T-5 RFP Industry Questions with Government Responses Amendment 0003.pdf

T-5 Managed Care Support Services

HT9402-20-R-0005

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

497 L.6. Volume II, Technical Proposal

L.6.2.4.6 Alternative Payment Models

Please confirm that in addressing Section L.6.2.4.6, regarding Alternative Payment Models (APMs), an Offeror may propose to be reimbursed for its administrative costs of implementing and administering APMs so long as the Offeror includes such. reimbursement in its methodology for calculating the cost neutrality of the APMs.

GOVERNMENT REVISED RESPONSE 07/29/2021: Offerors shall include the costs of startup and administration of the offeror’s APMs and existing/known government-directed APMs in their proposed PMPM rates. An Offeror may propose to be reimbursed for its administrative costs of implementing and administering future Government-directed APMs in the change order proposal.

573 Acquisition L.1. Solicitation Provisions

Federal Acquisition Regulation (FAR) Provisions

Updated RFP FAR Clauses

The RFP indicates in Section L.1 that FAR Clause 52.222-46 is applicable for this solicitation. Sections L.8.16 and L.8.16.1, which previously required the submission of a Total Compensation Plan, have been removed.

Can you please confirm that the Total Compensation Plan is no longer required to be submitted?

Correct, to confirm, the requirement for submission and the Government's evaluation of a Total Compensation Plan have been removed from the T-5 RFP under Amendment 0001.

574 Acquisition L.5. Volume I, Executed Proposal

L-5w Updated CDRL List The RFP amendment 1 released on 5/21/21, states that the CDRL list in Section F - Deliveries or Performance (F.3.

REPORTS AND PLANS) was updated to include CDRL A310:

Contractors Record of Subcontractors Receiving / Developing Covered Defense Information. However, RFP Attachment L- 5w - Amendment 0001 does not include A310 in the CDRLs tab.

Should RFP Attachment L-5w include the added A310 CDRL on the CDRLs tab?

Thank you for identifying the issue. CDRL A310 have been added to attachments L-5e/L-5w under Amendment 0002.

575 Acquisition L.7. Volume III, Past Performance Information

L.7.6 Past Performance Questionnaires

The RFP states, "References will return the completed questionnaires directly to the Government as directed on the Questionnaire (Attachment L-12)." Within Attachment L-12, the instructions say "Respondent, please submit the completed PPQ via direct upload to DoD SAFE at https://safe.apps.mil/. Or email to: PPQ@DHA.MIL or fax to

XXX-XXX-XXXX."

Can the Government please clarify the submission instructions?

Thank you for identifying the issue. The Government has revised the submission instructions, email address and fax number of Attachment L- 12 under Amendment 0002.

576 C.2.

Performance Requirements

C.2.13.1 Interoperability Standards

The final RFP states, "The Contractor's claims, referral, and population health systems shall be capable of CMS-9123-P final rule interoperability standards prior at the SHCD."

Since there is currently no final rule, will any changes to CMS- 9123-P after T-5 proposals are submitted be managed through the normal change order process?

Yes. Changes to CMS final rule that are signficant difference from the interim rule would be managed through the normal change order process.

577 C.2.

Performance Requirements

C.2.13.1 Interoperability Standards

Some of the CMS-9123-P prior authorization requirements, including turn-around times, conflict with TRICARE requirements. Will the requirements in the TRICARE Operations Manual take precedence over the CMS Medicare and Medicaid requirements?

Yes. Page 113 of CMS-9123-P shortens the CMS prior authorization timeline to 7 days (from 14) while TOM Chapter 1, Section 3, Paragraph 5 contains higher standards.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

578 C.2.

Performance Requirements

C.2.13.1 Interoperability Standards

There are several requirements around payer-to-payer clinical data exchanges (including claims, authorizations, pharmacy/lab information, etc.) when a member enrolls into a new health plan. Is it DHA's intent for the MCSC to share a member's longitudinal health record with other entities when a member loses coverage in that region and enrolls in another health plan, including not only other TRICARE plans (e.g., the other TRICARE region, USFHP, TRICARE Overseas, TRICARE for Life), but also after they lose TRICARE coverage and enroll in a commercial health plan, Medicaid plan or Medicare plan? If so, will the TRICARE Systems Manual security requirements be changed to allow the MCSC to share DoD data outside a NIST-compliant security boundary and making it possible to comply with some of the CMS-9123- P requirements?

No. There is no requirement for the MCSC to share the medical records with another payer.

579 Exhibit A.

Contract Data Requirements List

A290 CDRLs CDRL A290 requires the first submission of the contractor's NIST self-assessment score in the Supplier Performance Risk System (SPRS) within 30 calendar days prior to projected award date; however, the final RFP M.7.2.4.4.1 states, "The Government will evaluate the Offeror's reported summary level score for its current basic self-assessment in the SPRS to assess the Offeror's ability to implement the NIST Special Publication 800-171 by contract award." Is it the Government's expectation that the self-assessment score be submitted in the SPRS prior to proposal submission; and if so, will CDRL A290 be revised to reflect the correct first submission date?

