CS) (See Block 10 of the SF 33) at least one (1) business day prior to the due date/time to ensure timely submission. Proposals must be received no later than the date/time and at the address stated on the SF 33.

L.3. GENERAL INFORMATION

L.3.1. Communications. The CO and the CS are the sole points of contact for this procurement. Offerors shall submit any questions regarding the solicitation or other concerns via email to the CS with a courtesy copy to the CO.

L.3.1.1. The CO encourages offerors to submit questions regarding the solicitation or other concerns via email to the CS at duane.a.foley.civ@mail.mil no later than 10 business days after issuance of solicitation. Government responses to questions pertaining to the solicitation will be provided to all potential offerors in accordance with FAR 15.201(f) via the Federal Business Opportunities website at https://www.fbo.gov. The Government reserves the right not to respond to any questions received concerning this solicitation after the question receipt date.

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

L.3.3. Data on eligible beneficiaries, electronic and paper claims quantities and administrative support services workload volumes are located in Section L Exhibits L-1 and L-2.

L.3.4. Offerors may access the TRICARE Manuals on the DHA website at https://manuals.health.mil/. A draft TOM Chapter 20 will be added to the RFP and is expected to be posted to the TRICARE website once approved. Offerors are reminded that only the manuals referenced in Section C of the RFP are applicable to this effort. For the purposes of this solicitation, please see Attachment J-4, Draft TOM, Chapter 20 for all TOM Chapter 20 references.

L.4. PROPOSAL PREPARATION

L.4.1. The offeror’s proposal shall consist of six (6) physically separated volumes, individually titled as indicated below. Each copy of each volume shall be in separate three (3)-ring binders in the appropriate quantity. The total number of copies includes the original (e.g., 4 copies = original + 3 copies.)

L.4.1.1. Table 1, Proposal Volumes

· Completed and signed SF 33

· Completed Section B

· Completed Section K

· OCI representation and mitigation plan (if applicable)

· Organizational chart

· Written technical proposal

· Proposed enhancements summary

· Past performance narrative

· Past Performance Questionnaires (PPQ)

· Electronic Subcontracting Reporting System (eSRS) documents

· Organizational roadmap

· Terminated contracts

· Client authorization, Subcontractor Consent Letter

· Copy of Section B, Supplies or Services and Prices/Costs

· Supporting spreadsheets and any additional support

· Wage determination(s) and/or Collective Bargaining Agreements (CBAs) for the offeror’s place(s) of performance

· Subcontracting plan

· Dun and Bradstreet (D&B) comprehensive report(s)

· Financial Statements

· DCMA Form 1620 04-04 guaranty agreement for corporate guarantor

L.4.2. Electronic. The electronic portion of the proposal shall be submitted on virus-free CD-ROMs that are compatible with Microsoft Office 2013. For the original and copies listed above, the documents shall be either in Word or Excel format. If this is not possible, then a PDF document in Optical Character Recognition (OCR) format is acceptable for all volumes except for Volume IV, Price Proposal, which shall only be submitted in Word and Excel format (See paragraph L.8. for additional requirements.) Each CD shall be labeled as stated in paragraph L.2.4. 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. Do not use compressed file formats. Use separate files to permit rapid location of all portions, including exhibits, annexes, and attachments, if any. 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. Electronic versions shall be exact duplicates of the paper copy proposals in both content and format.

L.4.3. Paper Copies. Paper copy proposals shall be exact duplicates of the electronic versions in both content and format. Offerors shall submit each copy of each volume in a separate three (3)-ring binder with the offeror’s name, volume number, volume title, proposal date and solicitation number on the outside front cover and spine. Offerors shall also indicate which set of the volumes is the original and indicate the number of each set of copies (COPY 1 of 3). All paper proposal material shall be submitted on white paper with one-inch (1”) margins on all sides. The font for both CD ROM and paper submissions shall be Times New Roman, and at least 12 point with normal spacing and kerning. However, offerors may use 8-point Times New Roman, or higher, for illustrations, organization charts, supporting data exhibits, report listings or levels on process flows. Elaborate brochures or documentation, binding, detailed artwork or other embellishments shall not be submitted. Screenshots and images may contain font and/or point outside the prescribed standards. Screenshots and images not legible will not be considered. The screenshots and images will only be evaluated to the extent described in the proposal narrative. Proposal Volumes I-III shall be printed on letter sized paper, single-spaced, double-sided only with non-duplicative, sequential page numbers at the bottom of each page that includes the offeror’s name and solicitation number at the bottom of each page. Volumes IV-VI shall be printed single-sided. In instances where the paper copy differs from the electronic copy, the original paper volumes prevail.

