TMEP_RFP_Industry_Questions_Matrix_MASTER_08August2019_FBO.pdf

RFP Section Section Title/ Category/ Page Question DHA Response To Industry

1 Multiple: Section B, Section L Multiple What is the rationale for the significant change in claims mix that we are seeing between the L-2 historic net claim volumes and the Section B Claim Volumes? The 2018 paper volumes provided in L-2 are 2.8% of the Net Claims Receipts Volumes (i.e., 1.766M / 62.469M), and the paper claims volumes Provided in Section B for each Option Period are 6% of the total claim volume (e.g., OP 3.982M / 66.380M = 6%)

The Government's estimates were developed using multiple years of historical data.

2 Multiple Multiple In comparing the CY 2015 through CY 2018 Net Claim Receipts in the in RFP Attachment L-2 to the Claim Volumes on Section B, it appears the estimated Claim Volumes on Section B may be understated. Per RFP Attachment L-2, the average annual increase in Net Claim Receipts for CY2015-CY2018 was 4.57%. In comparing the CY2018 Net Claim Receipts in RFP Attachment L-2 to the Option Period 1 (i.e., CY2021) Claim Volumes on Section B, it appears the Government assumed a 2.05% annual escalation rate to estimate the Option Period 1 (OP1) claim volumes. Additionally, for OP1 – OP6, the Government used a 3.00% annual escalation rate.

The estimated/assumed claim volumes have an impact on the estimated costs and the corresponding price for the Administration CLINs. For example, per RFP Section L.8.5 the costs for Customer Service and Appeals should be included in the Administration CLIN; however, the cost of Customer Service and Appeals are correlated to claim volumes. The Administration CLIN is a fixed unit price per month, which will not change if the actual claim volumes are different than the estimated claim volumes provided in Section B. Further, RFP section F.5 indicates that the Government may not accept a Request for Equitable adjustment if the actual claim volumes are less than +/- 25% variation from the Section B estimated claim volumes. Accordingly, offerors must incorporate the potential for this large cost variation into their proposed prices, at the detriment to the Government (i.e., higher risk = higher prices). Question: Will the Government consider revising the Claim Volumes in Section B of the RFP to reflect a 4.57% annual escalation rate from CY2018 to CY2021 (OP1) and from OP1 to OP6 – NOTE: 4.57% is the average annual increase from CY2015-CY2018)?

No.

3 Multiple Multiple In comparing the CY 2015 through CY 2018 Net Claim Receipts in the in RFP Attachment L-2 to the Claim Volumes on Section B, it appears the estimated Claim Volumes on Section B may be understated. Per RFP Attachment L-2, the average annual increase in Net Claim Receipts for CY2015-CY2018 was 4.57%. In comparing the CY2018 Net Claim Receipts in RFP Attachment L-2 to the Option Period 1 (i.e., CY2021) Claim Volumes on Section B, it appears the Government assumed a 2.05% annual escalation rate to estimate the Option Period 1 (OP1) claim volumes. Additionally, for OP1 – OP6, the Government used a 3.00% annual escalation rate.

The estimated/assumed claim volumes have an impact on the estimated costs and the corresponding price for the Administration CLINs. For example, per RFP Section L.8.5 the costs for Customer Service and Appeals should be included in the Administration CLIN; however, the cost of Customer Service and Appeals are correlated to claim volumes. The Administration CLIN is a fixed unit price per month, which will not change if the actual claim volumes are different than the estimated claim volumes provided in Section B. Further, RFP section F.5 indicates that the Government may not accept a Request for Equitable adjustment if the actual claim volumes are less than +/- 25% variation from the Section B estimated claim volumes. Accordingly, offerors must incorporate the potential for this large cost variation into their proposed prices, at the detriment to the Government (i.e., higher risk = higher prices). Question: Will the Government consider lowering the price variation listed in F.5 to mitigate the cost variation that offerors need to account for in their proposed pricing?

Yes, the Government will revise to a +/- 20% variance and an amendment will update Section F.5.

4 SOW TOM C20 S2 P1.3.2.1 Please provide the number of Congressional Offices for the required mailings per TOM chapter 20 section 2 paragraph 1.3.2.1. The mailings are expected to go to the office of each Senator and Representative. More information can be found at the following websites www.house.gov and www.senate.gov.

5 SOW TOM C20 S2 P1.3.2.2 Please provide the number of beneficiary households who had claims activity in the previous 12 months. DHA does not track the volume of beneficiary households. DHA was able to generate the number of unique beneficiaries for CY2018. An amendment will update Exhibit L-2 TMEP Workload History. An incoming contractor will be able to derive this information from the history file that will be provided by the outgoing contractor.

6 C.2.1.4 Claims Processing C-3 Will DHA provide a claims history file from the outgoing contractor? Yes, file transfers occur during transition between the outgoing and incoming contractors. Please see TOM Chapter 20, section 2 for additional transition information.

7 C.2.1.8.2.2 Providers Receiving Reimbursement C-4 C.2.1.8.2.2. states "The contractor shall have a copy of the participation agreement (a copy from the contractor authorizing the provider or requesting one from the provider) for facilities requiring them prior to reimbursing claims from those facilities." Is the participation agreement specific to TRICARE? If so, would DHA consider posting a sample participation agreement?

Yes, the agreement is specific to TRICARE. Please see TPM Chapter 11, addendum A, B, and D-H, TRM Chapter 8, addendum G and other applicable sections.

