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Section C_7.1.1 DMDC TASS Application.xlsx XLSX spreadsheet
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Section L Exhibit L-12 Solicitation Cross-Reference Table (Sections L M and C) v1.docx DOCX document
Attachment J-23 - QSRS Software Installation and Update Process.docx DOCX document
Section L Exhibit L-1 Sample Client Authorization Letter v1.docx DOCX document
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HT940222R0002

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

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

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

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

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 208

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

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)(Hour) local timeuntildepository located in 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

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

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

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

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

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

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

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ______________ calendar days (60 calendar days unless a different period is inserted

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

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

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

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

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

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

06/21/2022 X

HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011

1700 MS 08/15/2022

Kristin Moore 303 kristin.m.moore13.civ@mail.mil

676-3905

X

X

X

X

X

X

X

X

X

X

X

X

X

PAGE(S)

Kristin Moore

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

2-44 C1-C72 D1 E1 F1-F4 G1-G7 H1-H13

I1-I18

J1

K1-K13

L1-L23

M1-M10

303-676-3905 kristin.m.moore13.civ@mail.mil

NAME OF OFFEROR OR CONTRACTOR

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

TRICARE Quality Monitoring Contract (TQMC)

Solicitation

Delivery Location Code: HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011-9066 USA

Base Period

0001 Transition-in (PWS Section 1, paragraph 1.6.1.1) 1 LO

0002 Deliverables (DD Forms 1423-1, Contract Data

Requirements List (CDRLS))

Not separately priced (NSP)

(Not Separately Priced)

Option Period 1

1001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

(Option Line Item)

1001AA Annual NCQA HEDIS® Validation Audit (PWS Section 1 EA

5 paragraph 5.3.1)

FFP

(Option Line Item)

1001AB HEDIS Consultation and Education (PWS Section 5 24 HR paragraph 5.3.1.3)

FFP

(Option Line Item)

1002 National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

(Option Line Item)

1002AA National Hospital Quality Measures Data 192 EA

Continued ...

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

1002AB 1 EA

1003AA

120 EA

1003AB

95000 EA

1003AC

2000 EA

1004AA

Collection Tools and Data Management (MTF with

Essentris) (PWS Section 5 paragraph 5.3.2)

FFP per Inpatient MTF per quarter

(Option Line Item)

National Hospital Quality Measures data file for submission to CMS (PWS Section 5 paragraph 5.3.2.1.4)

FFP

(Option Line Item)

Joint Commission ORYX® Hospital Quality Measures

(PWS Section 5 Paragraph 5.3.3)

(Option Line Item)

Joint Commission ORYX® Data Collection Tools, Data Management and Data File Submission (For

MTFs with Essentris) (PWS Section 5 paragraph

5.3.3.2-5.3.3.7) FFP per MTF per quarterly submission.

(Option Line Item)

Joint Commission ORYX Hospital Quality

Measures (Direct Care) Chart Abstraction

(PWS Section 5 paragraph 5.3.3.1) Fixed price per chart. (Option Line Item)

Clinical Quality Measurement Result Accuracy

Validation (PWS Section 5 paragraph 5.3.4)

Fixed price per chart.

(Option Line Item)

Leapfrog Program Support (PWS PWS Section 5, paragraph 5.3.5)

(Option Line Item)

Leapfrog Value-Based Purchasing Program Data &

Reports package for Health Plans (PWS Section 5 paragraph 5.3.5.1)

FFP

(Option Line Item)

1 EA

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

1004AB Leapfrog Communications (PWS Section 5 paragraph 5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

1 EA

1004AC Leapfrog Education Series Attendance (PWS

Section 5 paragraph 5.3.5) FFP

(Option Line Item)

6 EA

1004AD Leapfrog Annual Meeting (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.2.2)

FFP

(Option Line Item)

1004AE MHS Leapfrog Survey and Safety Grade 12 MO

Participation Value-Based Purchasing Program Data

& Reports package for Health Plans analysis (PWS

Section 5 paragraphs 5.3.5.2 & 5.3.5.3)

FFP

(Option Line Item)

1004AF MHS Leapfrog Survey and Safety Grade 12 MO

Participation Training, Email Box and Frequently

Asked Question Support (PWS Section 5 paragraph

5.3.5.5.2)

FFP

(Option Line Item)

1005 Institute for Healthcare Improvement (IHI) Global 11000 EA

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

(Option Line Item)

1006 QSRS Data Abstraction (PWS Section 5 paragraph 6000 EA

5.3.6.2.1.2)

FFP

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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PAGE OF

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

1007 Behavioral Health Facility Initial Fees 55 EA

Calculations (PWS Section 5 paragraph 5.4) Fixed price per application.

(Option Line Item)

1008 Quality and Utilization Reviews (PWS Section C 6500 EA paragraph 5.5.2.10) Fixed price per chart.

(Option Line Item)

1009 Medical Necessity Reconsideration Reviews (Second 150 EA

Level Appeals) (PWS Section 5 paragraph 5.5.3.1)

Fixed price per review.

(Option Line Item)

1010 Appeals & Hearings Internal and External Reviews and Hearing Support (PWS Section 5 Paragraph

5.5.4)

(Option Line Item)

1010AA Appeals & Hearings Internal Reviews (PWS Section 5 2 EA paragraph 5.5.4.1 and PWS Section J, Attachment J-4)

Fixed price per internal review.

(Option Line Item)

1010AB Appeals & Hearings Routine External Reviews (PWS 75 EA

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per routine external review.