L.4.4. Page Limitations. Page limitations shall be treated as maximums. If exceeded, the excess pages will not be considered in the evaluation of the proposal. The excess hard copy pages will be destroyed without review, and excess electronic pages will not be reviewed. Table 2 below shows the required documents with page limits and the corresponding paragraph in Section L. If a required document is not listed in Table 2, then it has no page limit. Where a page limit is indicated, a page is defined as the text on one (1) side of a letter sized paper. Although double-sided pages are required per L.4.3., for page limitation counting purposes, a double-sided page equates to two (2) pages.

L.4.4.1. Table 2 Proposal Page Limits

L.4.5. If the CO issues an Evaluation Notice (EN) (e.g. clarification questions), the offeror shall follow the instructions in the EN.

L.4.6. If the CO requests final proposal revisions, the offeror shall follow the revision instructions in the request for final proposal revision.

L.4.7. An offeror’s proposal will not be incorporated into the awarded contract as a whole. However, the Government may incorporate portions of the proposal into the resulting contract.

L.4.8. In accordance with FAR 4.803, Contents of Contract Files, MC-CD will retain one (1) copy of all unsuccessful proposals. DHA’s Office of General Counsel (OGC) may retain copies of proposals. Unless the offeror requests otherwise in writing, the contracting office will destroy the remaining copies of unsuccessful proposals.

L.4.9. Organization Chart. The offeror shall submit a proposed organizational structure and must include the prime contractor, the parent entity, affiliates, subsidiaries, teaming partners, and first-tier subcontractors. A first-tier subcontractor is a company with a direct contractual relationship with the offeror to perform TMEP requirements, and whose contract price exceeds $25,000,000.00 in any one year. The offeror should only submit information for up to two (2) first-tier subcontractors. In the case of a joint venture or other business structure, a clear description of the organizational relationships must be included.

L.4.9.1. The offeror shall include an address, telephone number, and email of a point of contact for issues regarding the organizational chart.

L.5. VOLUME I, EXECUTED OFFER

L.5.1. Volume I shall contain the signed original of all documents requiring the offeror’s signature, including the SF 33 and the acknowledgement of any issued amendments to this solicitation. Use of reproduction of the signed original is authorized in the copies. An electronic Representation and Certification application is available at the System for Award Management (SAM) website https://www.sam.gov/SAM/.

L.5.2. Offerors shall submit a completed Section B, Supplies or Services and Prices/Costs, in Volumes I and IV. Volume I is the original. Offerors shall not include price information anywhere else in the proposal. Offerors are instructed to price the appropriate Contract Line Item Number (CLIN) in Section B, Supplies or Services and Prices/Costs, as described in paragraph L.8., Volume IV, Price Proposal. Offers submitted in response to this solicitation shall be in terms of U.S. dollars.

L.5.3. Offerors must complete, sign, and date Blocks 12 through 18 of the SF 33. The Government estimates it will require a minimum of 180 calendar days to evaluate the TMEP offers and select the successful offeror. Therefore, offerors shall provide at least 180 days in Block 12, Minimum Acceptance Period.

L.5.4. Offeror’s Point of Contact (POC). An offeror shall include a cover page in Volume I identifying offeror’s POCs authorized to respond to evaluation notices (ENs) and/or hold discussions/negotiations with the Government with the full authority to bind the company. The following POC information is required: Full name, title, email address, phone number, fax number and level of authority.

L.5.5. Section G, Contract Administration Data. As required in paragraph G.3.1.1., the offeror shall provide the POC’s name and contact information for contract administration in Volume I.

