HT9402-20-R-0001 Amend 0001 Final.pdf

(x)

HT940220R0001

x x

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

HT9402

AURORA CO 80011-9066

16401 E CENTRETECH PARKWAY

DEFENSE HEALTH AGENCY-AURORA

DEFENSE HEALTH AGENCY

HT9402

AURORA CO 80011

16401 E CENTRETECH PARKWAY

DEFENSE HEALTH AGENCY-AURORA

DEFENSE HEALTH AGENCY

05/14/20200001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

05/14/2020

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

This amendment revises the proposal due date because of logistical concerns from the COVID

19 pandemic, and makes other minor revisions described in the “Summary of Changes” on page

2.

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

JACK R. DIEMER

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

jack.r.diemer.civ@mail.mil

303-676-3664

July 22, 2020

The following have been modified:

BLK 14 CONTINUATION

Summary of Changes:

Document Section/Paragraph # Change/Revision

RFP Section A, SF 33 Blk 9 Revised Blk 9 due date from July 29, 2020 to August 26, 2020 RFP Section C, Par C.2.6. Update the TRICARE Policy Manual change number from 64 to 67 RFP Section C, Par C.2.7. Updated the TRICARE Systems Manual change number from 36 to 37 RFP Section C, Par C.2.8. Updated the TRICARE Operation Manual change number from 65 to 66 RFP Section I, FAR 52.222-17 Removed FAR 52.222-17 NONDISPLACEMENT OF QUALIFIED

WORKERS (MAY 2014). This clause was removed from the FAR, effective June 5, 2020.

RFP Section L, Par L.1. Revised FAR 52.252-1 electronic reference from http://farsite.hill.af.mil to https://www.acquisition.gov/browse/index/far

RFP Section L, Par L.6.2.2. Revised the last sentence from …(see Section C.4.1.4.), correct instances of network inadequacy and ensure access standards… to …(see Section C.4.1.4.), correct instances of network inadequacy to ensure access standards…

RFP Section M, Par M.3.1. Revised Subfactor 2 from Beneficiary and Network Provider Services to Active Duty Service Member (ADSM) and Network Provider Services

RFP Section M, Par M.3.2. Revised Subfactor 2 from Beneficiary and Network Provider Services to Active Duty Service Member (ADSM) and Network Provider Services

RFP Section M, Par M.4.3.1.1. Revised strength reference from M.4.1.1.2. to M.4.1.

RFP Section M, Par M.4.4.1. Revised strength reference from M.4.1.1.2. to M.4.1.

HT9402-20-R-0001 Page 2 of 65 Amendment 0001 http://farsite.hill.af.mil/ https://www.acquisition.gov/browse/index/far

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and See L-4 copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the depository located in Mail Room until 1200 MS local time August 26, 2020

FACILITY_CAGE_CO

PAGE OF PAGES

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED

ORDER UNDER DPAS (15 CFR 700)

RATING

DO-C9

1 112

2. CONTRACT NUMBER 3. SOLICITATION NUMBER

HT940220R0001

4. TYPE OF SOLICITATION

SEALED BID (IFB)

X NEGOTIATED (RFP)

5. DATE ISSUED

May14, 2020

6. REQUISITION/PURCHASE NUMBER

7. ISSUED BY CODE HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011

8. ADDRESS OFFER TO (If other than Item 7)

(Hour) CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)

B. TELEPHONE (NO COLLECT CALLS)10. FOR

INFORMATION

CALL:

A. NAME

Lauren Robbins

AREA CODE

NUMBER

676-3857

EXT.

C. E-MAIL ADDRESS

lauren.n.robbins.civ@mail .mil

11. TABLE OF CONTENTS

(X) SEC. DESCRIPTION PAGE(S) (X) SEC. DESCRIPTION PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 1 X I CONTRACT CLAUSES I1-I15

X B SUPPLIES OR SERVICES AND PRICES/COSTS 2-13 PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

X C DESCRIPTION/SPECS./WORK STATEMENT C1-C17 X J LIST OF ATTACHMENTS J1-J2

X D PACKAGING AND MARKING D1 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE E1

X F DELIVERIES OR PERFORMANCE F1-F3

X K REPRESENTATIONS, CERTIFICATIONS AND

OTHER STATEMENTS OF OFFERORS K1-K12

X G CONTRACT ADMINISTRATION DATA G1-G10 X L INSTRS., CONDS., AND NOTICES TO OFFERORS L1-L21

X H SPECIAL CONTRACT REQUIREMENTS H1-H8 X M EVALUATION FACTORS FOR AWARD M1-M9

OFFER (Must be fully completed by offeror) NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within 180 calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52.232.8)

10 CALENDAR DAYS (%) 20 CALENDAR DAYS (%) 30 CALENDAR DAYS (%) CALENDAR DAYS (%)

AMENDMENT NO. DATE AMENDMENT NO. DATE14. ACKNOWLEDGEMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the SOLICITATION for offerors and related documents numbered and dated):

CODE FACILITY

15A. NAME

AND

ADDRESS

OF

OFFEROR

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

15B. TELEPHONE NUMBER

AREA CODE NUMBER EXT.