8 C.2.1.8.2.2 Providers Receiving Reimbursement C-4 C.2.1.8.2.2. states "The contractor shall have a copy of the participation agreement (a copy from the contractor authorizing the provider or requesting one from the provider) for facilities requiring them prior to reimbursing claims from those facilities." Does DHA intend for the contractor to have this on file for all provider types or just facilities?

DHA expects the contractor to obtain a copy of the participation agreement for providers and facilities as required in the TRICARE manuals. An amendment will update language at Section C.2.1.8.2.2.

9 C.2.2.2.3 C-5 This section requires operations between 6 AM and 11 PM. Please clarify the days of the week to which this requirement applies. The toll-free telephone inquiry system shall be provided on a 24-hour, seven days a week basis. The system shall be fully staffed, with callers having the option of speaking with a customer service representative between the hours of 6:00 am and 11:00 pm EST (except weekends and federal holidays). Please refer to TOM Chapter 20, Section 11 for additional guidance regarding telephone operations.

10 C.2.2.4. Telephone Interactive Voice Response (IVR) Unit C-6 "C.2.2.4. states "The contractor shall provide comprehensive, readily accessible customer services that include multiple, contemporary avenues of access (e.g., email, worldwide web, telephone, chat) for the beneficiary and provider. The RFP lists several avenues of access in this requirement, as follows (email, worldwide web, telephone, chat). Does DHA intend for this list to be purely examples, or does DHA expect the Contractor to provide all of these avenues of access?

The list provided are examples. DHA expects offerors to propose comprehensive, readily accessible customer services that include multiple, contemporary avenues of access.

11 E.4 Quality Assurance Surveillance Plan (QASP) E-1 While the QASP will be available post-award, would DHA consider posting a sample QASP for offerors to review? A QASP was provided with RFP posting, See Section L, Exhibit L-8.

12 F.4.2 Notice Regarding Late Delivery F-2 F.4.2 states "In the event the contractor anticipates difficulty in complying with the delivery schedule, the contractor shall immediately notify the Contracting Officer (CO) or the Contracting Officer’s Representative (COR), in writing, giving pertinent details, including the date by which it expects to make delivery. This notification shall be informational only. The Government’s receipt of such notification shall not be construed as the Government’s waiver of any contract delivery schedule or any rights or remedies provided by law." Will DHA confirm that e-mail is an acceptable form of notification "in writing?"

No, an email is not an acceptable form of notification. Following contract award, the Government will anticipate a signed letter denoting late delivery details from the awardee. The Government will accept the signed letter attached to an email.

13 G.9.4.2 Payment Suspension and TED Processing During Partial Funding Shortages G-12

G.9.4.2. states "The suspension of claims payment and TED records may be based on a single value (e.g., SBCC=A) or a combination of values (e.g., SBCC=A & E/HPC=SR). Suspension of TED records (institutional) or TED line items (non-institutional) containing specific values shall be implemented by the contractor within five

(5) workdays after receiving notification from the CO. On the sixth workday, DHA/CRM will implement immediate payment offset against contractor invoices of any amounts paid by the contractor from their bank account(s) for institutional TED records or non-institutional TED line items containing suspended value(s). The contractor shall not, without prior CO approval, initiate payment offset against any provider or beneficiary for payments made against suspended transactions and offset by DHA/CRM on contractor invoices." Will DHA confirm if the term 'workdays' used in this section refers to business days, federal workdays, or both?

Business day as defined in the TRICARE Operations Manual Appendix A,"…a business workday is Monday through Friday, excluding federal holidays." An amendment will update the language throughout Section G.

14 H.2.2 General Performance Metric H-1 H.2.2. states "The contractor shall not be below the acceptable quality level (AQL) for more than three (3) metrics, monitored via the Contractor Management Contract Data Requirements List (CDRL) and Government TRICARE Encounter Data (TED) and Duplicate Claims Report, in any given month of the quarter or be below the AQL for a specific metric more than three (3) consecutive months. When these conditions are met, the contractor will be eligible for an incentive based on H.2.3." There is no Duplicate Claims Report listed in the CDRL list or as part of another CDRL in the J-3 attachments. Would DHA post the related CDRL?

Please reference H.5.4. The duplicate claims performance metrics are monitored via a monthly Government generated report.

15 L.1 L-1 Section L.1 incorporates by reference DFARS 252.215-7012 -- REQUIREMENTS FOR SUBMISSION OF PROPOSALS VIA ELECTRONIC MEDIA (JAN 2018).

After reviewing the full text of DFARS 252.215-7012, we noticed there is a blank space that is to be completed by the Contracting Officer in order to provide the proper instructions to the offerors.

Can the Government incorporate the full text of this clause into the RFP with the completed instruction in the blank section of the clause so that offerors are clear on the Contracting Officer’s preference/instruction?

An amendment will remove DFARS 252.215-7012. The submission requirements remain in Section L.4.2.

16 L.2.1.3 & Section I, L.6.1 L-4, I-4, L-10 & M-9 Section L.2.1.3 states “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.” 1) Can the Government confirm that FAR 52.204-22 is included in this proposal to allow for offerors to submit pricing for the proposed enhancements that exceed the Government’s minimum requirements, which may or may not incorporate proposed enhancements into the contract per L.6.1.?

