PSAS PWS FY20 Recompete - 2-11-21 FINAL.pdf

ATTACHMENT 1 PERFORMANCE WORK STATEMENT (PWS)

Title: Policy and Statistical Analysis Services (PSAS)

Requiring Activity: Defense Health Agency/J5 Analytics and Evaluation Division (A&E)

1.0. Scope:

The purpose of this acquisition is to request Contractor services to assist the Director, Defense Health Agency (DHA)/ J5 Analytics and Evaluation Division in the support of DHA and the Military Health System (MHS) in addressing their requests for support and analysis in the following functional areas: (1) budgeting, pricing and financial analysis; (2) policy analysis (3) lifecycle contract management ; (4) contract cost adjustment; (5) reimbursement support; (6) cost certification; (7) information systems and data mining; (8) MHS Requirements Portal Triage support; and (9) Optimization and Scenario Modeling Tool associated with the financing and delivery of the MHS using TRICARE. Analytic Requests require knowledge of the Military Health Care System Direct and Purchased Sector Care, MHS Data Systems, Working Information Systems to Determine Optimal Management (WISDOM) training requirements, the Program Objective Memorandum (POM), health care acquisition & contracting, health care policy, business and clinical analytics, cost containment, etc.

1.0.1 Background:

DHA, is a Combat Support Agency, which provides integrated, affordable, and high quality health care services to 9.4 million beneficiaries of the Military Health System (MHS); and executes responsibility for shared services, functions, and activities in support of Military Healthcare. The DHA serves as program manager for the DHA military health program.

DHA J-5 Strategy, Planning and Functional Integration Directorate strengthens MHS-wide support for integrated operations through strategy management, analytics, measurement and reporting, and support for continuous improvement efforts. Responsible for integrating across the MHS and DHA by proposing strategy, innovation and future plans for achieving MHS and DHA roles, responsibilities, priorities, and

Director's intent in support of an integrated health system. A&E will also be responsible for coordinating design and implementation planning for integrated health system.

J5 Analytics and Evaluation Division (A&E) provides performance-based decision making for DHA by applying appropriate scientific methods and operational support. A&E uses a multidisciplinary approach to investigate complex issues in measuring, evaluating, and analyzing the performance of healthcare delivery systems and developing innovative methods for providing high quality health care. Moreover, A&E provides big data Analytics and Program Evaluation support combining skills in mathematics, statistics, predictive modeling, machine learning techniques and operations research.

1.0.2 Objectives:

The Contractor will furnish the necessary personnel, materials, facilities, and other services as may be required to assist the Deputy Assistant Secretary of Defense (Health Affairs), Defense Health Agency, and

DHA Regional Offices in the support of DHA and military health system (MHS) contracts and the various functions identified in the Scope and Performance Work Statement (PWS).

PSAS operates under the 9 functional analytic areas of (1) budgeting, pricing and financial analysis; (2) policy analysis (3) lifecycle contract management; (4) contract cost adjustment; (5) reimbursement support;

(6) cost certification; (7) information systems and data mining; (8) MHS Requirements Portal Triage support; and (9) and Optimization and Scenario Modeling Tool associated with the financing and delivery of the MHS using TRICARE. Specifically, the PSAS contract includes:

development and maintenance of corporate databases and data systems analysis of cost containment opportunities through various policy changes in benefit design, organization of service delivery, and provider reimbursement actuarial modeling and projecting changes in health care utilization and cost under various policy and program scenarios claims processing systems enhancements analysis and evaluation of dental insurance programs funded by TRICARE technical analysis of health care financing and delivery requirements associated with the acquisition, implementation, operation and expansion of the TRICARE evaluation of various programs/initiatives development of Independent Cost Analysis (ICA) for programs, projects and initiatives

Financial analysis and support for the DoD budget formulation

Develop and maintain databases with cost projections for the Managed Care (contracts T-17 and

T-5)

Reference information support tasks consisting of the creation, maintenance, management, analysis, quality assurance, and distribution of a very large and detailed suite of current and historical medical and technical information. These are the MHS official sources of basic reference material and are used in most major MHS accounting, information, enrollment and claims processing systems such as Defense Enrollment Eligibility and Reporting System

(DEERS), Defense Health Services (DHSS), Defense Manpower Data, MHS Mart (M2) &

MHS Data Repository (MDR), etc.

Provide support to the Analytics and Evaluation Request Portal (AERP); by reviewing, clarifying and evaluating initial portal submissions; ensuring deliverables are accurate and timely and developing routine reports on triage activities as well as reporting on Analytic request completions and deliveries.

Contractor shall provide a report for each analytic request on their associated methodology, Statistical

Analysis Software (SAS) Coding, snap shots of queries, and/or other source information used for the submission for validation and quality control. The Government shall perform a quality assurance review and analysis of every analytic request before it is sent to the Requester.

On 1 October 2018, the first phase of Military Treatment Facilities (MTFs) transitioned, with other MTFs to follow in accordance with Section 702 of the National Defense Authorization Act (NDAA) of 2017. This provision transfers administration and management of military MTFs to the DHA.