15C. CHECK IF REMITTANCE ADDRESS

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS IN SCHEDULE.

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by government)

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

10 U.S.C. 2304 (c) ( ) 41 U.S.C. 253 (c) ( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTERED BY (If other than Item 7) CODE 25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print)

JACK R. DIEMER

jack.r.diemer.civ@mail.mil

303-676-3664

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97) Prescribed by GSA - FAR (48 CFR) 53.214(c) mailto:jack.r.diemer.civ@mail.mil

SECTION C

DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

ADDP3

HT9402-20-R-0001 Page C1 of C17 Amendment 0001

C.1. MISSION.

C.1.1. The Department of Defense (DoD) through the Defense Health Agency (DHA) has a mission to offer dental care services to eligible Active Duty Service Members (ADSMs). In order to fulfill DHA’s mission, the contractor will provide comprehensive dental care services worldwide to eligible ADSMs under the Active Duty Dental Program 3 (ADDP3) contract.

C.1.2. Scope.

C.1.2.1. In support of the DHA Dental Program Section of the TRICARE Health Plan, ADDP3 provides worldwide dental coverage to ADSMs of the Uniformed Services of the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marine Corps, and the U. S. Coast Guard. For the purposes of this contract, reference to “ADSMs” are defined as the service members covered by ADDP3. ADSMs also consist of eligible members of the Reserves and National Guard, Reserve Component members with delayed activation orders or discharged after serving more than 30 days on active duty in support of a contingency operation or a preplanned mission. Additionally, ADSMs consist of Foreign Forces Members (FFMs) eligible for care pursuant to an approved agreement (e.g. reciprocal health care agreement, North Atlantic Treaty Organization [NATO] Status of Forces Agreement [SOFA], Partnership for Peace [PFP] SOFA). Finally, the ADSMs also include the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA), and the Commissioned Corps of the Public Health Service (PHS). The Commissioned Corps of the PHS is not currently included in the ADDP3. However, the Government reserves the right to expand coverage to include PHS personnel under this contract.

C.1.2.1.1. Dental Services. ADDP will supplement ADSM care provided in the DoD’s Dental Treatment Facilities (DTFs), as well as provide care to those ADSMs living in regions without access to DTFs. The contractor shall supplement authorized care by developing and maintaining a dental provider network in the Continental United States (CONUS), which includes the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and the Northern Mariana Islands. The Outside Continental United States (OCONUS) service area includes all other countries, island masses and territorial waters. The contractor shall supplement authorized OCONUS remote care by developing and maintaining agreements with TRICARE OCONUS Preferred Dentists (TOPDs).

C.1.2.1.2. TRICARE Overseas Program (TOP) Remote Dental Services. The ADSM OCONUS dental coverage was previously provided by the TRICARE Overseas Program (TOP) contract. Under ADDP, the contractor shall provide OCONUS routine, urgent, and emergency dental care services to ADSMs who are enrolled in remote areas (greater than 50 miles from the nearest Military Treatment Facility [MTF] capable of providing dental care services). The Kingdom of Bahrain and Souda Bay, Greece, areas are exceptions because, for these two locations, ADSMs do not have to be enrolled as a remote ADSM in order to receive care.

Additionally, the contractor shall provide OCONUS urgent and emergency dental care to ADSMs who are on Temporary Duty/Temporary Additional Duty (TDY/TAD), deployed, deployed on liberty, or in an authorized leave status in a remote overseas location. The Government anticipates it will transition the TOP remote dental services into ADDP at award.

The Government reserves the right to modify the contract to add the TOP remote dental services

ADDP3

HT9402-20-R-0001 Page C2 of C17 Amendment 0001 at a later date (see Section B, Contract Line Item Number [CLIN] x002; Section J, Attachment J- 3b, Program Operations for OCONUS; and Attachment J-13, Transition-In).

C.2. APPLICABLE DIRECTIVES. The following documents form an integral part of this contract and have the same force and effect as if set forth in full text. The TRICARE Manuals provide instruction, guidance and responsibilities to establish contractual requirements for implementation of federal statutes and regulations. In the event of a conflict between the manuals and either statute or regulation, which are incorporated into this contract, the statute or regulation takes precedence. If there is a conflict between the manuals, the order of precedence is (1) TRICARE Policy Manual (TPM); (2) TRICARE Systems Manual (TSM); and (3) TRICARE Operations Manual (TOM). The TRICARE Manuals are located at http://manuals.health.mil. If the contractor believes that a conflict exists between the incorporated documents, the contractor shall inform the Contracting Officer.

C.2.1. Title 10, United States Code (U.S.C.), Chapter 55, Section 1074(c)(1).

C.2.2. 32 Code of Federal Regulations (CFR) Part 199.1, 199.3, 199.6, 199.9.

C.2.3. 36 CFR Part 1222 (data created or received and maintained for the Government by contractors).

C.2.4. 45 CFR Parts 160, 162 and 164 (the Health Insurance Portability and Accountability Act [HIPAA] of 1996 security and privacy standards, transaction and code set standards, National Provider Identifier [NPI] requirements and implementation specifications).

