HT940222R0002 TQMC.pdf

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TRICARE Quality Monitoring Contract (TQMC)
Solicitation number
HT940222R0002
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HT940222R0002_Conformed 0006.pdf PDF
HT940222R0002_Amendment 0006.pdf PDF
Attachment J-24 CDRL to CLIN Crosswalk v1.pdf PDF
Additional QA_Amendment 0006.pdf PDF
HT940222R0002_Amendment 0005.pdf PDF
HT940222R0002_Conformed 0005.pdf PDF
Section L Exhibit L-11 Price Proposal Template v2.xlsx XLSX spreadsheet
HT940222R0002_Amendment 0004.pdf PDF
CDRLs updated via Amendment 0004.zip ZIP file
HT940222R0002_Conformed 0004.pdf PDF
Attachment J-24 CDRL to CLIN Crosswalk.pdf PDF
Additional QA_Amendment 0004.pdf PDF
Section C 7.1.2 DHA FY22 Annual Training List.pdf PDF
Section L Exhibit L-11 Price Proposal Template v1.xlsx XLSX spreadsheet
HT940222R0002_Conformed 0003.pdf PDF
Section L Exhibit L-14 CMS Care Compare quarterly TE Continuous data-Redacted.xlsx XLSX spreadsheet
HT940222R0002_Amendment 0003.pdf PDF
Attachment J-4 OGC Appeals and Hearings Internal and External Reviews v1.docx DOCX document
Section C_7.1.1 DHA CAC Request Process.pdf PDF
Section C_7.1.1 DMDC TASS Application.xlsx XLSX spreadsheet
CDRL 0T010 Transition-In Plan v1.pdf PDF
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
Section L Exhibit L-13 CMS Care Compare quarterly TE Rate data-Redacted.xlsx XLSX spreadsheet
TQMC QA.pdf PDF
HT940222R0002_Amendment 0002.pdf PDF
Attachment J-17 QASP v1.docx DOCX document
HT940222R0002_Amendment 0001.pdf PDF
Section J CDRLs.zip ZIP file
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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

1 211

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 07/22/2022

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)

2-47

C1-C76 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

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940222R0002

(A) (B) (C) (D) (E) (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 ...

3 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940222R0002

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

Collection Tools and Data Management (MTF with

Essentris) (PWS Section 5 paragraph 5.3.2)

FFP per Inpatient MTF per quarter

(Option Line Item)

1002AB National Hospital Quality Measures data file for 1 EA submission to CMS

FFP

(Option Line Item)

1003 Joint Comission ORYX® Hospital Quality Measures

(PWS Section 5 Paragraph 5.3.3)

(Option Line Item)

1003AA Joint Commission ORYX® Data Collection Tools, 120 EA

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)

1003AB Hospital Quality Measures Chart Abstraction 95000 EA

(Joint Commission ORYX, CMS Hospital Care)

Compare Rename Joint Commission ORYX® Hospital

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

(Option Line Item)

1004 Leapfrog Program Support (PWS PWS Section 5, paragraph 5.3.5)

(Option Line Item)

1004AA Leapfrog Group Reports (56 MTFs) (PWS Section 5 56 EA paragraph 5.3.5.1)

FFP

(Option Line Item)

1004AB Leapfrog Group Reports (custom cohort report) 1 EA

4 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

1004AC CAHPS Child Hospital Survey (PWS Section 5 1 EA paragraph 5.3.5)

FFP

(Option Line Item)

1004AD CAHPS Outpatient and Ambulatory Surgery (OAS) 1 EA

Survey (PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

1004AE Leapfrog Communications (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

1004AF Leapfrog Education Series Attendance (PWS Section 6 EA

5 paragraph 5.3.5)

FFP

(Option Line Item)

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

5.3.5)

FFP

(Option Line Item)

1004AH Leapfrog Health System Analyst (PWS Section 5 5760 HR paragraph 5.3.5)

FFP

(Option Line Item)

1004AJ Leapfrog Administrative Assistant (PWS Section 5 960 HR paragraph 5.3.5)

5 43

CONTINUATION SHEET

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

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 6000 EA

1007 55 EA

1008 6500 EA

1009 150 EA

1010AA 2 EA

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)

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)

Appeals & Hearings Internal Reviews (PWS Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per internal review.

