Attachment 1 - IRMAC PERFORMANCE WORK STATEMENT - Amendment 6.pdf

Defense Health Network Indo-Pacific

PERFORMANCE WORK STATEMENT

(Includes associated Performance Requirements Summary (PRS))

In support of Defense Health Network Indo-Pacific MTFs supported by the Pacific/Hawaii

Integrated Referral Management and Appointing Center (P/HIRMAC) delivering Patient

Appointing Services (PAS), Referral Management Services (RMS) and Clear and Legible

Reporting Services (CLR).

1. GENERAL:

1.1. The contractor shall provide centralized Patient Appointing Services (PAS), Referral

Management Services (RMS), and Clear and Legible Report accountability Services (CLR) for

Defense Health Network Indo-Pacific Military Treatment Facilities (MTF). Operational principles, practices, policies and performance will be in accordance with current Defense Health Agency

(DHA) directives, guidelines, policies and standard business rules applying to appointing, referral management, and CLR services.

1.1.1. Patient Appointing Services (PAS), Referral Management Services (RMS), and Clear and

Legible Report Services (CLR) will be provided to MTF TRICARE enrolled and empaneled beneficiaries, and selective Veterans Administration (VA) eligible beneficiaries within the

Defense Health Network Indo-Pacific (DHN-IP). This contract supports all the Defense Health

Network Indo-Pacific to include; Oahu-based medical and dental organizations to include;

Tripler Army Medical Center (TAMC), Schofield Barracks (Desmond Doss) Health Clinic, 15th

Medical Group (MEDGRP) Joint Base Pearl Harbor-Hickam, Naval Health Clinic (NHC) Hawaii

Pearl Harbor, Branch Medical Clinic (BMC) Marine Corps Air Station (MCAS) Kaneohe Bay, Branch Medical Clinic (BMC) NSY Pearl Harbor, Wheeler Field Aviation Clinic, Naval Branch

Health Clinic (NBHC) NAVCAMS EASTPAC, Naval Branch Health Clinic (NBHC) Marine Corps

Base (MCB) Camp Smith and Community Based Medical Home (CBMH) Warrior Ohana, 5th

MDG Dental Clinic, JBPHH; Makalapa Dental Clinic; JBPHH; Camp Smith Dental Clinic; Camp

Smith; Wahiawa Dental Clinic; NCTAMS Wahiawa; Kaneohe Bay Dental Clinic, Marine Base

Kaneohe; Scofield Barracks Dental Clinic, Schofield Barracks; Na Koa Dental Clinic, Schofield

Barracks; TAMC Dental Clinic, Tripler AMC; Bhaskar Dental Clinic, Fort Shafter. This contract supports all Puget Sound MTFs within the Defense Health Network Indo-Pacific to include;

Madigan Army Medical Center (MAMC), Naval Health Clinic Bremerton (NHCB), Naval Health

Clinic Oak Harbor (NHCOH), the 62nd Medical Squadron, Presidio of Monterey California

Medical Detachment (CALMED), all MTF subordinate activities, Fulton Dental Clinic, Lefler

Dental Clinic, McClung Dental Clinic, Madigan Dental Clinic, McChord Dental Clinic, Okubo

Dental Clinic, Naval Base Kitsap-Bremerton Dental Clinic, Naval Station Everett Dental Clinic, Oak Harbor Dental Clinic, and Presidio of Monterey Dental Clinic.

1.1.2.

1.2. BACKGROUND:

1.2.1. The Puget Sound enhanced Multi-Service Network (eMSM) was established IAW the

Deputy Secretary of Defense (DepSecDef) memorandum dated 11 March 2013 with the mission to optimize utilization of MTF direct care resources, improve beneficiary access to care, enhance beneficiary satisfaction, and improve military readiness.

1.2.2. The Defense Health Agency released DHA Interim Procedures Memorandum

Procedures, Hours of Operation, Productivity, Performance Measures and Appointing Types in

Primary, Specialty and Behavioral Health Care in Medical Treatment Facilities (MTFs)” dated 4

February 2020, mandating the establishment of Integrated Referral Management and

Appointing Centers (IRMACs). The directive to IRMACs included standardized business processes and practices, as well as performance management and reporting.

1.2.3. DHA operates and directs healthcare delivery services worldwide for TRICARE beneficiaries. The Defense Health Agency established Defense Health Networks to integrate operations of DHA Medical Treatment Facilities under a unified command structure in order to achieve economies of scale while enhancing delivery of medical services to TRICARE beneficiaries.

1.2.4. The overarching objective of this contract is to support the Defense Health Network

IndoPacific (DHN-IP) MTFs in their mission to deliver quality, timely services to TRICARE beneficiaries. This contract will support the mission of eliminating unwarranted variation in patient appointing, referral management and CLR services in order to increase MTF capacity while providing the highest standards of patient service delivery and satisfaction.

1.2.5. The Pacific/Hawaii Integrated Referral Management and Appointing Center (P/HIRMAC) is co-located and at a common operations site that serves as the primary source for patient appointing, referral management and CLR services serving PIRMAC and HIRMAC beneficiaries. The operational intent of the P/HIRMAC is to serve as the patient’s primary point of contact for appointing, referral and CLR services. The contractor will operate a call center that manages inbound and outbound calls from beneficiaries, validates beneficiary eligibility, schedules, cancels, and reschedules patient appointments in order to provide timely access to quality healthcare. Furthermore, this service will provide outbound calls in order to schedule specialty appointments for beneficiaries who have received a direct care specialty referral. The contractor will record each beneficiary call with the contractor-supplied computers that interface with the standardized Military Healthcare System (MHS) GENESIS electronic health record appointing and referral management system. Calls will be documented in MHS GENESIS using the most current DHA and DHN-IP policies. Additional services include processing appointment requests via the MHSG Patient Portal, as well as outbound calls for patient care cancellations and rescheduling. The contractor shall also generate outbound notification letters to beneficiaries referred to direct care specialty clinics.