C.2.5. National Institute of Standards and Technology (NIST) Special Publications (SP) 800- 171.

C.2.6. TRICARE Policy Manual (TPM) 6010.60-M, April 1, 2015, through change 67. The following TPM Sections apply:

Chapter 10, Section 5.1, Transitional Assistance Management Program, paragraph 2.10 Dental Coverage

Chapter 10, Section 9.1 – Early Eligibility Benefits for the Reserve Components (RCs) Chapter 10, Section 10.1 – TRICARE Coverage for Certain Members of the National

Guard (NG)

C.2.7. TRICARE Systems Manual (TSM) 7950.3-M, April 1, 2015, through change 37. The following TSM Chapters apply:

Chapter 1, General Automated Data Processing (ADP) Requirements Chapter 3, Defense Enrollment Eligibility Reporting System (DEERS) (excluding

Section 5.1)

Note: The TRICARE Encounter Data (TED) requirement as stated in the TSM does not apply to

ADDP.

http://manuals.health.mil/

ADDP3

HT9402-20-R-0001 Page C3 of C17 Amendment 0001

C.2.8. TRICARE Operations Manual (TOM) 6010.59-M, April 1, 2015, through change 66. The following TOM Chapters apply:

Chapter 1, Section 1 – Organization of the Defense Health Agency (DHA) Section 2 – Contract Administration and Instructions (excluding paragraphs

4.0 and 5.0) Section 4 – Management (excluding paragraphs 2.2, 2.3, 2.4, 3.1, 3.2, 3.4 and 4.0) Section 5 – Compliance with Federal Statutes Section 6 – Legal Matters

Chapter 9, Records Management (Section 5, paragraph 3.0 titled “Transfer to Other Contractors/Records Center” does not apply to ADDP per Section J, Attachment J-14, Transition-Out and Residual Services)

Chapter 11, Addendum A TRICARE Logo Chapter 13, Program Integrity Chapter 14, Reports, Section 1 – Contract Data Requirements Lists (CDRLs), Plans and

Access Chapter 19, Health Insurance Portability and Accountability Act (HIPAA) of 1996 Chapter 24, TRICARE Overseas Program, Section 12 – TRICARE Overseas Program

(TOP) Point of Contact (POC) Program Chapter 28, Prescription Monitoring Program (PMP) Appendix A, Definitions Acronyms and Abbreviations may be located at http://manuals.health.mil

C.2.9. When a statute, regulation, or manual changes, the contract requirements shall not change until the Contracting Officer modifies the contract to incorporate the change. The contractor shall utilize the most current version of the TRICARE manuals for the requirements stated above (paragraphs C.2.6. through C.2.8.). When a manual change is applicable to the contract, a contract modification shall be issued to incorporate the change and update the manual references to reflect the latest manual change number. Manual change numbers may also be updated when other modifications are issued. In the event there are no applicable manual changes during an option period (OP), an administrative modification may be issued annually to update the manual references to the most current manual change number.

C.3. GENERAL REQUIREMENTS.

C.3.1. Contract Management and Administration. The contractor shall establish clear organizational lines of authority and responsibility to ensure adequate, effective resources are assigned to the contract requirements. The contractor shall have primary and alternate points of contact who are authorized to negotiate with the Government and commit to contract implementation and compliance (see Section G.2.5.). The contractor shall notify the Government within 5 business days of personnel changes to the contractor’s leadership (e.g.

president, vice president, etc.) and/or any changes to the primary and alternate points of contact.

C.3.1.1. The contractor shall establish and maintain effective management strategies, staff education and training programs, lines of authority, and reporting and coordination interfaces

ADDP3

HT9402-20-R-0001 Page C4 of C17 Amendment 0001 with the Government. The contractor shall comply with the directives cited in paragraph C.2., Applicable Directives.

C.3.2. Out of Office and Closures. The contractor shall notify the Government when its primary and alternate points of contact will be out of the office for a full day or more. The contractor shall notify the Government when it or its subcontractors have unscheduled closures of their offices.

C.3.3. Proper Identification of Contractor Personnel. Contractors, including subcontractors at all tiers, shall provide for a clear distinction from Government personnel. Contractor employees shall not act, advertise, or presume to be Government employees, agents, or representatives. Contractor employees are required to appropriately identify themselves as contractor employees at all times, including in telephone conversations, formal and informal written correspondence, paper and electronic, and in any other situation where their actions could be construed as acts of Government officials, unless, in the judgment of the Government, no harm can come from failing to identify themselves. Contractor employees shall be introduced as contractor personnel and display distinguishing visible identification at all times whether in conversations, meetings, or other forms of communication with Government personnel.

C.3.3.1. Contractor personnel, while performing in a contractor capacity, shall refrain from using their retired or reserve component military rank or title (if applicable) in written or verbal communications associated with the contracts for which they provide services.

C.3.3.2. The contractor shall incorporate the substance of this requirement in all subcontracts awarded under this contract.