CDRL A290 was removed from the contract under Amendment 0002.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

580 Exhibit A.

Contract Data Requirements List

CDRL S070 Clinical Quality Management

CDRL S070 instructs the MCSC to report Core Quality Measures Collaborative (CQMC) data every six months with a due date of 15 calendar days after the reporting period.

The CQMC has a number of core data sets, several of which include measures for which the data reported will not be available by administrative methods alone and require medical record chart review, and others are not publicly-reported measures. Will the Government consider limiting measures from the CQMC core data sets to only those measures with publicly-reported data and to those for which administrative data only will be required?

CQMC measures have various measure stewards as the CQMC is a collaborative initiative bringing together various entities to promote quality of care. For several CQMC measures, the data source includes claims, but others include medical records, registry data, and others.

Some measures are not fully publicly reported, and others are only publicly reported for certain age groups. Measures requiring medical records will require a longer period of time to allow for medical record retrieval and data abstraction.

No. Some datasets will need to be calculated by the MCSCs and notice of those datasets will be provided 60 days prior to the start of each option period.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

581 Exhibit A.

Contract Data Requirements List

CDRL S070 Clinical Quality Management

CDRL S070 instructs the MCSC to report Core Quality Measures Collaborative (CQMC) data every six months. The CQMC has a number of core data sets, some of which have measures that report 30-day mortality after a diagnosis or procedure. Measuring mortality following a procedure or diagnosis will be problematic for a MCSC. This is because death data is not available in claims unless the death occurs in a facility, is only available in DEERS if the beneficiary's family updates their records, and is not available in a timely manner from external sources such as the Social Security Administration or the Centers for Disease Control (CDC).

Will the Government consider excluding measures from the CQMC core data sets that measure mortality?

The American College of Cardiology has indicated that death data is not available from the CDC for 30 months after death, resulting in a measure that is nearly 3 years old when calculated.

No, the Government will not exclude measures of mortality, if timely facility or other data is available it shall be reported.

582 Exhibit A.

Contract Data Requirements List

R030 CDRLs The population health accreditation requirement was removed and replaced with a disease management accreditation requirement in the final RFP, Section C, paragraph C2.3.4. However, the CDRL R030 still indicates that a population health accreditation is still required. Is it correct to assume that DHA will be updating CDRL R030 to reflect this change?

Yes, the Government will update CDRL R030 to reflect Disease Management accreditation as opposed to Population Health.

583 Acquisition I. Contract Clauses

Page I2 of I17 Contract Clauses Page I2 of I17 of Amendment 0001 states, "© Submit the cost portion of the proposal via the following electronic media: MICROSOFT EXCEL Format with formulas." Will the Government please clarify how this relates to Section I?

FAR 52.215.-21, Alt III. Requires the Government to state via fill-in space, a specificied format which in this case, MS Excel has been applied. For more information see https://www.acquisition.gov/far/part-

52#FAR_52_215_21

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

584 Acquisition I. Contract Clauses

Pages I5-6 of I17 Service Contract Act

Why does the RFP include FAR clauses relating to the Service Contract Labor Standards Act (SCA)?

The SCA applies only to service contracts where “the principal purpose” of the contract “is to furnish services … through the use of service employees” and incidental services should not be enough to create a service contract.

FAR 22.1003-1. The principal purpose of the T-5 contract is not to furnish services through the use of service employees.

The RFP states that the Contract’s purpose is to provide Managed Care Support to DoD for the TRICARE benefits program and to assist the MHS in coordinating healthcare delivery between the Contractor’s civilian network of health care providers and the military’s direct care system. Any services furnished through the use of services employees are only incidental and not the principal purpose of the T-5 Contract.

Also, Department of Labor regulations provide that “contracts which provide for insurance benefits to a third party under the Medicare program are not subject to the Act.” 29 CFR § 4.107(b). Congress already requires TRICARE to be treated consistently with Medicare by, among other things, applying the same reimbursement rules and applying the same requirements for claims processing. See, e.g., 10 USC §§ 1079(j); 1095c. As a result, even when the MCS Contractor may assist DoD in providing certain TRICARE benefits to eligible beneficiaries, doesn’t this regulation result in excluding TRICARE from coverage under the SCA?

The Contracting Officer has determined that the Service Contract Act (SCA) applies to the T-5 contracts, therefore the Government has included the applicable SCA clauses in the solicitation.

585 J. List of Attachments and Exhibits

J-10 High-value KSAs The draft TOM Ch 7, Sec 5, para 4.8.4. indicates that "Referrals for high-value KSAs must be accepted by the DCS…." Subsection 4.7.1.3. indicates that the Government will assign a KSA value from 1 (low) to 10 (highest). The information included in Attachment J-10 presents KSA scores ranging from 76 to 430. Can DHA please clarify KSA scores and identify which procedures are deemed high value?

The procedures and KSA scores in J-10 are specifically for the Award Fee and are not part of the referenced KSA values identified in TOM Ch 7, Section 5, which speaks to the overall referral process. Per TOM Ch 7, Section 5, para 4.8.4., these KSA ratings will be provided by the local Market Director/MTF Director.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

586 J. List of Attachments and Exhibits

J-12a Award Fee Is the requirement for the MCSC to submit full HEDIS scores to NCQA for publishing or to have an NCQA auditor certify our measures only?