(Option Line Item)

6 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

1010AB 75 EA

1010AC 5 EA

1010AD 10 HR

1010AE 10 HR

1010AF 10 HR

1010AG 10 HR

1011 700 EA

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

Post Hearing (PWS Section 5 paragraph 5.5.4.2) FFP (Option Line Item)

Transcription (PWS Section 5 paragraph 5.5.4.2) FFP (Option Line Item)

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

7 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940222R0002

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

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 160 HR

Data Collection and Analysis (PWS Section 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

8 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F) assessment.

(Option Line Item)

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)

(Option Line Item)

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 Website Management Quality Communications (PWS 1920 HR

Section 5 paragraph 5.8.2.1)

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

9 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

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.

(Option Line Item)

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)

FFP

(Option Line Item)

Option Period 1

2001AB HEDIS Consultation and Education (PWS Section 5 24 HR paragraph 5.3.1.3)

FFP

(Option Line Item)

2002 National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

2002AA National Hospital Quality Measures Data 192 EA

Collection Tools and Data Management (MTF with

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

(Option Line Item)

2002AB National Hospital Quality Measures data file for 1 EA submission to CMS

10 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

FFP

(Option Line Item)

2003 Joint Comission ORYX® Hospital Quality Measures

(PWS Section 5 Paragraph 5.3.3)

(Option Line Item)

2003AA Joint Commission ORYX® Data Collection Tools, 120 EA

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)

2003AB Hospital Quality Measures Chart Abstraction 95000 EA

(Joint Commission ORYX, CMS Hospital Care)

Compare Rename Joint Commission ORYX® Hospital

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

(Option Line Item)

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

(Option Line Item)

2004AA Leapfrog Group Reports (56 MTFs) (PWS Section 5 56 EA paragraph 5.3.5.1)

FFP

(Option Line Item)

2004AB Leapfrog Group Reports (custom cohort report) 1 EA

(PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

2004AC CAHPS Child Hospital Survey (PWS Section 5 1 EA paragraph 5.3.5)

FFP

11 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(Option Line Item)

2004AD CAHPS Outpatient and Ambulatory Surgery (OAS) 1 EA

Survey (PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

2004AE Leapfrog Communications (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.3.1

(Option Line Item)

2004AF Leapfrog Education Series Attendance (PWS Section 6 EA

5 paragraph 5.3.5)

FFP

(Option Line Item)

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

5.3.5)

FFP

(Option Line Item)

2004AH Leapfrog Health System Analyst (PWS Section 5 5760 HR paragraph 5.3.5)

FFP

(Option Line Item)

2004AJ Leapfrog Administrative Assistant (PWS Section 5 960 HR paragraph 5.3.5)

FFP

(Option Line Item)

2005 Institute for Healthcare Improvement (IHI) Global 11000 EA

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

12 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

2006 6000 EA

2007 55 EA

2008 6500 EA

2009 150 EA

2010AA 2 EA

2010AB 75 EA

QSRS Data Abstraction (PWS Section 5 paragraph 5.3.6.2.1.2) (based on 2021 CQI abstraction studies)

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)

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)

Appeals & Hearings Internal Reviews (PWS Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per internal review.

(Option Line Item)

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

13 43

CONTINUATION SHEET

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

2010AC 5 EA

2010AD 10 HR

2010AE 10 HR

2010AF 10 HR

2010AG 10 HR

2011 700 EA

2012 5 EA

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)

Post Hearing (PWS Section 5 paragraph 5.5.4.2) FFP (Option Line Item)

Transcription (PWS Section 5 paragraph 5.5.4.2) FFP (Option Line Item)

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

(Option Line Item)

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

Fixed price per QOC review.