C.3.4. Government and Contractor Visits/Meetings. Generally, the Government will provide a 14-day notice for all meetings hosted by DHA at one of its Government locations. The Government anticipates hosting approximately 4 meetings per year. These meetings are in addition to those stated Section J, Attachment J-13, Transition-In; and Attachment J-14, Transition-Out and Residual Services. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor.

Deliverables M070 Employee Access to DoD IS/Networks Report A020 Proposed Freedom of Information Act (FOIA) Releasable Contract R020 Identification of Systems of Records Notice Report

C.4. PERFORMANCE REQUIREMENTS.

C.4.1. The contractor shall provide worldwide dental care services for ADSMs.

C.4.1.1. The contractor shall comply with the most current version of American Dental Association's (ADA) Current Dental Terminology (CDT) manual for covered services and update its required systems.

ADDP3

HT9402-20-R-0001 Page C5 of C17 Amendment 0001

Performance Standards

a) Standard: Whenever the ADA issues an updated CDT manual, the contractor shall identify CDT codes to be added, deleted and/or revised for Section J, Attachment J-2, Benefits, Exclusions and Limitations. The contractor shall provide the DHA Dental Program Section with its recommended changes for approval. The ADA updates CDT codes approximately once a year and the revisions are effective January 1 of the following year (see Section H.2, Current Dental Terminology).

Acceptable Quality Level (AQL): The contractor shall submit its CDT recommendation within 30 calendar days of the release of the ADA’s updated CDT manual.

b) Standard: The contractor shall update its systems to reflect the DHA Dental Program Section’s approved CDT code changes no later than January 1 of the following year.

AQL: System updates shall be completed no later than January 1 100% of the time.

C.4.1.2. The contractor shall process remote ADSMs’ enrollments.

Performance Standard

a) Standard: The contractor shall process remote ADSMs’ enrollment actions in accordance with TSM, Chapter 3; and Section J, Attachment J-3a, Program Operations.

AQL: 99% of remote ADSM enrollment actions shall be accurate and complete, and within 5 business days of receipt of the updated information.

Deliverables M010 Management Report

C.4.1.3. The contractor shall provide and maintain access to general and specialty network providers for ADSMs.

Network compliance shall be determined based off the network provider’s fixed structure location. “Driving miles” do not include alternative means of transportation (e.g. ferries, trains, or planes) in order for the beneficiary to access the provider’s office.

“Rural” is defined as less than 1,000 residents per square mile.

“Suburban” is defined as 1,000 to 3,000 residents per square mile.

“Urban” is defined as more than 3,000 residents per square mile.

See Section H.6.1., Network Provider Retention incentive, and Section J, Attachment J-3a, Program Operations for provider requirements.

Performance Standards

a) Standard: The contractor shall establish networks for general dental care in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and the Northern Mariana Islands.

AQL: (1) For Rural: 97% of ADSMs shall have access to two general dentists within 21 calendar days of requesting a periodic or initial (non-emergency) appointment and within 35 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

ADDP3

HT9402-20-R-0001 Page C6 of C17 Amendment 0001

(2) For Suburban: 97% of ADSMs shall have access to two general dentists within 21 calendar days of requesting a periodic or initial (non-emergency) appointment and within 15 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

(3) For Urban: 97% of ADSMs shall have access to one general dentist within 21 calendar days of requesting a periodic or initial (non-emergency) appointment and within 5 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

b) Standard: The contractor shall establish networks for specialty dental care in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and the Northern Mariana Islands.

AQL: (1) 90% of ADSMs shall have access to an orthodontist within 28 calendar days of requesting an appointment and within 35 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

(2) 95% of ADSMs shall have access to an oral surgeon within 28 calendar days of requesting an appointment and within 35 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

(3) 85% of ADSMs shall have access to an endodontist within 28 calendar days of requesting an appointment and within 35 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

(4) 85% of ADSMs shall have access to a periodontist within 28 calendar days of requesting an appointment and within 35 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

(5) 80% of ADSMs shall have access to a prosthodontist within 28 calendar days of requesting an appointment and within 35 driving miles of ADSM DTF referred care and place of residence for remote ADSMs.

c) Standard: The contractor shall maintain a network provider retention rate in accordance with Section J, Exhibit B, Contract Data Requirements List (CDRL) M050, Provider Network Access Report. For OP 1 the COR will validate the baseline 6 months after start of dental care delivery.

The baseline shall be reset at the beginning of each OP, and the Contracting Officer Representative (COR) will re-validate at the end of the OP.

AQL: 95% of network providers shall be retained annually.

Deliverables M050 Provider Network Access Report

C.4.1.4. The contractor shall develop, maintain and make available to ADSMs, providers and Government representatives an up-to-date directory of network providers.

Performance Standard

ADDP3

HT9402-20-R-0001 Page C7 of C17 Amendment 0001

a) Standard: The contractor shall post the updated directory on the contractor’s website in accordance with Section J, Attachment J-3a, Program Operations.

AQL: 100% updated within 5 business days of receipt of the updated information.

Deliverables M050 Provider Network Access Report

C.4.1.5. The contractor shall develop and maintain agreements with TRICARE OCONUS Preferred Dentists (TOPDs).