1.2.6. The contractor shall execute referral management functions, in compliance with DHA and

DHN-IP referral management standardized business processes, in order to deliver timely dispositioning of MTF generated specialty referrals. Referral management services are designed to optimally support the delivery of specialty care services within access standards and facilitate the appointing of patients within the direct and/or the private sector care network of providers.

1.2.7. The Contractor shall provide CLR accountability services for MTF enrolled patients referred to the Managed Care Support Contractor (MCSC) civilian provider network. These time-sensitive services are necessary in order to ensure that the documentation of care delivered in the civilian network is retrieved and documented in the patient’s permanent military healthcare record. These CLR include direct communication and coordination with civilian network provider offices in order to retrieve all documentation of healthcare services rendered and complete the communication cycle to the referring MTF health care provider.

1.2.8. The DHN-IP Healthcare Operations (HCO) Directorate coordinates and exercises operational oversight of contractor delivered services in support of the PIRMAC and HIRMAC direct care healthcare delivery system MTFs.

1.3. SCOPE OF WORK: The contracted services include delivering centralized PAS, RMS, and

CLR to DHN-IP beneficiaries

1.3.1. Appointing services span a range of functions to include, but not limited to; verifying beneficiary eligibility via the Defense Enrollment Eligibility Reporting System (DEERS) system, updating patient demographic information, and scheduling beneficiary requests for MTF primary or specialty care appointments, as well as completing requests for cancellations and appointment rescheduling. The work includes completing outbound calls to facilitate the timely scheduling of appointments. With the expansion of integrated specialty service lines at sister

MTFs, appointing agents will serve an important role in scheduling and coordinating appointments with other PIRMAC and HIRMAC MTFs in order to meet beneficiary health care needs within TRICARE access standards.

1.3.2. Referral processing supports the timely scheduling of specialty care referrals ordered by

MTF providers. Referral services span a range of functions to include, but not limited to:

identifications of specialty referrals to be deferred to the network, ensuring processing in accordance with DHA timeliness. To achieve DHA quality standards for access to specialty care, the processing of these referrals is highly time sensitive. The contractor’s role includes a review of each MTF generated referral and determining a disposition as either “Appoint to MTF” or “Defer to Network (DTN)” based on specific MTF specialty clinic capabilities, capacities, and

DHA access to care standards. The contractor likewise plays an important role in supporting force generation and Grduate Medical Education (GME) programs by maximizing the retention of complex specialty care within the MTFs to strengthen Military Services readiness within capability and capacity parameters.

1.3.3. Clear and Legible Report accountability is an essential component of the quality care continuum. Clear and Legible Report services span a range of functions to include, but not limited to: monitoring care delivered in the MCSC network and ensuring the return of clinical care documentation to the MTF in accordance with DHA timeliness standards. MTF enrolled beneficiaries who are referred to civilian network care due to limitations in MTF specialty capability and/or capacity return to their MTF referring provider for care management. The referring MTF provider is reliant on the conclusions and recommendations documented in the

CLR. The CLR ensures the retrieval of health care records from the civilian provider and the delivery of those documents to the beneficiaries’ medical record. The contracted services includes the upload of network care (CLR) results into the electronic health record as well as conducting outbound calls and faxes in order to provide full accounting for network care results based on appointment and network claims data.

1.4. PHASE-IN/PHASE-OUT:

1.4.1. This contract includes a phase-in period to provide the contractor time to perform all tasks required to ensure complete preparation for successful performance at the start of contract operations. The required tasks during the phase-in period includes, but is not limited to, recruiting and training personnel, obtaining security clearances, submitting copies of credentials, determining and meeting training requirements, developing work plans and procedures, submitting performance report formats, and finalizing quality control plans and procedures.

1.4.2. PHASE-IN:

The contractor shall: (see Exhibit I –DHN-IP Phase-In Plan of Action & Milestones)

1.4.2.1. Ensure a smooth transition from the incumbent contractor to the follow-on contractor.

1.4.2.2. Become thoroughly familiar with work requirements and work procedures.

1.4.2.3. Complete personnel requirements including the hiring of personnel to ensure satisfactory performance beginning on the full-performance start date.

1.4.2.4. Obtain security clearances, as required

1.4.2.5. Complete training requirements and accomplish necessary training of contractor employees.

1.4.2.6. Complete the development of necessary work plans and procedures.

1.4.2.7. Demonstrate readiness to successfully perform required services on the full-performance start date.

1.4.2.8. Ensure performance requirement reporting data elements and formats are approved

The contractor shall: (see Exhibit I – DHN-IP Phase-In Plan of Action & Milestones)

1.4.3. PHASE-OUT:

The contractor shall:

1.4.3.1. Cooperate fully to the extent required to permit an effective, orderly, and successful transition that will maintain mission continuity. This may include a collective weekly discussion between the incumbent contractor, follow-on contractor, and the KO on the status of the phaseout. All official files, manuals, charts, records, drawings, and other official documentation are the property of the Government and shall remain on location for use by the Government or follow-on contractor at the time of contract expiration. Reference FAR clause 52.237-3, Continuity of Service.