(Option Line Item)

1010AC Appeals & Hearings Urgent External Reviews (PWS 5 EA

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per urgent external review

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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PAGE OF

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

1010AD Pre-Hearing Preparations (PWS Section 5 paragraph

5.5.4.2)

10 HR

FFP

(Option Line Item)

1010AE Hearing Appearance (PWS Section 5 paragraph 5.5.4.1) 10 HR

FFP

(Option Line Item)

1010AF Post Hearing (PWS Section 5 paragraph 5.5.4.2) 10 HR

FFP

(Option Line Item)

1010AG Transcription (PWS Section 5 paragraph 5.5.4.2) 10 HR

FFP

(Option Line Item)

1011 Standard of Care (SOC) Reviews (PWS Section 5 700 EA paragraph 5.5.5.1) Fixed price per review.

(Option Line Item)

1012 Quality of Care (QOC) Reviews (PWS Section 5 5 EA paragraph 5.5.2.2.1) (Direct and Purchased

Care): Fixed price per QOC review.

(Option Line Item)

1013 Clinical Quality Improvement Studies (PWS Section

5 paragraph 5.6.1)

(Option Line Item)

1013AA Clinical Quality Improvement Study Methodology 240 HR

Development, Approval and Study Report (PWS

Section 5 paragraph 5.6.1) FFP

(Option Line Item)

1013AB Clinical Quality Improvement Administrative

Study Data Collection and Analysis (PWS Section

160 HR

Continued…

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

5 paragraph 5.6.1). Fixed price per hour.

(Option Line Item)

1013AC Clinical Quality Improvement Abstraction Study 2000 EA

(Fewer than 2,000 Records) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

(Option Line Item)

1013AD Clinical Quality Improvement Chart Abstraction 4000 EA

Study (2000 or more charts) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

(Option Line Item)

1014 Annual Autism Care Demonstration (ACD) Study (PWS 2000 EA

Section 5 paragraph 5.6.2.2.8.1) Fixed price per chart.

(Option Line Item)

1015 Long Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment

1016 Short Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

1017 Webinar (PWS Section 5 paragraph 5.8.1.1) FFP 12 EA

(Option Line Item)

1018 Meeting Support (PWS Section 5 Paragraph 5.8.2)

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

1018AA Meeting Support (PWS Section 5 paragraph 5.8.2.1) 12 MO

FFP

(Option Line Item)

1018AB Meeting Support Annual MHS Clinical Quality 1 EA

Management conference (PWS Section 5 paragraph

5.8.2) FFP

(Option Line Item)

1019 Quality Communications (PWS Section 5 paragraph 5.8.2.1)

12 MO

FFP

(Option Line Item)

1020 Travel (PWS Section 1 paragraph 1.8.3; FAR Part 1 EA

31.2)

This CLIN establishes a cost-reimbursed (no fee) amount for travel. Not to exceed: $10,000

(Option Line Item)

1021 Deliverables (DD Forms 1423-1, Contract Data

Requirements List (CDRLS)) Not separately priced

(NSP)

(Option Line Item)

1022 Transition-out. (PWS Section 5 paragraph 5.2.2 1 LO and FAR 52.237-3) FFP.

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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PAGE OF

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

Option Period 2

2001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

(Option Line Item)

2001AA Annual NCQA HEDIS® Validation Audit (PWS Section 1 EA

5 paragraph 5.3.1)

2001AB 24 HR

2002AA 192 EA

2002AB 1 EA

FFP

(Option Line Item)

HEDIS Consultation and Education (PWS Section 5 paragraph 5.3.1.3)

FFP

(Option Line Item)

National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

National Hospital Quality Measures Data

Collection Tools and Data Management (MTF with

Essentris) (PWS Section 5 paragraph 5.3.2) FFP per Inpatient MTF per quarter.

(Option Line Item)

National Hospital Quality Measures data file for submission to CMS (PWS Section 5 paragraph 5.3.2.1.4)

FFP

(Option Line Item)

Joint Commission ORYX® Hospital Quality

Measures (PWS Section 5 Paragraph 5.3.3)

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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PAGE OF

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

2003AA Joint Commission ORYX® Data Collection Tools, Data Management and Data File Submission (For

MTFs with Essentris) (PWS Section 5 paragraph

5.3.3.2-5.3.3.7) FFP per MTF per quarterly submission.

(Option Line Item)

120 EA

2003AB Joint Commission ORYX Hospital Quality Measures

(Direct Care) Chart Abstraction (PWS Section 5 paragraph 5.3.3.1) Fixed price per chart.

(Option Line Item)

95000 EA

2003AC Clinical Quality Measurement Result Accuracy

Validation (PWS Section 5 paragraph 5.3.4)

Fixed price per chart.

(Option Line Item)

2000 EA

2004 Leapfrog Program Support (PWS Section 5, paragraph 5.3.5)

(Option Line Item)

2004AA Leapfrog Value-Based Purchasing Program Data &

Reports package for Health Plans (PWS Section 5 paragraph 5.3.5.1)

FFP

(Option Line Item)

1 EA

2004AB Leapfrog Communications (PWS Section 5 paragraph 5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

1 EA

2004AC Leapfrog Education Series Attendance (PWS

Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

6 EA

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

2004AD Leapfrog Annual Meeting (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.2.2)

FFP

(Option Line Item)

2004AE MHS Leapfrog Survey and Safety Grade 12 MO

Participation Value-Based Purchasing Program Data &

Reports package for Health Plans analysis (PWS Section

5 paragraph 5.3.5.2 & 5.3.5.3)

2004AF 12 MO

2005 11000 EA

2006 6000 EA

2007 55 EA

(Option Line Item)

MHS Leapfrog Survey and Safety Grade Participation

Training, Email Box and Frequently Ask Question

Support (PWS Section 5 paragraph 5.3.5.5.2)

FFP

(Option Line Item)

Institute for Healthcare Improvement (IHI) Global

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

(Option Line Item)

QSRS Data Abstraction (PWS Section 5 paragraph

5.3.6.2.1.2)

FFP

(Option Line Item)

Behavioral Health Facility Initial Fees

Calculations (PWS Section 5 paragraph 5.4) Fixed price per application.