Performance Standards

a) Standard: The contractor shall complete agreements with existing providers identified by the Government and for any new providers identified each option period in accordance with Section J, Attachments J-3b, Program Operations for OCONUS; and J-13, Transition-In.

AQL: The contractor shall complete agreements with 95% of those existing providers identified by the DHA COR prior to OP 1 and any new providers identified each option period.

b) Standard: The contractor shall make available to ADSMs, TOPDs and Government representatives an up-to-date list of TOPDs in accordance with Section J, Attachment J-3b, Program Operations for OCONUS.

AQL: 100% updated within 5 business days of receipt of the updated information.

Deliverables W010 Transition-In Status Report M010 Management Report R010 MOU with TRICARE Overseas Program (TOP) Contractor

C.4.1.6. The contractor shall process referrals, appointments and authorizations for ADSMs.

Performance Standards

a) Standard: The contractor shall schedule appointments as requested in accordance with Section J, Attachment J-3a, Program Operations.

AQL: 90% of appointments shall be scheduled within 5 business days of the request.

b) Standard: The contractor shall complete authorization requests in accordance with Section J, Attachment J-3a, Program Operations.

AQL: (1) 95% of authorization requests shall be electronically sent to the Dental Service Point of Contact (DSPOC) within 5 business days of receipt of a complete authorization request (to include required documentation).

(2) 100% of authorization requests shall be electronically sent to the DSPOC within 7 business days of receipt of a complete authorization request (to include required documentation).

ADDP3

HT9402-20-R-0001 Page C8 of C17 Amendment 0001

(3) 95% of authorization requests shall be completed within 5 business days of receiving all required information from the DSPOC.

(4) 100% of authorization requests shall be completed within 7 business days of receiving all required information from the DSPOC.

Deliverables M010 Management Report

C.4.1.7. The contractor shall process claims to completion for ADSMs and providers.

“Process to completion” is defined in the TOM, Appendix A.

Performance Standards

a) Standard: Process claims to completion.

AQL: (1) CONUS Claims 95% within 14 calendar days of receipt.

98% within 30 calendar days of receipt.

100% within 60 calendar days of receipt.

(2) OCONUS Claims 95% within 21 calendar days of receipt.

98% within 45 calendar days of receipt.

100% within 60 calendar days of receipt.

b) Standard: Claims shall be accurately paid in accordance with the covered benefit. CONUS and OCONUS claims shall be separately tracked.

AQL: 98% are accurately paid on initial submission of the claim.

c) Standard: Claim errors shall be corrected. CONUS and OCONUS claims shall be separately tracked.

AQL: 99% are corrected within 10 calendar days after contractor identifies the error.

Deliverables M010 Management Report M020 Market Basket Comparison/CDT Summary Report A010 Market Basket Comparison/CDT Summary Report A070 MOU with TRICARE Claims Review Services (TCRS) Contractor R190 MOU with Federal Employee Dental & Vison Insurance Program (FEDVIP)

C.4.1.8. The contractor shall process all appeals to completion.

a) Standard: The contractor shall process provider, ADSM and remote ADSM appeals in accordance with Section J, Attachment J-3a, Program Operations.

AQL: (1) 100% of completed appeal packages shall be forwarded to the DSPOC within 7 calendar days of receipt.

ADDP3

HT9402-20-R-0001 Page C9 of C17 Amendment 0001

(2) The appealing party will be notified of the decision within 14 calendar days after receipt 100% of the time.

Deliverables M010 Management Report

C.4.1.9. The contractor shall process all grievances to completion.

a) Standard: The contractor shall process provider and ADSM and grievances to completion in accordance with Section J, Attachment J-3a, Program Operations.

AQL: 95% within 60 calendar days of receipt.

99.9% within 90 calendar days of receipt.

Deliverables M010 Management Report

C.4.1.10. The contractor shall provide readily accessible comprehensive customer service for ADSMs and providers.

Performance Standards

a) Standard: The contractor shall provide customer service in accordance with Section J, Attachment J-3a, Program Operations.

AQL: (1) 98% of telephone calls answered by Automated Response Unit within 30 seconds.

(2) 80% of telephone calls answered by Customer Service Representative (CSR) within 30 seconds of selection by caller.

(3) 5% or less telephone calls blocked at all times (measured at least hourly).

(4) 80% of telephone calls resolved during the initial call; 99.9% within 7 business days.

(5) Priority Written and E-mail Correspondence (final response). Priority correspondence is that which is received from Members of Congress, DoD leadership and DHA leadership.

95% within 7 business days of receipt 99.9% within 20 business days of receipt.

(6) Non-priority (routine) Written and E-mail Correspondence (final response).

85% within 10 business days of receipt 99.9% within 30 business days of receipt.

Deliverables M010 Management Report

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C.4.2. The contractor shall promote the value of utilizing diagnostic and preventive services.

C.4.2.1. The contractor shall inform and educate ADSMs, providers, and Military Dental Treatment Facilities (DTF) staff about the program benefits with emphasis to the ADSMs about the benefit of utilizing diagnostic and preventive services.

