TDP7_TPA Q and A.pdf

Question # Questions Government Response

1 What is the procurement timeline (for both TPA and Dental Carriers)?

The procurement timeline is dependent on the rulemaking process. The aquisition plan is to start the NDAA23 improvements at the beginning of the TPA and TDP-7 procurements, which may coincide with the end of the TDP-6 contract.

2 Will DHA adopt a phased implementation schedule to test TPA-carrier data exchanges prior to go-live in 2027?

Yes. The TPA contract will be awarded, and the period of performance will begin, prior to the TDP-7 contracts.

3 How will DHA handle cybersecurity certification reciprocity and required personnel security clearances between dental carriers and the TPA?

TRICARE Systems Manual (TSM) requirements will be followed. The government expects CMMC requirements.

4 What does transition look like?

The TPA contractor will transition in prior to the TDP-7 contractors in order to establish the DMDC/Defense Enrollment and Eligibility Reporting System (DEERS) interfaces. The TPA and TDP-7 contractors will be required to coordinate closely with each other during transition in order to synchronize on transition milestones.

In the NDAA, Congress established Jan 1, 2027 as the TDP-7 start date to give DHA more time to procure a TPA and dental carrier contracts. The government, however, has indicated its intent to exercise all options of the current TDP-6 contract prior to implementation of TDP-7. Has the Office of General Counsel opined on DHA's intent to exercise of TDP-6 vice adherence to the implementation dates required by law?

DHA is familiar with the requirements of the NDAA.

In the NDAA, Congress established Jan 1, 2027 as the TDP-7 start date to give DHA more time to procure a TPA and dental carrier contracts. The government, however, has indicated its intent to exercise all options of the current TDP-6 contract prior to implementation of TDP-7. Will the government clarify its intent to adhere to the implementation date required by Section 701 of the NDAA for fiscal year 2023?

The procurement timeline is dependent on the completion of the rulemaking process. The aquisition plan is to start the NDAA23 improvements at the beginning of the TPA and TDP-7 procurements, which may coincide with the end of the TDP-6 contract.

7 The government states there are 35,000 OCONUS TDP beneficiaries. Will the government provide beneficiaries' locations and sponsor status in the upcoming RFP? Yes.

Does the government intend to require the same appointment availability and drive time standards for OCONUS beneficiaries as it does for CONUS beneficiaries, understanding that the delivery and availability of dental services OCONUS varies considerably from country to country and in different locations within the same country?

No. Networks are not established OCONUS. In some areas, there will not be a TRICARE Overseas Preferred Dentist (TOPD). Beneficiaries will have the choice to see any provider and the contractor will be required to verify licensure and credentialing.

9 Will the government provide OCONUS dental services utilization rates, delineated by the American Dental Association's Current Dental Terminology Codes, in the upcoming RFP?

Utilization rates will be provided. The majority of countries do not use ADA codes. Oftentimes it's up to the contractor and/or Dental Service Point of Contact (DSPOC) to intrepret what care was provided. They will then list the procedure codes.

Note: Care provided OCONUS is not reimbursed by codes, but rather billed charges.

10 What technical interface standards or platforms are anticipated for TPA-TDP data exchange?

The TPA and TDP-7 carrier will be expected to define their own. The TSM will provide system and security connectivity requirements for the TPA. The TDP-7 carriers are required to comply with federal HIPAA privacy and security requirements.

11 Will there be specific small business set-asides within the TPA or TDP-7 components (for outreach, data management, or customer support)?

If award is made to a large business, the successful contractor will have to meet DoD's established goals for subcontracting to small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns.

12 How will DHA structure subcontracting or teaming under the TPA contract to allow small business participation?

If award is made to a large business, the successful contractor will have to meet DoD's established goals for subcontracting to small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns.

13 Will the Government consider qualified minority-owned, small business subcontractors for call center, enrollment support, and beneficiary education services under the TDP-7 or TPA contracts?

If award is made to a large business, the successful contractor will have to meet DoD's established goals for subcontracting to small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns. Small businesses interested in subcontracting opportunities should work with interested prime contractors.

14 Will there be opportunities for industry to engage with the Government or prime contractors to discuss potential subcontracting arrangements after the Industry Forum?

The Government will not engage directly with potential subcontractors. Interested parties to subcontracting opportunities are encouraged to take advantage of the Industry Forum to identify and collaborate with potential prime contractors that will be participating in the Industry Forum.

15 For the TPA model, will there be standardized technical requirements or data-sharing protocols for eligibility verification, enrollment processing, and premium administration that subcontractors should align with?

Eligibility verification will be accomplished using the DEERS. Contractors should align with industry standard technical and data-sharing protocols.

16 What performance measures or service level expectations will be prioritized for enrollment, eligibility, and call center functions?

Some measures or expectations will be identified in the Draft Request for Proposal (RFP) Section C (PWS) or Section H.

17 Will the Government provide additional guidance on the expected enrollment timeline and outreach requirements during the transition to TDP-7?

Transition activities and timelines will specifically be identified in the PWS or elsewhere in the

RFP.

18 Could DHA clarify whether TDP contractors will retain any direct customer support responsibilities, such as those related to detailed claims-processing questions beyond general status updates?

Yes, they would still have to have direct customer service related to certain functions (claims, verify eligibility, follow privacy and HIPAA rules, provider & beneficiary verification and questions, etc.)

19 What is the government's expectations for system performance and scalability during transition?

Transition-in activities, to include performance and scalability requirements, will be specifically identified in the PWS and in the RFP. The objective for Transition-in is for the successful contractor to be fully operational at the Start of Dental Care Delivery with no negative impact to beneficiaries or the Program. Interim performance and scalability timelines during Transition-in will be identified.