HEDIS data submitted to the Government shall be certified. The contractor may choose to use a vendor for this purpose. The Government does not require data to be published by NCQA.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

587 J. List of Attachments and Exhibits

J-8 Clinical Quality Metrics

The measure "30-day all cause risk standardized mortality rate following Percutaneous Coronary Intervention (PCI) for patients with ST segment elevation myocardial infarction (STEMI) or cardiogenic shock" is listed on Attachment J-8 with a measure steward of American College of Cardiology, CQMC, NQF 0535. As written, this measure is NQF 0536. The measure steward for both 0535 and 0536 is the American College of Cardiology's (ACC) NCDR CathPCI voluntary data registry and neither are publicly reported measures. As a voluntary registry, not all hospitals performing PCIs participate in the registry so a score for these measures is not available for all hospitals, and for those that do participate, approximately 15% are ineligible to be included in the measures because they do not submit patient identifiers in their data. In addition, the mortality data used to calculate the scores for these measures are 30 months old when received by ACC. Since the data reported will not be timely or an accurate and complete reflection of hospital performance for all hospitals in the MCSC's network performing PCIs, would the Government consider removing this measure and its corresonding performance target?

Measures 0535 and 0536 are similar measures. Both are NQF endorsed, and both are measures in the CQMC Cardiovascular Core Measures set.

Twelve states currently report PCI outcomes, but there is no current national effort to publicly report PCI mortality. This measure is calculated by the ACC by linking the voluntary CathPCI registry data with CDC National Death Index (NDI) data and applying risk adjustment methodology. The CDC NDI data is only released on a yearly basis, approximately 18 months after death. The ACC reports challenges with these measures including "calculating 30 Day mortality for December of the calendar year requires waiting for an extra 12 months (30 months total) in order to get death certificates for January of the following year." The ACC also reports that approximately 15% of hospitals participating in the registry do not include patient identifiers in their data, so they are ineligible for NDI matching and cannot be

The Government will be tracking this measure in the DC system and is therefore maintaining the measure requirement for "30-day all cause risk standardized mortality rate following Percutaneous Coronary Intervention (PCI) for patients with ST segment elevation myocardial infarction (STEMI) or cardiogenic shock" along with the corresponding performance target. However, the Government will add "as available" for reporting. Please note that the Government is considering adding this measure to the Award Fee in coming option years to improve care choices for beneficiaries.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

588 J. List of Attachments and Exhibits

J-8 Clinical Quality Metrics

The measure, "Therapy with aspirin, P2Y12 inhibitor, and statin at discharge following PCI in eligible patients" is a measure endorsed by NQF, but the measure steward is the American College of Cardiology's NCDR CathPCI data registry, a voluntary registry. As a voluntary registry, it only includes data from hospitals choosing to participate. The participating hospitals also have control over whether or not this data is visible to the public. Since the data reported will only include performance of those hospitals choosing to participate in the registry and have their data visible. This will not be an accurate reflection of the performance all MCSC network facilities performing PCIs, would the Government consider removing this measure and its corresponding performance target?

Currently, this measure is publicly reported on the American College of Cardiology's website, but the data only includes hospitals that participate in the registry and of those, only hospitals that voluntarily agree to publicly display their data.

While CMS has added this measure to the Alternate Quality Measures Set for their BPCI Advanced Model voluntary bundled payment methodology, participants in this payment methodology have the option to use the Administrative Quality Measures Set instead. Those facilities choosing to use the Alternate Quality Masures Set will submit data calcuated by ACC.

The Government will be tracking this measure in the DC system and is therefore maintaining the measure requirement for "Therapy with aspirin, P2Y12 inhibitor, and statin at discharge following PCI in eligible patients" along with the corresponding performance target. However, the Government will add "as available" for reporting. Please note that the Government is considering adding this measure to the Award Fee in coming option years to improve care choices for beneficiaries.

589 Acquisition L.4. Proposal Preparation

L.4.1 Proposal Submission

The RFP was revised to require a drop-off code be requested on 31 July 2021. This is a Saturday. Will DHA please confirm that this is the intended date?

Yes this is correct. Requests may be submitted sooner.

590 L.4. Proposal Preparation

L.4.3 System Security Plan

Amendment 0001 of the final RFP added a note regarding page limitations that stated, "The System Security Plan does not count toward the Written Technical Proposal page limitation." However, the System Security Plan is not listed on the chart of proposal volume contents in the introduction to L.4. Is it the Government's intent for the offeror to include its System Security Plan as an attachment to Volume

II?

The System Security Plan should be included by the offeror as an attachment to Volume II.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

591 Acquisition L.5. Volume I, Executed Proposal

Attachment L-5e Price Evaluation Template, East Region

In Attachment L-5e, Price Evaluation Template East Region - Amendment 0001, the Transition-In CLIN 0001 Grand Total Price is not included in "Total Option/Contract, without Transition-Out" row. Is this an error?

Thank you for identifying the issue. The Government has corrected the issue with the L-5 attachment in amendment 0003.

592 L.6. Volume II, Technical Proposal

L.6.2.2.1 TRICARE Select Recapture to MTFs

As the MCSCs work to identify TRICARE Select beneficiaries for recapture to the MTFs for speciality care, will the MTFs increase their capacity to handle the increased call volume from the Select beneficiaries and MCSC staff?