1.4.3.2. Reserved

1.4.3.3. Within seven working days following completion/termination of the contract, the contractor shall return all CACs issued to their personnel to the issuing office or the location specified by local policy/directives. Failure to comply with this requirement may result in withholding of final payment.

1.4.3.4. Within seven working days prior to the last day of the contract, a joint assessment shall be conducted with the COR of the status of all transition tasks.

1.5. SAFETY REQUIREMENTS. The contractor shall ensure PAS, RMS, and CLR agents maintain safety and health standards compliant with the requirements of the Occupational

Safety and Health Administration (OSHA).

1.6. SECURITY REQUIREMENTS

1.6.1. Background Investigations. The contractor shall achieve the same level of trustworthiness for PAS, RMS, and CLR agents as required for government personnel with similar access to automated information systems (AISs) and networks containing Department of Defense (DoD)

Sensitive Information (SI). The contractor shall meet the personnel security requirements for

Automated Data Processing (ADP) access in DoDI 5200.02, DoD Personnel Security Program

(PSP), for employees and subcontractor employees that require access to government IT systems or DoD SI, or are involved in developing, delivering, or supporting Information

Technology (IT) systems and services, or safeguarding DoD SI within government or contractor systems. The contractor shall classify ADP/IT or related positions, submit appropriate paperwork for background investigations or proof of a favorable adjudication, ensure individuals receive requisite training, and document compliance. The contractor must complete a personnel background investigation and training before accessing the DoD AIS/networks or

DoD SI. Details/discussions for completing and forwarding forms for requesting an investigation will take place within seven calendar days after award of contract with the government IT

Security Officer for the networks and systems being accessed.

1.6.2. The contractor shall comply with the most current version of all government privacy and security regulations and directives identified in Paragraph 6, Documentation, and other applicable DoD Service privacy and security instructions and regulations. In addition, the contractor shall comply with the most current version of all relevant rules and regulations that implement the applicable requirements of the Health Insurance Portability and Accountability

Act (HIPAA) of 1996. This shall include the regulations at Parts 160 and 164 of title 45, Code of

Federal Regulations, TRICARE Operations Manual 6010.51-M, August 1, 2002, Chapter 21, Section 3; DoD Health Information Privacy Regulation (DoD 6025.18-R); Privacy of Individually

Identifiable Health Information in DoD Health Care Programs (DoDI 6025.18); the Privacy Act;

and DoD Privacy Program (DoD 5400.11-R). Additions supplements, amendments, or changes to these publications may be issued during the life of the contract. Changes to mandatory publications which cause a change in performance that will increase or decrease price will be incorporated into the contract by mutual agreement of the parties

1.6.3. Use of Protected Health Information (PHI). The contractor shall use PHI for their designated project. The contractor shall not use the PHI to create databases or any other product not intended for use specifically for this requirement. The contractor shall destroy all

PHI related to the requirement, that is not delivered to the government at the conclusion of the tasking. All hard drives containing unclassified data outside of DOD shall be removed and destroyed through sanitation of SI from storage media in a manner that gives assurance that the information is unrecoverable by technical means. Destruction of hard drives shall comply with National Institute of Standards and Technology (NIST) Special Publication 800-88, Revision 1, regarding destruction of computer hard drives prior to disposal.

1.6.3.1. Personally Identifiable Information (PII)/PHI that is processed and printed out on government or contractor Information Systems (ISs) and networks is considered SI and will be treated as “For Official Use Only” (FOUO) information, as directed by DoDD 5400.7, “DoD

Freedom of Information Act Program.” Any SI, e.g., PHI and privacy data, processed, printed, stored, or manipulated on government or contractor ISs and networks will be protected, marked, and labeled IAW DoD 5200.1-R.

1.6.3.2. The contractor shall maintain, transmit, retain in strictest confidence, and prevent the unauthorized duplication, use, and disclosure of PHI IAW the regulations at Parts 160 and 164 of title 45, Code of Federal Regulations, DoD Health Information Privacy Regulation (DoD

6025.18-R), the Privacy Act, and DoD Privacy Program (DoD 5400.11-R). The contractor shall ensure that beneficiary information is only accessible to employees, contractors, subcontractors, and government personnel having a need to know such information in the performance of their duties for this requirement.

1.6.4. The Risk Management Framework (RMF) is the standardized approach to the

Assessment and Authorization (A&A) process within DoD. Each IS/network that undergoes

RMF will have security controls implemented as defined in the NIST 800-53, must have documented the security components and operation of the Information System (IS)/network, and must successfully complete testing of the required security controls. The contractor shall ensure RMF documentation and artifacts are available for review and are accurate. Each contractor IS/network must also comply with the requirements for Information Assurance

Vulnerability Management (IAVM) to ensure that the security posture is maintained. Guidance regarding the requirement for IAVM can be found in the DoD Information Assurance

Vulnerability Alert (IAVA), 30 Dec 1999. The contractor shall execute the RMF process by providing, for receipt by the KO within 30 calendar days following contract award, the required documentation necessary to receive an Authorization to Operate (ATO) and making their

IS(s)/networks available for testing. The contractor shall mitigate the vulnerabilities identified for correction during the risk assessment process. These requirements shall be met before allowing authorized access when interconnecting with any DoD information system or network.