20 What are the data standards and interoperability requirements? TSM requirements and industry standards.

21 What does the government currently use in regards to interoperability platforms or APIs? TSM requirements will be followed.

22 What are the small business involvement intentions?

The acquisitions will be subject to full and open competition. At the subcontracting level, if the contract is awarded to a Large Business, the successful contractor will be required to submit its Small Business Subcontracting Plan to the Contracting Officer, negotiate, and meet DoD's established Small Business Goals. The Government expects its prime contractors to utilize Small and Disadvantaged businesses to the maximum extent practicable.

23 Are there any areas that may be de-scoped and broken out / any intentions on splitting this into different contracts?

The Third-Party Administrator concept breaks out the eligibility, enrollment, and other adminstrative functions from the basic Dental (TDP) requirement. It is not anticipated that further breakout of the TPA tasks will result in any additional benefit or value to the Government.

24 Can the government clarify the expected effective date of the new model?

The procurement timeline is dependent on the completion of the rulemaking process. The aquisition plan is to start the NDAA23 improvements at the beginning of the TPA and TDP-7 procurements, which may coincide with the end of the TDP-6 contract.

25 Has DHA considered a separate payment integrity contract, in addition to a TPA contract to provide services to the TDP-7 contract? The government will not be further breaking out the TPA contract requirements.

26 Will the Government consider a hybrid model where TPAs manage enrolment and reporting, while carriers retain premium and risk management responsibilities?

No. The NDAA23 requires the TPA contractor to manage eligibility, enrollments and premiums.

27 If multiple carriers are awarded, will the Government define geographic or population-based segmentation, or allow carriers to compete nationally? Carriers will compete worldwide.

28 Will the Government permit modular subcontracting arrangements for credentialing, compliance, and member experience functions outside of core carrier or TPA roles?

The TPA and TDP-7 prime contractors will be free to subcontract out their respective contract requirements as they deem appropriate.

29 Will DHA proivde standardized data schemas for enrollment, eligibility, and premium reconciliation, or will carriers/TPAs be exptected to define their own?

No, the TPA and carrier will be expected to define their own. The TSM will provide system and security connectivity requirements for the TPA. The TDP-7 carriers are required to comply with federal HIPAA privacy and security requirements.

30 Will the Government require real time data exchange (e.g. API-based) for eligibility and QLE processing, or allow batch-based reporting?

Yes, real time as the TPA data links to DEERS and as the TPA and carriers exchange eligibility data. Batch reporting may be available.

31 Will audit logic and compliance triggers be embedded in the contract, or defined post-award through operational guidance? Compliance triggers will be included within the RFP.

32 Will the Government allow auto-assignment (fair share) of unenrolled beneficiaries post-enrollment period, and if so, will opt-out flexibility be mandated? The Government has not yet determined how it will handle unenrolled beneficiaries.

33 Will TDP-7 maintain open season + QLE enrollment logic, or consider continuous open enrollment for certain populations (reserve, rural, tribal)? The Government intends to permit continuous open enrollment.

34 Will DHA provide branded outreach templates or require carriers/TPAs to develop their own member education materials?

Yes, the Government will provide branded templates through Director's Communications and Public Affairs Division (DCPAD) and DMDC.

35 Can DHA clarify whether the TPA's responsibilities will extend beyond eligibility, enrollment, and premium administration to include encounter data collection and reconciliation across all participating carriers?

The TPA responsibilities will not include encounter data collection but will include premium reconciliation with carriers.

36 How does DHA envision the TPA coordinating standarized proceses and data exchanges with multiple carriers while maintaining fairness and performance accountability?

The TPA and TDP carriers will use industry standards for data exchanges. There will likely be contractual documentation indicating if an issue is out of your control, you will not be held responsible.

37 Could DHA provide more detail on the anticipated procurement and award timeline for the TPD TPA contract, including key milestones or draft RFP release dates?

The procurement timeline is dependent on the completion of the rulemaking process. The aquisition plan is to start the NDAA23 improvements at the beginning of the TPA and TDP-7 procurements, which may coincide with the end of the TDP-6 contract. As additional information relating to the timeline becomes available, the Government will share with industry.

38 What transition period does DHA anticipate between contract award and go-live, and how will DHA evaluate a bidder's ability to minimize disruption during this phase?

The TPA procurement will precede the TDP-7 procurement. The government is still determining the proper transition period (i.e. 12 Months, 18 Month, etc.). Evaluation criteria will be in Sections L & M of the RFP.

39 Will DHA run the TPA procurement in parallel with the carrier solicitation, or will one award precede the other? The TPA procurement will precede the TDP-7 procurement but then run concurrently.

40 Given that the current stand-alone EEE solution for the CPD will sunset in 2028, is DHA evaluating whether the future TDP TPA could serve as the centralized EEE administrator for future competitive plan contracts? Requirements and documentation only pertain to TPA/TDP-7.

The CPD EEE requirements include encounter data processing (medical, pharmacy, OHI, PCM), DEERs queries with X12 271 responses, enrollment and fee processing, call center support, and a secure decision-support website for 10,000-50,000 beneficiaries. To what extent does DHA expect the future TPA to possess or scale to this full capability set?

The CPD requirements are distinct and separate from the TPA/TDP-7 requirements.

Would DHA prefer a TPA partner that can integrate CPD EEE functions into existing TRICARE dental or medical infrastructure to improve efficiency and consistency, rather than maintaining separate EEE platforms in future demonstrations?

No.