L.5.6. Offerors must acknowledge receipt of any and all amendments when submitting the offer and include the acknowledgements in this volume.

L.5.7. Reserved.

L.6. VOLUME II, TECHNICAL PROPOSAL (FACTOR 1, TECHNICAL APPROACH)

L.6.1. The offeror shall submit a written technical proposal which effectively demonstrates the offeror’s understanding of the requirements and provides a successful technical solution for the prospective contract. Offerors shall not merely reiterate the objectives or reformulate the requirements specified in the solicitation. The written technical proposal may also include elements of the offer that exceed the Government’s minimum requirements including performance standards that exceed the minimum standard or additionally offered performance standards “enhancements.” The Government, at its sole discretion, may or may not incorporate proposed enhancements into the contract.

L.6.1.1. The technical proposal shall clearly describe or demonstrate how the offeror will meet or exceed the TMEP requirements.

L.6.1.2. A proposal enhancement summary shall include the following (this summary does not count in the 75 page technical volume):

L.6.1.2.1. List of all proposed enhancements.

L.6.1.2.2. Reference each enhancement to the TMEP Performance Work Statement (Section C), the TRICARE Manuals and the Performance Standards (Section H.5.4.) when applicable or identify as an unreferenced enhancement.

L.6.1.2.2.1. If a proposed enhancement does not relate to an existing requirement, then the offeror shall so state and explain how the enhancement is advantageous to the Government.

L.6.1.2.2.2. Identify a new acceptable quality level proposed if applicable.

L.6.1.2.2.3. Identify the location in the proposal where the enhancement is discussed.

L.6.1.2.2.4. Propose language that may be incorporated into the contract as an enforceable provision.

L.6.1.3. The Government will not assess a strength as defined in Section M, Evaluation Factors for Award, to any enhancement to the following Government standards or requirements: TRICARE Operations Manual (TOM) 6010.59-M, April 1, 2015, Chapter 1, Section 3 and TRICARE Operations Manual, Chapter 20, Section 1.

L.6.1.3.1. Claims Occurrence Errors. TOM, Chapter 1, Section 3, Paragraph 1.6.2.

L.6.1.3.2. TED - Timelines. TOM, Chapter 1, Section 3, Paragraph 1.7.

L.6.1.3.3. Vouchers/Batches. TOM, Chapter 1, Section 3, Paragraph 1.8.2.

L.6.1.3.4. Filing. TOM, Chapter 1, Section 3, Paragraph 2.1.

L.6.1.3.5. Availability of Information. TOM, Chapter 1, Section 3, Paragraph 2.2.

L.6.1.3.6. Blockage Rates. TOM, Chapter 1, Section 3, Paragraph 3.4.

L.6.1.3.7. Telephones answered within 2 rings by Interactive Voice Recognition (IVR). TOM, Chapter 20, Section 1, paragraph 3.3.

L.6.1.3.8. Telephone “hold-time” shall not exceed 30 seconds. TOM, Chapter 20, Section 1, paragraph 3.3.

L.6.1.3.9. Grievances. TOM, Chapter 1, Section 3, Paragraph 5.0.

L.6.1.3.10. Anti-fraud software program(s). TOM, Chapter 13, Section 1, Paragraph 1.3.

L.6.1.4. The proposal shall not reflect a marketing or sales presentation. Unnecessarily elaborate proposals beyond those sufficient to present a complete and effective response to this solicitation are not desired. The proposal should illustrate the offeror’s capability and clearly demonstrate the organization and methodology that will satisfy the solicitation requirements.

L.6.1.4.1. The proposal shall clearly describe the technical approach to the solicitation requirements. The proposal shall address all of the subfactors identified in paragraphs L.6.2. through L.6.5. The Government will evaluate the proposal using the criteria in Section M, Evaluation Factors for Award.

L.6.1.4.2. 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 the 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 the purposes of evaluating past performance as described in paragraph M.7.

L.6.1.4.3. The price proposal, past performance information, and financial information shall not be addressed in the technical proposal volume, and no part of the technical proposal shall be incorporated by reference in any other proposal volume.

