TPharm5 Draft Section F 20191202.docx

SECTION F

DELIVERIES OR PERFORMANCE

F.1. Contract Clauses.

FAR 52.242-15 Stop-Work Order (AUG 1989) F.2. Period of Performance.

F.2.1. Transition-In. The Base Period of Performance (PoP) is 18 months and will begin no later than July 1, 2021. The Contractor shall begin contract transition-in activities and complete specific activities by the timelines specified in the TRICARE Operations Manual (TOM) Chapter 23, Section 5. The Contractor shall also complete contract transition-in activities by the date specified in the Contractor’s phase-in transition plan. In the event there is a conflict or overlap of dates/timelines between this contract, TRICARE Manuals, and the Contractor’s transition-in transition plan, the dates/timelines specified in this contract take precedence. The Contractor shall make every effort to coordinate the dates accordingly and shall promptly notify the Contracting Officer and Contracting Officer’s Representative if a conflict of dates arises.

F.2.2. Full Performance. Option periods one through seven will be 12 months each beginning on the next calendar day following the base period or completed option period, if exercised. The option periods identified herein are hereby defined as the period in which pharmacy services will be delivered to TRICARE beneficiaries. The start of pharmacy services delivery is the first day of option period 1; no pharmacy services delivery will be performed during transition-in. To meet the requirements for pharmacy services delivery for a given period, the Contractor will perform incidental administrative tasks associated with the given pharmacy service delivery period beyond that period (e.g. transfers, bank account close-out, etc.).

F.2.3. Transition-Out. When services under this contract are (or scheduled) to be discontinued, a contract phase-out period will be exercised concurrent with one of the pharmacy services delivery periods. The Contractor will begin contract phase-out activities upon exercise of the contract phase-out Contract Line Item Number (CLIN) and complete such activities within the timelines specified in TOM Chapter 23, Section 5. All contract phase-out activities shall be accomplished no later than 270 days after the start of pharmacy services delivery by the incoming Contractor(s).

F.3. Reports and Plans – Contract Data Requirements List (CDRL). The Contractor shall electronically submit all CDRL items in accordance with each CDRL. The Contractor shall submit all CDRL items in the specified format using Microsoft Office Excel, Word, PDF, or other specified software. If no format is specified, the Contractor may use its own format. Unless otherwise specified in this section, all CDRL items shall be submitted to the Government via the E-commerce Extranet (Attachment J-3, Line 12). (See TOM, Chapter 14, for report submission requirements.)

F.3.1. Training. The incoming contractor shall schedule initial training on the submission of deliverables within 30 calendar days after award. Additional training for new users will be provided throughout the contract upon request.

F.3.2. Administrative Requirements. All reports shall include definitions of key terms, descriptions of methodology used when applicable, and a change log capturing any report modifications.

F.3.3. Accuracy. The Contractor is accountable for assuring that reports contain accurate and complete data. Upon identification of any errors following initial submission, the Contractor shall notify the Government within two business days and provide updated corrected reports within thirty days unless otherwise approved by the Government. The Contractor shall identify to the Government upon discovery the specific data to be corrected and provide an explanation for the initial error. The Contractor shall prepare written procedures describing the source of information as well as the specific steps followed in the collection and preparation of data for each report. All reports must be accompanied with data, documentation and audit trails sufficient to support and validate the reported information. The reports shall be titled as listed. The Contractor shall submit a negative report if there is no data to report.

F.3.4. Contract Data Requirements List (CDRL). The following is a list of the CDRLs the Contractor is required to complete and submit in accordance with the guidance provided above:

F.3.4.1. Daily.

D010 Mail Order Daily NDC Change Requests Report D011 Mail Order Daily Backorder Report D020 MTF Rejection Detail Report D030 Contractor Payment Check Issue Data D040 Retail Pharmacy Claims (RPC) Data Requirements

F.3.4.2. Weekly.

W010 Mail Order Rebaseline and Continuous Monitoring Approval Report W020 MTF Data Integrity Report W021 MTF High Cost Claim Report W030 MHS GENESIS Drug Reject Report

F.3.4.3. Monthly.