(Option Line Item)

Quality and Utilization Reviews (PWS Section C paragraph 5.5.2.10) Fixed price per chart.

(Option Line Item)

2008 6500 EA

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

2009 150 EA

Medical Necessity Reconsideration Reviews (Second

Level Appeals) (PWS Section 5 paragraph 5.5.3.1)

Fixed price per review.

(Option Line Item)

Appeals & Hearings Internal and External Reviews and Hearing Support (PWS Section 5 Paragraph

5.5.4)

(Option Line Item)

2010AA Appeals & Hearings Internal Reviews (PWS Section 5 2 EA paragraph 5.5.4.1 and PWS Section J, Attachment J-4)

Fixed price per internal review.

(Option Line Item)

2010AB Appeals & Hearings Routine External Reviews (PWS 75 EA

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per routine external

2010AC 5 EA

2010AD 10 HR

2010AE 10 HR

review.

(Option Line Item)

Appeals & Hearings Urgent External Reviews (PWS

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per urgent external review

(Option Line Item)

Pre-Hearing Preparations (PWS Section 5 paragraph

5.5.4.2)

FFP

(Option Line Item)

Hearing Appearance (PWS Section 5 paragraph 5.5.4.1)

FFP

(Option Line Item)

150 EA

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

2010AF Post Hearing (PWS Section 5 paragraph 5.5.4.2) FFP 10 HR

(Option Line Item)

2010AG Transcription (PWS Section 5 paragraph 5.5.4.2) FFP 10 HR

(Option Line Item)

2011 Standard of Care (SOC) Reviews (PWS Section 5 700 EA paragraph 5.5.5.1) Fixed price per review.

(Option Line Item)

2012 Quality of Care (QOC) Reviews (PWS Section 5 5 EA paragraph 5.5.2.2.1) (Direct and Purchased Care):

Fixed price per QOC review.

(Option Line Item)

2013 Clinical Quality Improvement Studies (PWS Section 5 5 EA paragraph 5.6.1)

(Option Line Item)

2013AA Clinical Quality Improvement Study Methodology 240 HR

Development, Approval and Study Report (PWS

Section 5 paragraph 5.6.1) FFP

(Option Line Item)

2013AB Clinical Quality Improvement Administrative Study 160 HR

Data Collection and Analysis (PWS Section 5 paragraph 5.6.1). Fixed price per hour.

(Option Line Item)

2013AC Clinical Quality Improvement Abstraction Study 2000 EA

(Fewer than 2,000 Records) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

2013AD Clinical Quality Improvement Chart Abstraction 4000 EA

Study (2000 or more charts) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

(Option Line Item)

2014 Annual Autism Care Demonstration (ACD) Study (PWS 2000 EA

Section 5 paragraph 5.6.2.2.8.1) Fixed price per chart.

(Option Line Item)

2015 Long Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

2016 Short Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

2017 Webinar (PWS Section 5 paragraph 5.8.1.1) FFP 12 EA

(Option Line Item)

2018 Meeting Support (PWS Section 5 Paragraph 5.8.2)

(Option Line Item)

2018AA Meeting Support (PWS Section 5 paragraph 5.8.2.1) 12 MO

FFP

(Option Line Item)

2018AB Meeting Support Annual MHS Clinical Quality 1 EA

Management conference (PWS Section 5 paragraph

5.8.2) FFP

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

2019 12 MOQuality Communications

(PWS Section 5 paragraph 5.8.2.1)

FFP

(Option Line Item)

2020 Travel (PWS Section 1 paragraph 1.8.3; FAR Part 1 EA

31.2) This CLIN establishes a cost-reimbursed (no fee) amount for travel.

Not to exceed: $10,000

(Option Line Item)

2021 Deliverables (DD Forms 1423-1, Contract Data

Requirements List (CDRLS)) Not separately priced

(NSP)

(Option Line Item)

2022 Transition-out. (PWS Section 5 paragraph 5.2.2 1 LO and FAR 52.237-3) FFP.

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

Option Period 3

3001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

(Option Line Item)

3001AA Annual NCQA HEDIS® Validation Audit (PWS Section 1 EA

5 paragraph 5.3.1)

3001AB 24 HR

3002AA 192 EA

3002AB 1 EA

FFP

(Option Line Item)

HEDIS Consultation and Education (PWS Section 5 paragraph 5.3.1.3)

FFP

(Option Line Item)

National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

National Hospital Quality Measures Data

Collection Tools and Data Management (MTF with

Essentris) (PWS Section 5 paragraph 5.3.2) FFP per Inpatient MTF per quarter.

(Option Line Item)

National Hospital Quality Measures data file for submission to CMS (PWS Section 5 paragraph 5.3.2.1.4)

FFP

(Option Line Item)

Joint Commission ORYX® Hospital Quality

Measures (PWS Section 5 Paragraph 5.3.3)

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

3003AA Joint Commission ORYX® Data Collection Tools, Data Management and Data File Submission (For

MTFs with Essentris) (PWS Section 5 paragraph

5.3.3.2-5.3.3.7) FFP per MTF per quarterly submission.

(Option Line Item)

120 EA

3003AB Joint Commission ORYX Hospital Quality Measures

(Direct Care) Chart Abstraction (PWS Section 5 paragraph 5.3.3.1) Fixed price per chart.

(Option Line Item)

95000 EA

3003AC Clinical Quality Measurement Result Accuracy

Validation (PWS Section 5 paragraph 5.3.4)

Fixed price per chart.