L.6.1.5. The technical proposal shall not exceed 75 pages inclusive of the exhibits, illustrations attachments, flow diagrams, data dictionaries, figures, charts and any other non-narrative documents. The table of contents, index and tabs separating sections of the volume will not be counted as long as they do not contain proposal content. The offeror may cross-reference information within the technical proposal rather than repeating the information (i.e., a cross-reference to another paragraph within the technical volume; a cross-reference to another volume is not allowed.)

L.6.2. TECHNICAL SUBFACTOR 1, CLAIMS PROCESSING

L.6.2.1. The offeror shall describe its approach to ensure timely and accurate claims processing for medical care rendered within the United States (U.S.), Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands to dual Medicare and TRICARE eligible beneficiaries.

L.6.2.2. The offeror shall describe how it will establish, maintain and monitor its claims processing system and reimbursement procedures from claim receipt through record retention requirements utilizing best business practices and cost containment measures when appropriate. At a minimum, the offerors description shall include its approach for:

· Receipt and processing of claims

· Mailroom activities

· Claim development of missing information

· Verify patient eligibility

· Determining jurisdiction and related processing actions

· Ensuring a service is medically necessary and a covered benefit

· Complying with the claims filing deadline

· Processing authorization/pre-authorizations (including skilled nursing facilities when TRICARE becomes primary payer) and including processes to accept authorizations from Managed Care Support Contractors (MCSC)

· Completing appeals/reconsiderations

· Determining the allowable payment amount for primary and secondary claims

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

· Creating and distributing the explanation of benefits and release of payment

· Completing provider certification to include participation agreements

· Complying with records retention requirements

· Submitting TED records and meeting the TED timelines and accuracy standards

L.6.3. TECHNICAL SUBFACTOR 2, CUSTOMER SERVICE

L.6.3.1. The offeror shall describe its approach for providing comprehensive customer service via multiple, contemporary avenues of access. The approach shall include the types of customer services offered, the manner in which the services can be accessed, the availability of the services, how it will result in beneficiary and provider satisfaction and comply with customer service standards. The offeror shall not propose its own beneficiary and/or provider surveys.

L.6.3.2. The offeror shall describe its approach for identifying and responding to beneficiary and provider targeted education. The approach shall include the methods of conducting proposed education and coordination with the Government.

L.6.4. TECHNICAL SUBFACTOR 3, MANAGEMENT FUNCTIONS

L.6.4.1. The offeror shall describe its proposed management approach to provide the necessary oversight and risk management in delivering high quality services and achieving the solicitation requirements. The description shall include organizational structure, decision points and quality and internal management controls.

L.6.4.2. The offeror shall describe its management approach for establishing and maintaining the necessary staff, facilities, systems and infrastructure to achieve the requirements. The description shall include staffing models for each activity (including staffing levels), training and retention to ensure knowledgeable, courteous and responsive staff, availability of facilities, subcontractor management (if applicable) and automated data systems development, monitoring and support.

L.6.5. TECHNICAL SUBFACTOR 4, TRANSITION ACTIVITIES

L.6.5.1. The offeror shall describe its approach to ensure services and systems are fully operational at the beginning of Option 1 with minimal disruption of services to beneficiaries and providers. The approach shall include a timeline of start-up activities which comply with the requirements of the RFP.

L.6.5.2. The offeror shall describe its plan to comply with all necessary Transition-Out requirements to include maintaining resources, services and systems.

L.7. VOLUME III, PAST PERFORMANCE (FACTOR 2, PAST PERFORMANCE)

L.7.1. Past Performance shall be submitted for the prime contractor (offeror) and its first-tier subcontractors (as described in paragraph L.4.9.) As used in this paragraph, “offeror” is inclusive of the prime contractor, teaming partners, and first-tier subcontractors. For the purpose of submitting past performance information, the prime contractor may be an individual company or an entity that is a subsidiary, affiliate or partner.

L.7.1.1. The Government may conduct its own past performance evaluation for all contractors, teaming partners, and subcontractors identified in the organizational chart.