System access is required to train new staff. The contractor shall meet these requirements within the first 30 calendar days of the transition.

1.6.4.1. IS/Networks Physical Security. The contractor shall employ physical security safeguards for IS/Networks involved in the operation/use of a centralized appointment system to prevent the unauthorized access, disclosure, modification, destruction, use, etc., of SI and to otherwise protect the confidentiality and ensure the authorized use of SI.

1.6.5. Government Information. All inquiries, comments or complaints arising from any matter observed, experienced, or learned of as a result of or in connection with the performance of this contract, the resolution of which may require the dissemination of official information, report to the COR and the KO.

1.6.5.1. Documents received from external sources requesting additional information beyond the access and ability of the contractor will be forwarded/routed to the COR for routing determination

1.6.5.2. United States Government (USG) records, copies of original results and reports, verified original data, corrected data and supporting final reports are maintained by the contractor, but remain the property of the USG. The COR will gain possession of files/results upon request or completion of the contract.

1.6.5.3. The contractor shall only conduct business with designated government personnel listed as points of contact (POCs). Names of authorized personnel shall be provided to the contractor by the COR, in writing, and updated as necessary throughout the contract.

1.6.6. TRUSTED ASSOCIATE SPONSORSHIP SYSTEM (TASS):

1.6.6.1. The contractor shall comply with agency personal identity verification procedures that implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and

Budget (OMB) guidance M-05-24, and Federal Information Processing Standards Publication

(FIPS PUB) Number 201

1.6.6.2. The contractor shall comply with agency personal identity verification procedures in all subcontracts when the subcontractor is required to have physical access to a federally controlled facility or access to a Federal information system

1.6.6.3. The contractor shall ensure compliance with the provisions set forth below. For purposes of Federal Acquisition Regulation (FAR) 52.204-9, the government will designate a

Trusted Agent (TA) for this contract. The government reserves the right to amend or supplement these provisions pursuant to the changes clause in the contract

1.6.6.4. The contractor is responsible for absences of PAS, RMS, and CLR agents due to expired identification and access documents. Such absences shall not relieve the contractor of its obligation to perform the services required under this contract.

1.6.6.5. The government will sponsor the PAS, RMS, and CLR agents for an Army Knowledge

Online (AKO) account. All PAS, RMS, and CLR agents email addresses will identify them as a contractor and use the format firstname.lastname.ctr@health.mil. The government will discontinue AKO accounts when the PAS, RMS, and CLR agents no longer require access

1.6.6.6. The Government TA will send a notice through TASS to the AKO e-mail address provided IAW the above requirement. The PAS, RMS, and CLR agents’ user ID and password will be provided in the email and shall require a change at first login. In the event the e-mail message is not received, the contractor may request the username and password from the TA and proceed to the website https://www.dmdc.osd.mil/tass to complete the process.

1.6.6.7. The PAS, RMS, and CLR agents shall log into TASS and complete the verification process by submitting the application to the TA for approval.

1.6.6.8. The application will be accepted, returned, or rejected by the TA. Notice as to whether the application has been accepted, returned, or rejected will be provided to the individual's email address within 48 hours after submission. If the application is returned or rejected, the

PAS, RMS, and CLR agents shall contact the TA and comply with the TA's guidance to attempt to correct and resolve the issues.

1.6.6.9. Upon approval of the application, the PAS, RMS, and CLR agents shall receive an email sent to the address provided stating the Common Access Card (CAC) application was approved. The applicant must then go to a Real-Time Automated Personnel Identification

System (RAPIDS) Issuing Facility to have the government credential issued. The PAS, RMS, and CLR agents must present two acceptable forms of ID, which may include Driver’s License, http://www.dmdc.osd.mil/tass http://www.dmdc.osd.mil/tass

Military ID, Contractor Company ID with picture and expiration date, charge card with picture imprinted, or passport.

1.6.6.10. Revalidation Requirements. The TA is required to revalidate all PAS, RMS, and CLR agents through TASS every 180 days. In the event revalidation is denied, the CAC credentials shall be revoked and the CAC will not be usable to login

1.6.6.11. Out-processing Requirements. When a PAS, RMS, and/or CLR agent’s performance under this contract ceases, each agents shall personally bring the CAC to the TA and complete the Department of the Army (DA) Form 2962. The TA will revoke the CAC from TASS

1.6.6.12. The PAS, RMS, and/or CLR agents shall immediately report any lost or stolen badges to the COR within 24 hours or the next business day.

1.7. QUALITY CONTROL (QC). The contractor is responsible for quality control of all services provided. The contractor shall establish and maintain a complete Quality Control Plan (QCP) that shall ensure the requirements of the contract are provided as specified in this PWS. The contractor shall provide copies of the QCP to the KO and COR no later than 30 calendar days after contract award, and within five calendar days when changes are made thereafter.

1.8. QUALITY ASSURANCE (QA). The government is responsible for quality assurance and shall evaluate the contractor’s performance under this contract IAW the Quality Assurance

Surveillance Plan (QASP). The QASP is the government’s internal plan for performing QA, and as such does not become part of the resultant contract.

1.9. PERSONNEL:

1.9.1. PAS, RMS, and CLR Center Management: The contractor shall provide on-site operations management to conduct the day-to-day management tasks of the call center.