No, enhancements shall not be proposed separately. This clause is included in the solicitation in accordance with 4.1008 - Solicitation Provision which states "Insert the provision at 52.204-22, Alternative Line Item Proposal, in all solicitations." Alternative proposals per FAR 52.204-22 -- Alternative Line Item Proposal will be evaluated only to accommodate situations that where the Government's proposed CLIN structure does not conform to an Offeror's business practices and " ...can result in difficulties in acceptance of deliverables and processing payments." Due to the nature of this acquisition, the Government does not anticipate Alternative Line Item Proposals will be required.

17 L.2.1.3 & Section I, L.6.1 L-4, I-4, L-10 & M-9 Section L.2.1.3 states “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.” 2) If so, are offerors to propose the price for these enhancements on a separate CLIN / SLIN from those that appear on Schedule B or may an offeror include the price of these enhancements in the CLINs / SLINs included on Schedule B?

No, enhancements shall not be priced separately.

18 L.2.1.3 & Section I, L.6.1 L-4, I-4, L-10 & M-9 Section L.2.1.3 states “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.” 3) If the offeror proposes a new CLIN for a proposed enhancement, will the Government include this new CLIN in the Total Evaluated Price (TEP) (See M.8.1)?

No, enhancements shall not be priced separately.

19 L.2.1.9 & L.4.9 L-4, L-9 Please clarify if the organizational chart should include staff members or only the structure of the organization’s parents, affiliates, subsidiaries, and Tier 1 subcontractors. The organizational structure should identify a point of contact that can address issues regarding the organizational chart. An amendment will update Sections L.2.1.9 and L.4.9.1.

21 Section L.2.1.9. Organizational Chart Section L.2.1.9. states that, "Offerors should submit their anticipated organizational chart referenced in L.4.9. at least 10 calendar days prior to the proposal due date. The organizational structure shall include the addresses, telephone numbers and emails." Since the government is seeking e-mail address and telephone numbers can you clarify that offerors should submit names of key individuals even if resumes for Key Personnel are not required?"

The organizational structure should identify a point of contact that can address issues regarding the organizational chart. With regards to Sections L.2.1.9 and L.4.9.1., names of key individuals and resumes are not needed and shall not be submitted per Section L.7.11. An amendment will update Sections L.2.1.9 and L.4.9.1.

22 Section L.4.0. Organizational Chart Is the government expecting offerors to name the key individuals and provide resumes for any Key Personnel expected to staff the TMEP upon award or should the Organization Chart required in Section L.4.0. simply reflect the offerors organizational structure with functional job titles without proposed management names?

The organizational structure should identify a point of contact that can address issues regarding the organizational chart. With regards to Sections L.2.1.9 and L.4.9.1., names of key individuals and resumes are not needed and shall not be submitted per Section L.7.11. An amendment will update Sections L.2.1.9 and L.4.9.1.

23 L.4.1 Past Performance Section L.4.1 list the following items to be included in Past Performance Volume III:

Past Performance:

• Past performance narrative

• Past performance description of relevant contracts

• Past Performance Questionnaires (PPQ)

• Electronic Subcontracting Reporting System (eSRS) documents

• Organizational roadmap

• Terminated contracts

• Client authorization, Subcontractor Consent Letter Is the "Past performance description of relevant contracts" part of the "Past Performance Narrative" 10-page limit? Or is it a stand alone document? There are no requirements or references to the "Past performance description of relevant contracts" document in the RFP other than in Section L 4.1. Please provide clarity on what is expected.

The past performance description of relevant contracts is the past performance narrative. An amendment will update Section L.4.1 to remove the reference to past performance description of relevant contracts.

24 L.4.1.1 L-7 Please confirm Cost Accounting Standards Board (CASB) Disclosure Statement(s) were deleted intentionally from the required contents of Volume I and are no longer included elsewhere in the final RFP?

Yes, the requirements for Cost Accounting Standards Board (CASB) Disclosure Statement(s) was intentionally removed from the RFP.

25 L.4.1.1 L-7 Should copies be labeled as X of XX only count the copies? That is, would the first copy of the Volume I be Copy 1 of 9 or Copy 1 of 10 (including the original)? See Section L.4.1. The total number of copies includes the original (e.g., 4 copies = original + 3 copies.) Therefore for Volume 1 it should be 10 copies = original + 9 Copies, e.g., Copy 1 of 10.

26 L.4.1.1 & L.5.2 L-7, L-10 Section B is in Volume I and Volume IV and occur in different parts of the volume, which means that Section B in Volume I will have different page numbers than Section B in Volume IV. Please clarify directions on numbering Section B.

Do not repaginate the completed Section B submittals for Volumes I and IV.

27 L.4.3 L-8 Section L indicates that Proposal Volumes I-III shall have non-duplicative, sequential page numbers. Should offerors also number the SF-33 form, amendments, and Government forms such as Section K that appear in Volume I?

No, it is not necessary to repaginate the SF-33 form, amendments, and Government forms, such as Section K, that appear in Volume I.

28 L.4.3 L-8 Section L.4.3 states “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. Offerors shall include the offeror’s name and solicitation number at the bottom of each page.” [Emphasis added] 1) Please confirm that Proposal Volumes IV-VI do NOT need to be printed on letter size paper, single-spaced, double-sided with non-duplicative, sequential page numbers at the bottom of each page.

Correct, per Section L.4.3. Proposal Volumes IV through VI shall be printed single-sided and this is the only formatting requirement for Volumes IV through VI.

