Department of War1 (DoW)

Defense Health Agency (DHA) Performance Work Statement (PWS)

Enterprise Referral Care Coordination Center (RC3)

Deputy Assistant Director for Health Care Operations (DAD-HCO)

Assistant Director for Research, Development, and Acquisition (AD-RDA), Portfolio Acquisition Executive for Medical Services (PAE-MS), Program Management Office for Enterprise Medical Services (PMO-EMS)

Solicitation Number:

Version: 1.0 Date: 10.30.26

1 10 U.S.C. § 111(a) designates the “Department of Defense” as an executive agency. Executive Order 14347 authorizes a "secondary" name of “Department of War.”

PART 1

1. GENERAL INFORMATION

This is a non-personal services contract. The Government shall not exercise any supervision or control over the contract service providers performing the services herein.

1.1 Introduction: The Defense Health Agency (DHA) requires a standardized, unified, enterprise solution to eliminate unwarranted variation in patient appointing, referral management, and care coordination across all Military Treatment Facilities (MTFs) worldwide. Historically, services have been fragmented across multiple regional sites (such as Colorado Springs, CO; San Antonio, TX; Tidewater, VA; the National Capital Region; and the Indo-Pacific), each operating under distinct business rules.

1.1.1. This contract establishes a single, consolidated and enterprise solution known as the Referral Care Coordination Center (RC3). This framework integrates appointing, referral processing and tracking, including clear and legible report (CLR) retrieval for care deferred to the private sector, direct care processing and closure, and care coordination to optimize direct care utilization, capacity, improve access to specialty care, enhance beneficiary satisfaction, and minimize costs for Private Sector Care (PSC).

1.2 Background: Currently, RC3 is a mixture of individual geographic contract awards, some require the full RC3 scope, while others only serve to augment the MTF staffing with specific positions. The care coordination requirement is standardized by the Defense Health Agency – Procedural Memorandum, DHA-PM 6000.100 Standard Process and Procedures for Optimizing Health Care with the DHA.

1.3 Objectives: The Contractor shall establish a single, consolidated and enterprise RC3 solution servicing all DHA MTFs and clinics (Exhibit A) with the following:

1.3.1. Appointing: Centralize all patient direct care appointments utilizing the electronic health record (EHR) ensuring strict adherence to Access to Care (ATC) standards.

1.3.2. Referral Management: Standardize the processing, routing, tracking, and closure of all Direct Care (DC), PSC, and out-of-area referrals, including Right of First Refusal (ROFR).

1.3.3. Care Coordination: Deliver consistent, high-quality care coordination and specialty navigation support for all beneficiaries striving for first call resolution and high customer satisfaction.

1.4 Scope: The RC3 serves as the central hub for care coordination for beneficiaries enrolled in DC as well as the private sector, which includes the Managed Care Support Contractor(s) (MCSC(s)) for referral processing and appointing management. For all enrolled beneficiaries, the RC3 will actively manage patient transitions of care, securely exchange clinical information between referring and receiving providers, and assist high-risk patients in navigating complex and specialty care pathways. RC3 care coordination will be customer-centric and include functions such as maintaining high standards for first call resolution, actively identifying beneficiaries who may and should receive direct care, proactively identifying patients requiring multi-disciplinary care, facilitating the synchronization of appointments and services to minimize patient travel, reducing administrative burdens, and ensuring continuity of care and quality or services throughout the referral lifecycle.

1.5 Period of Performance (PoP): The initial PoP combines a transition period and an ‘X’ month base period, the sum of which should not exceed 12 months, for the first year (base year) of the contract, and four 12-month option years, for a total of five years.

1.6 Transition:

1.6.1. Transition-in period: The Contractor shall create a transition-in plan detailing execution of the below provided within 10 calendar Days After Contract Award (DACA), that mirrors the transition-in plan provided for the Request for Proposal. The Transition-in Plan shall include Phase 0 and the detailed Proposed Waves. The Contractor shall propose the phased roll-out and the order of that roll-out as part of the Transition-In plan. The transition-in period shall not exceed 1 year after contract award.

(Deliverable 1)

1.6.1.1 Phase 0: Mobilization and Onboarding: The Contractor shall utilize the first 30 calendar days following contract award as a dedicated, non-operational Phase. During this period, the Contractor shall not assume responsibility for active patient appointing or referral management. Instead, the Contractor shall focus exclusively on program functions, staff onboarding, security clearance processing, and system access provisioning.