Yes; the MTF will assess whether they have the capability and capacity to address Select demand. If they do, they will document this in the capability and capacity tables, which will be updated at least monthly. In addition, MTFs will have the ability to assess/score the referral for KSA-value; even if there is no excess capacity in a given month, the MTF will have established processes for the Product Line Leader to approve the inbound referral and create additional capacity.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

593 Acquisition L.8. Volume IV, Price/Cost Organization/Ins tructions

Attachments L-5e and L-5w

Price Evaluation Templates, East and West Regions

In Amendment 0001, following the Underwritten Healthcare Costs by Option Period by Region table containing Government Provided Plug-In Figures, Section L.8.17 states, "*For CLINs 1001-8001, these figures represent the Government’s baseline estimate for underwritten healthcare prior to the application of Offeror proposed network discounts." Within both L-5e, Price Evaluation Template East Region Amendment 0001 and L-5w, Price Evaluation Template West Region Amendment 0001, the respective "Healthcare Cost & Discount" tabs include figures which do not match to the Government Provided Plug-In Figures for underwritten healthcare costs prior to the application of proposed network discounts, but instead match the calculation for underwritten healthcare costs post network discount. Will the Government please provide clarification?

Thank you, this oversight was corrected and published under Amendment 0002.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

594 Acquisition L.8. Volume IV, Price/Cost Organization/Ins tructions

L.8 Service Contract Act

Over the life of the T-5 contract, how will DHA ensure that it is evaluating the PMPM fixed-price CLINs on an equal basis to permit a meaningful comparison of PMPM pricing and the effectiveness of offerors’ proposed technical approaches to provide administrative services?

The RFP includes the Price Adjustment clause for the Service Contract Act (SCA) at FAR 52.222-43, Fair Labor Standards Act and Service Contract Labor Standards—Price Adjustment (Multiple Year and Option Contracts). See RFP, §§ H.15.5, L.8. Under this clause, offerors may propose labor rates in line with the currently applicable SCA wage determinations for the life of the contract, without any escalation. These offerors can later seek a price adjustment to recover actual costs incurred to comply with a revised SCA wage determination that results in increased labor costs. As a result, even though the required labor rates and the corresponding PMPM prices will inevitably increase over the life of the T-5 contract (and result in increased cost to the Government), those escalated labor costs will not be reflected in these offerors’ proposed prices.

On the other hand, to ensure the hiring and retention of qualified SCA-covered personnel, other offerors may propose compensation that exceeds the current minimum rates required by the applicable SCA wage determinations and may propose escalation of labor rates for the option years of the contract because those offerors cannot seek a

The Contracting Officer has determined that the Service Contract Act (SCA) applies to the T-5 contracts, therefore the Government has included the applicable SCA clauses in the solicitation. SCA clauses only allow awardees to recover differences between DoL Wage Determinations and originally proposed SCA covered rates, and differences between fringe benefits for those SCA covered employees.

This represents a very small portion of an offeror's proposed PMPM, therefore the Government considers its evaluation of PMPM to be a meaningful evaluation.

595 L.8. Volume IV, Price/Cost Organization/Ins tructions

L.8.18 Network Discount Guarantee

We understand DHA is likely to continue the practice of reducing reimbursement for certain medical services throughout the T-5 contract as it has done historically. The T- 5 RFP indicates MCSCs will be expected to deliver a network discount guarantee even if/as DHA reduces reimbursement for discounted services, which presents a significant challenge to MCSCs in achieving the discount guarantee.

Because the penalty/disincentive to MCSCs for not delivering the network discount guarantee can be significant, would the Government please provide more guidance, detail or data on reimbursement reduction practices?

Reimbursement changes initiated by DHA, including evolving practices, are subject to the contract changes clause as referenced by paragraph H.6. Changes affecting network discount guarantees may be addressed during the change negotiations.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

596 Acquisition L.8. Volume IV, Price/Cost Organization/Ins tructions

L.8.23 MTF/Guard/Reserv e/ MSO/VSO Briefings CLINs X005

Section L.8.23 of Amendment 0001 to the T-5 RFP states, "For Total Evaluated Price and proposal purposes, the Offeror shall use the estimated amount of $100,000. A ceiling amount of $200,000 has been established by the Government. The Offeror shall not propose different costs for X005 CLINs." How did the DHA determine the estimated amount of $100,000 with a ceiling amount of $200,000?

The Government's internal estimating methodology will not be released.

597 Acquisition L.8. Volume IV, Price/Cost Organization/Ins tructions

L.8.23 MTF/Guard/Reserv e/ MSO/VSO Briefings CLINs X005

Based upon previous experience conducting TRICARE Program Briefings, we believe the estimated annual amount of $100,000 and the established ceiling of $200,000 annually is inadequate to meet this requirement. Due to the number of Briefings required, the geographical distributions, and the scheduling restrictions of such Briefings, the resources required to fulfill this requirement are significant. Can the DHA increase the ceiling to more accurately represent the amount of resources required?

CLIN X005 figures are derived by Government known estimates. Since this is a cost reimburseable CLIN, the Government has the opportunity to address ceiling adjustments via contract modification during performance.