L.7.2. The offeror shall provide a narrative that describes the past performance that the prime contractor and first-tier subcontractor(s) have in performing work that the offeror deems relevant to this solicitation. The narrative shall specifically address past performance in claims processing, customer service, management functions and transition activities as relevant to the requirements of this solicitation. Within the narrative, the offeror is required to explain what aspects of the past performance are deemed relevant to the proposed efforts, and to what aspects the proposed efforts relate. The offeror is required to clearly demonstrate management actions employed in resolving problems and the effects of those actions, in terms of improvements achieved or problems resolved (i.e., submittal of quality performance indicators or other management indicators). The narrative will not exceed 10 pages.

L.7.2.1. The offeror shall describe in the narrative the type and nature of any data breach which affected 500 or more individuals within the last three (3) years from proposal due date. The offeror shall describe what actions the offeror took in response to any data breach to include mitigation efforts.

L.7.3. The offeror shall submit a PPQ (See Section L Exhibits, L-4, Past Performance Questionnaire) and a separate one (1) page of additional information for each PPQ (if desired.) The offeror shall identify no more than three (3) most relevant and recent Government or non-Government contracts/agreements related to this effort, as defined at M.7. for itself and no more than four (4) most relevant and recent contracts/agreements for first-tier subcontractors (if applicable.) The offeror shall provide no more than two (2) PPQ’s per first-tier subcontractor.

L.7.3.1. The offeror shall send the PPQ to the customer (Government or non-Government), receive the signed questionnaire back from the customer, and provide the completed questionnaire as a part of their past performance record. (This does not count against the 10 page narrative limitation or the one (1) page of additional information.) If a PPQ cannot be submitted, the offeror should describe why it is not being submitted in the one (1) page of additional information.

L.7.3.2. Offeror’s understand that a failure to remit a PPQ may result in a neutral assessment for the associated past performance experience, and it is the offeror’s responsibility to have the questionnaire completed and signed by the referenced client. The Government is not obligated to seek PPQ’s that have not been submitted, and the offeror understands that the PPQ shall be completed by the most cognizant officer of the contract/program, or if it is a Government contract, by the CO or Contracting Officer’s Representative (COR) if available. The offeror shall not include PPQs from their own subsidiaries, subcontractors, or other team members.

L.7.3.2.1. PPQ template will be provided at Section L Exhibits, L-4, Past Performance Questionnaire. Offeror’s shall use the template provided.

L.7.3.2.2. The Offeror is solely responsible for adding adequate specifics to the PPQ (Section 1), so the Government can easily identify to which offeror the past performance refers and the specific contract referenced.

L.7.3.2.3. For each PPQ, the offeror shall provide additional information not provided in the PPQ when the offeror feels additional information is necessary. The additional information shall be provided for each reference not to exceed one (1) page. (This summary does not count against the 10 page narrative.) Do not duplicate information provided in the PPQ.

L.7.3.2.4. For each past performance reference, the offeror shall submit the most recent Electronic Subcontracting Reporting System (eSRS) report, when available.

L.7.3.3. Recency. To be recent, past performance references submitted by offerors must be ongoing for at least six (6) months during the three (3) year period from, June 01, 2016 through May 31, 2019. References failing to meet this condition will not be evaluated.

L.7.3.4. Relevancy. Past performance references submitted by offerors and other information collected by the Government will be evaluated for relevancy in terms of scope, magnitude of effort and complexities as it relates to the requirements in this RFP.

L.7.4. Quality. Past performance references submitted by offerors and other information collected by the Government will be evaluated for quality in terms of the offeror’s performance and general trends.

L.7.5. Performance confidence assessment. Past performance information collected by the Government will result in an overall performance confidence assessment.

L.7.6. Subcontractor’s Consent. If a subcontractor or other teaming relationship is proposed, the offeror shall submit the consent of its proposed first-tier subcontractor(s) and teaming partners, as applicable, to disclose past performance information to the offeror along with the offeror's proposal submission (see Section L Exhibits, L-6, Sample Teaming Partner/ Subcontractor’s Consent.) If the proposed subcontractor or teaming partner’s consent is not provided with the offeror's proposal, the Government will not consider the subcontractor’s past performance in assessing the offeror's past performance.