1.6.2. Requirements and Deliverables: The Contractor shall complete the following activities during Phase 0 to receive Government approval to initiate Wave 1 Go-Live:

1.6.2.1 Security, Credentialing, and Common Access Card (CAC) Issuance:

1.6.2.1.1 Personnel Security: The Contractor shall submit all required security background investigation paperwork for 100% of the Phase 1 (Wave 1) staff within five (5) calendar DACA.

1.6.2.1.2 Credentials: The Contractor shall coordinate with the Contracting Officer (COR) Representative and Alternate Contracting Officers (ACORs), as requested, to facilitate fingerprinting, credentialing, and CAC issuance for all scheduled Wave 1 personnel.

1.6.2.2 System Access and Health Insurance Portability and Accountability Act (HIPAA) Training

1.6.2.2.1 Mandatory Training: The Contractor shall ensure all staff complete required DoW cyber awareness training, HIPAA compliance training, and Joint Information Technology System access requirements NLT five (5) days before performing functions on the EHR. (Exhibit E2) (Performance Requirements Summary (PRS) #1)

1.6.2.2.2 EHR Provisioning: The Contractor shall coordinate with the COR/ACOR(s) to submit account requests for the EHR and the Referral Management System (RMS).

1.6.2.3 Appointing and Referral Management Training

1.6.2.3.1 Standard Operating Procedure (SOP) Development: The Contractor shall work with the MTF Point of Contact (POC), designated and provided by the COR/ACOR(s), to incorporate and document local "Business Rules" (e.g., clinic-specific scheduling templates, triage protocols, and private sector care referral guidelines).

1.6.2.3.2 Skills Verification: The Contractor shall conduct train-the-trainer through Government provided training on role-specific training, simulating patient calls and referral entry within EHR training environments.

1.6.2.4 Phase 0 Exit Criteria

1.6.2.4.1 The Contractor shall not assume responsibility for any active call logs or referral logs until the Contracting Officer (CO) and the COR/ACOR(s) approve the Phase 0 requirements’ completion.

1.6.2.4.2 The checklist must verify:

1.6.2.4.2.1 100% of Wave 1 Contractor Key Personnel and staff have been issued CACs.

1.6.2.4.2.2 95% of Wave 1 Contractor appointing/referral staff have active, verified access to EHR.

1.6.3. Phased Transition-In Strategy

1.6.3.1 The Contractor shall execute a phased Transition-In plan to assume Referral Management and Appointing Services from the legacy contracts. Rather than a simultaneous nationwide cutover, the Contractor shall transition operations using a wave approach. This structured rollout ensures zero degradation in patient access to care, medical readiness, or referral processing timelines at all DHA MTFs.

1.6.3.2 Waves and Operational Requirements

1.6.3.2.1 Wave 1: Program Establishment and First Wave

1.6.3.2.1.1 Scope: The Contractor shall successfully transition referral and appointing services for the proposed MTFs in the First Wave.

1.6.3.2.1.2 Information Technology (IT) and System Access: The Contractor shall immediately initiate and track CAC issuance, HIPAA training compliance, and system access requests (e.g., EHR, RMS) for all Wave 1 personnel.

1.6.3.2.2 Wave 2: Second Wave Expansion and Initial Operating Capability (IOC)

1.6.3.2.2.1 Scope: Upon successful stabilization of the First Wave, the Contractor shall transition referral and appointing services for Second Wave.

1.6.3.2.3 Initial Operating Capability (IOC) Requirements: The Contractor shall successfully assume operation control of all MTFs designated in the Second Wave, demonstrating that referral processing backlogs are within acceptable limits and average speed of answer (ASA) for appointing telephonic scheduling and synchronous and asynchronous chat meets PWS standards. The Government will formally declare IOC before authorizing Wave 3 to begin.

1.6.3.2.4 Wave 3: Third Wave Integration and Final Operating Capability (FOC)

1.6.3.2.4.1 Scope: The Contractor shall successfully transition referral and appointing services for the remaining MTFs into the unified contract structure.

1.6.3.3 Full Operating Capability (FOC) Gate: The Contractor shall successfully assume 100% operational responsibility for referral management and appointing services across all DHA MTFs following the standardized performance metrics.

1.6.4. Transition-Out Period. The Contractor shall, upon the Contracting Officer’s written notice, furnish phase-out services for up to 180 calendar days in the final exercised option year of the contract. The Contractor shall provide sufficient experienced personnel during the phase-out period to ensure that the services called for by this contract are maintained at the required level of security and proficiency.