(Option Line Item)

2000 EA

3004 Leapfrog Program Support (PWS Section 5, paragraph 5.3.5)

(Option Line Item)

3004AA Leapfrog Value-Based Purchasing Program Data &

Reports package for Health Plans (PWS Section 5 paragraph 5.3.5.1)

FFP

(Option Line Item)

1 EA

3004AB Leapfrog Communications (PWS Section 5 paragraph 5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

1 EA

3004AC Leapfrog Education Series Attendance (PWS

Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

3004AD Leapfrog Annual Meeting (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.2.2)

FFP

(Option Line Item)

3004AE MHS Leapfrog Survey and Safety Grade 12 MO

Participation Value-Based Purchasing Program Data &

Reports package for Health Plans analysis (PWS Section

5 paragraph 5.3.5.2 & 5.3.5.3)

3004AF 12 MO

3005 11000 EA

3006 6000 EA

3007 55 EA

(Option Line Item)

MHS Leapfrog Survey and Safety Grade Participation

Training, Email Box and Frequently Ask Question

Support (PWS Section 5 paragraph 5.3.5.5.2)

FFP

(Option Line Item)

Institute for Healthcare Improvement (IHI) Global

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

(Option Line Item)

QSRS Data Abstraction (PWS Section 5 paragraph

5.3.6.2.1.2)

FFP

(Option Line Item)

Behavioral Health Facility Initial Fees

Calculations (PWS Section 5 paragraph 5.4) Fixed price per application.

(Option Line Item)

Quality and Utilization Reviews (PWS Section C paragraph 5.5.2.10) Fixed price per chart.

(Option Line Item)

3008 6500 EA

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

3009 150 EA

Medical Necessity Reconsideration Reviews (Second

Level Appeals) (PWS Section 5 paragraph 5.5.3.1)

Fixed price per review.

(Option Line Item)

Appeals & Hearings Internal and External Reviews and Hearing Support (PWS Section 5 Paragraph

5.5.4)

(Option Line Item)

3010AA Appeals & Hearings Internal Reviews (PWS Section 5 2 EA paragraph 5.5.4.1 and PWS Section J, Attachment J-4)

Fixed price per internal review.

(Option Line Item)

3010AB Appeals & Hearings Routine External Reviews (PWS 75 EA

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per routine external

3010AC 5 EA

3010AD 10 HR

3010AE 10 HR

review.

(Option Line Item)

Appeals & Hearings Urgent External Reviews (PWS

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per urgent external review

(Option Line Item)

Pre-Hearing Preparations (PWS Section 5 paragraph

5.5.4.2)

FFP

(Option Line Item)

Hearing Appearance (PWS Section 5 paragraph 5.5.4.1)

FFP

(Option Line Item)

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

3010AF Post Hearing (PWS Section 5 paragraph 5.5.4.2) FFP 10 HR

(Option Line Item)

3010AG Transcription (PWS Section 5 paragraph 5.5.4.2) FFP 10 HR

(Option Line Item)

3011 Standard of Care (SOC) Reviews (PWS Section 5 700 EA paragraph 5.5.5.1) Fixed price per review.

(Option Line Item)

3012 Quality of Care (QOC) Reviews (PWS Section 5 5 EA paragraph 5.5.2.2.1) (Direct and Purchased Care):

Fixed price per QOC review.

(Option Line Item)

3013 Clinical Quality Improvement Studies (PWS Section 5 5 EA paragraph 5.6.1)

(Option Line Item)

3013AA Clinical Quality Improvement Study Methodology 240 HR

Development, Approval and Study Report (PWS

Section 5 paragraph 5.6.1) FFP

(Option Line Item)

3013AB Clinical Quality Improvement Administrative Study 160 HR

Data Collection and Analysis (PWS Section 5 paragraph 5.6.1). Fixed price per hour.

(Option Line Item)

3013AC Clinical Quality Improvement Abstraction Study 2000 EA

(Fewer than 2,000 Records) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

3013AD Clinical Quality Improvement Chart Abstraction 4000 EA

Study (2000 or more charts) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

(Option Line Item)

3014 Annual Autism Care Demonstration (ACD) Study (PWS 2000 EA

Section 5 paragraph 5.6.2.2.8.1) Fixed price per chart.

(Option Line Item)

3015 Long Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

3016 Short Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

3017 Webinar (PWS Section 5 paragraph 5.8.1.1) FFP 12 EA

(Option Line Item)

3018 Meeting Support (PWS Section 5 Paragraph 5.8.2)

(Option Line Item)

3018AA Meeting Support (PWS Section 5 paragraph 5.8.2.1) 12 MO

FFP

(Option Line Item)

3018AB Meeting Support Annual MHS Clinical Quality 1 EA

Management conference (PWS Section 5 paragraph

5.8.2) FFP

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

3019 12 MOQuality Communications

(PWS Section 5 paragraph 5.8.2.1)

FFP

(Option Line Item)

3020 Travel (PWS Section 1 paragraph 1.8.3; FAR Part 1 EA

31.2) This CLIN establishes a cost-reimbursed (no fee) amount for travel.

Not to exceed: $10,000

(Option Line Item)

3021 Deliverables (DD Forms 1423-1, Contract Data

Requirements List (CDRLS)) Not separately priced

(NSP)

(Option Line Item)

3022 Transition-out. (PWS Section 5 paragraph 5.2.2 1 LO

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

Option Period 4

4001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

(Option Line Item)

4001AA Annual NCQA HEDIS® Validation Audit (PWS Section 1 EA

5 paragraph 5.3.1)

4001AB 24 HR

4002AA 192 EA

4002AB 1 EA

FFP

(Option Line Item)

HEDIS Consultation and Education (PWS Section 5 paragraph 5.3.1.3)

FFP

(Option Line Item)

National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

National Hospital Quality Measures Data

Collection Tools and Data Management (MTF with

Essentris) (PWS Section 5 paragraph 5.3.2) FFP per Inpatient MTF per quarter.

