Draft_PC-16-R-007_Q A's_9-9-16.pdf

Number Draft PC-16-R-007 Contract Section Page # Question/Comment Response

Attachment J.2

Attachment Are the DC Panel Providers currently contracted based on Medicare benchmarked rates? Would Peace Corps share the current fee schedules of the direct contracted providers?

No, the DC Panel Providers rates are not based on Medicare benchmarked rates and we are unable to share the current fee schedule. The principle benefit that Peace Corps currently receive from the DC Panel provider network is prioritized care for PCVs. Priority service for PCV's is required under this solicitation and thus must be arranged.

The offeror may either: include these providers in their network, or negotiate rates with the providers in Attachment J.2. (Section C.5.2. will be revised for clarification in the formal RFP).

2 C.1.3.4 Objective 4 - Provider Networks, Attachment J.2

Latest industry trends include mental health and primary care telehealth options. This would appear to be a good option for some of the volunteers being medevaced to DC for treatment depending on the diagnosis as well as for plan 3 and plan 4 members. While overseas telehealth is limited via regulation with providers needing to be licensed in the State they are providing the televisit, provider to provider consults and assessments can be provided overseas via telehealth if internet connection allows.

Telehealth options are not a requirement under this solicitation and will not replace current services provided abroad by Peace Corps staff at Post. The Offeror may choose to propose telehealth for some domestic service;

however, these services are not a requirement under this solicitation.

3 C.1.4.3. Health Care Authorizations Page 15 Requiring URAC Accreditation is an industry best practices for companies being contracted to assist with authorization, concurrent and retrospective review, and medical records coordination. Additionally 24/7 On Call Nurse Line can be an additional benefit for care coordination.

Authorization, concurrent and retrospective review, and medical records coordination are done in house by Peace Corps staff for Plans 1-3. Plan 4 requirements as related to these services can be found in Attachment J.9.

4 C.1.4.3. Health Care Authorizations Page 15

Medical Conceirage Services defined as follows, can also be an added benefit for scheduled procedures: If a volunteer requires a medical procedure, the volunteer or a PC representative can contact a Medical conceriage service and provide basic information about the patient and your procedure. The staff will research and report to information regarding the cost and quality of area providers specific to the service including: Quality ratings of local facilities, Local provider pricing information for the requested procedure, Determination of facilities and physicians in your PPO network to maximize your benefits, educational material concerning the required procedure for the patient, and if requested, assistance with scheduling of appointments. The final decision as to which providers you wish to go for treatment is entirely up to the patient and PC, however, with the information supplied through a medical concierage service the decision can be a well informed one.

Medical concierge services will not be included as a requirement; however it is part of the requirement that Peace Crops staff be able to locate quality providers themselves (Sections C. 2.1.2. & C.5.2. will be revised for clarification in the formal RFP).

5 C.1.3.3 14 What is meant by "Coordination interfaces with the government?" Section C.1.3.3. will be revised for clarification in the formal RFP.

C.1.3.4 14

International networks may not have specific medical specialist such as mental health providers. What is the expectation for the contractor in these cases?

Peace Corps understands that there are certain services that may not always be available "in network." In these cases, if Peace Corps identifies a provider, the expectation is that the contractor negotiate with that provider and, at a minimum, processes claims for these specialized services.

C.1.3.5 14 AfterCorps

Currently referred to as "AfterCorps," please see Attachment J.9 for details of the coverage and underwriting terms for Peace Corps' Plan 4 coverage.

C.1.5 15 This section refers to contractor furnished items. Does this relate to contents of a medical claim?

No, this does not refer to the contents of a medical claim. It refers to items necessary for the work of processing claims. The claims themselves are the property of PC.

C.2.1.2 16

Is Peace Corps' expectation for the web portal to have FECA benefit information available on the vendor's website? This would not be possible since FECA is administered by DOL and the vendor would not have access to this information.

No, it is not Peace Corps expectation that the Offerors web portal have FECA benefit information. However, the Web Portal should guide RPCVs as to which Plan the claim falls under (i.e. Plan 3 or Plan 4) and provide a link to the POCs/webpages applicable to the relevant Plan.

C.2.2.1 18

Appeals procedures consistent with ACA requirements. ACA requirements allow for a third party review.

Since the Peace Corps authorizes all services, it would seem that the appeal process should include review by Peace Corps and not a third party company. Also, would Peace Corps be invoiced for a third party review or would this be expected to be paid for by the vendor?

"Third Party" in this content refers to Peace Corps. Peace Corps is the entity that determines if a service(s) is necessary and appropriate.

C.2.2.5 20

Financial administration- This section states that the contractor is not required to pay interest on claims.