1.6.4.1 The Contractor shall prepare and deliver to the Government a transition out plan that facilitates the accomplishment of a seamless, low-risk transition to the incoming contractor at the expiration of the contract. The Transition Out Plan is due NLT 90 calendar days prior to end of the base year of the contract, and the Contractor shall update it with each option period exercised thereafter (Deliverable 2). The Contractor’s transition-out plan shall describe the process it will use to transfer government data and Protected Health Information (PHI)/Personal Identifiable Information (PII) (e.g., all Controlled Unclassified Information (CUI) and other information collected and stored by the Contractor in communicating with beneficiaries and performing services under this contract) to the successor contractor and/or the Government. The Contractor’s plan shall also describe how it will provide data and reports created from the telephonic scheduling and synchronous and asynchronous chat process, as well as digital recordings and transcripts, to the successor contractor and/or the Government.

1.6.4.2 When requested by the Government the Contractor shall participate in transition-out meetings with the Program Manager (PM), project staff, and representatives of the successor contractor and/or Government personnel. The purpose of these meetings will be to review project materials and take preparatory steps to ensure an effective transition in contractor support. When requested, the contractor shall develop, document, and monitor the execution of a Transition-Out Plan that may be used to transition tasks and materials described in this PWS to a new contractor or to the Government.

1.6.4.3 The Contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC as defined by Department of Defense* Instruction (DoDI) 5015.02.

1.7 Administrative specifications

1.7.1. Place of performance: The work shall be performed at specified On-Site Support MTFs (Exhibit A1), contractor facilities and/or at remote workstations as approved by the Government.

1.7.2. The contractor shall safeguard all issued information and property provided by the Government at all workstations, remote or otherwise. The contractor shall ensure that its employees have a suitable workspace, utilities adequate for installing equipment, and a general work environment that is free from interruptions and provides reasonable security and protection of Government property and information.

1.7.3. The contractor shall continue service during local, state, or national events or crises through the use of alternate work locations.

The contractor shall safeguard all Government-issued equipment, information, and property at these locations. Additionally, the contractor shall adhere to all security protocols and maintain workspace standards to ensure the protection of Government property and information, as well as uninterrupted service during such events. The Contractor shall document the process in the Continuity of Operations Plan (COOP).

1.7.4. Recognized Federal holidays: The Contractor shall perform the duties on recognized federal holidays, except Christmas Day, unless otherwise stated in Part 5. The recognized federal holidays are:

New Year’s Day Birthday of Martin Luther King, Jr.

Washington’s Birthday Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veteran’s Day Thanksgiving Day Christmas Day

1.7.5. Hours of operation: The Contractor shall perform as described in Part 5.

1.8 Contractor travel: Contractors may be required to travel locally during the performance of this contract to attend meetings, conferences, and training. Travel will not be separately priced. Non-local travel will not be authorized.

1.9 Shipping: Shipping is not required, except as required in Section 4 of the PWS.

1.10 Other Direct Costs (ODC): ODCs are not authorized.

1.11 Quality

1.11.1. Quality Control (QC): The Contractor shall develop and maintain an effective QC program to ensure services are performed in accordance with this PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services, which include recommended changes to business rules. The Contractor’s QC program shall document that its work complies with stated requirements. The Contractor shall submit an initial QC Plan (QCP) within 30 calendar DACA and an updated QCP within 5 business days after incorporating any updates/changes to the plan. (Deliverable 3)

1.11.2. Quality Assurance (QA): The Government will evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). The QASP provides a systematic method for the Government to evaluate performance and to ensure that the Contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.12 Contractor personnel

1.12.1. CAC requirements. The Contractor shall identify those contractor employees who will require a Government issued CAC based on their duties and required level of DHA network access. To obtain CACs, the Contractor Facilities Security Officer (FSO) shall provide the COR/ACOR(s) the required information per the DHA CAC request process, including complying with DoW and DHA training requirements, forms and background investigations. (Exhibit B1)

1.12.1.1 The Contractor shall return the CACs of departing contractor personnel to the COR/ACOR(s) within three business days after their last day and shall return all CACs when the contract ends (Deliverable 4).

1.12.2. Personnel Security. All Contractor personnel identified as needing a CAC shall have a minimum of a TIER 1 adjudicated investigation for Non-Critical, Non-Sensitive positions.