29 L.4.3 L-8 Section L.4.3 states “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. Offerors shall include the offeror’s name and solicitation number at the bottom of each page.” [Emphasis added] 2) Please confirm that Offerors may provide the name and solicitation number at the bottom of each page for Proposal Volumes IV-VI but it is not a requirement.

Correct. An amendment will update the language in Section L.4.3.

30 L.4.3 Paper Copies L-8 L.4.3 states "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." Will the government please confirm that 8 point font is acceptable for tables as well?

To the extent tables are used as supporting data exhibits, 8 point font will be acceptable.

31 L.4.3 Paper Copies L-8 L.4.3 states "Volumes IV-VI shall be printed single-sided. In instances where the paper copy differs from the electronic copy, the original paper volumes prevail. "

Due to the large size of our financial documents, some in excess of hundreds of pages, and out of consideration for the environment, will DHA allow contractors to print on both the front and back of the pages?

The Government will accept financial documents to be printed on both the front and back of each page.

32 L.4.3 Paper Copies L-8 L.4.3. states "The font for both CD ROM and paper submissions shall be Times New Roman, and at least 12 point with normal spacing and kerning." Does this include the CD label or can a minimum of 8pt. be used on the CD label due to limited space and content requirements for the label?

Yes, 8 point font for the CD labels will be accepted as long as it is legible.

33 L.4.3 Proposal Preparation Will DHA please confirm that any Excel documents submitted in support of Volume IV, Price Proposal, which may contain large amounts of data, are required to be printed for paper copies? Printed Excel documents may result in hundreds of pages of data, which may be difficult to review in paper format.

Yes, a paper copy is required. NOTE: An amendment will be done to update language at Section L.8.2. After this change, the Government does not expect to receive extensive supporting data.

34 L.4.3 Proposal Preparation Would DHA consider allowing contractors to submit the Excel documents in electronic format only? (If so, will DHA also revise the last sentence in Section L. 4.3 to state that electronic copies of the Excel documents will prevail if no paper copy is required?)

No, paper copies are required. NOTE: An amendment will be done to update language at Section L.8.2. After this change, the Government does not expect to receive extensive supporting data.

35 L.4.3 Proposal Preparation If above answer is yes, will DHA also revise the last sentence in Section L. 4.3 to state that electronic copies of the Excel documents will prevail if no paper copy is required?

Not applicable.

36 L.4.4 Page Limitations L-9 Will DHA please confirm that contractors may submit an acronym dictionary in the beginning of each volume, and it will not be included in the page limitations? Acronyms only need to be defined if they are not in any of the TRICARE Manuals. If an offeror elects to include an additional acronym list, it will be included in the page count.

37 L.4.4 Page Limitations L-9 Are 11 x 17 size pages, more commonly known as foldout pages permitted, provided they are counted as 2 pages per side and remain in page count? 11 x 17 size pages will not be accepted.

38 L.5.2 & L.5.7 L-10 These two instructions seem to contradict each other. L.5.2 indicates that originals of Section B are in Volumes I and IV; L.5.7 indicates that the original is in Volume I only. Please clarify.

The Government requires a completed Section B submitted in both Volumes I and IV, Volume I is the original. An amendment will update the language in Sections L.5.2. and L.5.7.

39 L.6.1 & L.6.1.4.2 L-10, L-12 This section limits the statement of experience in Volume II to “what an offeror has done, not how well it was accomplished…” However, L.6.1 requires a written technical proposal that “effectively demonstrates the offeror’s understanding of the requirements and provides a successful technical solution…” Without some indication of performance, experience cited in this section would not demonstrate an understanding of the requirements, and evaluators would not be able to determine success of the solution. For example, if an Offeror processed 50 million claims a year but did not reference the timeliness or accuracy, it would not be possible to determine if the solution were successful – the Offeror’s timeliness rate may only have been 30 percent. We understand that experience cannot extend over multiple volumes and that performance cited in Volume II will not be evaluated as Past Performance (Volume III). To help ensure accurate evaluation of Volume II, we suggest that Offerors be able to cite performance that supports both their understanding of requirements and the success of their solutions.

L.6.1.4.2 provides 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. Proposal information should clearly identify the method or process the offeror will use in meeting all technical requirements in performance of the contract. As identified above in L.6.1.4.2, information on the offeror's experience may be considered in the evaluation of proposal risk; however, DHA will not evaluate experience in isolation of an offeror's description of its technical approach in evaluating whether a proposal sufficiently demonstrates an understanding of the solicitation's technical requirements in performance of the contract.

40 L.6, L.5.7, M.8.1, & L.2.1 L-10, M-9, L-3 Section L.6 of the RFP requests offerors to propose enhancements that exceed the Government’s minimum requirements. Further, per L.6.1 of the RFP, “the Government, at its sole discretion, may or may not incorporate proposed enhancements into the contract.” 1) Is it the Government’s intent that offerors only submit one price proposal that is inclusive of the cost of these enhancements, which may or may not be incorporated into the contract? If so, an offer may include the cost of enhancement in its proposed price which may not be incorporated into the contract by the Government. In addition, equitably evaluating the proposed prices across offerors would be difficult (e.g., an offeror with no enhancement may have a lower price than an offeror with several enhancements).

Yes. Proposed enhancements are not to be priced separately. Each proposal will be evaluated as a whole with a single technical solution and single total evaluated price.