Would Peace Corps be responsible for any interest accrued on claims paid after 20 days due to no authorization or plan eligibility? The PCV may be billed in these instances.

The Peace Corps does not require the contractor to pay interest on all claims not paid within 20 days but PC expects that the contractor will negotiate interest charged w provider, when necessary. If contractor is at fault for the delay in claims processing, contractor is expected to pay interest if charged. If Peace Corps is at fault for the delay in claims processing, and contractor cannot negotiate out any interest charged, Peace Corps will pay interest, if charged.

C.2.2.8 20

Pharmacy claims- Will Peace Corps provide a list of excluded prescription drugs/categories under this health plan besides OTC drugs?

No, the Peace Corps cannot provide a list of excluded prescription drugs for Plans 1-3. Prescription drugs are approved on a case by case basis. Information about Plan 4 approved prescription drugs can be found in Attachment J.9.

C.2.2.9 20

End of health care delivery- Does this also include claims that have not been authorized and paid beyond the 180 days?

This refers to the end of the contracts Period of Performance. Section C.2.2.9. will be revised for clarification in the formal RFP.

C.2.3.1 21

Certification- Peace Corps has utilized a national PPO network in the US. Would the credentialling process of a national PPO network meet the requirement for this contract? Also, how does Peace Corps recommend that all non-network providers be credentialled? If providers are not in network, they are not held to credentialling standards as in network providers. Depending on the provider, it may take several weeks/months to receive credentialling information from a provider. And since Volunteers are free to seek care from any provider, there is not a way to steer PCVs to in network providers as in most commercial health plans. How does Peace Corps propose processing non network claims under the 180 days allowed to adjudicate claims? This would not only be a challenge to obtain but would not be likely under the timeliness requirement.

Yes, the credentialing process of a national PPO network meets the requirement for this contract. Section C.2.3.1.

will be revised for clarification in the formal RFP.

C.2.3.4 21

Medical Malpractice- Does Peace Corps accept the PPO network standards for credentialling? Typically, PPO networks include this during the credentialling process. Foreign providers outside the US are held to credentialing requirements but may not include malpractice coverage standards.

Yes, the Peace Corps will accept PPO network standards for credentialling. Section C.2.3.4. will be revised for clarification in the formal RFP.

C.5.4.2.1 28

Air ambulance serices- When the contractor is contacted, will an valid authorization be sent to the contractor which approves the Guarantee of payment authorization to coordinate the service?

Verbal notification (IAW the process at Section C.5.4.2.1) shall be sufficient for the contractor to issue the GOP immediately; but would be followed with written authorization shortly thereafter.

C.7.3 32

What is meant the statement in this section? "The Contractor shall provide RPCVs with assistance coordinating benefits with both Peace Corps post-service evaluations and FECA medical benefits". True coordination of benefits requires direct contact with other insurance company or administrators. The contractor can provide general benefits, information and eligibility to the insured. However, determination of what is payable under FECA and what is approved/pending can only be determined by DOL. Contractors are not likely able to provide this type of information and coordinate this type of information. Section C.7.3. will be revised for clarification in the formal RFP.

18 A.4.Effective Date 5 of 70 What will be the proposed effective date for all plans? The effective date for all health plan coverage under the new contract will be when the government transition team confirms the readiness for the transfer of responsibilities from the current contract to the new contract.

19 9 of 70 Please provide more details on the ceiling price of rmedical claims (how will it be calculated; what components will comprise the ceiling price; have claims ever exceeded the ceiling price in previous years)

The ceiling price is the government's estimated amount for the cost of claims, based on historical and budgetary data. If there is reason to believe the ceiling price should be increased, the government will obtain internal approval to increase the ceiling price.

20 9 of 70 Please provide details on the performance incentives for the successful contractor.

The contract will not have performance incentives. Any reference to performance incentives will not be included in the formal solicitation.

21 C.1.1.3. - Plan 1 12 of 70 For Plan 1, is there a plan design for all covered medical services for the contractor to adjudicate benefits?

Or, will the Peace Corps calculate the reimbursement to member and/or provider and provide advice to contractor to issue benefits?

Attachment J.6 defines cost-reimbursement terms for 90% of invitees. For all other cases, PC clearly defines on standard documentation which services are authorized.

22 C.1.1.3. - Plan 3 13 of 70 Please confirm that Plan 3 will be self-funded just like Plans 1 & 2. Yes, Plan 3 is self-funded just like Plans 1 & 2.

23 C.1.1.3. - Plan 4 13 of 70 Please confirm that Plan 4 is fully insured. Yes, Plan 4 is fully insured.

24 C.5.4. 27 of 70 Does evacuation benefit apply to political evacuations as well as medical evacuations? No, evacuation benefit does not apply to political evacuation.