1.12.3. Contractor onboarding and training. Contractor personnel shall complete all requirements, training, and forms (as applicable) prescribed in Exhibits E1, E2 (taking into account the training timing and frequency requirements), as well as the following requirements (as applicable): (PRS #1)

1.12.3.1 Prior to accessing the DHA network, Contractor personnel shall complete the following:

1.12.3.1.1 Sign a DHA Acceptable User Policy (AUP), and

1.12.3.1.2 DHA-approved training for HIPAA and Privacy Act and DoD Cyber Awareness Challenge, and annually thereafter.

1.12.4. Licensing and Compliance:

1.12.4.1 The Contractor shall ensure that all Contractor nurses who deliver services under this contract are currently licensed in good standing to render professional health care services in each state in which they render services to beneficiaries and/or satisfy the special license portability requirements described in Title 10 United States Code (USC) Section 1094(d)(2) (i.e., relating to providing “an examination or assessment under [10 USC] Section 10206”). The license must be at full clinical practice level to meet this requirement. A temporary license at the full practice level is acceptable. When a state does not license a specific category of individual professional provider, certification by a qualified accrediting organization is required. Certification must be at full clinical practice level. A temporary certification at the full clinical practice level is acceptable. The Contractor shall ensure that providers comply with any applicable state immunization requirements for health care providers. (PRS #2)

1.12.5. Physical Security: The Contractor shall follow DHA and local security guidelines when services occur at government facilities or on government property.

1.12.6. Access Control: The Contractor shall follow local guidance to access Government installations or Government facilities (when such access is necessary) and shall use only specified gates or routes when provided.

1.12.7. Emergency Procedures:

1.12.7.1 The Contractor shall draft, provide and be prepared to execute an Emergency Preparedness Plan (EPP), which includes contingencies for providing the objectives in Para 1.3 and tasks in Part 5. The Contractor shall submit the EPP NLT 15 calendar DACA. (Deliverable 5)

1.12.7.2 The Contractor shall create a quick response team (QRT) who shall assist in resolving phone system downtimes, synchronous and asynchronous chat downtimes, phone system and/or synchronous and asynchronous chat emergencies, as described in Part 6.

1.12.8. Key personnel (Contractor): The Contractor shall provide a list of personnel with requisite qualifications to fill the Key Personnel positions listed in paragraph 1.12.8.3 below to the COR NLT five (5) business DACA. Key Personnel are considered essential to the work described within the PWS, and personnel in the Key Personnel positions shall meet the pertinent education and experience requirements described in paragraph 5.9. (Deliverable 6)

1.12.8.1 The Contractor shall submit in writing to the CO and COR any proposed changes (replacements, substitutions, etc.) to its Key Personnel (with appropriate documentation) 30 calendar days prior to the key person on-boarding into a position on the contract. The Contractor shall notify the COR within three business days of notification from the affected Key Personnel of a change in work status. (Deliverable 6)

1.12.8.2 All Key Personnel shall have CACs.

1.12.8.3 Personnel in the following positions are Key Personnel:

1.12.8.3.1 Program Manager and Alternate

1.12.8.3.2 Quality Assurance Manager

1.12.8.3.3 Senior Training Manager

1.12.8.3.4 Referral Management Team Lead and Alternate

1.13 Data Rights: In addition to the data rights clauses below, the Contractor shall be bound by the provisions in Exhibit G.

1.13.1. Materials means all items in any format and includes, but is not limited to, data, reports, documents, pamphlets, advertisements, surveys, studies, software and computer programs, films, tapes, sound reproductions, chat and/or video and/or telephone call recordings and transcripts, protocols, scripts, workflows, standard operating procedures and business practices related to the services being performed in the PWS. Ownership includes the right to copyright, patent, register and the ability to transfer these materials and rights.

1.13.2. For services that are delivered under the contract, but that incorporate pre-existing technical data or computer software developed by the contractor at private expense and not produced under the contract, the contractor may submit assertions pursuant to DFARS 252.227-7992 and will grant to the Government either a nonexclusive, royalty-free, irrevocable license in such materials, or the asserted level of license rights (e.g., Government Purpose Rights, Limited Rights, etc.) as permitted under the DFARS. The Contractor shall warrant and represent that it has all rights and permissions, including intellectual property rights, moral rights and rights of publicity, necessary to grant such a license. The Contractor shall provide the Government written notice within one business day of each notice or claim of infringement received by the Contractor with respect to any data delivered under this contract. (CDRL A010)

1.13.3. The Contractor shall provide the Government with, at a minimum, Government Purpose rights to intellectual property first produced and delivered in the performance of this contract in accordance with the terms of DFARS clause 252.227-7989. This includes all software source code first produced and delivered in performance of this contract and any and all documentation created in support thereof. (CDRL A020)

1.13.4. The Contractor, upon request of the Government, shall deliver copies of all commercial licenses required to support this contract, including (but not limited to) those required to establish, operate, or maintain the appointment scheduling methods. Any commercial items, including without limitation commercial computer software, delivered to the Government under this contract will be delivered subject to their standard commercial license terms, provided such terms are consistent with applicable Federal law and regulations.