(Option Line Item)

National Hospital Quality Measures data file for submission to CMS (PWS Section 5 paragraph 5.3.2.1.4)

FFP

(Option Line Item)

Joint Commission ORYX® Hospital Quality

Measures (PWS Section 5 Paragraph 5.3.3)

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

4003AA Joint Commission ORYX® Data Collection Tools, Data Management and Data File Submission (For

MTFs with Essentris) (PWS Section 5 paragraph

5.3.3.2-5.3.3.7) FFP per MTF per quarterly submission.

(Option Line Item)

120 EA

4003AB Joint Commission ORYX Hospital Quality Measures

(Direct Care) Chart Abstraction (PWS Section 5 paragraph 5.3.3.1) Fixed price per chart.

(Option Line Item)

95000 EA

4003AC Clinical Quality Measurement Result Accuracy

Validation (PWS Section 5 paragraph 5.3.4)

Fixed price per chart.

(Option Line Item)

2000 EA

4004 Leapfrog Program Support (PWS Section 5, paragraph 5.3.5)

(Option Line Item)

4004AA Leapfrog Value-Based Purchasing Program Data &

Reports package for Health Plans (PWS Section 5 paragraph 5.3.5.1)

FFP

(Option Line Item)

1 EA

4004AB Leapfrog Communications (PWS Section 5 paragraph 5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

1 EA

4004AC Leapfrog Education Series Attendance (PWS

Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

4004AD Leapfrog Annual Meeting (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.2.2)

FFP

(Option Line Item)

4004AE MHS Leapfrog Survey and Safety Grade 12 MO

Participation Value-Based Purchasing Program Data &

Reports package for Health Plans analysis (PWS Section

5 paragraph 5.3.5.2 & 5.3.5.3)

4004AF 12 MO

4005 11000 EA

4006 6000 EA

4007 55 EA

(Option Line Item)

MHS Leapfrog Survey and Safety Grade Participation

Training, Email Box and Frequently Ask Question

Support (PWS Section 5 paragraph 5.3.5.5.2)

FFP

(Option Line Item)

Institute for Healthcare Improvement (IHI) Global

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

(Option Line Item)

QSRS Data Abstraction (PWS Section 5 paragraph

5.3.6.2.1.2)

FFP

(Option Line Item)

Behavioral Health Facility Initial Fees

Calculations (PWS Section 5 paragraph 5.4) Fixed price per application.

(Option Line Item)

Quality and Utilization Reviews (PWS Section C paragraph 5.5.2.10) Fixed price per chart.

(Option Line Item)

4008 6500 EA

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26 44

ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

4009 150 EA

Medical Necessity Reconsideration Reviews (Second

Level Appeals) (PWS Section 5 paragraph 5.5.3.1)

Fixed price per review.

(Option Line Item)

Appeals & Hearings Internal and External Reviews and Hearing Support (PWS Section 5 Paragraph

5.5.4)

(Option Line Item)

4010AA Appeals & Hearings Internal Reviews (PWS Section 5 2 EA paragraph 5.5.4.1 and PWS Section J, Attachment J-4)

Fixed price per internal review.

(Option Line Item)

4010AB Appeals & Hearings Routine External Reviews (PWS 75 EA

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per routine external

4010AC 5 EA

4010AD 10 HR

4010AE 10 HR

review.

(Option Line Item)

Appeals & Hearings Urgent External Reviews (PWS

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per urgent external review

(Option Line Item)

Pre-Hearing Preparations (PWS Section 5 paragraph

5.5.4.2)

FFP

(Option Line Item)

Hearing Appearance (PWS Section 5 paragraph 5.5.4.1)

FFP

(Option Line Item)

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

4010AF 10 HR Post Hearing (PWS Section 5 paragraph 5.5.4.2)

FFP

(Option Line Item)

4010AG 10 HR Transcription (PWS Section 5 paragraph 5.5.4.2)

FFP

(Option Line Item)

4011 Standard of Care (SOC) Reviews (PWS Section 5 700 EA paragraph 5.5.5.1) Fixed price per review.

(Option Line Item)

4012 Quality of Care (QOC) Reviews (PWS Section 5 5 EA paragraph 5.5.2.2.1) (Direct and Purchased Care):

4013 5 EA

4013AA 240 HR

4013AB 160 HR

4013AC 2000 EA

Fixed price per QOC review.

(Option Line Item)

Clinical Quality Improvement Studies (PWS Section

5 paragraph 5.6.1)

(Option Line Item)

Clinical Quality Improvement Study Methodology

Development, Approval and Study Report (PWS

Section 5 paragraph 5.6.1) FFP

(Option Line Item)

Clinical Quality Improvement Administrative Study

Data Collection and Analysis (PWS Section 5 paragraph 5.6.1). Fixed price per hour.

(Option Line Item)

Clinical Quality Improvement Abstraction Study

(Fewer than 2,000 Records) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

4013AD Clinical Quality Improvement Chart Abstraction 4000 EA

Study (2000 or more charts) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

(Option Line Item)

4014 Annual Autism Care Demonstration (ACD) Study (PWS 2000 EA

Section 5 paragraph 5.6.2.2.8.1) Fixed price per chart.

(Option Line Item)

4015 Long Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

4016 Short Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

4017 Webinar (PWS Section 5 paragraph 5.8.1.1) FFP 12 EA

(Option Line Item)

4018 Meeting Support (PWS Section 5 Paragraph 5.8.2)

(Option Line Item)

4018AA Meeting Support (PWS Section 5 paragraph 5.8.2.1) 12 MO

FFP

(Option Line Item)

4018AB Meeting Support Annual MHS Clinical Quality 1 EA

Management conference (PWS Section 5 paragraph

5.8.2) FFP

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

4019 12 MOQuality Communications

(PWS Section 5 paragraph 5.8.2.1)

FFP

(Option Line Item)

4020 Travel (PWS Section 1 paragraph 1.8.3; FAR Part 1 EA

31.2) This CLIN establishes a cost-reimbursed (no fee) amount for travel.