598 Acquisition L.8. Volume IV, Price/Cost Organization/Ins tructions

L.8.23 MTF/Guard/Reserv e/ MSO/VSO Briefings CLINs X005

Based upon previous experience conducting TRICARE Program Briefings, the costs associated with performing this requirement are not solely limited to the time an associate presents information. Additional costs include, but are not limited to: preparation time to tailor approved Briefing materials to audience, the costs of materials, the travel time and travel expenses of the associate necessary to attend the Briefing, post-presentation Q&A sessions, and other miscellaneous expenses. Does the DHA agree that all aforementioned costs associated with requirements are chargeable to CLIN X005?

CLIN X005 figures are derived by Government known estimates. Since this is a cost reimburseable CLIN, the Government has the opportunity to address ceiling adjustments via contract modification during performance.

599 Acquisition L.8. Volume IV, Price/Cost Organization/Ins tructions

L.8.23 MTF/Guard/Reserv e/ MSO/VSO Briefings CLINs X005

Once the annual CLIN X005 cap of $200,000 is met, does the DHA intend to cease Briefings until the subsequent Option Period?

CLIN X005 figures are derived by Government known estimates. Since this is a cost reimburseable CLIN, the Government has the opportunity to address ceiling adjustments via contract modification during performance.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

600 Acquisition L.8. Volume IV, Price/Cost Organization/Ins tructions

L.8.27 Execessive Pass-through Charges

Amendment 0001 to the T-5 RFP Section L.8.27 states, "Identification of Subcontractor Effort, per FAR 52.215-22, for this solicitation, this requirement applies to the total cost of work performed for all of the following CLINs: X007 SATs, X005 MTF/Guard/Reserve/MSO/VSO Briefings." This FAR clause is not identified within Section I Contract Clauses;

however, Section I Contract Clauses includes FAR 52.215-23.

We believe there is a disconnect between these two sections of Amendment 0001. Will the Government please clarify which FAR clause is applicable?

Yes, FAR 52.215-22 will be included in Section I under issuance of Amendment 0003.

601 TRICARE

Operations Manual (TOM)

TOM Ch 1, Sec 3 TEDs Processing In response to Question #142 on draft RFP2, the Government has stated that standards for TRICARE Encounter Data (TED) records with regard to submission and resubmission timeliness and accuracy were intentionally omitted from the T-5 RFP. Without metrics, contractors will not have any incentive to be timely with the submission of TEDs or the resubmission of failed records. Does the Government intend not to apply any contractual standards with regards to TEDs in the T-5 contract or will they be added in a later amendment?

The Government does not intend to apply any contractual standards with regards to TEDs timeliness in the T-5 contract.

602 TRICARE

Operations Manual (TOM)

TOM Ch 1, Sec 3, para 5.2

TRICARE Processing Standards

The draft TOM states, "The contractor shall issue a referral authorization or denial following the date of receipt of a request for a referral on at least:

• Ninety percent (90%) of all requests within 24 hours

• One hundred percent (100%) of all requests within two business days" Does DHA expect routine referrals received on Friday to be processed on Saturday? Or should the 24 hours process start on the next business day, which would be Monday?

Yes. TOM Chapter 1, Sect 3, Paragraph 5.2.1 was updated in Amendment 0002 to reflect one business day.

603 TRICARE

Operations Manual (TOM)

TOM Ch 11, Sec 6, para 8.0

Branding The draft TOM prohibits the MCSC from using its own branding, logos, or marks on materials sent to TRICARE beneficiaries and providers. Will DHA require the same branding standards to be applied to third-party vendors' applications such as claims vendors, sites and materials?

Yes. TOM Chapter 11, Section 6 paragraphs 7.2 and 8.0 also apply to subcontractors.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

604 TRICARE

Operations Manual (TOM)

TOM Ch 2, Sec 4, para 1.5

Transition-in Enrollment

The draft TOM Ch 2, Sec 4, para 1.5 states, "The incoming contractor shall begin processing new enrollments at the start of the open enrollment period in accordance with Chapter 6." However, TOM Ch 2, Sec 4, para 3.2 later states, "The outgoing contractor shall continue to process enrollments in accordance with Chapter 6 until the incoming contractor's SHCD." Which contractor is ultimately responsible for the enrollment period requirements under TOM Chapter 6 during transition?

The contractor is responsible for all enrollment actions that are effective within their contract. The outgoing contractor remains responsible for enrollments that are effective in their contract period; the incoming contractor is responsible for managing enrollments within their contract period. With a SHCD of January 1, the incoming contractor will perform all enrollment actions that are effective January 1 and beyond. The Outgoing contractor remains responsible for enrollments with effective dates prior to the SHCD. Until the SHCD has been reached, the incoming contractor cannot change an enrollment that is effective prior to the start of their contract. On and after the SHCD, the outgoing contractor can no longer perform/change enrollments, as their contract has ended, and all enrollments (including retroactive changes) are managed by the new contractor. The overlapping time frames are referred to as "Dual Processing".