1.13.5. All materials used, created, developed, incorporated and/or assimilated by the contractor in the course of performance under this contract remain in the ownership of the Government and are provided to the Contractor as Government Furnished Information. Commercialization of any Contractor developed software or technical data using DHA Protected Health Information and/or Personally Identifiable Information and/or materials as defined herein is prohibit unless approved by the Contracting Officer. It is the Contractor’s burden to prove, to the CO, its software and/or technical data being commercialized was not developed and/or furthered with the use of GFI, PHI or PII before commercialization of the item.

1.13.6. Reporting

1.13.7. Non-Disclosure Agreement (NDA): The Contractor shall ensure that all contractor personnel who will access proprietary, classified, or confidential information or any information release of which is protected or governed by law or regulation complete and sign a DHA contractor NDA (Exhibit D) prior to beginning work on the contract or an associated task order. The Contractor also shall execute an NDA on behalf of the company. Contractor personnel NDAs shall be executed not later than the personnel’s first day and shall be renewed upon the exercise of a contract/task order option period. Assignment of personnel who have not executed an NDA or have failed to adhere to the terms of the NDA shall constitute default on the part of the Contractor. The Contractor shall maintain originally signed NDAs of its personnel and provide a copy of the NDAs to the COR. (Deliverable 7)

1.13.8. Government’s COR: The COR is not authorized to change any of the terms and conditions of the resulting contract.

1.13.8.1 Government’s ACOR: The Government will provide ACORs upon contract award based on proposed MTFs included in the Waves in the Transition-In Plan.

1.13.9. Post Award Conference (PAC): The Contractor’s Key Personnel shall attend all PACs. The PACs will be scheduled by the CO within 20 calendar DACA. (Deliverable 8)

1.13.10. Periodic Progress Meetings/ Monthly Progress Reviews (MPR): Government personnel will meet on a set schedule with the Contractor to review the Contractor's performance. At these meetings the CO will inform the Contractor of how the Government views the Contractor's performance and the Contractor will inform the Government of problems, if any, being experienced.

Appropriate action shall be taken by the Contractor and will be taken by the Government to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.14 Contractor Identification

1.14.1. The Contractor shall ensure that when contractor personnel and subcontractor personnel are performing services in a Government facility or on Government property that they wear identification badges that display their name and the name of the Contractor.

1.14.2. Contractors, including subcontractors at all tiers, shall clearly distinguish themselves from Government personnel.

Contractor employees shall not act, advertise, or presume to be Government employees, agents, or representatives. Contractor employees shall be introduced as contractor personnel and always display distinguishing visible identification whether in conversations, meetings, or other forms of communication with Government personnel.

1.14.3. Contractor personnel, while performing in a contractor capacity, shall refrain from using their retired or reserve component military rank or title (if applicable) in written or verbal communications associated with the contracts under which they provide services.

1.14.4. The Contractor shall incorporate the substance of this requirement (relating to Contractor Identification) in all subcontracts awarded under this contract.

1.14.5. Dress and Appearance: When in-person for Government hosted meetings or at the on-site support MTFs, contractor personnel shall dress in a neat, professional manner in good keeping with standard health care practices, be easily recognized and provide professional, modest appearance in keeping with normally accepted community standards of dress for the work being performed.

1.14.6. The Contractor shall provide all services in accordance with (IAW) applicable national, state and local regulations and policies governing the use of personal protective equipment, at no additional cost to the Government.

1.15 Media Inquiries: Neither the Contractor nor its personnel are authorized to respond to media and/or social media inquiries related to this contract. Any inquiries shall be promptly relayed to the COR. The Contractor or its personnel shall not provide interviews, comments, or any other response without authorization by the CO.

PART 2

2. DEFINITIONS, ACRONYMS, AND APPLICABLE PUBLICATIONS/ INSTRUCTIONS

2.1 Definitions:

ACCEPTABLE QUALITY LEVEL (AQL): The minimum level of performance a contractor shall meet to be satisfactory on this contract.

ACCEPTABLE USER POLICY (AUP): The practices users must agree to use a network or other resource.

ACCESS TO CARE (ATC) STANDARDS: The contractor shall implement processes to ensure that referral processing, appointing including in and outbound appointing attempts, and RC3 care coordination efforts comply with all standards in the Code of Federal Regulation, DHA 6000.100, Appendix A, and TRICARE standards.

ALTERNATE CONTRACTING OFFICER’S REPRESENTATIVE (ACOR): An individual designated and authorized in writing by the CO as a backup to the COR to perform specific technical or administrative functions. This individual does NOT have authority to change the terms and conditions of the contract.

APPLICATION VIRTULIZATION HOSTING ENVIRONMENT (AVHE): The Department of War (DoW) / Defense Health Agency (DHA) enterprise virtualization platform that provides authorized users with secure, remote access to a virtual desktop capable of accessing legacy and current clinical and operational applications.