25 C.6.1. 31 of 70

Please confirm that plan is self-funded and please provide plan design for the six month period.

Yes, plan 3 is self-funded. Your question refers to a defined medical plan, this is not a defined medical plan. Refer to section C.6.1. and https://www.dol.gov/owcp/dfec/regs/compliance/dfecfolio/FECA-PT2/group5.htm#217019 for Plan 3 details for the majority of cases. In very rare, unusual instances, PC reserves the right to directly reimburse a provider or an RPCV for service-related health care that falls outside these procedures.

26 C.9.9. 36 of 70 Please note that providers not participating in a network are not tracked for certification/accreditation

Yes, the credentialing process of a national PPO network meets the requirement for this contract. Section C.9.9.

will be revised for clarification in the formal RFP.

27 C.9.20. 38 of 70 Please confirm that Group Health Insurance Report is appliable to Plan 4 Yes, Group Health Insurance Report is applicable to Plan 4.

28 C.10.1 38 of 70 Is it possible to list claim $ separately for Plan 1, Plan 2 and Plan 3? Yes, we are able to provide the total dollar value of claims by Plan. This will be included in the formal RFP.

29 Please provide instructions on how prospective contractors are to respond to the final RFP. Instructions to Offerors will be provided in the formal RFP under Section L of the solicitation.

Will prospective contractors have the opportunity to ask questions after receipt of the final RFP? Yes, prospective contractors will have the opportunity to ask questions after the formal RFP is released.

Will prospective contractors receive all of the questions/comments/responses submitted by other prospective contractors? Yes, questions and responses will be posted via the Federal Biz Opportunities (FBO) website.

32 C.1.1.3 12 Are any aspects of Plans 1-4 currently administered by a third party, or are all of the 4 plans noted in Section C (C.1.1.3) self-administered by Peace Corps? If a third party is involved, details of the current services provided would be helpful as part of the final RFP document.

Yes, previous and current contracts (contract PC-05-03-009, PC-11-3-009 and PC-12-3-002) were/are "Third Party" administered with regards to administration of benefits (not authorizations). Current services provided are similar in nature to the requirements under this solicitation.

33 C.1.1.3 13 Plan 3 notes coverage for RPCV's for up to 6 months for "Conditions of Coverage while Serving Abroad". Is this to mean that up to 6 months of coverage can be authorized for conditions the volunteer acquired while on assignment? Further clarity on "Conditions of Coverage" is requested.

For six (6) months after the RPCV's end of service, Peace Corps pays directly for evaluation and services for service-related conditions in compliance with: https://www.dol.gov/owcp/dfec/regs/compliance/dfecfolio/FECA- PT2/group5.htm#217019. Outside of these specifications, an RPCV must file a FECA claim with DOL through PC's post-service unit.

34 C.1.1.3 13 Plan 4 notes coverage for short-term medical for RPCV of up to 3 months. Is this program currently fully-insured or also self funded? If fully insured will plan design documents and current carrier information be made available as part of the RFP?

Plan 4 is fully Insured. Please see Attachment J.9 and https://www.sevencorners.com/gov/peacecorps/aftercorps for plan design documents and current carrier information.

35 C.1.3 14

Comment: Each of the desired outcomes are certainly reasonable and available. Each interested bidder will have variances in their systems, strengths and ability to meet or exceed each desired outcome. It would be advisable to either a.) include a questionnaire focused on each desired outcome, or b.) allow for a details section in the RFP such that each bidder can elaborate on their capabilities in each area and manner in which they propose to meet these outcomes.

Offerors will have an opportunity to demonstrate their strengths and capabilities IAW sections L&M, which will be included in the formal solicitation.

36 C.1.4.3 15

In this section Peace Corps provides details of the current authorization process for PCV's and RPCV's to receive medical services under the 4 plans. This process involves a authorization of medical services by any of the medically licensed Peace Corps health care clinicians, domestic or abroad. We interpret this to mean that currently all services must be authorized by a health care clinician of the Peace Corps. Is this correct? If so, under Section C, C.1.3.1, it is noted that part of the claims processing function of the administrator is authorizations. Is it the intent of the Peace Corps to transition authorizations to the administrator, have Peace Corps continue to provide authorizations internally, or a combination of the two?

Yes, for Plans 1-3 only, all services must be authorized by a health care clinician of the Peace Corps. Offerors are encouraged to propose a way to automate the process by which PC staff submit authorizations to the contractor.

Section C.1.3.1 will be revised for clarification in the formal RFP.