605 TRICARE

Operations Manual (TOM)

TOM Ch 2, Sec 7, para 1.5

Critical Processes (CPs) - Referral Management

The draft TOM states, "The incoming contractor shall phase in referral processing as follows:

• Day 1 of health care delivery (HCD) - The contractor shall process Active Duty Service Member (ADSM) and TRICARE Prime Remote (TPR) ADSM and Active Duty Family Member (ADFM) referrals only.

• Day 31 of HCD - The contractor shall include in its referral processing TRICARE Prime beneficiaries enrolled to MTF Primary Care Managers (PCMs).

• Day 61 of HCD - The contractor shall include in its referral processing TRICARE Prime beneficiaries enrolled to a network PCM.

•Day 91 of HCD - The contractor shall include any other beneficiary category that requires a referral. " Is the MCSC required to process referrals received from MTF and civilian providers for beneficiary categories not identified during the phase-in approach?

Assumption is that even if processed, the MCSC will only be accountable for time standards for those categories mentioned here.

The intent of the waiver is to start with fewer referrals/authorizations required to process and gradually increase to allow the contractor time to work out any system issues while minimizing impact on the beneficiaries. 2. With a waiver in place, the contractor may choose to process or ignore the referral that are not identified in the phase in approach. 3. The only accountable time standards are for those catergories being processed.

606 TRICARE

Operations Manual (TOM)

TOM Ch 7, Sec 5, para 4.3

Referral Appointing The draft TOM Chapter 7, Section 5, paragraph 4.3.1.

describes collaboration between the IRMACs/RACs and the MCSC to facilitate referrals from the Direct Care System (DCS) to the network. Paragraph 4.3.2. states, "…The contractor shall send the DCS enrolled beneficiary a message...and instruct them to contact the IRMAC/RAC to schedule an appointment." Please clarify the intent and inter-relationship of these two requirements. Will the IRMAC/RAC have a role in scheduling appointments with network providers for DCS-enrolled beneficiaries?

Current plans are for the IRMAC/RAC to assist the beneficiary with making appointments in the network and to ensure the patient does make an appointment. Currently, 34% do not, which is concerning from a clinical perspective. DHA intends to close this loop. A pilot is currently underway to inform this new capability. While the contractor may make the approved authorization information available to the patient in its portal, we want the patient enrolled to the DCS to know there is "one number' to call for appointments.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

607 TRICARE

Systems Manual

(TSM)

TSM Ch 2, Sec 1.2, para 1.1.1

NPI Requirements The current T2017 contract requires the MCSC to send TRICARE Encounter Provider Records (TEPRVs) for every provider to use in processing a claim. The TEPRV has to be on the DHA database, and there is editing surrounding this process. The T-5 draft TSM indicates that DHA will now use the National Provider Identifier (NPI) for provider records and that TEPRVs will only be submitted for providers without an NPI. When will DHA provide the parameters and specifics around this new process and potential format for this change to match on NPI? Also, will there be additional editing around the new NPI requirement to change TRICARE Encounter Data (TED) provider edits?

TSM Chap 2, Sec 1.2, Para 1.1.1 will be removed in Amendment 002. No change from past requirements.

608 C.2.3. Medical Management

C.2.3.4 Accreditation Section C.2.3.4 was updated for the final RFP draft, with the removal of following program “population health” and replaced the “disease management” program.

At this time, both Section H.16.1.7.8 and the R30 CDRL continue to require the “population health” program accreditations. Can you please confirm that the updated Section C, which calls for “disease management” accreditation is the required program accreditation to be held by the contractor?

Yes, Disease Management is the proper program accreditation. The Government will correct this reference in Section H in Amendment 0003 and R030 CDRL was corrected in Amendment 0002.

609 C.2.4. Case Management

C.2.4.3 In Home Case Management

The RFP states, “Contractors are to offer in-home CM services to beneficiaries who have a high-need for care and are at high-risk of re-admission for 30 calendar days following discharge from an inpatient setting.”

In remote “white space” areas, certified case managers (CM) are prohibitively expensive. High quality in-home post-discharge care can be achieved by paring a Registered Nurse (RN) providing the in-home service with a remote CM providing oversight. The cost of care coordination would be

No, the Government will not amend the requirement to allow pairing of an RN with a remote CM.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

610 Exhibit A.

Contract Data Requirements List

M0202 Directory Audit In CDRL M0202, does the deliverable mean 400 records per PSA every month or does it mean we need to identify the PSAs captured in the 400.

Please confirm.

Government has not set a minimum or maximum of 400 records to audit.

Per the CDRL Contractor will submit a monthly report reporting the results of an audit of provider data located in the provider directory. The monthly audit shall report the accuracy of no less than 10 providers per Prime Service Area (PSA) and at least 1% annually for large PSAs (more than 12,000 providers in the network). The annual 1% audit for large PSAs will be distributed evenly over the 12 month period. The audit shall report the accuracy of the following six elements: provider name, provider specialty, provider sub-specialty, provider place of practice address, provider fax number and provider appointment telephone number. A record will be counted as accurate only if all six elements of that record are accurate.

This report will have three parts:

1. Geographic area of responsibility summary that shows the overall percentage, the total numbers of the records audited and the total number ofeach type of error.