APPOINTING: Actions completed to schedule and book appointments or services.

ARTIFICIAL INTELLIGENCE (AI): Machine-based systems that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments, including Natural Language Processing (NLP) conversational interfaces and Machine Learning (ML) predictive analytics engines.

APPOINTMENT ERROR: Any booking transaction executed by contractor personnel that fails to comply with established booking protocols and business rules. This includes, but is not limited to, scheduling into an incorrect appointment type or clinic template;

omitting or mis-entering mandatory administrative/clinical data fields; booking with an inappropriate provider type or specialty;

assigning an incorrect physical or virtual facility/location; or failing to enforce TRICARE Prime beneficiary booking priorities in the TRICARE Operations Manual and Military Health System (MHS) ATC standards.

ASYNCHRONOUS CHAT: A secure digital messaging interaction where participants communicate without requiring real-time concurrency, allowing beneficiaries to submit inquiries, complete guided workflows, and receive automated or coordinator responses over time while preserving full interaction context.

AVERAGE SPEED OF ANSWER (ASA): The average elapsed time (measured in seconds) from when an inbound caller enters the telephone system queue until the call is answered by a live, qualified customer service agent. This metric captures elements of customer service provided by employees and does not include calls that are resolved without the need for person-to-person interaction (i.e. hours of operations).

BLOCKED CALL: Any inbound call attempt that cannot connect to the automated call distribution (ACD) or interactive voice response (IVR) infrastructure due to insufficient line capacity, trunk saturation, or system unavailability, resulting in a busy signal or carrier re-order tone.

BOOKING PROTOCOLS: The standardized procedures, requirements, and protocols that govern the submission, approval, tracking, and execution of all booking requests necessary for the Contractor to perform required services under this contract.

BUSINESS RULES: The mandatory policies, operational constraints, and compliance requirements established by the Government that the Contractor must follow when performing work under this contract.

CALL ABANDONMENT RATE: Calls that disconnect while in queue or on hold after the initial interactive voice response and before reaching an agent. The operational performance measure reflects the frequency of queued caller disconnections relative to total queued call volume during a designated evaluation period, indicating the proportion of beneficiaries who disconnect prior to receiving assistance or completing their transaction.

CARE COORDINATION: Actions completed to promote health outcomes through proactive outreach, anticipating patient needs, actively managing patient transitions of care, securely exchanging clinical information, assisting high-risk patients in navigating complex specialty care pathways, and purposefully engaging with beneficiaries to identify and meet their needs.

CLEAR AND LEGIBLE REPORT (CLR): The initial medical and diagnostic documentation (records) generated from an encounter for specialty care provided in the private sector. To ensure continuity of care and completeness of patient records, CLRs are systematically retrieved and added to the beneficiary’s health record (closing the loop) in accordance with applicable policy and mandated timelines. CLRs must be legible, contain clinical findings, treatment plans, and diagnostic results. Any attempts to retrieve the CLR (chasing) must be appropriately documented, and if after 180 days, the CLR has not been retrieved, it is to be administratively closed. Records from subsequent encounters from the same referral are desirable but are not subject to the described CLR lifecycle.

COMMON OPERATING PICTURE (dashboard): A shared, real-time display of information that provides all involved parties with the same situational awareness, enabling effective, consistent, and timely decision making. This may include dashboards or other real-time data sharing methods.

COMMUNICATION MODALITIES: Refers to synchronous chat, in-person and telephone.

COMPLEX CARE: Any care or patient case scenario that falls outside of prescribed guidelines and regulations can be defined as a system variance, and/or warrants additional review by an individual with demonstrated competence in critical thinking.

CONTRACTING OFFICER (CO): A person with the authority to enter, administer, and/or terminate contracts and make related determinations and findings.

CONTRACTING OFFICER’S REPRESENTATIVE (COR): An individual designated and authorized in writing by the CO to perform specific technical or administrative functions. This individual does NOT have authority to change the terms and conditions of the contract.

CREDENTIALING: A formal process of assessing, verifying, and validating the qualifications (training requirements), experience (licensure), and professional standing, ensuring the individual is competent and authorized to complete specific duties.

DAYS AFTER CONTRACT AWARD: The number of days after the contract has been awarded for the base year, and each option year.

DIRECT CARE: Medical care and services provided to beneficiaries at Military Treatment Facilities (MTFs) by military, civilian and/or contractor health care providers funded and employed by the Defense Health Agency (DHA) or Military Services.

DROPPED CALL: An active call that terminates prematurely and unexpectedly during interaction with an agent or interactive voice response (IVR) system due to network, hardware, or software failure, without deliberate disconnect action by either the caller or agent.