Not to exceed: $10,000

(Option Line Item)

4021 Deliverables (DD Forms 1423-1, Contract Data

Requirements List (CDRLS)) Not separately priced

(NSP)

(Option Line Item)

4022 Transition-out. (PWS Section 5 paragraph 5.2.2 1 LO

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

Option Period 5

5001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

(Option Line Item)

5001AA Annual NCQA HEDIS® Validation Audit (PWS Section 1 EA

5 paragraph 5.3.1)

5001AB 24 HR

5002AA 192 EA

5002AB 1 EA

FFP

(Option Line Item)

HEDIS Consultation and Education (PWS Section 5 paragraph 5.3.1.3)

FFP

(Option Line Item)

National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

National Hospital Quality Measures Data

Collection Tools and Data Management (MTF with

Essentris) (PWS Section 5 paragraph 5.3.2) FFP per Inpatient MTF per quarter.

(Option Line Item)

National Hospital Quality Measures data file for submission to CMS (PWS Section 5 paragraph 5.3.2.1.4)

FFP

(Option Line Item)

Joint Commission ORYX® Hospital Quality

Measures (PWS Section 5 Paragraph 5.3.3)

REFERENCE NO. OF DOCUMENT BEING CONTINUED

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

5003AA Joint Commission ORYX® Data Collection Tools, Data Management and Data File Submission (For

MTFs with Essentris) (PWS Section 5 paragraph

5.3.3.2-5.3.3.7) FFP per MTF per quarterly submission.

(Option Line Item)

120 EA

5003AB Joint Commission ORYX Hospital Quality Measures

(Direct Care) Chart Abstraction (PWS Section 5 paragraph 5.3.3.1) Fixed price per chart.

(Option Line Item)

95000 EA

5003AC Clinical Quality Measurement Result Accuracy

Validation (PWS Section 5 paragraph 5.3.4)

Fixed price per chart.

(Option Line Item)

2000 EA

5004 Leapfrog Program Support (PWS Section 5, paragraph 5.3.5)

(Option Line Item)

5004AA Leapfrog Value-Based Purchasing Program Data &

Reports package for Health Plans (PWS Section 5 paragraph 5.3.5.1)

FFP

(Option Line Item)

1 EA

5004AB Leapfrog Communications (PWS Section 5 paragraph 5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

1 EA

5004AC Leapfrog Education Series Attendance (PWS

Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

5004AD Leapfrog Annual Meeting (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.2.2)

FFP

(Option Line Item)

5004AE MHS Leapfrog Survey and Safety Grade 12 MO

Participation Value-Based Purchasing Program Data &

Reports package for Health Plans analysis (PWS Section

5 paragraph 5.3.5.2 & 5.3.5.3)

5004AF 12 MO

5005 11000 EA

5006 6000 EA

5007 55 EA

(Option Line Item)

MHS Leapfrog Survey and Safety Grade Participation

Training, Email Box and Frequently Ask Question

Support (PWS Section 5 paragraph 5.3.5.5.2)

FFP

(Option Line Item)

Institute for Healthcare Improvement (IHI) Global

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

(Option Line Item)

QSRS Data Abstraction (PWS Section 5 paragraph

5.3.6.2.1.2)

FFP

(Option Line Item)

Behavioral Health Facility Initial Fees

Calculations (PWS Section 5 paragraph 5.4) Fixed price per application.

(Option Line Item)

Quality and Utilization Reviews (PWS Section C paragraph 5.5.2.10) Fixed price per chart.

(Option Line Item)

5008 6500 EA

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

5009 150 EA

Medical Necessity Reconsideration Reviews (Second

Level Appeals) (PWS Section 5 paragraph 5.5.3.1)

Fixed price per review.

(Option Line Item)

Appeals & Hearings Internal and External Reviews and Hearing Support (PWS Section 5 Paragraph

5.5.4)

(Option Line Item)

5010AA Appeals & Hearings Internal Reviews (PWS Section 5 2 EA paragraph 5.5.4.1 and PWS Section J, Attachment J-4)

Fixed price per internal review.

(Option Line Item)

5010AB Appeals & Hearings Routine External Reviews (PWS 75 EA

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per routine external

5010AC 5 EA

5010AD 10 HR

5010AE 10 HR

review.

(Option Line Item)

Appeals & Hearings Urgent External Reviews (PWS

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per urgent external review

(Option Line Item)

Pre-Hearing Preparations (PWS Section 5 paragraph

5.5.4.2)

FFP

(Option Line Item)

Hearing Appearance (PWS Section 5 paragraph 5.5.4.1)

FFP

(Option Line Item)

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ITEM NO.

(A)

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(B) (C) (D) (E) (F)

5010AF Post Hearing (PWS Section 5 paragraph 5.5.4.2) FFP 10 HR

(Option Line Item)

5010AG Transcription (PWS Section 5 paragraph 5.5.4.2) FFP 10 HR

(Option Line Item)

5011 Standard of Care (SOC) Reviews (PWS Section 5 700 EA paragraph 5.5.5.1) Fixed price per review.

(Option Line Item)

5012 Quality of Care (QOC) Reviews (PWS Section 5 5 EA paragraph 5.5.2.2.1) (Direct and Purchased Care):

Fixed price per QOC review.

(Option Line Item)

5013 Clinical Quality Improvement Studies (PWS Section 5 5 EA paragraph 5.6.1)

(Option Line Item)

5013AA Clinical Quality Improvement Study Methodology 240 HR

Development, Approval and Study Report (PWS

Section 5 paragraph 5.6.1) FFP

(Option Line Item)

5013AB Clinical Quality Improvement Administrative Study 160 HR

Data Collection and Analysis (PWS Section 5 paragraph 5.6.1). Fixed price per hour.