L.7.7. Organizational Roadmap. Many companies have been acquired by, or otherwise merged with other companies, and/or reorganized divisions, business groups, of subsidiary companies. The offeror shall include a “roadmap” describing all such changes in the offeror’s organization to facilitate the Government’s relevancy determination. If an offeror provides past performance information that was rendered by a predecessor company, the offeror shall describe how the past performance efforts of the predecessor company are relevant to this solicitation and how that work can be attributed to the offeror that is proposing to perform the TMEP requirement in the Past Performance Narrative (see L.7.2.) Based on corporate changes in business relationships, the offeror shall also identify the commitment of resources between predecessor companies, divisions, business groups, first-tier subcontractors or subsidiary companies.

L.7.8. The Government may obtain past performance data from any source, including, but not limited to, the references listed in the proposal, other customers known to the Government, consumer protection organizations, business news sources and persons inside or outside the Government who may have useful and relevant information.

L.7.9. If the offeror, or its first-tier subcontractors, has had any contracts terminated for default within the last three (3) years from the proposal due date, the offeror shall provide documentation detailing the reason for the termination. The documentation shall identify the customer, its address, the contracting official and his/her telephone number and email. For any contract terminated for default, the offeror shall provide what actions have been taken to prevent similar failures from reoccurring. (This summary is limited to two (2) pages per event and does not count against the 10 page narrative limitation.)

L.7.10. If the offeror, or its first-tier subcontractor(s), were formed solely for the purpose of proposing on this solicitation and the parent corporation, affiliate or individual entity/entities of a joint venture has relevant past performance, the offeror shall submit information required for the applicable entity/entities. The offeror must document how the submitted past performance is relevant to this solicitation. For parents and affiliates, the offeror shall also explain the resources that will be provided by the parent or affiliate and the involvement that entity will have in the performance of the TMEP contract. For joint venture members, offerors shall explain the efforts that entity will perform under the TMEP contract. This information shall be included in the 10 page narrative.

L.7.11. Any offeror without past performance history relevant to this solicitation may submit past performance information relating to key personnel in the firm who have relevant past performance history. Offerors shall specifically identify relevant past performance efforts for each individual cited, the nature of the history and the results of the individuals efforts. Resumes of key personnel are not required and shall not be submitted. Any offeror without relevant past performance may also submit relevant past performance of their parent corporation, affiliate or individual entity/entities of a joint venture. The offeror must document how the submitted past performance is relevant to this solicitation. For parents and affiliates, the offeror shall also explain the resources that will be provided by the parent or affiliate and the involvement that entity will have in the performance of the TMEP contract. For joint venture members, offerors shall explain the efforts that entity will perform under the TMEP contract. This information shall be included in the 10 page narrative.

L.8. VOLUME IV, PRICE PROPOSAL (FACTOR 3, PRICE)

L.8.1. Section B, Supplies or Services and Prices/Costs. The offeror shall submit fixed unit prices and extended amounts based on the Government-provided estimated quantities in Section B, Supplies or Services and Prices/Costs in United States (US) Dollars. For all CLINs, the unit price (to two decimal places (0.00)) multiplied by the estimated quantity for each respective CLIN shall equal the extended amount on the SF 33, Section B, Supplies or Services and Prices/Costs, with no rounding. A zero dollar figure (i.e., $0.00) entered or a line item left blank will be interpreted as the CLIN shall be provided at no charge to the Government. The offeror’s completed Section B of the solicitation constitutes its offer to the Government.

L.8.1.1. The estimated quantities are based on historical data and do not constitute the Government’s commitment that these quantities will actually occur over the course of the contract.

L.8.1.2. In the event there is a discrepancy between Volume IV, Price Proposal and the SF 33, Section B, the amounts on the SF 33, Section B, Supplies or Services and Prices/Costs, shall prevail.

L.8.1.3. The Price Proposal shall clearly state the offeror’s proposed total price/total evaluated price (see section M.8.1.) It also shall include the price totals by CLINs and option period.