Performance Standards

a) Standard: The contractor shall comply with its education plan in accordance with Section J, Attachment J-3a, Program Operations. The contractor shall allow 30 calendar days for the DHA Dental Program Section to approve/deny any changes to the contractor’s education plan. Timing of the publication and/or implementation shall be mutually agreed upon between the contractor and DHA Dental Program Section.

AQL: 99% of planned education activities shall be completed within the current option period.

Deliverables AP010 ADSM, Provider and DTF Education Plan R110 MOU with DHA Communications

C.4.3. The contractor shall provide data systems to coordinate care between the DHA Dental Program Section, Military DTF ADSM referred care, and remote ADSM dental care authorizations, and the means in which to monitor dental health plan data and outcome measures for all dental care rendered.

C.4.3.1. The contractor shall provide training for the users on the data systems stated in Section J, Attachment J-3c, Program Operations for Data Systems.

Performance Standards

a) Standard: The contractor shall train (initial and refresher) and provide secure means for the users to access the systems for viewing and/or utilization. The contractor may provide the training on-site or electronically.

AQL: (1) Initial system training conducted during the Transition-In period shall be completed no later than 30 calendar days prior to OP 1.

(2) After start of OP 1, new users shall receive initial training no later than 30 calendar days after identification is made to the contractor.

(3) Refresher training shall be provided quarterly.

Deliverables M010 Management Report

C.4.3.2. The contractor shall provide Government designated users with read-only access to the contractor’s full ADDP data set.

Performance Standard

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a) Standard: The user shall have the ability to download any of the data elements for manipulation purposes in accordance with Section J, Attachment J-3c, Program Operations for Data Systems.

AQL: The system shall be available 99% of the time 24 hours, 7 days a week (excluding downtime for scheduled maintenance).

Deliverables M010 Management Report

C.4.3.3. The contractor shall provide Government designated users with read-only access to an ADDP dashboard.

Performance Standard

a) Standard: The ADDP data shall be provided in a consolidated manner in which the user shall have the ability to easily view dental health plan data and the outcome measurements without having to manipulate the data in order to retrieve the information in accordance with Section J, Attachment J-3c, Program Operations for Data Systems.

AQL: The system shall be available 99% of the time 24 hours, 7 days a week (excluding downtime for scheduled maintenance).

Deliverables M010 Management Report

C.4.3.4. The contractor shall establish an electronic means to track and transmit ADSM referrals and authorizations.

Performance Standard

a) Standard: The system shall be Health Insurance Portability and Accountability Act (HIPAA) and Public Key Infrastructure (PKI) compliant, which shall allow the user the ability to search, process, and transmit referrals and authorizations in accordance with Section J, Attachment J-3c, Program Operations for Data Systems.

AQL: The system shall be available 99% of the time 24 hours, 7 days a week (excluding downtime for scheduled maintenance).

Deliverables M010 Management Report

C.4.3.5. The contractor’s system shall interface with the Military Health Services (MHS) Genesis/Defense Health Medical Systems Modernization (DHMSM) Electronic Health Record System (EHRS).

The contractor shall implement the MHS Genesis/DHMSM EHRS at a later date as directed by DHA. DHA will provide the MHS Genesis/DHMSM EHRS requirements will be incorporated into the contract prior to implementation.

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C.4.3.6. The contractor shall correct any data submission mistakes identified by the Government or the contractor.

Performance Standards

a) Standard: If the Government or the contractor identify data submission mistakes (e.g. the manner in which the data is submitted leads to incorrect data reporting), the contractor shall correct the mistakes.

AQL: 99% within 30 calendar days of identification.

100% within 60 calendar days of identification.

Deliverables M010 Management Report

C.5. ADDITIONAL REQUIREMENTS.

C.5.1. System Security. The contractor shall acquire, develop, and maintain processes for safeguarding unclassified DoD information, including covered defense information, commonly referred to as controlled unclassified information on all contractor/subcontractor systems/networks that store, process, transmit or access unclassified DoD information or controlled unclassified information in accordance with TSM, Chapter 1, Section 1.1. The contractor shall implement and maintain adequate security in its project, enterprise, or company-wide internal information systems or covered contractor information systems that process, store, create, or transmit unclassified DoD information in accordance with the basic safeguarding requirements in FAR 52.204-21. The contractor shall implement and maintain adequate security in its project, enterprise, or company-wide internal information systems or covered contractor information systems that process, store, create, or transmit covered defense information, commonly referred to as controlled unclassified information (e.g. PII/PHI), in accordance with safeguarding covered defense and cyber incident reporting requirements in DFARS Clause 252.204-7012. Covered contractor information systems shall be subject to the security requirements in National Institute of Standards and Technology (NIST) Special Publication (SP) 800-171, "Protecting Controlled Unclassified Information in Nonfederal Information Systems and Organizations", Privacy Act Program Requirements (DoD 5400.11-R), NIST Certification and Compliance Checklist, and the Personnel Security Program (DoD 5200.2-R). The contractor's Annual Checklist and Certification for Minimum Level of Enhanced Safeguarding for DoD Controlled Unclassified Information (also known as the "NIST Checklist") is required prior to accessing DoD data, interfacing with Government systems, or conducting testing.