41 L.6, L.5.7, M.8.1, & L.2.1 L-10, M-9, L-3 Section L.6 of the RFP requests offerors to propose enhancements that exceed the Government’s minimum requirements. Further, per L.6.1 of the RFP, “the Government, at its sole discretion, may or may not incorporate proposed enhancements into the contract.” 2) Are offerors permitted to submit multiple price proposals to account for the costs of the various proposed enhancements?

No. Proposed enhancements are not to be priced separately. Each proposal will be evaluated as a whole with a single technical solution and single total evaluated price.

42 L.6, L.5.7, M.8.1, & L.2.1 L-10, M-9, L-3 Section L.6 of the RFP requests offerors to propose enhancements that exceed the Government’s minimum requirements. Further, per L.6.1 of the RFP, “the Government, at its sole discretion, may or may not incorporate proposed enhancements into the contract.” 3) If multiple price proposals are permitted, should the offeror complete multiple Schedule B to include in Volume I and IV per L.5.7?

Multiple price proposals are not permitted.

43 L.6, L.5.7, M.8.1, & L.2.1 L-10, M-9, L-3 Section L.6 of the RFP requests offerors to propose enhancements that exceed the Government’s minimum requirements. Further, per L.6.1 of the RFP, “the Government, at its sole discretion, may or may not incorporate proposed enhancements into the contract.” 4) If multiple price proposals are permitted, how will the Government determine the Total Evaluated Price (TEP) of the alternative price proposals (M.8.1)?

Multiple price proposals are not permitted.

44 L.6, L.5.7, M.8.1, & L.2.1 L-10, M-9, L-3 Section L.6 of the RFP requests offerors to propose enhancements that exceed the Government’s minimum requirements. Further, per L.6.1 of the RFP, “the Government, at its sole discretion, may or may not incorporate proposed enhancements into the contract.” 5) Would the submission of multiple price proposal result in the rejection of a proposal per Section L.2.1 (i.e., - “failure to provide pricing information in accordance with Section B and L may result in a rejection of a proposal”)?

Yes, with the exception of alternative line item proposals submitted in accordance with FAR 52.204-22 -- Alternative Line Item Proposal.

45 L.6.2.2 L-12 This section references some of the requirements in Section C, but not all of them, and not all the protocols involved in processing claims. Please provide additional direction on how to align Section C requirements with L.6.2.2.

Section L.6.2.2. list the minimum for the offerors approach. The offeror shall describe how it will establish, maintain and monitor its claims processing system (protocols) and reimbursement procedures from claim receipt through record retention requirements utilizing best business practices and cost containment measures when appropriate. Section C identifies the Performance work statement of what must be accomplished not how it will be accomplished.

46 L.6.4.3 Subfactor 3, Management Functions The RFP draft included a section L.6.4.3 "The offeror shall describe its internal quality management/quality improvement program." This is not in the final RFP in section L.6.4 – did it get moved to another section?

The information was incorporated into L.6.4.1.

47 L.7.3 L-15 This section requires completion and submission of the Past Performance Questionnaire (PPQ) with Volume III. However, Exhibit L-5 requires a Client Authorization Letter in the proposal to provide consent for the Government to contact clients. Please clarify which approach the Government requires.

Exhibit L-5 is an optional tool which could facilitate follow up discussions with an offeror's client. If an offeror elects to issue a client authorization letter, a copy should be included in Volume III. Verifiable information inspires more confidence that non-verifiable information.

48 L.7.3.; Exhibit L4 Attachment 4 Volume III, Past Performance (Factor 2, Past Performance);

TRICARE Medicare Eligible Program (TMEP) Past Performance Questionnaire (PPQ) L-15; L4-1-2

L.7.3. states "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.)"

1) .Please confirm that the PPQ is not limited to its current three-page length, given the narrative responses called for in the offeror's Part 1 13., 14. and 15. and the minimal space between each.

Correct, there is no page limit for the PPQ.

49 L.7.3.; Exhibit L4 Attachment 4 Volume III, Past Performance (Factor 2, Past Performance);

TRICARE Medicare Eligible Program (TMEP) Past Performance Questionnaire (PPQ) L-15; L4-1-2

L.7.3. states "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.)"

2) Should the separate one-page-limited additional information be added at the end of the PPQ or be submitted as a stand-alone element of the Vol. III submission?

Please submit along with its respective PPQ.

50 L.7.3.2.4. 17 RFP L.7.3.2.4. Volume III, Past Performance (Factor 2, Past Performance) L - 15 L.7.3.2.4. states "For each past performance reference, the offeror shall submit the most recent Electronic Subcontracting Reporting System (eSRS) evaluation, when available."

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

Does DHA require eSRS evaluations (when available) from first-tier subcontractors whose past performance references are included in Vol. III?

Yes.

51 L.7.3.2.4 L-15 Please confirm the eSRS evaluation is not within the page limits. ESRS reports are not included in the page limit under Past Performance.

52 Section L.7.3.2.4 Electronic Subcontracting Reporting System Section L.7.3.2.4 says "For each past performance reference, the offeror shall submit the most recent Electronic Subcontracting Reporting System (eSRS) evaluation, when available." Please define the word "evaluation". It is unclear if the DHA is asking for the eSRS reports themselves or something else such as the offeror's Contractor Performance Assessment Report that contains the evaluation of Small Business Utilization.

DHA is asking for the eSRS Report. An amendment will update the language in Section L.7.3.2.4.