(Option Line Item)

5013AC Clinical Quality Improvement Abstraction Study 2000 EA

(Fewer than 2,000 Records) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

5013AD Clinical Quality Improvement Chart Abstraction 4000 EA

Study (2000 or more charts) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

(Option Line Item)

5014 Annual Autism Care Demonstration (ACD) Study (PWS 2000 EA

Section 5 paragraph 5.6.2.2.8.1) Fixed price per chart.

(Option Line Item)

5015 Long Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

5016 Short Assessment of Evolving Practices, Devices, 4 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

5017 Webinar (PWS Section 5 paragraph 5.8.1.1) FFP 12 EA

(Option Line Item)

5018 Meeting Support (PWS Section 5 Paragraph 5.8.2)

(Option Line Item)

5018AA Meeting Support (PWS Section 5 paragraph 5.8.2.1) 12 MO

FFP

(Option Line Item)

5018AB Meeting Support Annual MHS Clinical Quality 1 EA

Management conference (PWS Section 5 paragraph

5.8.2) FFP

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

5019 12 MOQuality Communications

(PWS Section 5 paragraph 5.8.2.1)

FFP

(Option Line Item)

5020 Travel (PWS Section 1 paragraph 1.8.3; FAR Part 1 EA

31.2) This CLIN establishes a cost-reimbursed (no fee) amount for travel.

Not to exceed: $10,000

(Option Line Item)

5021 Deliverables (DD Forms 1423-1, Contract Data

Requirements List (CDRLS)) Not separately priced

(NSP)

(Option Line Item)

5022 Transition-out. (PWS Section 5 paragraph 5.2.2 1 LO

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ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

Option Period 6, 52.217-8 Option to Extend

6001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

(Option Line Item)

6001AA Annual NCQA HEDIS® Validation Audit (PWS Section .5 EA 5 paragraph 5.3.1)

6001AB 12 HR

6002AA 96 EA

6002AB .5 EA

FFP

(Option Line Item)

HEDIS Consultation and Education (PWS Section 5 paragraph 5.3.1.3)

FFP

(Option Line Item)

National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

National Hospital Quality Measures Data

Collection Tools and Data Management (MTF with

Essentris) (PWS Section 5 paragraph 5.3.2) FFP per Inpatient MTF per quarter.

(Option Line Item)

National Hospital Quality Measures data file for submission to CMS (PWS Section 5 paragraph 5.3.2.1.4)

FFP

(Option Line Item)

Joint Commission ORYX® Hospital Quality

Measures (PWS Section 5 Paragraph 5.3.3)

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(B)

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(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

6003AA Joint Commission ORYX® Data Collection Tools, Data Management and Data File Submission (For

MTFs with Essentris) (PWS Section 5 paragraph

5.3.3.2-5.3.3.7) FFP per MTF per quarterly submission.

(Option Line Item)

60 EA

6003AB Joint Commission ORYX Hospital Quality Measures

(Direct Care) Chart Abstraction (PWS Section 5 paragraph 5.3.3.1) Fixed price per chart.

(Option Line Item)

47000 EA

6003AC Clinical Quality Measurement Result Accuracy

Validation (PWS Section 5 paragraph 5.3.4)

Fixed price per chart.

(Option Line Item)

1000 EA

6004 Leapfrog Program Support (PWS Section 5, paragraph 5.3.5)

(Option Line Item)

6004AA Leapfrog Value-Based Purchasing Program Data &

Reports package for Health Plans (PWS Section 5 paragraph 5.3.5.1)

FFP

(Option Line Item)

.5 EA

6004AB Leapfrog Communications (PWS Section 5 paragraph 5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

.5 EA

6004AC Leapfrog Education Series Attendance (PWS

Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

3 EA

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6004AD Leapfrog Annual Meeting (PWS Section 5 paragraph .5 EA 5.3.5, 5.3.5.5.2.2)

FFP

(Option Line Item)

6004AE MHS Leapfrog Survey and Safety Grade 6 MO

Participation Value-Based Purchasing Program Data &

Reports package for Health Plans analysis (PWS Section

5 paragraph 5.3.5.2 & 5.3.5.3)

6004AF 6 MO

6005 5500 EA

6006 3000 EA

6007 27.5 EA

(Option Line Item)

MHS Leapfrog Survey and Safety Grade Participation

Training, Email Box and Frequently Ask Question

Support (PWS Section 5 paragraph 5.3.5.5.2)

FFP

(Option Line Item)

Institute for Healthcare Improvement (IHI) Global

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

(Option Line Item)

QSRS Data Abstraction (PWS Section 5 paragraph

5.3.6.2.1.2)

FFP

(Option Line Item)

Behavioral Health Facility Initial Fees

Calculations (PWS Section 5 paragraph 5.4) Fixed price per application.

(Option Line Item)

Quality and Utilization Reviews (PWS Section C paragraph 5.5.2.10) Fixed price per chart.

(Option Line Item)

6008 3250 EA

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(B) (C) (D) (E) (F)

6009 75 EA

Medical Necessity Reconsideration Reviews (Second

Level Appeals) (PWS Section 5 paragraph 5.5.3.1)

Fixed price per review.

(Option Line Item)

Appeals & Hearings Internal and External Reviews and Hearing Support (PWS Section 5 Paragraph

5.5.4)

(Option Line Item)

6010AA Appeals & Hearings Internal Reviews (PWS Section 5 1 EA paragraph 5.5.4.1 and PWS Section J, Attachment J-4)

Fixed price per internal review.

(Option Line Item)

6010AB Appeals & Hearings Routine External Reviews (PWS 37.5 EA Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per routine external

6010AC 2.5 EA

6010AD 5 HR

6010AE 5 HR

review.