37 C.2.1.3 17

Further information is needed on the Data Access requirements noted. Many of the requirements listed would be included in our standard employer web portal, however what level of detail is required for things such as authorizations, claims processing, and customer satisfaction surveys. These data points are normally not available on an unlimited access anytime basis online. Claims reports are typically provided monthly, customer satisfaction results are typically provided annually, and the authorization system currently used by Peace Corps would require custom reporting which is non-standard.

The level of detail the Peace Corps is requiring with regards to data access include up to date claims status & details, eligibility status, authorizations details and network provider lists. The purpose of the online portal requirement is to allow volunteers and RPCVs access to their individual claims information and network provider lists. Further, it should also allow Peace Corps staff access to network provider lists as well as agency-wide claims information. Section C.2.1.3. will be revised for clarification in the formal RFP.

38 C.2.2.7 20

Does Peace Corps consider their current plan to be Primary or secondary? Most global health programs pay on a primary basis, meaning the covered individual does not need to submit claims to any other plan before benefits are payable. Subrogation is still preformed on primary programs assuming the administrator has information on what other policies are in place that may apply. Most common would be a foreign voluntary workers compensation program, but could also include other private insurance, national health systems, etc.

For Plan 2, Peace Corps is primary for all authorized care. For Plans 1, 3 and 4 Peace Corps may or may not be the primary.

39 C.2.2.8 20

It is common for global healthcare programs to cover prescription drugs which are locally common practice, though may not be considered common in the US. For example many global programs cover traditional Chinese medicine for expats in China (though the same services are not covered if accessed in the US as it is not locally common in the US). Is the Peace Corps intent to only cover prescription drugs which are approved in the US?

Pharmacy benefit plan should only cover US-approved pharmaceuticals when incurred in the U.S. For pharmaceutical claims incurred outside the U.S, claims are authorized/approved on a case-by-case basis.

40 C.2.3.1 21

It is stated in this section that the contractor shall verify the credentials of non-network providers upon receipt of the first claim, and do so before payment of the claim is made. If a claim has been submitted it is typically after services have been provided by the medical facility, as such what is the goal of credentialing the provider after services are rendered? Is it network expansion? If services are rendered, and a claim is submitted but the provider does not meet the credentialing standard would reimbursement not be authorized? We would like to further understand the intent and goal around this requirement.

See response to question 14 above. Section C.2.3.1. will be revised for clarification in the formal RFP.

41 C.2.3.4 21

This will be a difficult requirement to comply with, and is not typically part of the international credentialing and network agreements. International networks focus on top quality providers around the world and do go through a rigorous inspection for safety, sanitation, medical training, equipment, etc., but it will be difficult to track and retain medical malpractice coverage for all network providers in addition to non-network providers which Peace Corps Volunteers may access care at. Further discussion on this requirement is requested.

Section C.2.3.1. will be revised for clarification in the formal RFP.

42 C.4.1 26 Please confirm that the cost sharing maximum's noted is simply the maximum amount that the plan will pay, regardless of the cost of the services needed. Therefore the individual will be balanced billed for the reminder of the cost and is responsible for that cost personally.

Yes, the cost sharing maximums noted for Plan 1 are the maximum amount that the plan will pay, regardless of the cost of the services paid or billed to the invitee. Thus balanced billing is not applicable to Plan 1. In most cases the invitee has already paid out of pocket.

43 C.5.3 27

It is common for global healthcare programs to cover prescription drugs for up to a 1 year supply to allow individuals on maintenance medications which may not be available in their location to bring an adequate amount of medication with them. Would Peace Corps be open to a pre-agreed upon list of conditions and medications that can be auto-approved for quantiles above a 30 day supply in such situations?

No, Peace Corps is not open to a pre-agreed upon list of conditions and medications that can be auto-approved.

Maintenance medication for volunteers are mainly provided by staff at Post. The pharmaceutical plan is mostly used by med-evacs in the U.S.

44 C.5.4.4 31 Please explain in greater detail what facilitation of PCV passage through immigration, security, boarder control, and customs involves. Is this specific to managing these aspects as part of an active evacuation, or general to all PCV's?

The Contractor will be responsible for ensuring that all authorizations and/or paperwork is completed to ensure PCV's obtain passage through Immigration, border control and customs for active air ambulance med-evacs as authorized in C.5.4.2.1.

45 C.7 31 Would Peace Corps be interested in exploring options under the US health insurance exchanges for Plan 4?

The purpose of Plan 4 is to bridge the gap in health insurance coverage provided by the Peace Corps (in accordance with Attachment J.9) and the RPCV's own insurance. The offeror is responsible for proposing coverage that meets this requirement.