(Option Line Item)

Clinical Quality Improvement Studies (PWS Section 5 paragraph 5.6.1)

14 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(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.

(Option Line Item)

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.

15 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(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

(Option Line Item)

2019 Website Management Quality Communications (PWS 1920 HR

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.

16 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(Option Line Item)

Option Period 2

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)

FFP

(Option Line Item)

Option Period 1

3001AB HEDIS Consultation and Education (PWS Section 5 24 HR paragraph 5.3.1.3 )

FFP

(Option Line Item)

3002 National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

(Option Line Item)

3002AA National Hospital Quality Measures Data 192 EA

Collection Tools and Data Management (MTF with

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

(Option Line Item)

3002AB National Hospital Quality Measures data file for 1 EA submission to CMS

FFP

(Option Line Item)

3003 Joint Comission ORYX® Hospital Quality Measures

(PWS Section 5 Paragraph 5.3.3)

17 43

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

3003AA Joint Commission ORYX® Data Collection Tools, 120 EA

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)

3003AB Hospital Quality Measures Chart Abstraction 95000 EA

(Joint Commission ORYX, CMS Hospital Care)

Compare Rename Joint Commission ORYX® Hospital

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

(Option Line Item)

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

(Option Line Item)

3004AA Leapfrog Group Reports (56 MTFs) (PWS Section 5 56 EA paragraph 5.3.5.1)

FFP

(Option Line Item)

3004AB Leapfrog Group Reports (custom cohort report) 1 EA

(PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

3004AC CAHPS Child Hospital Survey (PWS Section 5 1 EA paragraph 5.3.5)

FFP

(Option Line Item)

3004AD CAHPS Outpatient and Ambulatory Surgery (OAS) 1 EA

Survey (PWS Section 5 paragraph 5.3.5)

FFP

18 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

3004AE Leapfrog Communications (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

3004AF Leapfrog Education Series Attendance (PWS Section 6 EA

5 paragraph 5.3.5)

FFP

(Option Line Item)

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

5.3.5)

FFP

(Option Line Item)

3004AH Leapfrog Health System Analyst (PWS Section 5 5760 HR paragraph 5.3.5)

FFP

(Option Line Item)

3004AJ Leapfrog Administrative Assistant (PWS Section 5 960 HR paragraph 5.3.5)

FFP

(Option Line Item)

3005 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)

3006 QSRS Data Abstraction (PWS Section 5 paragraph 6000 EA

5.3.6.2.1.2) (based on 2021 CQI abstraction studies)

FFP

19 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

3007 55 EA

3008 6500 EA

3009 150 EA

3010AA 2 EA

3010AB 75 EA

3010AC 5 EA

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)

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)

Appeals & Hearings Internal Reviews (PWS Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per internal review.

(Option Line Item)

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

FFP

(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.

FF

20 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(Option Line Item)

3010AD Pre-Hearing Preparations (PWS Section 5 paragraph 10 HR

5.5.4.2)

FFP

(Option Line Item)

3010AE Hearing Appearance (PWS Section 5 paragraph 10 HR

5.5.4.1)

FFP

(Option Line Item)

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

FFP

(Option Line Item)

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

FFP

(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 paragraph 5.6.1)

(Option Line Item)

3013AA Clinical Quality Improvement Study Methodology 240 HR

Development, Approval and Study Report (PWS

21 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

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.

(Option Line Item)

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

22 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(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

(Option Line Item)

3019 Website Management Quality Communications (PWS 1920 HR

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 and FAR 52.237-3) FFP.