1.9.2. Government Meetings. The contractor shall ensure on-site management attends, at a minimum, weekly meetings which may be conducted virtually with the Network Operations

Management team. The contractor shall attend virtual monthly meetings with each MTF and respective staff in each of the functional areas to include: PAS, RMS, and CLR and other meetings requested by the COR in order to support operational requirements. The contractor shall be prepared to travel to the various MTFs in order to interface with the MTF and clinic leaders whom they support.

1.9.3. The contractor shall ensure all staff are familiar with basic medical terminology and

Microsoft Office products used with the beneficiary a PAS, RMS, and CLR processes and understand business rules addressing beneficiary category access to the direct care and network systems. The contractor shall ensure that PAS, RMS, and CLR agents possess a functional knowledge of the TRICARE Healthcare Program and are familiar with the terminology and inter-relationships of the ATC categories, appointment types, referral processes, detail codes, provider specialties, and ATC standards. The PAS, RMS, and CLR agents shall receive annual refresher training in these areas, as well as stay abreast with TRICARE Program changes. The contractor shall provide proof of refresher training to the COR annually.

1.9.4. The contractor shall ensure PAS, RMS, and CLR agents possess appropriate customer service skills (telephone courtesy).

1.10. SEXUAL HARASSMENT/ASSAULT RESPONSE AND PREVENTION (SAPR-).

1.10.1. The contractor shall comply with OTSG/MEDCOM Policy Memo 19-019, Sexual

Harassment/Assault Response and Prevention Program, 21 March 2019, or superseding DHA or DOD policy once issued and provided to the contractor. The SAPR- reporting requirements apply only to knowledge obtained by contractor personnel while performing services under this contract.

1.10.2. Contractor Reporting of Sexual Assault and Sexual Harassment Incidents under the

SAPR- Program. The contractor shall require all personnel with knowledge of an incident of sexual assault occurring on a Government facility, to include a Government leased facility, where the contractor is providing services under this contract, to report the incident to the contractor who shall immediately (within 24 hours of gaining knowledge of the incident) report the incident in writing to the government's COR. This reporting policy also applies to sexual assault incidents involving DoD personnel that occur on the contractor's owned or leased facility under this contract. All incidents shall be reported whether they involve contractor personnel or

Government personnel, or other individuals, when the incidents occur on a Government facility, or a Government leased facility

1.11. Hours of Performance. The contractor shall provide PAS/RMS and CLR services from

Monday through Friday excluding federal holidays.

1.11.1. HIRMAC PAS hours of operation are from 6:00 a.m. to 6:00 p.m. Hawaii Aleutian

Standard Time (HST)

1.11.2. PIRMAC PAS hours of operation are from 6:00 a.m. to 6:00 p.m. Pacific Standard Time

(PST) / Pacific Daylight Time (PDT) as applicable.

1.11.3. The Contractor may utilize telework as necessary to ensure continuing operations for contingencies including, but not limited to, inclement weather and pandemic such as COVID19.

2. DEFINITIONS/ACRONYMS:

2.1. DEFINITIONS: The following is a list of basic definitions:

2.1.1. Appointment Error. Appointing Errors occur when: (1) a beneficiary is given the wrong appointment type for the level and type of care needed, (2) the appointing agent does not correctly complete the data elements, (3) the beneficiary is sent to the wrong location or the wrong provider, or (4) any other booking error that results in inconvenience to the beneficiary, disruption of clinic effectiveness/efficiency, and failure to appropriately match

TRICARE Prime beneficiaries to appointment slots reserved for Prime. Feedback regarding incorrectly scheduled appointments may be collected from beneficiaries, providers, clinic support staff, booking clerks, and appointment supervisors.

2.1.2. Appointing Agent. Individual who will schedule an appointment.

2.1.3. Average Speed of Answer. This is the cumulative total length of time of calls that are in queue or that are ringing before being answered by an Agent, divided by the total numbers of calls answered (measured in seconds).

2.1.4. Call "Blockage rate". Those calls that cannot be completed by the caller due to the call capacity of the telephone switch (i.e., all telephone lines are busy).

2.1.5. Call “Abandonment rate”: The number of callers whose calls were received by the telephone switch/ARU/ACD, but who disconnected (i.e., hung up before reaching an appointing clerk/scheduler) at any time during the entire call transaction.

2.1.6. Call “hold” Time. The total time the beneficiary is placed on hold or in queue by the telephone system or the contractor staff during the call. This includes the initial wait time and any subsequent times the beneficiary is placed on hold/in queue by the telephone system, appointment clerk/scheduler, or other contractor staff. This information shall be provided in 15minute increments.

2.1.7. Call Processing Time. The total length of call to include call-waiting time, hold time, and talk time.

2.1.8. Centralized Patient Appointing Services. Appointing services span a range of functions to include, but not limited to,; verifying beneficiary eligibility via the Defense Enrollment

Eligibility Reporting System (DEERS) system, updating patient demographic information, and scheduling beneficiary requests for MTF primary or specialty care do appointments, as well as completing requests for cancellations and appointment rescheduling.

Contractor appointing staff working physically and functionally within a single call center located outside a federal installation in support of the DHN-IP located in the Defense

Health Network Indo-Pacific, not to exceed 25 miles from a military facility.

2.1.9. Clear and Legible Report accountability services. CLR services span a range of functions to include but not limited to: monitoring care delivered in the MCSC network and ensuring the return of clinical care documentation to the MTF in accordance with

DHA timeliness standards. CLR includes the receipt of documentation of medical services provided by network providers/facilities following a valid referral generated by an MTF provider.