53 L.7.3.4 L-16 Please clarify if affiliates, parents, or subsidiaries of the Offeror are acceptable for the purpose of competing Past Performance Questionnaires. It would not be appropriate for an affiliate, parent, or subsidiary of an offeror to submit a PPQ evaluating the offeror's performance.

54 L.8.1.3 L-17 Section L.8.1.3 states that 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.” [Emphasis added] 1) However, each Option Period includes a Transition-Out CLIN. Section M.8.1 of the RFP states that only the highest priced Transition-Out CLIN will be included in the Total Evaluated Price.

Only the highest priced Transition-Out CLIN will be included in the total evaluated price.

55 L-17 Section L.8.1.3 states that 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.” [Emphasis added] 2) Should the Transition-Out CLIN be included in the requested “Price totals by Option Period” or should only the highest Transition-Out CLIN be included in the “Price totals by Option Period”?

The Transition-Out CLIN should be included in the price totals by Option Period.

56 L.1, L.8.2 and M.8.2 L-1, L-16 & M-9

Section M.8.2 states that the “Government anticipates adequate price competition.” In addition, section L.8.2. states that “Data Other than Certified Cost or Pricing Data” shall be submitted by the offeror. However, Section L.1 contains DFARS 252.215-7010 -- REQUIREMENTS FOR CERTIFIED COST OR PRICING DATA AND DATA OTHER THAN CERTIFIED COST OR PRICING DATA (JAN 2018). In accordance with FAR 15.403-1(b)(1) and 15.408-1(c)(ii), if adequate price competition is anticipated, then Certified Cost or Pricing data is not required. Since the Government anticipates adequate price competition per M.8.2, can the Government remove DFARS 252.215-7010 as it is not applicable?

An amendment will remove DFARS 252.215-7010 and add language to clarify the Government's intentions regarding data other than certified cost or pricing data to Section L.

57 L.4.3 & L.8.2.2 L-17 , L-8 Section L.8.2.2 states that offers may determine the types and formats of the data submitted for Volume IV. However, section L.4.3 states that all paper copies must be submitted on white paper with one-inch (1”) margins on all sides; 12-point Times New Roman front with normal spacing; or 8-point Times New Roman for illustrations, organization charts, supporting data exhibits, etc. 1) Do offerors need to follow the font and margin requirements described in L.4.3 for Volume IV, or are offerors able to determine the type and format of the documents in Volume IV per L.8.2.2?

Yes, per Section L.4.3. Volumes IV-VI shall be printed single-sided and per Section 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.

58 L-17 , L-8 Section L.8.2.2 states that offers may determine the types and formats of the data submitted for Volume IV. However, section L.4.3 states that all paper copies must be submitted on white paper with one-inch (1”) margins on all sides; 12-point Times New Roman front with normal spacing; or 8-point Times New Roman for illustrations, organization charts, supporting data exhibits, etc. 2) If offerors are required to follow the formatting requirements in L.4.3, is it acceptable for the Excel files to be submitted using 8-point Times New Roman font?

Yes, Excel files submitted using 8-point Times New Roman font are acceptable.

59 L.8 Volume IV, Price Proposal L-17 L.8.10.1 states “Offerors shall identify SCA labor categories and labor rates within the price proposal and warrant on the first page of its Volume IV”.

Labor rates may be considered proprietary by subcontractors. Are subcontractors permitted to submit proprietary data directly the Government or within sealed packages instead of within the prime proposal?

Yes, if a subcontractor is required to submit a Collective Bargaining Agreement (CBA), then the subcontractor may submit their CBA within a sealed package along with their prime's Volume IV submission.

60 L.9.1 L-19 Does this section require a response to the individual elements of FAR 19.704? Per Section L.9.1. The offeror shall submit their subcontracting plan in accordance with the requirements outlined at FAR 19.704(a).

61 Exhibit L-2 Workload History for Phone Calls In the draft RFP Q&A response, question number 76 asked DHA to define and explain the difference between phone calls attempted and phone calls received. DHA responded by stating "Phone calls attempted enter the IVR, and Phone calls received are answered by representatives". Please confirm that this is an accurate response as it appears from a review of the CDRL definitions, the calls received are "the number of calls received" and not the "number of calls answered by an agent".

An updated CDRL was attached in the RFP package which is correct. DHA's previous response was for the legacy contract. CDRL M010 provided in attachment J-3, section 3 TELEPHONE INQUIRIES, provides the updated requirements.

62 Exhibit L-2 Workload History for Phone Calls Will the DHA provide the number of calls answered by an agent for the 2014 through 2018 historical period? The total calls answered by an agent during 2014 - 2018 was approximately 12,000,000.

63 Section L Exhibit L-2 Workload Summary

Workload History for Skilled Nursing Facility (SNF)authorizations.

The number of SNF authorizations received decreased substantially in 2018, and specifically the volumes for November and December are much lower than previous months. Please confirm the data is accurate and/or explain the anomaly.

The original data was not accurate. An amendment will update Exhibit L-2 TMEP Workload History.

64 L-2 Workload History In calendar year 2018 there was a significant increase in the volume of adjustments completed versus previous years. Can DHA provide insight into the reason for these adjustments and whether this is an anomaly or representative of the adjustment volume that should be expected in future years. Also, is it possible to break down what percentage or volume of adjustment activity by year is due to credits (recoupments and unsolicited refunds) and debits (add-pay adjustments).