ELECTRONIC HEALTH RECORD (EHR): A digital version of a patient’s paper chart that stores their medical history and other health information.

EMERGENCY: An unexpected situation requiring immediate attention to include indicating harming themselves or others.

EMERGENCY PREPAREDNESS PLAN (EPP): A structured, written document outlining the strategic actions, resources, and procedures an organization will implement to effectively anticipate, respond to, and recover from potential disasters and emergencies.

Key elements include risk assessment, roles and responsibilities of key personnel, and communication protocols.

ENTERPRISE SOLUTION: A standardized, unified system designed to eliminate variation in patient appointing, referral management, and care coordination across all MTFs.

FEDERAL RISK AND AUTHORIZATION MANAGEMENT PROGRAM (FedRAMP): A federal compliance program that provides a standardized approach to security assessment, authorization, and continuous monitoring for cloud products and services.

FIRST CALL RESOLUTION: The ability to resolve a customer’s issue, question, or need, during the first interaction, eliminating the need for any unneeded follow-up contact and contributing to customer satisfaction on the patient's first call without requiring a callback. Resolution includes, but is not limited to: completing a booked, rescheduled, or cancelled appointment; providing verified referral status; or successfully completing an administrative or clinical navigation action without subsequent touches for the same inquiry.

FULL OPERATING CAPABILITY (FOC): The formal milestone and operational state achieved when the Contractor has fully established, validated, and assumed all required enterprise clinical appointing and referral management requirements for all DHA Military Treatment Facilities (MTFs).

INITIAL OPERATING CAPABILITY (IOC): The formal milestone when the Contractor has successfully established foundational technical infrastructure, acquired credentialed and trained baseline staffing, established secure EHR connections, and successfully assumed phased appointing and referral management functions at proposed MTFs for Waves 1 and 2 prior to full enterprise rollout.

INTERACTIVE VOICE RESPONSE (IVR): An automated telephony capability that interacts with callers, gathers necessary information, and routes calls to the appropriate recipient.

KEY PERSONNEL: Employees of the contractor, or any subcontractor(s), affiliates, joint venture partners, or team members, and consultants engaged by any of these entities, are essential to the work being performed under contract, and have met education and experience standards as required.

LEARNING MANGEMENT SYSTEM (LMS): A software application or web-based technology used to plan, implement, assess specific learning processes, and document completed training requirements.

MACHINE LEARNING (ML) PERFORMANCE IMPROVEMENT: The algorithmic evaluation of referral processing intervals, appointment slot utilization, no-show trends, and clinic template efficiency to generate actionable recommendations for MTF operational improvement.

MILITARY READINESS / READINESS CARE: Clinical encounters, physical examinations (PHAs, pre/post deployment), Soldier Readiness Center (SRC) clearances, and specialty consultations required to establish or maintain an Active Duty Service Member’s (ADSM) physical/psychological deployability under DoDI 6025.19 and DoDI 6200.05.

MILITARY TREATMENT FACILITY (MTF): A specific location where medical care is provided by DHA and uniformed health care workers.

MODULAR PROVISION / CONDITIONAL REQUIREMENT: A contractual tasking that may or may not depend upon a certain circumstance or condition before the Government elects to selectively require the Contractor to execute or remove depending on a Government-made determination.

NON-PERSONAL SERVICES CONTRACT: A contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

ON-SITE SUPPORT MTFS: Subset of DHA MTFs requiring support on-site.

ONE-BUSINESS-DAY PROCESSING RULE: Referrals must be reviewed and assigned to either: remain in direct care, to be deferred to private sector care, or administratively closed (dispositioned) within ONE business day and in accordance with DHA policy. Urgent referrals will be prioritized in processing. Weekends and holidays are not considered business days.

OUTREACH STANDARD: Mandated three (3) outreach attempts across separate days within 14 calendar days.

PERSONAL HEALTH INFORMATION (PHI): Individually identifiable health information that is transmitted or maintained by electronic media or in any other form or medium. This includes any information (including demographic data) that relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.

PERSONALLY IDENTIFIABLE INFORMATION (PII): Any information about an individual that can be used to distinguish or trace an individual's identity, such as their name, Social Security Number (SSN), date and place of birth, mother's maiden name, or biometric records; and any other information that is linked or linkable to a specific individual, such as medical, educational, financial, and employment information.

PREVENTATIVE APPOINTMENT / PREVENTATIVE SCREENING: Proactive health maintenance encounters (e.g. diabetic monitoring, mammography, well-child, immunizations) initiated from Government provided beneficiary rosters.