2.1.10. CLR error. A CLR error occurs when (1) a report is sent to the incorrect provider or attached to an incorrect patient’s medical record, (2) a referral is incorrectly closed before or after receiving reports from network providers, or (3) reports are uploaded that do not qualify as CLR.

2.1.11. Contracting Officer. A government employee having the authority vested by a

Contracting Officer’s Certificate of Appointment to execute, administer, and terminate contracts and orders, and modifications thereto, which obligate government funds and commit the government to contractual terms and conditions.

2.1.12. Contracting Officer's Representative (COR). An individual designated and authorized in writing by the contracting officer to perform specific technical or administrative functions.

Only an employee of the USG may be appointed as a COR. A COR does NOT have authority to change any terms or conditions of the contract.

2.1.13. Direct Care. The DoD's system of Military Treatment Facilities that provides care to MHS authorized beneficiaries.

2.1.14. Drive-time standards. A specialty care drive time standard is the distance between a beneficiary’s home address and the servicing MTF as defined by DHA and Network business rules. There are separate and distinct drive time standards for primary care, specialty care and out of area care.

2.1.15. Eligible Beneficiary. Eligible beneficiaries include TRICARE eligible beneficiaries, as well as Veterans Administration and/or civilians under special, previously authorized conditions.

2.1.16. Defense Health Network. A DHA designated Military Healthcare System comprised of

MTFs. These treatment facilities collaborate to establish an integrated healthcare delivery system that supports high quality, timely access to care while serving to improve the readiness of the Force.

2.1.17. Enrolled Beneficiary. An MHS eligible beneficiary registered in the Defense Enrollment

Eligibility Reporting System (DEERS) and who is enrolled in a TRICARE plan, including

Active Duty Service members.

2.1.18. First Call Resolution (FCR). This is the total numbers of calls that were completely resolved during the course of the first inbound call initiated by the beneficiary.

2.1.19. IVR Average Response Time. The average amount of time, rounded to the nearest minute, it takes for an agent to answer a patient’s call after the patient has finished listening to the voicemail and selected their desired phone menu option.

2.1.20. MHS GENESIS. A DoD electronic healthcare record system that is used exclusively in the DHA-IP. MHS GENESIS provides an integrated system for appointment scheduling, referral management functions as well as the management of patient care.

2.1.21. Managed Care Support Contractor (MCSC). Government contractors supporting the

DoD TRICARE program. These contractors establish civilian provider networks that augment and support the capability and capacity of the Military Healthcare System. They are designed to operate seamlessly in support of TRICARE beneficiary healthcare.

2.1.22. Military Health System (MHS). The Military Health System incorporates all aspects of health services for the Department of Defense and its beneficiaries

2.1.23. Military Health System (MHS) Beneficiary. Any TRICARE eligible individual who is eligible to receive treatment in a Military Treatment Facility. Eligibility may be expanded to include Veterans Administration and/or civilians IAW DoD/DHA business rules

2.1.24. Military Treatment Facility (MTF). A military hospital or clinic.

2.1.25. Referral Management Services. RMS services span a range of functions to include but not limited to; identifications of specialty referrals to be deferred to the network, ensuring processing in accordance with DHA timeliness, and tracking status of network referrals.

Contractor referral management staff will be collocated with PAS and CLR staff.

2.1.26. Secure Messaging System (SMS). A system that allows beneficiaries to communicate with their primary provider and healthcare team in order to ask for advice, receive test results, request prescription renewals, schedule appointments, or access health information resources for education and self-treatment

2.1.27. Unmet Demand. Unmet demand includes patient demand for care that could not be met within DHA Access to Care standards in the MTF from patients who tried to access the system but failed, including those who were not given an appointment and leaked to network specialty and behavioral health care.

2.1.28. Warm transfer. Person to person transfer of caller to an MTF clinic. Contractor stays with the caller a minimum of 45 seconds or until a successful hand off has concluded.’

2.2. ACRONYMS. The following is a list of acronyms found in this PWS:

2.2.1.