The increased volume of adjustments for CY 2018 were a result of an increase in Medicare adjustment receipts. It is typical for TRICARE to receive an increase in Medicare adjustments a few times a year. The increase in CY 2018 is more than is typically experienced and it is not known if this increase can be expected in future years. The break out of these adjustments is not available.

65 L-2 Workload History Can DHA provide the number of payments (EFTs and checks) made to providers and beneficiaries for each year? Note that these would be included on the CDRL - D010 reports. If possible, can payment volumes be split between those that were EFT and those that were check?

The specific data being requested is not available. CDRL D010 is a data feed submitted through the B2B Gateway.

66 L-1 Beneficiary Volumes Can DHA provide the number of unique benes who actually received services on a monthly and/or annual basis? DHA does not track the volume of Unique Beneficiaries, but were able to obtain the data for CY2018. An amendment will update Exhibit L-2 TMEP Workload History.

67 L-2 Workload History Can DHA provide the volume of recoupments that were created for this contract as well as the volume or percentage of recoupments that were >$600 and uncollected and ultimately transferred to DHA in accordance with TOM Chapter 10 Section 4 Paragraph 19?

The data is not available.

68 Section M Evaluation Factors for Award; M.8.1. Total Evaluated Price

M-9 Please confirm that Total Evaluated Price specific to the Claims Processing CLINS (X001-X002 & X003-X004) will be determined by extending the fixed unit prices submitted by the offeror by the Government-provided estimated quantities in Section B.

DHA confirms the statement to be correct.

69 N/A N/A - Question about missing CDRL template TOM Chapter 13, Section 5, paragraph 2.2 mentions a quarterly PI Cost Avoidance and Recovery/Recoupments Report. This is missing from the list of CDRLs in J-3.

Would DHA post that CDRL?

Please reference CDRL Q030. The Fraud and Abuse Summary Report includes the Fraud and Abuse Workload Summary, the Program Integrity Cost Avoidance and Recovery/Recoupments and the Program Integrity Eligibility Recoupment Status.

70 Attachment J-3, CDRL R020 Integrated Master Plan Integrated Master Schedule The instructions for Subsequent Submissions state that updates are due "15 calendar days after transition interface meetings and as changes occur." Would DHA please define what constitutes ongoing updates?

Ongoing changes which require the IMP/IMS to be resubmitted are those which impact meeting milestones for a successful transition.

71 Attachment J-3, CDRL R020 Integrated Master Plan Integrated Master Schedule Item #3 in the Content Details begins on page 1; the text looks like it supposed to continue on page 2 but does not. Could this be updated and reposted. The entire sentence should read the following: The IMP shall include a Risk Management Strategy that clearly demonstrates how the contractor plans to mitigate risks identified in the RMP. An amendment will update the language in CDRL R020.

72 J-4, TOM Ch 20 Sec 1, Para 2.2, Contract Administration and Instructions In the following reference there is no Chapter number listed. Does this still refer to Chapter 1? "In addition to the provisions of Chapter, Section 2, paragraph 2.0, the TMEP shall submit, in accordance with DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the contract a quarterly report outlining the modifications and implementation dates."

Yes, it is referring to Chapter 1. An amendment will update the language in TOM Chapter 20, Section 1.

73 J-4, TOM Ch 20 Sec 2, N/A - Question about PRVs/PRAVs TOM Chapter 20 states that TOM Chapter 2 does not apply to TMEP. There are no PRVs or PRAVs listed in TOM Chapter 20 for this RFP. Does DHA intend for the Contractor to conduct any PRV or PRAV activities? If so, when will those requirements be made available?

TMEP will not conduct the PRV or PRAV activities outlined in the TOM Chapter 2. Incoming contractor testing and demonstration requirements are defined in TOM Chapter 20, Section 2.

74 J-4, TOM Ch 20 Sec 2, Para 1.1.4.1; Transition-In (Phase-In) Weekly Status Reporting

Will DHA define "Notice of Award" and Contract Award? For the purposes of TOM Chapter 20, Notice of Award and Contract Award means the beginning of the Transition-In Period.

75 J-4, TOM Ch 20 Ch 20 Sec 2 Para 1.1.6.1 and RFP H.4.2.2, TOM Pg 2 RFP Pg 7

TOM states processing guidelines due 60 days prior to SHCD, while H.4.2.2 states start of claims processing. Which due date is correct? These two requirements are not related. TOM Chapter 20, Section 2 paragraph 1.1.6.1 is a requirement to develop desk instructions and user’s guides 60 calendar days prior to the start of services delivery and RFP Section H.4.2.2 is referring to the required external audit process and documentation.

76 J-4, TOM Ch 20 Sec 2, Para 1.3.2.1, Mailings The requirement states "The contractor shall prepare a mailing to all Congressional offices by the 45th calendar day prior to the start of services delivery according to the specifications of the official transition schedule."

Does DHA intend for the contractor to mail the notification by 45 calendar days prior to SHCD?

Yes, DHA intends for the contractor to mail the notification 45 calendar days prior to start of services delivery.

77 J-4, TOM Ch 20 Sec 2, Para 1.6.2, Program Integrity Does "30 days from the start of services delivery" mean prior to SHCD or after SHCD? The requirement indicates no later than 30 days from the start of services delivery. This means any time before, and up to, the day of services delivery.