2. A PSA summary displaying the number of records audited and percentage ofaccuracy for each PSA.

3. A 12 month summary showing the geographic area of responsibility percentage over the last 12 months.

611 Exhibit A.

Contract Data Requirements List

R240 Clinical Quality Data Performance Improvement Strategies

Please clarify if this refers to HEDIS, CQM data Dashboard, or VVN data.

Should we anticipate reports of progress of performance on a monthly, quarterly, or ad hoc basis that would be in addition to the six month and one year intervals after strategy implementation?

All data with lagging trends are subject to performance improvement strategies. Progress reports are only required at six months and one year after strategy implementation unless government requests additional progress reports on PRN basis and anticipated to be infrequent to rare occurrences.

612 H.2. Award Fee H.2 Award Fee Will the Award Fee Quality Methodology include Select beneficiaries? The Quality reporting includes both Prime and Select, but they can be separated. There is a high level of OHI particularly in the Select population and care that was performed may not be paid by us and, therefore, will not be in claims data. We recommend that the Award Fee for Quality be based on Network Enrolled Prime without OHI.

All beneficiaries will be included in reporting for the Quality Incentive metrics.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

613 J.2. Large Market MTF- West Region

J.2, J.4, J.6 PSAs T2017 P00002 Section (J-2) includes the following 8 USCG PSAs, which are not included in T-5 RFP Attachment J-2, J-2a, J-4, or J-6.

1. 0418 - USection Coast Guard Clinic-Alameda

2. 0419 - USection Coast Guard Clinic-Petaluma

3. 0431 - USection Coast Guard Clinic-Astoria

4. 0434 - USection Coast Guard Clinic-Port Angeles

5. 0435 - USection Coast Guard Clinic-Seattle

6. 7045 - USection Coast Guard Clinic-North Bend

7. 7046 - USection Coast Guard Clinic-San Pedro

8. 7083 - USection Coast Guard Clinic-Humboldt Bay Was this removal intentional?

US Coast Guard unit areas are PSAs but they are not DHA Market areas because they are not DHA units.

614 Acquisition L.4. Proposal Preparation

L.4.3 System Security Plan

Amendment 0001 added the following note: "5. The System Security Plan does not count toward the Written Technical Proposal page limitation."

However, the requirement to provide the System Security Plan (SSP) with the proposal was deleted in the Final RFP.

The SSP is a contract deliverable. This offeror assumes that adding this note was a mistake, and that an SSP is not required for the proposal.

Is this assumption correct? Please confirm

Thank you. Section L.4.3. has been updated under Amendment 0003 to remove the footnote referencing the SSP as it is in fact no longer required for the proposal.

615 M.7. Evaluation of Technical/Mana gement SubFactors

L.6.2.2.6, M.7.2.2.6, C.2.3.3.1, C.2.12.5.1.

Real-time, beneficiary-centric data warehouse

Requirements in Sections C.2.3.3.1 and C.2.12.5.1 state real time access to a near time system (refresh on beneficiary, institutional, and non-institutional data no less frequently than once every 24 hours). However, Sections L.6.2.2.6 and M.7.2.2.6 mention a “real time, beneficiary centric data warehouse.”

Is the requirement for real time access to the systems and data, or to maintain a real time database? The evaluation criteria are in conflict.

The Government expectation is both; access to the data and information in the system are to be as real time as possible. Some data entry information will be entered/updated immediately upon entry, while other information from other feeds will have to be refreshed.

616 OTHER L-9w Total Network Build West

Wisconsin Network Build

The T-5 RFP Attachment L-9w - Total Network Build West does not include the state of Wisconsin (WI).

Should we include columns for the WI Current Network and WI Network Build Required?

Thank you. L.9w was updated to include Wisconsin under Amendment 0002.

617 TRICARE

Operations Manual (TOM)

Chapter 18, Section 6

P-BMP Currently hospitals eligible for incentive payments for maternity care under P-BMP may receive up to 2% incentive over their total labor and delivery billing, and up to 3% for High Risk delivery billing even if they are contracted at 100% of CMAC.

Under the T-5 contract, will facilities eligible for incentives under P-BMP be required to have a discount in place in order to receive P-BMP incentive payments so as to not exceed what would have been paid under CMAC?

The P-BMP Pilot is in its final year and is expected to be concluded by January, 2022.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

618 TRICARE

Operations Manual (TOM)

Chapter 7, Section 6, Para 2.2

Please clarify which clinical Quality metrics mentioned in TOM Chapter 7, Section 6, Para 2.2 regarding network providers will be due in OP1 for T-5.

• National Perinatal Information Center (NPIC) (as available)

• National Surgical Quality Improvement Program (NSQIP) (As available: NSQIP is not available to Managed Care Providers)

• The Joint Commission ORYX (as available)

• Leapfrog® Hospital Safety Grades (as available)

• Leapfrog® Hospital Survey (as available)

• Healthcare Effectiveness Data and Information Set (HEDIS)

• Consumer Assessment of Healthcare Providers and Systems (CAHPS)

• Centers for Medicare and Medicaid Services (CMS) Care Compare

All CQM metrics listed in TOM, Chapter 7 Section 6 and attachment J-8 are to be reported upon at times specified within each of the CQM CDRLs. The CQM metrics specifically mentioned in TOM Chapter 7, Section 6, Para 2.2 are to be applied to the network steerage model and the MCSC is to describe their processes for seeking providers who produce high quality clinical outcomes per CDRL P030 (CQM Annual Plan).