46 C.10.4.1 39 Please confirm that most of the medivacs listed are via commercial aircraft or ground transportation.

Yes, most of the med-evacs listed use commercial aircraft or ground transportation. Only the air ambulance cases, (historical averages listed in C.10.3) require air ambulances.

47 C.11 40

If Peace Corps is to determine the reimbursement amounts for all claims and such amounts are below pre-negotiated reimbursement rates with contracted providers the possibility and likely hood of balance billing by providers is high. Please expand on the Peace Corps intent and if they are agreeable to have PCV or RPCVs be balanced billed for service cost in excess of Peace Corps reimbursement amounts. We have noted throughout the Draft RFP that there is an expectation that no balance billing is done by network providers, which is the case at our negotiated rates. If Peace Corps is to set maximum reimbursement rates we would like to discuss in greater detail.

References to cost sharing only refer to Plan 1. Peace Corps will not allow balanced billing for Plan 2 or Plans 1 or 3 in cases where an authorization is issued. Section C.11 will be revised for clarification in the formal RFP.

48 G.4.1.2 48 Typically implementation cost (Phase-In) are part of the overall administration fee. Does this contract require that a separate implementation cost be identified and paid separately? The price for transition (phase-in and phase-out) should be segregated IAW the CLIN structure under Section B.

49 H.10 57 Are the Key Personal identified and noted in H.10 to be 100% dedicated to the Peace Corps contract, or are they able to preform other duties for other clients in addition to their role on the Peace Corps contract?

The contractor shall provide and commit sufficient, qualified staff who must be available for assignment under this contract as of the date the contract is awarded. Key Personnel shall be 100% dedicated to the contract for at least 180 days after contract award. It is then at the discretion of the contractor to determine the percentage of time key personnel are dedicated to the contract, so as long as the requirements under the contract are met. At no time shall key personnel be less than 50% dedicated to the contract. Section H. will be revised as stated above in the formal solicitation.

50 General N/A

Overall it would be helpful to understand how Peace Corps would like their program administered.

Specifically, how much control and involvement they would like to maintain. There are many possible administrative options ranging from as basic to network access only, to full administration where Peace Corps is largely removed from day to day operations (though they would always maintain final authority over if a claim is paid or not). Based on the information provided in the draft RFP it is clear that Peace Corps is looking for more than network access only, but how much control they would like to maintain is important to understand. Specifically, are they looking for a partner to administer claims after Peace Corps authorizes services, or would they like to transfer authorization and day to day claims management responsibility to the administrative partner? A detailed claims processing method based on Peace Corps criteria could easily be developed and followed which would allow Peace Corps clinical staff members to remove themselves from most claims authorization scenarios and free them to focus on other areas of health management if it was so desired by Peace Corps. Further, there are market leading clinical capabilities all designed around supporting the healthcare needs of global populations. What role would Peace Corps like the administrators clinical capabilities and population health management tools to play in the administration of the health program? Ultimately, there is the capability to administer the program however Peace Corps would like and would welcome an opportunity to meet with Peace Corps staff to discuss their program in greater detail.

For Plans 1-3, Peace Corps determines medical authorizations on a case-by-case basis, there is no baseline.

Specifically, we are looking for a partner to administer claims after Peace Corps authorizes services.

51 General N/A

In addition to medical, dental, vision and Rx administrative capabilities, there is also a rang of medical assistance, security assistance, and global onsite capabilities. Would Peace Corps be interested in learning more about any of the these capabilities and how they could integrated into the Peace Corps health programs to provide additional information, support and access to health care globally?

Peace Corps has an internal team of health care providers at Post that provide most global care for Plan 2 (see section C.1.1.1). Other than air ambulance services, GOPs to be issued to hospitals or providers, or in rare instances of med-evacs to a non-Peace Corps country, those teams provide most global care for Plan 2.

C.5.4 27

Is this solicitation intended to combine the requirements for administration of benefits as well as emergency medical evacuation services? There appears to be overlapping scope with this requirement and the contracts for Medical Evacuation Services under PC 129021 and PC 129022. If not, when will the contracts for Medical Evacuation Services be recompeted?

Yes, the requirement under this solicitation includes both administration of benefits and emergency medical evaluation services. Once this competitive contract is awarded and the contractor has transitioned in, all emergency medical evaluation services will be procured under this contract.

C.5.4 27 How many medical evacuations have been performed in the last three years under each contract (incumbent and contracts listed above)? PPlease see Section C.10 of the solicitation for statistical data.

54 Does the Peace Corps intend to hold an Industry Day? No, Peace Corps does not intend to hold an Industry Day.

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