A&A Assessment and Authorization

ACD Automated Call Distribution

ASP Appointment Standardization Phase III

ATC Access to Care

ATO Approval to Operate

C&A Certification and Accreditation

CAC Common Access Card

CIS Contractor Interface System

COE Common Operating Environment

CFR Code of Federal Regulations

CLR Clear and Legible Reporting

COR Contracting Officer’s Representative

DEERS Defense Enrollment Eligibility Reporting Systems

DEPSECDEF Deputy Secretary of Defense

DHA Defense Health Agency

DHN-IP Defense Health Network Indo-Pacific

DII Defense Information Infrastructure

DISA Defense Systems Information Agency

DoD Department of Defense

DoDI Department of Defense Instruction

DTN Defer to Network

F2F Face-to-face

FAR Federal Acquisition Regulation

FIPS PUB

Federal Information Processing Standards

Publication

FOUO For Official Use Only

FTE Full-time equivalent

HEDIS Healthcare Effectiveness Data and Information Set

HIPAA Health Insurance Portability and Accountability Act

HIRMAC

Hawaii Integrated Referral Management and

Appointing Center

HSPD-12 Homeland Security Presidential Directive-12

IAVA Information Assurance Vulnerability Alert

IAVM Information Assurance Vulnerability Management

IAW In Accordance With

IM Information Management

IRMAC

Integrated Referral Management and Appointing

Center

IS Information Systems

IVR Interactive Voice Response

IT Information Technology

KO Contracting Officer

MCSC Managed Care Support Contractor

MTF Military Treatment Facilities

MHS Military Health System

NHB Naval Hospital Bremerton

NHCOH Navy Health Clinic, Health Clinic Oak Harbor

NIPRnet Non-secure Internet Protocol Router Network

NIST National Institute of Standards and Technology

OMB Office of Management and Budget

OSHA Occupational Safety and Health Administration

PIRMAC

Pacific Integrated Referral Management and

Appointing Center

PAS Patient Appointment Services

PCM Primary Care Manager

PHI Protected Health Information

PII Personally Identifiable Information

PKI Public Key Infrastructure

POC Point of contact

PSP Personnel Security Program

PWS Performance Work Statement

QA Quality Assurance

QC Quality Control

QCP Quality Control Plan

RAPIDS

Real-Time Automated Personnel Identification

System

RM Referral Management

RMC Referral Management Center

RMF Risk Management Framework

SAPR- Sexual Assault Response and Assault Program

SI Sensitive Information

SMS Secure Messaging System

TA Trusted Agent

TASS Trusted Associate Sponsorship System

UCC Urgent Care Center

USG United States Government

VA

Veterans Administration

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. TRAINING:

3.1.1. The government will be responsible for furnishing the trainers, the training rooms, equipment, and materials required for the training. The government will provide initial and sustainment training (e.g., MHS GENESIS updates) on MHS GENESIS PAS, RMS, and CLR modules as required. The government will provide a MHS GENESIS training plan IAW the appointing, referral, and CLR processes of MHS GENESIS. The government will provide initial training on MHS GENESIS during phase-in. Using the government developed training plan and a government owned training database, the government will provide “train the trainer” MHS

GENESIS training for up to 10 contractor personnel.

3.1.1.1. The government will be responsible for making any changes to the government’s training plan as updates and/or revisions are made to MHS GENESIS and will provide inputs to the contractor so that they can update their training system and of their MHS GENESIS

Training Course(s) curriculum.

3.1.2. Defense Health Network Specific Business Procedures. The government will provide the contractor with network specific business procedures for PAS, RMS, and CLR five working days after contract award. If procedures change throughout the life of the contract, the government will provide the contractor with updates.

3.2. Government Unique Training. The government will provide any mandatory training which is offered through government sources to the contractor’s agents who are performing services under this contract. The DHN-IP may elect to provide Network unique training to

PAS, RMS, and CLR agents to enhance or improve services offered under this contract.

The DHN-IP Office will provide such training at no additional expense to the contractor.

When directed by the COR, PAS, RMS, and CLR agents shall attend all such training in a paid status as part of the normal services required and billed under the contract. Such training shall require a performance commitment by the contractor and the contractor shall reimburse the government (by means of a reduction in an invoice) if an PAS, RMS, and

CLR agent fails to satisfy the performance commitment after the PAS, RMS, and CLR agent receives the government unique training. The amount of the reimbursement shall be the prorated cost of training, calculated based on the total cost of the training and the number of months by which the appointing, referral management or CLR agent fails to complete the performance commitment. The length of the performance commitment shall be 12 months or until the end of all performance under this contract, whichever occurs first.

3.3. The DHN-IP, IAW DHA directives, will standardize similar or like clinical appointing criteria across the Network, to include disease management, population health, primary care medical home, and/or similar MTF services. The MTFs will work jointly within the DHN-IP to establish processes and deliverables, requirements, and information exchange for preventive, wellness and HEDIS appointing/ordering standardized criteria.

3.3.1. The Appointing, CLR and Referral Protocol/Business Rules Business rules will be provided electronically by the DHN-IP COR, upon request. Revisions to the appointing and referral criteria/business rules will be made to support the DHN-IP beneficiary appointing process.

4. CONTRACTOR FURNISHED EQUIPMENT AND RESPONSIBILITIES:

4.1. The contractor shall provide all required equipment and dedicated toll free access to interface with government telephony, to include the Automated Call Distribution (ACD) system. The contractor shall provide/support a toll- free number. The contractor will only use government-furnished computers for initial registration of the Common Access Card

(CAC) (reference paragraph 4.2.1).

4.1.1. The contractor shall retain the current 1-800 telephone number to minimize distribution to the beneficiaries. The contractor shall provide sufficient capacity to support peak call volume to ensure the contractor meets telephone performance standards.

4.2. The contractor shall identify the connectivity configuration between the contractor and government, to include use of DoD LAN, NIPRNet, B2B, or Point-to-Point circuit, Internet connectivity.

4.2.1. The contractor will complete the following tasks to gain access to MHS GENESIS:

complete background check paperwork (PSIP) online; submit DD 2785 to hospital security office to gain MHS GENESIS account access approval; complete MHS

GENESIS training modules for the role the contractor will be performing; after receipt of clearance, CAC card and account access. The COR will facilitate the contractor with navigating the process.

4.3. The contractor shall provide hardware/software and telephony system needed to perform required services, browser to support Internet connectivity requirements, e-mail software to support appointment cancellation, CAC reader and middleware, browser, and e-mail versions that are compatible with DoD PKI.