The Contractor shall provide a plan to support the DHA in the stand up and operations of the MHS

GENESIS and agency transformation. MHS GENESIS, the new electronic health record for the Military

Health System (MHS), provides enhanced, secure technology to manage health information. MHS

GENESIS integrates inpatient and outpatient solutions connecting medical and dental information across the continuum of care, from point of injury to the Military Treatment Facility. This includes garrison, operational, and en-route care to increase efficiencies for beneficiaries and healthcare professionals.

In FY19, a new process for submitting analytic requests must first be submitted through the MHS Request

Submissions Portal. All requests for support through the PSAS analytic contract, must be preceded by entry of the request into the AERP Portal. Through this process the requestor will receive a GOV ID# (for tracking purposes) and the AERP Triage Team will review the request and determine if it will be assigned to the Vendor for analysis and completion.

1.1 Non-Personal Services

This award identifies services that are strictly non-personal in nature.

1.2 Severable / Non-Severable Services

This award identifies services that are severable in nature.

These analytic requests are considered to be closely related to inherently governmental functions. Except it is the Government that maintains decision authority in all situations during the performance of these support analytic requests.

1.3 Organizational Conflict of Interest (OCI) Category

FAR Part 9.5 provides guidance for contracting activities with regards to OCI. As discussed OCI is characterized by biased judgment on the part of the Contractor or unfair competitive advantage in procurement. The FAR encourages mitigation of a conflict if at all possible. The Contracting Officer (CO) has significant discretion as to the acceptability of any mitigation plan offered.

a. OCI Mitigation Strategy

Offerors are encouraged to present their best strategy for mitigation of any potential OCI under this requirement. Offerors shall submit a mitigation plan at the contract level and update it as often as necessary throughout the life of the Contract.

b. Comparative OCI Analysis

At the Contract level the Contractor shall perform a comparative analysis of the potential new work against all current and previous work performed in any category other than that of the new work being offered. The comparative analysis must be included in the proposal for each contract, and must include a statement certifying whether the Contractor believes that its performance of the proposed contract would create a real or apparent OCI. Failure to adhere to this OCI statement may constitute default on the part of the

Contractor.

The Contractor shall also obtain a similar certification of OCI status from all subcontractors, teaming partners or consultants prior to tasking any such party under this contract. The Contractor shall appropriately modify and include this Paragraph, in all consulting agreements and subcontracts of any tier to preserve the rights of the Government.

For breach of any of the above restrictions or for nondisclosure or misrepresentation of any relevant facts required to be disclosed concerning this Contract, the Government may terminate this Contract, disqualify the Contractor from subsequent related contractual efforts, and pursue any remedies as may be permitted by law or this contract.

2.0 SPECIFIC ANALYTIC REQUESTS

2.1 Analytic Request Management

The Contractor shall provide sufficient management to ensure that this analytic request is performed efficiently, accurately, on time, and in compliance with the requirements of this document. Specifically, the

Contractor shall designate a single manager to oversee this analytic request and supervise staff assigned to this analytic request. The Contractor shall ensure that a Monthly Progress Report is submitted outlining the expenditures, billings, progress, status, and any problems/issues encountered in the performance of this analytic request.

2.1.1 Monthly Progress Report (MPR) – Deliverable 2

The Contractor shall include a MPR (Deliverable 2) outlining the expenditures, billings, progress, status, and any problems/issues encountered in the performance of this analytic request. The report shall be reviewed and discussed each month by the Contracting Officer’s Representative (COR).

2.1.2 TRANSITION IN /TRANSITION OUT PERIOD. To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the Contractor shall have personnel on board, during the 10 business day transition in / transition out periods. During the transition in period, the

Contractor shall become familiar with performance requirements in order to commence full performance of services on the contract start date.

a. Incoming Transition Plan–Deliverable 3

In accordance with the solicitation, the Contractor will provide a plan for 10 business days of incoming transition from contract to contract. The Contractor will coordinate with the Government in planning and implementing a complete transition to the Contractor’s support model. The Contractor will collaborate with the Government to develop and deliver an Incoming Transition Plan. The

Government will designate a transition period for the incoming Contractor to coordinate and work with the incumbent Contractor. This transition plan will include, but is not limited to:

Coordination with Government representatives, Review, evaluation and transition of current support services, Transition of historic data to new Contractor system, Government-approved training and certification process, Transfer of hardware warranties and software licenses (if applicable), Transfer of all necessary business and/or technical documentation, Transfer of compiled and un-compiled source code, to include all versions, maintenance updates and patches (if applicable), Changeover Agreement to introduce Government personnel, programs, and users to the Contractor’s team, tools, methodologies, and business processes, Distribution of Contractor purchased Government owned assets, including facilities, equipment, furniture, phone lines, computer equipment, etc., Transfer of Government Furnished Equipment (GFE) and Government Furnished