Deliverables M070 Employee Access to DoD IS/Networks Report A030 NIST Certification of Compliance Report A050 Disaster Recovery Test Results Report AP020 Continuity of Operations Plan (COOP)

C.5.2. Health Insurance Portability and Accountability Act (HIPAA). The contractor shall comply with the HIPAA requirements of TOM, Chapter 19.

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Deliverables M030 HIPAA/Privacy Complaint Report A040 Risk Assessment Letter of Assurance R070 Designated Standards Maintenance Organization (DSMO) Meeting Summary Report R130 Breach Report

C.5.3. Transition.

C.5.3.1. The transition-in of this contract shall be conducted in accordance with the requirements stated in Section J, Attachments J-13, Transition-In.

Deliverables W010 Transition-In Status Report R030 Transition-In Integrated Master Plan (IMP) and Integrated Master Schedule (IMS) R180 B2B Gateway Questionnaire

C.5.3.2. The transition-out and the residual services activities shall be conducted in accordance with Section J, Attachment J-14, Transition-Out and Residual Services. Transition-Out costs shall not apply, nor shall any payment be made on CLIN X007, if an incumbent contractor succeeds itself.

Deliverables M060 Transition-Out and Residual Services Status Report R040 Transition-Out and Residual Services Plan

C.5.4. Government Furnished Information.

C.5.4.1. The Government shall provide the contractor electronic data files containing relevant information pertaining to all ADSMs. The Government shall provide to the contractor a list of these data files and delivery times at the transition-in meeting with DMDC (see Section J, Attachments J-13, Transition-In). These data files will assist the contractor in determining their provider network adequacy and with ADSM educational purposes. The contractor shall comply with the security requirements stated in C.5.1. prior to receiving the data files.

C.5.4.2. The Government shall provide the contractor the appropriate application software required to access the DMDC Defense Eligibility Enrollment Reporting System (DEERS) to perform eligibility inquiries and remote enrollments. The Government shall grant the contractor access to DEERS only after the contractor's staff and all subcontractors' staff who will utilize systems which access and maintain ADDP data, are compliant with the safeguarding methods for unclassified DoD information, personnel security and clearance requirements as stated in C.5.1.

The contractor and its subcontractors shall comply with C.5.1. no later than 120 calendar days after award.

C.5.4.3. DMDC will print and mail enrollment cards for remote ADSMs. ADSMs that are not remote do not require an enrollment card (see TSM, Chapter 3, Section 4.2).

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C.5.4.4. The Government shall print and provide to the contractor educational documents as identified in Section J, Attachment J-3a, Program Operations.

C.5.5. Quality.

C.5.5.1. Quality Control Program (QCP). The contractor shall develop and implement a QCP in accordance with the TOM, Chapter 1, Section 4 (excluding paragraphs 2.2, 2.3, 2.4, 3.1, 3.2,

3.4 and 4.0) and Section J, Exhibit B, CDRL AP030, QCP Plan. The contractor shall maintain a QCP that ensures that services are performed in accordance with the contract. The contractor shall develop and implement procedures to identify, prevent, and correct problems for the duration of the contract.

Deliverables Q010 Quality Control Program (QCP) Report AP030 Quality Control Program (QCP) Plan

C.5.5.1.1. Clinical Quality. The contractor shall ensure that their QCP Plan includes written policies and procedures to identify and review all potential quality issues (PQIs) from any source, to include grievances. A quality issue (QI) is a verified deviation, as determined by a qualified reviewer, from acceptable standards of practice or care as a result of some process, individual, or institutional component of the health care/dental care system. All QIs, regardless of the source, shall be reviewed and confirmed by qualified staff to determine deviations from standards of care, assign severity levels, recommend interventions to include Corrective Action Plans (CAPs), report to licensure boards, and follow-up monitoring through resolution. All standard of care determinations shall be approved by the contractor’s head of clinical dental care.

The contractor shall assure all identified issues are tracked and trended and any patterns are identified; all issues must be appropriately addressed until complete resolution is achieved. The contractor shall ensure that no results from a quality review (quality assurance information) are disclosed to any person or entity unless specifically provided for under 10 USC §1102.

Deliverables M010 Monthly Management Report Q010 Quarterly Quality Control Program (QCP) Report AP030 Quality Control Program (QCP) Plan

C.5.5.2. Contract Surveillance. The CO and COR will develop a Quality Assurance Surveillance Plan (QASP) to define acceptable quality levels and identify how the COR will monitor the quality of the contractor’s performance and address contractor performance that falls below these standards. The CO and COR will finalize the QASP after award and provide a copy to the contractor (for purposes of the RFP see Section J, Attachment J-18, Draft QASP). The QASP is a living document, and the Government may unilaterally update it as necessary. The CO and COR will complete an annual contractor’s performance evaluation in the Contractor Performance Assessment Report System (CPARS).

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C.5.6. Records Management. All contractor records generated under this contract shall be maintained in accordance with 36 CFR 1222; TOM, Chapter 9; Section J, Attachment J-13, Transition-In; and Attachment J-14, Transition-Out and Residual Services.