78 J-4, TOM Ch 20 Sec 2, Para 2.4.4, Explanation of Benefits (EOB) Record Data Retention and Transmittal

The beginning of Section 2 states that TOM Chapter 2 doesn't apply to TMEP. In 2.4.4, it directs the reader to Chapter 2 (Transition) for additional information on electronic EOBs. Is this an exception to the statement at the beginning of the chapter?

TOM Chapter 20, Section 2, Paragraph 2.4.4 was included in error. Records Management requirements can be found in TOM Chapter 9. An amendment will update TOM Chapter 20, Section 2 removing Paragraph 2.4.4.

79 J-4, TOM Ch 20 Sec 3, Para 2.3, Payments to Beneficiaries/Providers Non-underwritten EFTs shall be done within two federal workdays after receiving payment approval from DHA. Rejected EFTs may be made as checks. If payment cannot be accomplished as a check or EFT, an adjustment/cancellation TED record shall be submitted within five work days or rejection of an EFT.

How does DHA define federal workdays?

Business day as defined in the TRICARE Operations Manual Appendix A,"…a business workday is Monday through Friday, excluding federal holidays." An amendment will update the language in TOM Chapter 20, Section 3.

80 J-4, TOM Ch 20 Sec 5, Para 1.1, Provider Networks Paragraph 1.1 states "The provisions of Chapter 5, Section 1, paragraph 2.4-Balanced Billing and paragraph 2.5-Billing for Non-Covered Services (Hold Harmless)"… There is no paragraph 2.4 or 2.5 in TOM Chapter 5, Sec1, for version Change 46. Should the statement refer to 3.4 and 3.5 instead?

Yes, paragraphs 3.4 and 3.5 are correct. An amendment will update language at TOM Chapter 20, Section 5.

81 J-4, TOM Ch 20 Sec 13, Para 3.0, Case Development and Action TOM Ch 20, Sec 13 states that the only exception to TOM Ch 13 is paragraph 7.5. Since pharmacy and dental claims are out of scope for the TMEP Contractor, should the following paragraphs from TOM Ch13 also be excluded?

* 3.1.4 (Prescription Records Audit for Pharmacy Claims/Pharmacy Claims Audit)

* 3.1.5 (Dental Necessity Audits for Dental Claims)

Yes. An amendment will update the language in TOM Chapter 20, Section 13.

82 TRICARE Operations Manual Chapter 20, Section 2, Paragraph 1.4.6

Workload History for Duplicate Claim Sets (DCS) TRICARE Operations Manual Chapter 20, Section 2, Paragraph 1.4.6 defines the requirements for the TMEP related to resolving Duplicate Claim Sets. In order to plan appropriate resources for this requirement, will the DHA provide historical reporting of DCS sets loaded to Section L Exhibit L-2 Workload Summary?

The volume in CY2018 was approximately 165,500. An amendment will update Exhibit L-2 TMEP Workload History.

83 RFP and TOM RFP, Section M.6.2.2 and TOM Appendix A, Definitions Does MCSC mean Managed Care Support Contractor or Managed Care Service Contractor? The correct term is Managed Care Support Contractor (MSCS). An amendment will update language at Sections L.6.2.2 and M.6.2.2.

84 TOM Chapter 2 Section 10 Paragraph 4.2

Records Retention TOM Chapter 2 Section 10 Paragraph 4.2 states the outgoing contractor shall maintain a complete set of documentation to be turned over to the incoming contractor.

Please provide the complete list and period ( e.g. 2 years) for each record series that the TMEP contractor will receive as part of the incoming transition.

The Incoming contractor can expect to receive all records that are not eligible for destruction. Some records may be transferred in electronic methods and others may be paper. The majority of the records have a 6 year retention period with Claims and Explanation of Benefits having a 10 year retention period. Please see the OSD Disposition Schedule or DHA RRS for specific records and related retention periods at https://info.health.mil/cos/admin/pmss/Pages/OSD-Disposition-Schedule.aspx or https://www.esd.whs.mil/Records-Privacy- Declass/OSD-Records-Information-Management/

85 TOM Chapter 9 Section 1 Paragraph 1.1; TOM Chapter 9 Section 2 Paragraph 1.5

Records Retention TOM Chapter 9 Section 1 Paragraph 1.1 states the TMEP Contractor is responsible for managing Government Records in their custody from capture or creation, during retention to their approved destruction. TOM Chapter 9 Section 2 Paragraph 1.5 provides a sample of record content typically managed by DHA contractors and refers contractors to the DHA RRS for the complete list. While the General Records Schedule in TOM Chapter 9 section 2 Paragraph 1.5 provides the Record Series Number and description, it does not provide the length of period records must be held prior to destruction for each record series. TOM Chapter 9 Section 1 Paragraph 4.5 states that specific guidance and techniques for using and applying disposition instructions are located in the DHA RRS. Please confirm that information currently available on the DHA Records Management web site contains the complete list of records that must managed by the TMEP contractor, including the period that the contractor must retain the records prior to destruction or transfer to DHA or the outgoing contractor.

The DHA RRS is another name for the OSD Disposition Schedule which DHA follows. Yes, all TMEP records that are required to be maintained are included on the OSD disposition Schedule or DHA RRS. The specific record retention requirements are also included. The OSD disposition schedule/DHA RRS can be found at, https://info.health.mil/cos/admin/pmss/Pages/OSD-Disposition-Schedule.aspx or https://www.esd.whs.mil/Records-Privacy-Declass/OSD-Records-Information-Management/.