Information (GFI), and GFE inventory management assistance, Applicable DHA briefing and personnel in-processing procedures, Coordinate with the Government to account for government keys, ID/access cards, and security codes.

b. Outgoing Transition Plan –Deliverable 4

The Contractor will comply with the proposed plan for 10 business days of outgoing transition for transitioning work from an active analytic request to a follow-on contract/order or Government entity. This transition may be to a Government entity, another Contractor or to the incumbent

Contractor under a new contract/order. In accordance with the Government-approved plan, the

Contractor will assist the Government in planning and implementing a complete transition from this

Contract and/or orders issued under this Contract to a successful provider. This will include formal coordination with Government staff and successor staff and management. It will also include delivery of copies of existing policies and procedures, and delivery of required metrics and statistics.

This transition plan will include, but is not limited to:

Coordination with Government representatives, Review, evaluation and transition of current support services, Transition of historic data to new Contractor system, Government-approved training and certification process, Transfer of hardware warranties and software licenses (if applicable), Transfer of all necessary business and/or technical documentation, Transfer of compiled and un-compiled source code, to include all versions, maintenance updates and patches (if applicable), Changeover Agreement to introduce Government personnel, programs, and users to the Contractor’s team, tools, methodologies, and business processes, Disposition of Contractor purchased Government owned assets, including facilities, equipment, furniture, phone lines, computer equipment, etc., Transfer of Government Furnished Equipment (GFE) and Government Furnished

Information (GFI), and GFE inventory management assistance.

Applicable DHA debriefing and personnel out-processing procedures.

Turn-in of all government keys, ID/access cards, and security codes.

The Contractor shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Contract, to permit the

Government to respond to a request by an Individual for an accounting of disclosures of Protected

Health Information in accordance with 45 CFR 164.528.

2.1.3 Program Management Plan (PMP) – Deliverable 5

The Contractor shall develop a Program Management Plan (Deliverable 5) that shall require Government approval. It will be used to manage, track and evaluate the Contractor’s performance. The Draft Program

Management Plan shall consist of control policies and procedures in accordance with standard industry practices for project administration, execution and tracking.

The Program Management Plan, at a minimum, should include the following:

Identification of milestones where Government information/activity is required and timeline dependencies for subsequent Contractor activities;

QA Validation Report;

Description of the Contractor’s overall management approaches, policies and procedures including suggested project metrics; and,

2.1.4 Quality Control Plan – Deliverable 6

The Contractor will develop and maintain an effective Quality Control Program (QCP) to ensure services are performed in accordance with this PWS. The Contractor will develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s QCP is the means by which he assures himself that his work complies with the requirement of the contract.

The QCP will initially be submitted with the vendor’s proposal and will be updated 30 days following the award of the Contract. Three copies of a comprehensive written QCP will be submitted to the CO and COR within 5 working days when changes are made thereafter. After acceptance of the QCP the Contractor will receive the Contracting Officer’s acceptance in writing of any proposed change to his QCP.

The QCP will document how the Contractor will meet and comply with the quality standards established in this Performance Work Statement (PWS). At a minimum, the QCP must include a self-inspection plan, an internal staffing plan, and an outline of the procedures that the Contractor will use to maintain quality, timeliness, responsiveness, customer satisfaction, and any other requirements set forth in this solicitation.

Data quality validation is a critical element for this Contract and required for the performance of the analytic requests. The Contractor will document and identify procedures and processes to ensure data is carefully and rigorously reviewed for accuracy, consistency, and relevance.

The Contractor must provide assurance to the Government that the data provided has undergone extensive review and quality control processes prior to delivery or release. There is a very low tolerance for data errors. The Contractor shall provide maximum quality control to assure the highest standards of data accuracy, integrity and delivery timeliness is achieved.

2.1.5 Contingency Operations Plan –Deliverable 7

The Contractor shall develop and submit a Contingency Operations Plan to the Government. The

Contingency Operations Plan will be due (10) calendar days after the award of this Contract, and will be updated on a quarterly basis. The Contingency Operations Plan shall document Contractor plans and procedures to maintain DHA support during an emergency. The Contingency Operations Plan shall include the following:

A description of the Contractor’s emergency management procedures and policy;

A description of how the Contractor will account for their employees during an emergency;

Planned temporary work locations or alternate facilities;

How the Contractor will communicate with DHA during emergencies;

A list of primary and alternate Contractor points of contact, each with primary and alternate telephone numbers and E-mail addresses;

Procedures for protecting Government Furnished Equipment (GFE) (if any) Procedures for safeguarding sensitive and/or classified Government information (if applicable)

2.1.6 Operations Plan During Emergency Situations

Individual Contingency Operations Plan shall be activated immediately after determining that an emergency has occurred, shall be operational within twelve (12) hours of activation, and shall be sustainable until the emergency situation is resolved and normal conditions are restored or the Contract is terminated, whichever comes first. In case of a life threatening emergency, the COR will immediately make contact with the

Contractor Task Managers to ascertain the status of any Contractor personnel who were located in

Government controlled space affected by the emergency. When any disruption of normal, daily operations occur, the Contractor Task Manager shall promptly open an effective means of communication with the

COR and verify:

Key points of contact (Government and Contractor), Temporary work locations (alternate office spaces, telework, virtual offices, etc.), Means of communication available under the circumstances (e.g. email, webmail, telephone, Fax, courier, etc.), and

Essential work products expected to continue production by priority.