L.8.2. Adequate price competition is anticipated, so offerors shall not provide certified cost and pricing data or information other than certified cost or pricing data. The Contracting Officer reserves the right to subsequently require additional data, including submission of certified cost or pricing data or information other than certified cost or pricing data.

L.8.2.1. Reserved

L.8.2.2. The types and formats of the data submitted are left up to the offeror to prepare and present in support of its proposed prices.Reserved

L.8.2.3. The electronic price proposal shall duplicate the hardcopy version and shall only be in Microsoft Word and Excel (compatible with Microsoft Office 2013.) Submitted files shall contain all formulas, calculations, and worksheet/workbook links used to compute the proposed amounts. The formulas, calculations, and links shall not be hidden in order for the Government to verify the accuracy of the data. Print image files or those files/worksheets containing only values are not acceptable.Reserved

L.8.3. Transition-In. Offerors shall propose a fixed price for the 12-month Transition-In base period CLIN, including all costs anticipated during the 12-month Transition-In period to accomplish the Transition-In requirements detailed in the solicitation.

L.8.4. Claims Processing. Offerors shall propose separate fixed-price claims processing rates for electronic and paper claims for each option period. These rates consist of the costs associated with claims processing, including adjudication, TED creation/submission requirements and payment. Claims processing rates shall not include costs for customer service, appeals, marketing, advertising, management or overhead not associated with adjudicating the claim. Offerors shall use the Government-provided estimated claims volume for each option period in Section B, Supplies or Services and Prices/Costs.

L.8.5. Administration. Offerors shall propose separate fixed price monthly administration rates for each option period. The prices for the Administration CLINs include costs for customer service, appeals, marketing, advertising, management and overhead not associated with adjudicating the claim. Administration rates shall not include costs associated with claims processing.

L.8.6. Transition-Out. Offerors shall propose a fixed price for each option period for the Transition-Out CLINs. These prices will include all costs associated with transitioning out the prospective contract in accordance with the contract requirements.

L.8.7. Option Period Escalation and Other Price Changes. The offeror shall provide the basis for its proposed price escalations and any price changes between option periods. The offeror shall discuss the price change rationale used in preparing its proposal. If the offeror used a price index to escalate the proposed prices, the offeror shall identify the index title, source, index number, and provide a copy of the index with a description of how it was used in its calculations. The CO may use this data to assist in determining if proposed prices are fair and reasonable.Reserved

L.8.8. Reserved

L.8.9. The CO may request assistance from the Defense Contract Audit Agency (DCAA) and/or Defense Contract Management Agency (DCMA). The offeror shall include the DCMA and DCAA POCs (office names, office addresses, name of cognizant Administrative Contracting Officer (ACO) and DCAA supervisory auditor/auditor, email addresses and phone numbers) for the offeror and any team members (subcontractors) in the proposal.

L.8.10. Service Contract Act (SCA). The SCA applies to this solicitation. Each offeror shall provide Wage Determination(s) for proposed place(s) of performance. Wage determinations are available from the Department of Labor website found at http://www.wdol.gov/sca.aspx. All performance under this contract shall be within the United States. The CO will incorporate the most current version(s) of the applicable Wage Determination(s) as an attachment to the contract and will incorporate any revisions annually thereafter with the exercise of any option period. The offeror shall not add economics/escalation to the proposed direct labor rates for those labor categories subject to the SCA.

L.8.10.1. Offerors shall identify SCA labor categories and labor rates within the price proposal and warrant on the first page of its Volume IV, Price Proposal, that the prices proposed do not include any allowance for any contingency to cover increased costs for which adjustment is provided under FAR Clause 52.222-43 -- Fair Labor Standards Act and Service Contract Act -- Price Adjustment (Multiple Year and Option Contracts.)

L.9. VOLUME V, SMALL BUSINESS SUBCONTRACTING PLAN (FACTOR 4, SMALL BUSINESS)

L.9.1. Offerors designated as large businesses shall include in Volume V a subcontracting plan as required by FAR 19.702, FAR 19.704, FAR 52.219-9 -- Small Business Subcontracting Plan (DEVIATION 2018-O0018, and 2019-O0005) and DFARS 252.219-7003, Small Business Subcontracting Plan (DoD Contracts).