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

619 TRICARE

Operations Manual (TOM)

Chapter 7, Section 6, Para 2.2

CAHPS TOM Chapter 7, Section 6, Para 2.2 mentions CAHP Section survey for the network provider steerage model. CHAP Section is a facility-level survey and is not statistically significant at the provider level for a steerage model. Will CAHP Section replace HCSDB for purchased care facilities? Or will both CAHP Section and HCSDB be expected to be used in the facility steerage model?

The Government will amend the manuals and remove CAHPS from TOM Chapter 7, Section 6, Para 2.2. This revision will be published under Amendment 0003.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

620 TRICARE

Operations Manual (TOM)

Chapter 7, Section 6, Para 3.0

CDRL Q280 The Q280 CQM Data Dashboard requires that data is available and displayed for individual network provider and facilities, by diagnosis and by Market/MTF.

Will there be any exclusion for low-volume providers where the results could be highly misleading due to low lower?

Will data be presented for PCMs only, as subset of specialties, or all provider specialties?

When multiple providers are engaged in the same care for the same beneficiary (e.g., HbA1C when the patient is seen by a PCM and an endocrinologist), how will the metric be attributed or will it count for both providers in this case?

No, there will not be exclusions for low-volume providers, please submit numerator and denominators in addition to rates.

All provider (primary and specialty care) data shall be considered for the dashboard, as applicable to individual measures.

When multiple providers are engaged in the same care for the same beneficiary, submit data for the provider who ordered tests (such as with the HbA1c test example). If the PCM ordered the test vs. the endocrinologist, please attribute the credit to the prescribing provider.

621 TRICARE

Operations Manual (TOM)

Chapter 7, Section 6, Para 3.0

CDRL Q280 Are the J-8 Quality Metrics in CDRL Q280 Metrics for OP1 of the Q280 Quality Management Dashboard?

If not, can the metrics be provided so the dashboard can be designed and priced?

There is no J-8 metric specifically addressing value.

Will DHA provide any metrics to be used for reporting health care value?

Data dashboard metrics for OP1 are provided in attachment J-11. Data may periodically change as per notations in data CDRLs. "The government reserves the right to make changes to the quality and value measures as is deemed necessary to remain aligned with current healthcare trends, and support the current requirements of the MHS."

622 TRICARE

Operations Manual (TOM)

Chapter 7, Section 6, Para 3.0

CDRL Q280 Regarding CDRL Q280, is the intent of the search functionality down to individual provider and facility level referring to Primary Care Providers alone, or are specialty providers expected to be included in HEDIS Section measures?

The intent is for reporting to the individual practitioner level including all primary and specialty care providers.

623 TRICARE

Reimbursement Manual (TRM)

Chapter 18, Section 1

APMs / Risk Sharing

TRM Chapter 18, Section 1 does not address any opportunity for MCSC risk sharing or shared savings.

Please address specifically whether an MCSC can potentially be allowed to bear some level of upside and downside risk for the health care spend in a shared savings arrangement.

The offeror may propose tools, techniques and processes to benchmark cost and achieve cost savings from APMs that are cost neutral to the government.

Revised Draft and Final RFP Questions and Government Responses

Question Number

Team Reference Contract/Manual Location

Subsection Question Rationale Government Response

624 TRICARE

Reimbursement Manual (TRM)

Chapter 18, Section 1

APMs / Risk Sharing

TRM Chapter 18, Section 1 indicates that when measuring the percent of network expenditures covered by the APMs the Contactor will receive credit for APMs whether they were initiated by the contractor or the Government.

Please confirm that facilities eligible for P-BMP, Hospital Value-Based Purchasing, and Home Health Value Based Purchasing would be considered to be participating in HCPLAN Category 2 APMs.

For the APM requirement are such providers consider to be in an APM model whether or not they successfully earn an incentive?

Yes, Hospital Value-Based Purchasing, and Home Health Value Based Purchasing would be considered to be participating in HCPLAN Category 2 APMs given that the intent of these programs is to improve quality and reduce costs (value). Yes, if the provider is enrolled to an APM they are considered an APM even if they do not earn an incentive or receive a negative incentive.

625 TRICARE

Reimbursement Manual (TRM)

Chapter 18, Section 1, Para 4.3.3

APMs / Risk Sharing

Per Chaper 18, Section 1, Para 4.3.3, fully capitated APM payments are excluded from the network discount guarantee described in Section H of the contract.

Do bundled payments for episodes of care count as fully capitated APM payments that are excluded from the discount guarantee?

Bundled payments for episodes are not a fully-capitated APM and claims for such episodes will be included when administering the discount guarantee, subject to the other Section H criteria regarding the discount guarantee.

626 TRICARE

Reimbursement Manual (TRM)

Chapter 3, Section 2, Para 5.0

CDRL A260 T-5 TRM Chapter 3, Section 2, Para 5.0 cited that the contractor shall submit a list of high-volume inpatient mental health providers and TRICARE-approved RTCs with the participation agreement status each fiscal year.