The Contractor Task Manager, in coordination with the COR, shall make use of the resources and tools available to continue DHA contracted functions to the maximum extent possible under emergency circumstances. Regardless of contract type, and of work location, Contractors performing work in support of authorized requests within the scope of their Contract shall charge those hours accurately in accordance with the terms of this contract.

2.1.7 Hours of Operation: The Contractor is responsible for conducting business, between the hours of 8

A.M. and 5 P.M, local time, Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all requests defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

2.1.8 Place of Performance: The work to be performed under this Contract will be performed primarily at the Contractor’s facility. The Contractor may be required to provide flexibility for telework.

2.1.9 Security Requirements: The Contractor will NOT require access to classified data to perform this task.

2.1.10 Physical Security: The Contractor shall be responsible for safeguarding all GFE, information and property provided for Contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured.

2.1.11 Contractor access to DHA Network/DoD Systems

Contracting Companies shall contact the DHA Privacy Office after being awarded a DHA contract that requires access to a DoD System. Each Contracting company is responsible for submitting the Standard

Form 85P and Fingerprint Document-258 for their respective Contractor employees. The Contractor employees may be required to gain access to the Health Affairs (HA)/DHA network/Program Office system for performance of this task. As such, Contractor personnel shall undergo appropriate background investigation (Trustworthiness Determination for Public Trust positions/Automated Data Processing-

Information Technology) or have a security clearance and Information Assurance Training. The Contractor should be prepared for this process to take at least two (2) weeks.

Prior to the submission of the SF85P for new Contractor employees, the Contractor’s Facility Security

Officer (FSO) shall submit the DHA Contract number, delivery order number, Contract start date, Contract end date, personnel names, and the ADP position designations, to the DHA Privacy Office for verification and approval with a list of personnel being submitted for an ADP/IT Trustworthiness Determination. The

Contractor’s FSO shall submit all appropriate forms as listed on the DHA Privacy website to request a background investigation to the Office of Personnel Management (OPM) and obtain receipt confirmation as a prerequisite for Contractor personnel to access the DHA network/DHA Program Office systems.

The Contracting Company shall follow the DHA Privacy Office guidelines for submittal of ADP/IT security clearances and ensure all Contractor personnel are designated as ADP/IT-I, ADP/IT-II, or ADP/IT-III where their duties meet the criteria of the position sensitivity designations. The DHA Privacy Office procedures for personnel security are listed on the following website: https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties.

Contracting Companies must notify the DHA Privacy Office when the security officer has submitted the

SF85P user form to OPM for new employees. Upon termination of a contractor employee from the DHA contract, the Contractor’s FSO must notify the DHA Privacy Office and OPM of the action, including the termination date. At the end of the base period of performance, the Contracting companies shall notify the

DHA Privacy Office if the Contract has been extended for the option years or terminated.

Non-U.S. Citizens

Only United States Citizens shall be granted a personnel security clearance, assigned to sensitive duties, or granted access to classified information unless approved by an authority designated in Appendix 6 of DoD

5200.2-R. Exceptions to these requirements shall be permitted only for compelling national security reasons.

Non-U.S. Citizens are not being adjudicated by any Government agency for a trustworthiness determination at this time. Non-U.S. Citizens are not allowed access to any DoD systems/networks.

https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties

The Contractor shall ensure that data which contains Protected Health Information (PHI) is continuously protected from unauthorized access, use, modification, or disclosure. The Contractor shall comply with all previously stated requirements for Health Insurance Portability and Accountability Act (HIPAA), Personnel

Security, Electronic Security, and Physical Security.

Termination of Access

Upon termination of a Contractor employee, the Contractor Point of Contact shall ensure the “Delete from

DHA Network Form: has been completed and forwarded to the HA/DHA Help Desk with a copy to the DHA

Privacy Office.

a. Electronic Security -- Deliverable 8

The Contractor shall complete Checklist and Certification for Minimum Level of Enhanced Safeguarding for Unclassified DoD Information (Deliverable 8). The Contractor shall implement and maintain information security in its project, enterprise, or company-wide unclassified information technology system(s) in accordance with the requirements set forth in DoD Instruction 8582.01, Security of

Unclassified DoD Information on Non-DoD Information Systems, June 6, 2012. The Contractor shall, at a minimum, comply with the security controls specified by National Institute of Standards and Technology

(NIST) Special Publication (SP) 800-53, Revision 4; DoD 5400.11-R, DoD Privacy Program; the DoD

5200.2-R, DoD Personnel Security Program; Office of Management and Budget (OMB) M-06-16, Protection of Sensitive Agency Information, and TRICARE Systems Manual 7950-M, Chapter 1, Section

1.1 (except for paragraphs 3.4 and 3.5 through 3.5.1.7).