(Option Line Item)

Option Period 2

23 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

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)

FFP

(Option Line Item)

Option Period 1

4001AB HEDIS Consultation and Education (PWS Section 5 24 HR paragraph 5.3.1.3 )

FFP

(Option Line Item)

4002 National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

(Option Line Item)

4002AA National Hospital Quality Measures Data 192 EA

Collection Tools and Data Management (MTF with

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

(Option Line Item)

4002AB National Hospital Quality Measures data file for 1 EA submission to CMS

FFP

(Option Line Item)

4003 Joint Comission ORYX® Hospital Quality Measures

(PWS Section 5 Paragraph 5.3.3)

(Option Line Item)

4003AA Joint Commission ORYX® Data Collection Tools, 120 EA

Data Management and Data File Submission (For

MTFs with Essentris) (PWS Section 5 paragraph

24 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

5.3.3.2-5.3.3.7) FFP per MTF per quarterly submission.

(Option Line Item)

4003AB Hospital Quality Measures Chart Abstraction 95000 EA

(Joint Commission ORYX, CMS Hospital Care)

Compare Rename Joint Commission ORYX® Hospital

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

(Option Line Item)

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

(Option Line Item)

4004AA Leapfrog Group Reports (56 MTFs) (PWS Section 5 56 EA paragraph 5.3.5.1)

FFP

(Option Line Item)

4004AB Leapfrog Group Reports (custom cohort report) 1 EA

(PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

4004AC CAHPS Child Hospital Survey (PWS Section 5 1 EA paragraph 5.3.5)

FFP

(Option Line Item)

4004AD CAHPS Outpatient and Ambulatory Surgery (OAS) 1 EA

Survey (PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

4004AE Leapfrog Communications (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.3.1)

25 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

FFP

(Option Line Item)

4004AF Leapfrog Education Series Attendance (PWS Section 6 EA

5 paragraph 5.3.5)

FFP

(Option Line Item)

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

5.3.5)

FFP

(Option Line Item)

4004AH Leapfrog Health System Analyst (PWS Section 5 5760 HR paragraph 5.3.5)

FFP

(Option Line Item)

4004AJ Leapfrog Administrative Assistant (PWS Section 5 960 HR paragraph 5.3.5)

FFP

(Option Line Item)

4005 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)

4006 QSRS Data Abstraction (PWS Section 5 paragraph 6000 EA

5.3.6.2.1.2) (based on 2021 CQI abstraction studies)

FFP

(Option Line Item)

4007 Behavioral Health Facility Initial Fees 55 EA

Calculations (PWS Section 5 paragraph 5.4) Fixed

26 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

4008 6500 EA

4009 150 EA

4010AA 2 EA

4010AB 75 EA

4010AC 5 EA

4010AD 10 HR

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)

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)

Appeals & Hearings Internal Reviews (PWS Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per internal review.

(Option Line Item)

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

FFP

(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.

FF

(Option Line Item)

Pre-Hearing Preparations (PWS Section 5 paragraph

27 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

5.5.4.2)

FFP

(Option Line Item)

4010AE Hearing Appearance (PWS Section 5 paragraph 10 HR

5.5.4.1)

FFP

(Option Line Item)

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

FFP

(Option Line Item)

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

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): Fixed price per QOC review.

(Option Line Item)

4013 Clinical Quality Improvement Studies (PWS Section

5 paragraph 5.6.1)

(Option Line Item)

4013AA Clinical Quality Improvement Study Methodology 240 HR

Development, Approval and Study Report (PWS

Section 5 paragraph 5.6.1) FFP

28 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

4013AB 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)

4013AC 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)

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)

29 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(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

(Option Line Item)

4019 Website Management Quality Communications (PWS 1920 HR

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 and FAR 52.237-3) FFP.

(Option Line Item)

Option Period 2

5001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

30 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

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

5 paragraph 5.3.1)

FFP

(Option Line Item)

Option Period 1

5001AB HEDIS Consultation and Education (PWS Section 5 24 HR paragraph 5.3.1.3 )

FFP

(Option Line Item)

5002 National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

(Option Line Item)

5002AA National Hospital Quality Measures Data 192 EA

Collection Tools and Data Management (MTF with

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

(Option Line Item)

5002AB National Hospital Quality Measures data file for 1 EA submission to CMS

FFP

(Option Line Item)

5003 Joint Comission ORYX® Hospital Quality Measures

(PWS Section 5 Paragraph 5.3.3)

(Option Line Item)

5003AA Joint Commission ORYX® Data Collection Tools, 120 EA

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.