4.3.1. Hardware Minimum as follows:

4.3.1.1. Processor: Modern multi-core 64-bit CPU (e.g., Intel Core i5/i7 or AMD

Ryzen 5/7 equivalent)

4.3.1.2. Memory: Minimum 16 GB RAM

4.3.1.3. Storage: Solid-State Drive (SSD) / 256 GB NVMe minimum

4.3.1.4. Display Support: Dual-monitor support (minimum 1080p per screen)

4.3.1.5. Peripherals: USB ports compatible with FIPS 201-compliant CAC readers and VoIP headsets

4.3.1.6. Security Hardware: TPM 2.0 chip enabled for BitLocker / hardware encryption

4.3.1.7. Citrix / OS Support: Capability to support Windows 11 Enterprise and

Citrix client instances

4.3.2. Software Minimum as follows:

4.3.2.1. Windows 11 Enterprise (or equivalent DoD-compliant OS),

4.3.2.2. DoD-compatible web browsers (Microsoft Edge / Google Chrome)

4.3.2.3. Approved CAC middleware (e.g., Purebred, ActivClient)

4.3.2.4. FIPS 140-2/3 compliant full-disk encryption (BitLocker)

4.3.2.5. Modern EDR/antivirus tools

4.4. PAS, RMS, and CLR Center Location. The appointing agents shall provide appointing and referral services via phone and electronic communication mediums. The primary centralized commercial facility must be physically situated within a twenty-five (25) statute mile radius of a Military Treatment Facility (MTF). The PAS, RMS, and CLR functions will be provided via remote or authorized hybrid contractors. The government reserves the right to conduct site visits in all contractor-operated facilities.

4.5. Staffing. Maintain a current listing of employees, to include full-time equivalency (FTE) and part-time designation, who staff the PAS, RMS, and CLR Center. The contractor shall provide the list to the COR within 10 calendar days after start of full contract performance and by the fifth calendar day of every month thereafter. The contractor will notify the COR when an employee's status or information changes.

4.5.1. The contractor shall provide up to 10 personnel to receive training by the government to serve as MHS GENESIS trainers during the transition period. The contractor provided trainers shall be familiar with the use of PC applications and have at least three years of experience as trainers.

4.5.2. The contractor shall ensure all PAS, RMS, and CLR agents complete MHS GENESIS training and ensure PAS, RMS, and CLR agents submit evidence of training completion and competence to the MHS GENESIS contractor, Cerner, and a copy to the COR.

Approved contractor MHS GENESIS trainers status is a requirement to start the MHS

GENESIS ‘Train the Trainer’ program. The Government will conduct initial and sustainment ‘Train the Trainer’ training that will be scheduled and agreed upon by all parties. Training shall be conducted during the transition period before the start of contract operations.

4.5.3. MHS Genesis And Access To Care Training:

4.5.3.1. The contractor shall be responsible for all MHS GENESIS training of contractor employees following the government provided initial training provided as a result of MHS

GENESIS system upgrades. The contractor shall ensure PAS, RMS, and CLR agents successfully complete training on MHS GENESIS before he/she is granted access by the government on MHS GENESIS.

4.5.3.1.1. The contractor provided MHS GENESIS PAS, RMS, and CLR agents training shall not be conducted on the “live” MHS GENESIS system. The government reserves the right to observe/monitor the contractors provided training sessions to ensure quality, consistency and adequacy of training.

4.5.3.2. Contractor provided training will also include training on general contract requirements and “Access to Care” procedures that are IAW current DHA policy and/or current applicable DHA references. Training will conform to DHA and DHN standards, policies, procedures, regulations, and statutes listing herein (See Section 6).

4.6. The contractor shall utilize Government approved MHS GENESIS training modules for

Appointing, Referral Management and Clear and Legible Report accountability.

4.6.1. The contractor shall conduct technical training, which will focus on systems architecture, mandatory system procedures, security requirements, and functional operating procedures to include PAS, RMS, and CLR. The curriculum will include the functions of

MHS GENESIS to include, as a minimum, MHS GENESIS data entry, registration, appointment scheduling, and other MHS GENESIS functionalities. The contractor provided training will also include training on appropriate scheduling appointment protocols IAW MHS beneficiary “priorities of care” standards specified in Title 32, Code of Federal Regulations (32 CFR), Section 199.17 for TRICARE Prime beneficiaries under the TRICARE Program and how the Secretary of Defense plans to ensure that beneficiaries under TRICARE Prime who are seeking an appointment for health care will obtain an appointment within established access to health care standards.

5. DESCRIPTION OF WORK: PAS. RMS. CLR

5.1.1.The contractor shall provide trained staff to meet the standardized DHA and Network specific appointing criteria and business rules IAW DHA POLICY. The contractor shall ensure that phones are continuously staffed with trained personnel, sufficient to handle projected call volumes while achieving all performance standards, during the designated business hours.

5.1.2. Appointing agents shall schedule, reschedule, and/or cancel appointments as well as correct appointment- booking errors for all inbound and outbound calls and correspondence

IAW DHA business policies and procedures.

5.1.3. Appointment Scheduling. After validation of eligibility, the appointing agent shall interpret the beneficiary’s request for an appointment and apply the appropriate appointing criteria and directives to the request IAW DHA POLICY. Appointing agents shall match the beneficiary’s request for service with the most appropriate ATC category, choosing the appropriate standard appointment types and detail codes that will appoint the beneficiary to an appropriate provider within the applicable DHA ATC standards.

5.1.4. Provider Appointment Templates. The Contractor will utilize MHS GENESIS provider schedules.

5.1.5. Appointment Cancellation Procedures. The contractor shall ensure appointing agents cancel, and if appropriate, reschedule beneficiary appointments at the request of the beneficiary IAW DHN-IP standardized business procedures.