Government validation of the controls as shown in as shown in DFARS 252.204-7012 is required prior to accessing DoD data or inter-connectivity with the Government systems and testing. Descriptions for each control on the checklist are found in NIST SP 800-53, Revision 4. If a control is not implemented, the

Contractor shall prepare a written determination that explains how either the required security control is not applicable or how an alternative control or protective measure is used to achieve equivalent protection in accordance with the Deliverables Schedule. For inspection purposes, at the Government's direction the

Contractor will provide a NIST certification briefing at a designated Government location, presenting an overview of its certification efforts.

b. Additional NIST References and Related DoD Issuances

The references below support the Information Assurance (IA) requirements outlined in the following paragraphs.

• 48 CFR Parts 204, 212, and 252 as amended by 76 FR 69273 - 69282 / Vol. 78, No. 222

• NIST Special Publication (SP) 800-53, In Accordance With (IAW) Defense Federal

Acquisition Regulations System (DFARS) 252.204-7012, “Security and Privacy Controls for

Federal Information Systems and Organizations”

• NIST SP 800-53A, IAW DFARS 252.204-7012, “Guide for Assessing the Security Controls in Federal Information Systems and Organizations”

• NIST SP 800-37, IAW DFARS 252.204-7012, “Guide For Applying The Risk Management

Framework To Federal Information Systems”

• NIST SP 800-34, IAW DFARS 252.204-7012, “Contingency Planning Guide For Federal

Information Systems”

• DoD Directive (DODD) 5230.09, “Clearance of DoD Information for Public Release,”

August 22, 2008

• Department of Defense Instruction (DoDI) 8510.01, “Risk Management Framework (RMF) for DoD Information Technology (IT),” May 24, 2016

• “Health Insurance Portability and Accountability Act (HIPAA), Security Standards, Final

Rule,” February 20, 2003

2.1.12 Special Qualifications:

a. The Contractor is responsible for ensuring that all Contractor personnel receive Information

Assurance (IA) training before being granted access to DoD AISs/networks, and/or MHS SI information.

b. Section 508 Requirement

The Contractor shall comply with Section 508 of the Rehabilitation Act of 1973 (29 U.S.C.

794d). Specifically, the procurement, development, maintenance, or integration of Electronic and Information Technology (EIT) under this Contract must comply with the applicable accessibility standards issued by the Electronic and Information Technology Accessibility

Standards at Code of Federal Regulation Part 1194.

c. Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The Contracting Officer, Contracting Officer’s Representative (COR), and other Government personnel, as appropriate, may meet periodically with the Contractor to review the Contractor's performance. At these meetings the Contracting Officer will apprise the Contractor of how the Government views the Contractor's performance and the Contractor will apprise the Government of problems, if any, being experienced.

d. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the Government.

2.1.13 Contracting Officer’s Representative (COR):

The (COR) will be identified by separate letter. The COR monitors all technical aspects of the Contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the Contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the Contractor concerning technical aspects of the Contract; monitor Contractor's performance and notify both the Contracting Officer and Contractor of any deficiencies; coordinate availability of Government Furnished Property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting Contract.

2.1.14 Key Personnel: The follow personnel are considered Key Personnel by the Government:

Program Manager

Subject Matter Expert III

Subject Matter Expert IV

Consultant

The Contractor will provide a Program Manager who will be responsible for the performance of the work.

The name of this person and an alternate who will act for the Program Manager when he/she is absent will be designated in writing to the Contracting Officer. The Program Manager or alternate will have full authority to act for the Contractor on all Contract matters relating to daily operation of this Contract. The

Contract Manager or alternate will be available between 8:00 a.m. to 5:00 p.m., Monday thru Friday except

Federal holidays or when the Government facility is closed for administrative reasons.

Qualifications for all Key Personnel are listed below:

Program Manager A minimum Master’s Degree in Health Care Administration, Public

Health, Epidemiology, Policy Analysis, Operations Research, Statistics, Mathematics, Computer Science, or Business

Administration. The proposed individual must demonstrate eight years or more of experience in program/project management of major health care contracts with identifiable skills in management on at least four of the following six task areas: (1) budgeting, pricing and financial analyst support (2) policy support; (3) lifecycle contract management support activities; (4) health care contracts cost adjustment; (5)health care reimbursement support; (6) health care cost certification. As well as the more detailed tasks outlined in this PWS.

Subject Matter Expert (SME)

IV

A minimum Master’s Degree in Health Care Administration, Public

Health, Epidemiology, Policy Analysis, Operations Research, Statistics, Mathematics, Computer Science, or Business

Administration. The proposed individual must demonstrate eight years or more of experience in program/project management of major health care contracts with identifiable skills in management on at least four of the following six task areas: (1) budgeting, pricing and financial analyst support (2) policy support; (3) lifecycle contract management support activities; (4) health care contracts cost adjustment; (5)health care reimbursement support; (6) health care cost certification. As well as the more detailed tasks outlined in this PWS.