31 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

5003AB Hospital Quality Measures Chart Abstraction 95000 EA

(Joint Commission ORYX, CMS Hospital Care)

Compare Rename Joint Commission ORYX® Hospital

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

(Option Line Item)

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

(Option Line Item)

5004AA Leapfrog Group Reports (56 MTFs) (PWS Section 5 56 EA paragraph 5.3.5.1)

FFP

(Option Line Item)

5004AB Leapfrog Group Reports (custom cohort report) 1 EA

(PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

5004AC CAHPS Child Hospital Survey (PWS Section 5 1 EA paragraph 5.3.5)

FFP

(Option Line Item)

5004AD CAHPS Outpatient and Ambulatory Surgery (OAS) 1 EA

Survey (PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

5004AE Leapfrog Communications (PWS Section 5 paragraph 1 EA

5.3.5, 5.3.5.5.3.1)

FFP

32 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

5004AF Leapfrog Education Series Attendance (PWS Section 6 EA

5 paragraph 5.3.5)

FFP

(Option Line Item)

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

5.3.5)

FFP

(Option Line Item)

5004AH Leapfrog Health System Analyst (PWS Section 5 5760 HR paragraph 5.3.5)

FFP

(Option Line Item)

5004AJ Leapfrog Administrative Assistant (PWS Section 5 960 HR paragraph 5.3.5)

FFP

(Option Line Item)

5005 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)

5006 QSRS Data Abstraction (PWS Section 5 paragraph 6000 EA

5.3.6.2.1.2) (based on 2021 CQI abstraction studies)

FFP

(Option Line Item)

5007 Behavioral Health Facility Initial Fees 55 EA

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

33 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

5008 6500 EA

5009 150 EA

5010AA 2 EA

5010AB 75 EA

5010AC 5 EA

5010AD 10 HR

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

(Option Line Item)

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)

Appeals & Hearings Internal Reviews (PWS Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per internal review.

(Option Line Item)

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

FFP

(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.

FF

(Option Line Item)

Pre-Hearing Preparations (PWS Section 5 paragraph

5.5.4.2)

FFP

34 43

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

5010AE Hearing Appearance (PWS Section 5 paragraph 10 HR

5.5.4.1)

FFP

(Option Line Item)

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

FFP

(Option Line Item)

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

FFP

(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 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.

35 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

5013AC 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)

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

36 43

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

(Option Line Item)

5018AB Meeting Support Annual MHS Clinical Quality 1 EA

Management conference (PWS Section 5 paragraph

5.8.2) FFP

(Option Line Item)

5019 Website Management Quality Communications (PWS 1920 HR

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 and FAR 52.237-3) FFP.

(Option Line Item)

Option Period 2

6001 HEDIS Audit (PWS Section 5 Paragraph 5.3.1)

(Option Line Item)

6001AA Annual NCQA HEDIS® Validation Audit (PWS Section 0.5 EA

5 paragraph 5.3.1)

FFP

37 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

Option Period 1

6001AB HEDIS Consultation and Education (PWS Section 5 12 HR paragraph 5.3.1.3 )

FFP

(Option Line Item)

6002 National Hospital Quality Measures (PWS Section 5

Paragraph 5.3.2)

(Option Line Item)

6002AA National Hospital Quality Measures Data 96 EA

Collection Tools and Data Management (MTF with

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

(Option Line Item)

6002AB National Hospital Quality Measures data file for 0.5 EA submission to CMS

FFP

(Option Line Item)

6003 Joint Comission ORYX® Hospital Quality Measures

(PWS Section 5 Paragraph 5.3.3)