M010 TPharm Contract Performance Summary M020 Call Center Top Issues Report M030 Priority Correspondence Report M040 Network Pharmacy Report M041 Network Access Report M050 TPharm Metric Summary Report M060 Pharmacy Claims Processing System Availability Report M070 MTF Rejection Summary Report M071 MTF Data Integrity Summary Report M072 MTF High Cost Claim Summary Report M080 HIPAA Privacy Disclosure Report M090 Supervisory Review Report M100 Deployment Prescription Program Report M110 MOP Replenishment Reconciliation Report - Claims M111 MOP Replenishment Reconciliation Report - NDC Level M120 Expanded Mail Order and MTF Report M130 Auto Refill Dashboard M140 Market Pricing Report M150 TMDS Claims Volume Report M160 Bank Reconciliation Format M170 Accounts Receivable Reports M180 Bank Cleared Payment Report M190 Bank Account Statement Report M200 Benefit Design and Formulary Search Tool Changes M210 Compound Prescription Report M220 PDMP Overview Report M230 Prescription Monitoring Program Report - MTF M231 Prescription Monitoring Program Report - MCSC M240 Retail Refund Dispute Report M250 Pharmacy Claims Audit Report

F.3.4.4. Quarterly.

Q010 Clinical and Admin Review Report Q020 Beneficiary Services Report Q030 Pharmacy Help Desk Report Q040 Mail Order Pharmacy Prescription Report Q041 Mail Order Pharmacy Reship Report Q042 Mail Order Quality Control Report Q050 Paper Claims Processing Report Q060 Prescription Monitoring Program Utilizer Report Q061 Prescription Monitoring Program Overview Report Q070 Benefit Design Edit Safety Report Q080 EOB Report Q090 TED Summary Report Q100 Fraud and Abuse Summary Report Q110 OHI Development Report Q111 OHI Cost Avoidance Report Q120 CHCBP Monitoring Report Q130 Eligibility Recoupment Status Report Q140 Quarterly Review Program Report Q150 Specialty Pharmacy Services Report Q150 Specialty Dispensing and Services Report Q160 Educational Update Report Q170 Mail Order Pharmacy Utilizers Data File

F.3.4.5. Annual.

A010 FOIA Releasable Contract A020 MOU with DHA Communications A021 MOU with DHA Information Operations (Pharmacy Data Warehouse) A022 MOU with MHS Genesis Contractor A023 MOU with MCSC - East Region A024 MOU with MCSC - West Region A025 MOU with DHA Third Party Claims Review Contractor A030 Continuity of Operation Plan A031 Disaster Recovery Test Results A040 NIST Certification of Compliance Report updated 10.5.18 A050 Quality Control Annual Report A060 Statement on Standards for Attestation Engagement (SSAE) No. 16 A061 Bridge Letter Statement on Standards for Attestation Engagement No. 16 A070 Risk Assessment Letter of Assurance A080 Fraud Detection and Prevention Strategy and Internal Procedures A090 DEERS Query Volume Forecast A100 Education Plan

F.3.4.6. As Required.

R010 Operations Issues Log R020 Pharmacy Change Monitoring Report R030 Ad Hoc Management Reports R040 Appeals Processing Guidelines, Desk Instructions and Reference Material R050 Breach Report R060 Standard Operating Procedures (Desk Procedures) R070 Threats Report R080 Random Sampling Audit Worksheet R090 Fraud Abuse Patient Harm-Initial Notification Checklist R100 DHA-MTF Fraud and Abuse Cover Sheet R110 Declaration of Transfer and Destruction of Records R120 MOU with Outgoing Contractor

F.3.4.7. Transition.

T010 Transition-In Plan T020 Transition-In Status Report T030 Transition-Out Plan T040 Transition-Out Status Report

F.4. Updates to Performance Requirements. All changes to performance requirements shall be accurately incorporated by the respective effective date unless otherwise approved by the Government (e.g. benefit designs, manual changes, change orders, etc.).

F.5. Anticipated MHS GENESIS Transition Schedule. Current anticipated MHS Genesis transition schedule is attached under Section L (Attachment L-17) and will be updated if any changes are made.

(End of Section F)

HT9402-20-R-0002 Page F5 of F5 20 Nov 2019