Subject Matter Expert (SME)

III

A minimum Master’s Degree in Health Care Administration, Public

Health, Epidemiology, Policy Analysis, Operations Research, Statistics, Mathematics, Computer Science, or Business

Administration. The proposed individual must demonstrate eight years or more of experience in program/project management of major health care contracts with identifiable skills in management on at least four of the following six task areas: (1) budgeting, pricing and financial analyst support (2) policy support; (3) lifecycle contract management support activities; (4) health care contracts cost adjustment; (5)health

Consultant A Minimum Bachelor’s Degree and in Business, Computer Science, Engineering, Mathematics, Statistics, or any Bachelor's of Science degree The proposed individual must demonstrate eight years or more of experience in program/project management of major health care contracts with identifiable skills in management on at least four of the following six task areas: (1) budgeting, pricing and financial analyst support (2) policy support; (3) lifecycle contract management support activities; (4) health care contracts cost adjustment; (5)health

Substitutions of proposed Key Personnel will not be allowed for a period of one year after award, except under extreme circumstances. Any substitution or replacement of Key Personnel will have qualifications equal to or greater than the individuals proposed. For temporary and/or permanent replacement of Key

Personnel, the Contractor will provide a resume for each individual to the COR. Resumes will be provided at least two weeks (or as mutually agreed upon) prior to making any personnel changes. The Government reserves the right to pre-approve any replacement or substitution of Key Personnel. Contractor personnel must submit necessary information to be issued a security clearance prior to reporting for performance.

2.1.15

Depending upon your staffing plan, you may propose different positions to be filled by Key Personnel. For all Key Personnel positions, provide an attachment naming the individuals proposed to fill Key Personnel positions along with a description of the portion of the solicitation’s Performance Work Statement that each individual is being proposed to perform. Also for all individuals proposed to fill Key Personnel positions, you are to submit resumes. For those individuals proposed as Key Personnel who are not current employees of your company, include a signed a letter of intent.

The Contractor agrees that the Key Personnel utilized under the Contract shall not be removed from the

Contract, work, or supplemented with additional personnel, unless authorized in accordance with the following provisions:

2.1.15.1 The Government reserves the right to pre-approve any replacement or substitution of Key

Personnel. The Contractor shall not substitute Key Personnel assigned to perform services under this

Contract for one year after award, except under extreme circumstances. After one year the

Contractor must receive prior written approval of the Contracting Officer or his/her authorized representative. Requests for approval of substitutions shall be submitted in writing to the Contracting

Officer and COR at least two weeks (or as mutually agreed upon) prior to making any personnel changes; and shall provide for a detailed explanation of the circumstances necessitating the proposed substitution(s). Requests must contain a complete resume for the proposed substitute, and any other information as requested by the Contracting Officer or his/her authorized representative. Proposed substitutions must have qualifications that are equal to or higher than the Key Personnel being replaced. The Contracting Officer or his authorized representative shall evaluate such requests and promptly notify the Contractor in writing whether the proposed substitution is acceptable.

2.1.15.2 The above provisions shall be fully applicable to any subcontract or partnership, which the

Contractor may have entered into.

2.1.15.3 Key Personnel to include replacements during the performance of the Contract are subject to the vendor security requirements as stated within the Performance Work Statement

(PWS).

2.1.15.4 Resumes of all Key Personnel candidates must be reviewed and approved by the Government prior to commencing work on the Contract. Any vacancies shall be filled with appropriate, cleared personnel within 30 days.

2.1.15.5 The Contractor will provide an up-to-date staffing plan to the COR, which will include, but is not limited to, training certifications and labor categories.

2.1.15.6 Contractor personnel must submit necessary information to be issued a security clearance prior to reporting for performance.

2.1.16 Identification of Contractor Employees:

All Contract personnel attending meetings, answering Government telephones, and working in other situations where their Contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by Contractors are suitably marked as Contractor products or that Contractor participation is appropriately disclosed. When in Government facilities or attending meetings, etc. Contractor personnel will be required to obtain and wear badges in the performance of this service.

2.1.17 Contractor Travel:

No travel will be required by the Contractor.

2.1.18 Data Rights:

The Government has unlimited rights to all documents/material produced under this Contract. All documents and materials, to include the source codes of any software, produced under this Contract will be Government-owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the Contractor without written permission from the Contracting Officer. All materials supplied to the Government will be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

2.1.19 Dissemination of Information/Publishing

There shall be no dissemination or publication, except within and between the Contractor and any subcontractors or specified Integrated Product/Process Team (IPT) members who have a need to know, of information developed under this order or contained in the reports to be furnished pursuant to this Contract without prior written approval of the DHA TM or the Contracting Officer. DHA approval for publication will require provisions which protect the intellectual property and patent rights of both DHA and the

Contractor.