(Option Line Item)

Appeals & Hearings Urgent External Reviews (PWS

Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per urgent external review

(Option Line Item)

Pre-Hearing Preparations (PWS Section 5 paragraph

5.5.4.2)

FFP

(Option Line Item)

Hearing Appearance (PWS Section 5 paragraph 5.5.4.1)

FFP

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(B) (C) (D) (E) (F)

6010AF 5 HR Post Hearing (PWS Section 5 paragraph 5.5.4.2)

FFP

(Option Line Item)

6010AG 5 HR Transcription (PWS Section 5 paragraph 5.5.4.2)

FFP

(Option Line Item)

6011 Standard of Care (SOC) Reviews (PWS Section 5 350 EA paragraph 5.5.5.1) Fixed price per review.

(Option Line Item)

6012 Quality of Care (QOC) Reviews (PWS Section 5 2.5 EA paragraph 5.5.2.2.1) (Direct and Purchased Care):

Fixed price per QOC review.

(Option Line Item)

6013 Clinical Quality Improvement Studies (PWS Section 5 2.5 EA paragraph 5.6.1)

(Option Line Item)

6013AA Clinical Quality Improvement Study Methodology 120 HR Development, Approval and Study Report (PWS

Section 5 paragraph 5.6.1) FFP

(Option Line Item)

6013AB Clinical Quality Improvement Administrative Study 80 HR Data Collection and Analysis (PWS Section 5 paragraph 5.6.1). Fixed price per hour.

(Option Line Item)

6013AC Clinical Quality Improvement Abstraction Study 1000 EA (Fewer than 2,000 Records) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

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(E)

AMOUNT

(F)

6013AD Clinical Quality Improvement Chart Abstraction 2000 EA Study (2000 or more charts) (PWS Section 5 paragraph 5.6.1) Fixed price per chart.

(Option Line Item)

6014 Annual Autism Care Demonstration (ACD) Study (PWS 1000 EA Section 5 paragraph 5.6.2.2.8.1) Fixed price per chart.

(Option Line Item)

6015 Long Assessment of Evolving Practices, Devices, 2 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

6016 Short Assessment of Evolving Practices, Devices, 2 EA

Medicines, Treatments, and Procedures (PWS

Section 5 paragraph 5.7.3) Fixed price per assessment.

(Option Line Item)

6017 Webinar (PWS Section 5 paragraph 5.8.1.1) FFP 6 EA

(Option Line Item)

6018 Meeting Support (PWS Section 5 Paragraph 5.8.2)

(Option Line Item)

6018AA Meeting Support (PWS Section 5 paragraph 5.8.2.1) 6 MO

FFP

(Option Line Item)

6018AB Meeting Support Annual MHS Clinical Quality .5 EA Management conference (PWS Section 5 paragraph

5.8.2) FFP

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(C) (D)

UNIT PRICE

(E)

AMOUNT

(F)

6019 6 MOQuality Communications

(PWS Section 5 paragraph 5.8.2.1)

FFP

(Option Line Item)

6020 Travel (PWS Section 1 paragraph 1.8.3; FAR Part .5 EA 31.2) This CLIN establishes a cost-reimbursed (no fee) amount for travel.

Not to exceed: $10,000

(Option Line Item)

6021 Deliverables (DD Forms 1423-1, Contract Data

Requirements List (CDRLS)) Not separately priced

(NSP)

(Option Line Item)

6022 Transition-out. (PWS Section 5 paragraph 5.2.2 1 LO

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

HT940222R0002 Page 44 of 44

1.0 GUARANTEED CONTRACT MINIMUM AND CONTRACT MAXIMUM:

1.1 Minimum Guarantee: The guaranteed minimum is $300,000.00 and will be satisfied under the first task order.

1.2 Maximum Contract Value: The value of all task orders placed under the resultant contract may not exceed $75,000,000.00.

(End of Section)

SECTION C

DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

HT940222R0002 Page C1 of C72

Department of Defense

Defense Health Agency

Performance Work Statement

TRICARE Quality Monitoring Contract

Health Care Administration Directorate, Medical Affairs

Clinical Support Division, Clinical Quality Management Branch

Solicitation Number: HT9402-22-R-0002

Version: 1

Date: June 2022

HT940222R0002 Page C2 of C72

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide clinical quality monitoring support.

1.2 Description of services/introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform clinical quality monitoring support as defined in this

Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

1.3 Background: The Defense Health Agency (DHA) is a joint, integrated Combat Support

Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime.

The DHA supports the delivery of integrated, affordable, and high quality health services to approximately 9.6 million Military Health System (MHS) beneficiaries and is responsible for driving greater integration of clinical and business processes across the MHS. The DHA oversees the military medical treatment facilities (MTFs), TRICARE health plan, and medical resources.

DHA works in collaboration with the Service Surgeons General to support the readiness mission.

The MHS is a complex integrated healthcare system that consists of healthcare delivery, medical education, public health, the TRICARE health plan administered through regional contracts to implement the Civilian Health and Medical Program (CHAMPUS) authority to cost-share on claims from TRICARE authorized providers for private sector care, certain authorized private sector partnerships, and innovative medical research and development. The MHS has two major care delivery systems. The direct care system is in the process of implementing a congressionally mandated transition. DHA will oversee the provision of care through MTFs while the Services focus on readiness and care provided in the operational healthcare units. The private sector care system provides care through private sector contractors including the Managed Care Support

Contracts (MCSCs); the TRICARE Overseas Program (TOP) Contract, the Designated Providers

(DPs) under the Uniformed Services Family Health Plan (USFHP); the TRICARE Medicare

Eligible Program (TMEP); TRICARE Dental Program (TDP); TRICARE Retiree Dental

Program (TRDP), the TRICARE Pharmacy Program (TPharm), and the TRICARE Overseas

Program (TOP).

This contract meets the regulatory requirements of TRICARE’s Quality and Utilization

Peer Review Organization Program, 32 Code of Federal Regulations (CFR), Section 199.15, the

Department of Defense (DoD) policy Medical Quality Assurance and Clinical Quality

Management in the Military Health System,…

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