(Option Line Item)

6003AA Joint Commission ORYX® Data Collection Tools, 60 EA

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)

6003AB Hospital Quality Measures Chart Abstraction 47500 EA

(Joint Commission ORYX, CMS Hospital Care)

Compare Rename Joint Commission ORYX® Hospital

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

38 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

(Option Line Item)

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

(Option Line Item)

6004AA Leapfrog Group Reports (56 MTFs) (PWS Section 5 28 EA paragraph 5.3.5.1)

FFP

(Option Line Item)

6004AB Leapfrog Group Reports (custom cohort report) 0.5 EA

(PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

6004AC CAHPS Child Hospital Survey (PWS Section 5 0.5 EA paragraph 5.3.5)

FFP

(Option Line Item)

6004AD CAHPS Outpatient and Ambulatory Surgery (OAS) 0.5 EA

Survey (PWS Section 5 paragraph 5.3.5)

FFP

(Option Line Item)

6004AE Leapfrog Communications (PWS Section 5 paragraph 0.5 EA

5.3.5, 5.3.5.5.3.1)

FFP

(Option Line Item)

6004AF Leapfrog Education Series Attendance (PWS Section 3 EA

5 paragraph 5.3.5)

FFP

39 43

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

6004AG Leapfrog Annual Meeting (PWS Section 5 paragraph 0.5 EA

5.3.5)

FFP

(Option Line Item)

6004AH Leapfrog Health System Analyst (PWS Section 5 2880 HR paragraph 5.3.5)

FFP

(Option Line Item)

6004AJ Leapfrog Administrative Assistant (PWS Section 5 480 HR paragraph 5.3.5)

FFP

(Option Line Item)

6005 Institute for Healthcare Improvement (IHI) Global 5500 EA

Trigger Tool (GTT) (PWS Section 5 paragraph

5.3.6.1.1 ) Fixed price per chart.

(Option Line Item)

6006 QSRS Data Abstraction (PWS Section 5 paragraph 3000 EA

5.3.6.2.1.2) (based on 2021 CQI abstraction studies)

FFP

(Option Line Item)

6007 Behavioral Health Facility Initial Fees 27.5 EA

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

(Option Line Item)

6008 Quality and Utilization Reviews (PWS Section C 3250 EA paragraph 5.5.2.10) Fixed price per chart.

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

6009 75 EA

6010AA 1 EA

6010AB 37.5 EA

6010AC 2.5 EA

6010AD 5 HR

6010AE 5 HR

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)

Appeals & Hearings Internal Reviews (PWS Section 5 paragraph 5.5.4.1 and PWS Section J, Attachment J-4) Fixed price per internal review.

(Option Line Item)

Appeals & Hearings Routine External Reviews (PWS

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

FFP

(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.

FF

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

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

FFP

(Option Line Item)

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

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 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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(A) (B) (C) (D) (E) (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 0.5 EA

Management conference (PWS Section 5 paragraph

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

5.8.2) FFP

(Option Line Item)

6019 Website Management Quality Communications (PWS 960 HR

Section 5 paragraph 5.8.2.1)

FFP

(Option Line Item)

6020 Travel (PWS Section 1 paragraph 1.8.3; FAR Part 0.5 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 and FAR 52.237-3) FFP.

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

HT940222R0002 Page 43 of 43

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 C76

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 C76

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, DoD Instruction 6025.13, and the DHA procedures

Clinical Quality Management in the Military Health System (MHS), DHA Procedures Manual

(PM) 6025.13. In the event of conflict between the DODI 6025.13 and DHA PM 6025.13, DHA

PM 6025.13 takes precedence.

The purpose of this contract is to assist DHA Health Care Administration Directorates for

Medical Affairs, Health Care Operations, and the TRICARE Health Plan in assessing and

HT940222R0002 Page C3 of C76 improving the safety and quality of care delivered under the TRICARE benefit across the direct and private sector care systems.

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