2.1.20 Public Key Infrastructure Authentication and Encryption.

Contractors shall follow the DoD standards, policies, and procedures related to the use of Public Key

Infrastructure (PKI) certificates and biometrics for positive authentication including authentication to DoD private web servers or applications. Where interoperable PKI is required for the exchange of unclassified information, including the encryption of e-mail containing sensitive information, between DoD and its

Contractors, industry partners shall obtain all necessary certificates if they are not eligible for a DoD

Common Access Card. (refer to http://iase.disa.mil/pki/eca/ and http://www.cac.mil/)*

2.1.21 Safeguarding of Unclassified Controlled Technical Information (See DFAR Clause 252.204-http://iase.disa.mil/pki/eca/ http://www.cac.mil/)

7012)

2.1.22 Personally Identifiable Information (PII) and Protected Health Information (PHI)

The DHA Privacy Office website at https://health.mil/Military-Health-Topics/Privacy-and-Civil-

Liberties contains guidance regarding Protected Health Information (PHI) and Personally

Identifiable Information PII).

2.1.23 Business Associates

The DHA Privacy Office website at https://health.mil/Military-Health-Topics/Privacy-and-Civil-

Liberties/Privacy-Contract-Language/HIPAA-Compliant-Business-Associate-Agreement-for-the-

MHS contains standard contract clause language regarding Business Associates.

3.0 INSPECTION AND ACCEPTANCE

3.0.1

The Contracting Officer’s Representative (COR) for the Contract is a Government official who has been delegated specific technical, functional and oversight responsibilities for this Contract. The COR is designated in the COR appointment letter, issued by the Contracting Officer, and is responsible for inspection and acceptance of all services, incoming shipments, documents, and services.

3.0.2 Acceptance Criteria

Certification by the Government of satisfactory services provided is contingent upon the Contractor performing in accordance with the performance standards contained in the Performance Requirements

Summary Matrix (Section 6.7.2) and all terms and conditions of this order, including all modifications.

3.0.3 Contractor Payment Processing

The Contractor is responsible for properly preparing and forwarding to the appropriate Government official, the invoice and receiving report for payment. The Contractor shall invoice in accordance with Section B of the Contract. The Contractor shall attach back up information to receiving reports for direct labor and Other

Direct Costs (ODCs). Backup information for ODCs shall list all elements of costs, such as travel breakout backup, including itinerary, dates of travel, name of employees traveling plus per diem costs shall accompany the receiving report. All ODCs exceeding $3,000 requires that the Contractor conduct appropriate competition. When the Wide Area Workflow – Receipt and Acceptance application is able to be used, it is the preferred method of submission. (See below.)

a. Invoicing and Receiving Report Instructions – Fixed Price Contracts

The Contractor is responsible for submitting invoices and initiating receiving reports electronically through

Wide Area Work Flow – Receipt and Acceptance (WAWF) for goods and services rendered under this

Contract. For fixed price contracts, the WAWF 2 IN 1 format (for services), and the COMBO format (only for supplies or equipment), are the preferred methods of processing electronic invoices and receiving reports within DHA. Back up documentation (such as timesheets, etc.) can be included and attached to WAWF documents as requested by the responsible COR. Attachments created in any Microsoft Office product are attachable to the invoice in WAWF.

Contractor personnel (WAWF Vendor role) shall self-register at the web site: https://wawf.eb.mil/, and be activated by the Contractor’s designated Electronic Business Point of Contact. WAWF training is available on the internet at http://wawftraining.com.

https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties/Privacy-Contract-Language/HIPAA-Compliant-Business-Associate-Agreement-for-the-MHS https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties/Privacy-Contract-Language/HIPAA-Compliant-Business-Associate-Agreement-for-the-MHS https://health.mil/Military-Health-Topics/Privacy-and-Civil-Liberties/Privacy-Contract-Language/HIPAA-Compliant-Business-Associate-Agreement-for-the-MHS https://wawf.eb.mil/ http://wawftraining.com/

The Contractor shall submit invoices for payment and initiate receiving reports every month.

The Government shall process invoices for payment and associated receiving reports every month.

Prior to submitting the first WAWF-RA electronic form for a given contract, Contractors should first coordinate with the assigned DHA COR.

When initiating documents within WAWF, Contractors must use the appropriate two-part DHA location code to include BOTH the Government Acceptor Department of Defense Activity Address Code

(DoDAAC)/ Extension (Ext) fields and the Local Processing Office (LPO) DoDAAC / Extension fields as displayed within the WAWF application and illustrated below:

Service Acceptor /Extension LPO DoDAAC /Extension

HT0093 | HT0093 |

4.0 DELIVERABLES

4.1 Delivery Address

All deliverables shall be submitted to the COR designated in the COR appointment letter.