Deliverables R140 Declaration of Transfer and Destruction of Records

C.5.7. Fraud and Abuse.

C.5.7.1. The contractor shall implement a Fraud and Abuse program in accordance with TOM, Chapter 13.

Deliverables Q020 Fraud and Abuse Summary Report A060 Fraud Detection and Prevention Strategy and Internal Procedures R060 Threats Report R090 Standard Operating Procedures (Desk Procedures) R150 Random Sample Audit Worksheet R160 Fraud/Abuse Patient Harm-Initial Notification Checklist R170 DHA/MTF Fraud and Abuse Referral Cover Sheet

C.5.7.2. Potential Fraud and Abuse Cases. The contractor shall refer to DHA any potential case that involves more than a $10,000 loss to the Government and any potential case involving patient harm regardless of loss value (see TOM, Chapter 13, Section 3, for further requirements).

C.5.7.3. Post Payment Utilization Reviews. When performing post payment utilization reviews, the contractor shall consider high volume ADSMs as those ADSMs whose charges exceed $25,000 during a 12-month reporting period. High volume providers are considered institutional providers whose payments exceed $750,000, individual providers whose payments exceed $100,000, and group/clinics whose payments exceed $100,000 (the threshold average is $25,000 per professional provider within the group) during a 12-month reporting period (see TOM, Chapter 13, Section 4, for further requirements).

C.5.8. Military Health System (MHS) Data Repository (MDR) and MHS Mart (M2).

C.5.8.1. MDR is DHA’s centralized data repository that captures, archives, validates, integrates and distributes DHA corporate health care data worldwide. It receives and validates data from the DoD’s worldwide network of more than 260 health care facilities and from non-DoD data sources. M2 is DHA’s management and reporting tool. Each DHA contractor and DHA must program their systems to transmit and receive claims payment data to MDR and M2. The contractor shall provide dental care encounter data for input into the MDR. The data, which includes both clinical and financial information, will then be available for reporting and inquiry purposes in the MDR. The data will also be available on the reports residing on the M2.

C.5.8.2. The contractor shall work with the DHA Dental Program Section and DHA, Defense Health Services Systems (DHSS) in developing an ADDP Interface Control Document (ICD)

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describing the data exchange to the Military Health System (MHS) Data Repository (MDR).

The purpose of the ADDP ICD document is to describe the interface that provides the ADDP records from the contractor’s automated information systems in support of the ADDP.

C.5.8.3. The contractor shall submit the claims and provider data in accordance with the ICD and Section J, Attachment J-12, MDR Data Elements Layout.

C.5.8.4. The contractor shall protect the data in accordance with the C2-level protection standards mandated for all "Sensitive Unclassified Systems" as required in the DoD Directive

5200.28 since the data exchanged in this interface contains protected patient level identifiable information and the aggregate data being transmitted by DHSS becomes part of a database that contains sensitive data.

C.5.8.5. The contractor shall perform validation checks such as record counts, file formats, source stamps, and date-time stamps on data transferred from the contractor to the MDR as defined in the MDR ICD. When errors are discovered in the data exchange, the contractor will be notified immediately by DHSS operations personnel. If there are systemic problems, Interface Working Group (IWG) counterparts will be contacted by DHSS to work the issues.

Deliverables M040 MDR Data Claims and Provider Files

C.5.9. Deliverables.

C.5.9.1. The contractor shall provide all reports and plans in accordance with Section F.5.

C.5.9.2. The contractor shall work with the Government during transition-in on the report formats for the CDRLs (see Section J, Exhibit B, CDRLs). The contractor shall work with the Government to fully describe the format/data elements (e.g. field descriptions, field lengths, list of allowed entries for each field) to be used for each report and to build/test the reports to be forwarded to the Government. During the term of the contract, the Contracting Officer or designee may require additional changes to the makeup of these reports (e.g. add or delete data elements or change the format). The contractor shall implement these changes at no additional cost to the Government.

C.5.9.3. Special Reports and Plans.

C.5.9.3.1. CLIN Price Structure Report. The contractor shall provide its price structure build-up and supporting documentation for its Section B CLIN unit prices after award.

Deliverables R120 CLIN Price Structure

C.5.9.3.2. Ad Hoc Reports. The Government may request the contractor to submit up to four ad hoc reports per option period at no additional cost to the Government. The contractor shall

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provide the report within 2 weeks of the request unless a revised date is mutually agreed upon with DHA.

Deliverables R080 Ad Hoc Management Reports

C.5.9.3.3. Consolidated Historical Data File. The Government may request the contractor to submit a historical data file up to two times over the life of the contract at no additional cost to the Government.

Deliverables R100 Consolidated ADDP Historical Data File

C.5.9.3.4. Disaster Action Plan. The contractor shall develop a Disaster Action Plan to be implemented when the President of the United States declares an area of the United States or any U.S. territory with a provider network to be a "National Disaster Area" (see Section J, Attachment J-3a, Program Operations).

Deliverables R050 National Disaster Action Report

(End of Section)

SECTION I

CONTRACT CLAUSES

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FAR 52.202-1 DEFINITIONS…