4.2 Method of Delivery

Electronic copies shall be delivered using Microsoft Office (MS) suite of tools (for example, MS WORD, MS EXCEL, MS POWERPOINT, MS PROJECT, or MS ACCESS format), unless otherwise specified by the COR. Electronic submission shall be made via email, unless otherwise agreed to by the COR.

4.3 Shipping

The Contractor shall use the U.S. Postal Service standard delivery for delivery of materials, equipment, or required hardcopy documents. The COR must approve all exceptions to this requirement.

4.4 Government Acceptance Period

The COR will have ten (10) workdays to review draft deliverables and make comments. The Contractor shall have five (5) workdays to make corrections. Upon receipt of the final deliverables, the COR will have two (2) workdays for final review prior to acceptance or providing documented reasons for non-acceptance.

Should the Government fail to complete the review within the review period the deliverable will become acceptable by default, unless prior to the expiration of the ten (10) work days the Government notifies the

Contractor in writing to the contrary. The final submission should be deemed approved if the Government has not rejected it in 30 days.

The COR will have the right to reject or require correction of any deficiencies found in the deliverables that are contrary to the information contained in the Contractor’s accepted proposal. In the event of a rejected deliverable, the Contractor will be notified in writing by the COR of the specific reasons for rejection. The

Contractor shall have five (5) workdays to correct the rejected deliverable and return it per delivery instructions.

4.5 Delivery Schedule Abbreviations

The following abbreviations are used in the delivery/deliverable schedule:

Abbreviation Definition

AM Acquisition Manager

COR Contracting Officer's Representative

CS Contract Specialist

DA Days after

DACA Days after contract award (award of this order)

DAEOM Days after end of month

Days Calendar Days unless otherwise specified

E Electronic Copy

H Hard Copy

NLT No Later Than

PM Program Manager

PWS Ref Performance Work Statement Reference (paragraph number)

4.6 Deliverable/Delivery Schedule

A summary of deliverables follows. Copies are to be provided to the Government officials indicated in electronic file (E), and/or hard copy (H).

Item PWS Ref Title Dist E H Initial Subsequent

Deliverable

Attachment

Non-

Disclosure

Agreement

COR

PM

Signed statements are due, from each employee assigned, prior to performing ANY work on this analytic request.

Deliverable

2.1.1 Monthly

Progress

Report

COR

PM

NLT 45 DACA NLT 15th of each month

Deliverable

2.1.2.a 10-day

Incoming

Transition

Plan

COR

PM

With Proposal As required

Deliverable

2.1.2.b 10-day

Outgoing

Transition

Plan

COR

PM

With Proposal As required

Deliverable

2.1.3 Program

Management

Plan

COR

PM

With Proposal 5 DACA

Deliverable

2.1.4 Quality

Control Plan

COR

PM

With Proposal 5 DACA

Deliverable

2.1.5 Contingency

Operations

Plan

COR

PM

NLT 10 DACA Updated quarterly

2.1.11 a Electronic

Security

COR

PM

AM

Complete

Checklist and

Certification for

Minimum Level of Enhanced

Safeguarding for Unclassified

DoD

Information

Government validation of the controls as shown in as shown in DFARS

252.204-7012 is required prior to accessing DoD data or inter-connectivity with the Government systems and testing.

Deliverable

Section 5.0

Part 5.1

Budgeting, Pricing, and

Financial

Analysis

Support

COR

PM

AM

Provide actuarial and financial analyses to accomplish the pricing, re-pricing, adjustments, risk corridor, and equity loss determinations required by all health care and health care related contracts on an ongoing basis as outlined in the PWS

Provide annual reports as directed by the Government and COR

Deliverable

Part 5.2

POLICY

SUPPORT

COR

PM

AM

Military Health

Care Benefit

Analyses, and

Comparisons of

Military and

Civilian Health

Care Programs as described in the PWS

Ongoing through-out the Contract

Period of Performance

Part 5.3

LIFECYCLE

CONTRACT

MANAGEM

ENT

SUPPORT

COR

PM

AM

Support for developmen t and award of new health care or health care related contracts and monitoring awarded health care or health care related contracts

Ongoing throughout the Contract

Part 5.4

CONTRACT

COST

ADJUSTME

NT

COR

PM

AM

Using the

Managed

Care

Support

Contract

(MCSC)

business models and other sources of

MCS data, the

Contractor will develop and maintain data bases with Option

Period and

Fiscal Year contract cost projections, advising the

Governmen t of current and out-year cost implications of existing contracts and proposed changes.

Ongoing through-out the Contract

Part 5.5

REIMBURS

EMENT

SUPPORT

COR

PM

AM

Perform data analysis to determine the following for use under the

TRICARE

DRG-based payment system:

DRG

weights;

adjusted standardize d amount;

indirect medical education adjustments

; geometric mean length-of-stay and length-of-stay outlier cutoffs for each DRG;

and the per diem cost-share and cost-share limits for beneficiarie s other than active duty family members.

Annually, these items are to be calculated from

TRICARE

claims data for the

On an ongoing bases and IAW the

PWS…