PRIVATE SECTOR CARE: Healthcare delivery provided outside of MTFs. Also commonly referred to as network care, managed care, and community care.

PRIVILAGED PROVIDER: A clinician with access to the Military Health System (MHS) Electronic Health Record (EHR) due to their role in providing care for patients at a Military Treatment Facility (MTF).

QUALITY ASSURANCE: A systematic, process-oriented approach focused on preventing poor outcomes and ensuring products and services meet specified requirements through its development and implementation.

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP): An organized, written document specifying the surveillance methodology to be used for surveillance of contractor performance.

QUICK RESPONSE TEAM: A highly specialized small group trained and equipped to rapidly respond to and handle developing emergencies, critical incidents, and/or specialized crises.

REFERRAL: Medically necessary consultative, diagnostic, or therapeutic orders for care outside of the ordering clinician’s area of expertise.

URGENT [REFERRAL]: Referral that requires processing, routing, and administrative action within one day of receipt due to the potential for clinical deterioration or a compromise in force readiness. Disposition means the final determination to retain the referral in direct care, defer it to private sector care, or administratively close it in accordance with DHA policy. Weekends and holidays are excluded from this measure.

NON-URGENT (ROUTINE) [REFERRAL]: Referral for care that DOES NOT pose an emergent or acute threat to life, limb, eyesight, or force readiness in the event of delays.

REFERRAL GUIDELINES: The official policies, procedures, and standards established by the DHA and the TRICARE Health Plan (THP) that govern the initiation, processing, documentation, tracking, and completion of all referrals in the EHR.

REFERRAL MANAGEMENT: Actions completed to ensure continuity of care throughout a referral lifecycle.

REFERRAL NAVIGATOR: A specialized clinical or administrative coordinator designated as an enterprise Subject Matter Expert (SME) for specified clinical specialties.

REFERRAL (STATUS): The lifecycle phase of a referral. The category of progress or stage of a referral within the EHR Referral Management module.

REFERRAL (SUBSTATUS): A more granular indicator within EHR Referral Management that provides additional detail about the specific stage or condition of a referral within the referral status.

RIGHT OF FIRST REFUSAL (ROFR): Subject to facility capability, capacity, and strict acceptance timeframes (three business days for Routine; one business day for Urgent), the statutory and operational process by which Direct Care MTFs are granted the initial opportunity to review and accept specialty care referrals originating in the civilian Managed Care Support Contractor (MCSC) Network before private sector care authorization is finalized.

SERVICE LEVEL: This metric measures the percent of calls answered in a given number of seconds. Time measurement begins when calls reach the queue after they select appointments. Measurement is the number of calls answered in 20 seconds divided by the total calls abandoned plus the total calls answered. The minimum standard is that 80% of calls are answered within 20 seconds on a monthly average.

SPECIAL POPULATIONS: Beneficiaries that have multiple or unique entitlements (Wounded Warrior, newborns, reservists, etc.)

that create confusion regarding their eligibility or priority status as described in the TRICARE Systems Manual (TSM).

SYCHRONOUS: Happening, existing, or arising at precisely the same time. Real-time interactions, communications, or chat where all participants are actively engaged and interacting simultaneously.

TRANSITION-IN PERIOD: The period, not to exceed 12 months, during which the contractor prepares to meet all contract requirements, including training personnel and establishing capabilities, before the full performance start date.

TRANSITION-OUT PERIOD: A period of up to 180 calendar days during the final exercised option year where the contractor provides services to ensure a seamless transition to a successor contractor or the Government.

TRICARE PRIME BENEFICIARY: Eligible individual who has formally enrolled in TRICARE Prime, the Department of War’s private sector health insurance option.

UTILIZATION MANAGEMENT (UM): A clinical and administrative oversight process that ensures beneficiaries receive the right care, in the right setting, by the right provider, in a manner that is medically necessary, cost-effective, and fully compliant with TRICARE benefit plans. It actively balances patient healthcare needs with the operational capability and capacity of the direct care system.

WARM HANDOFF: A live, attended telephonic handoff wherein the initiating call center agent remains actively connected on the line until verbal contact and formal administrative/clinical case context have been successfully communicated to the receiving provider, clinic, or specialized care coordinator, ensuring that the beneficiary is never placed on an unassisted hold or subjected to a disconnected call during transition.

2.2 Acronyms:

ACD Automated Call Distribution ACOR Alternate Contracting Officer Representative AD-RDA Assistant Director for Research, Development, and Acquisition AI Artificial Intelligence AIR Additional Information Request APM Alternate Program Manager AQL Acceptable Quality Level ATC Access to Care ASA Average Speed to Answer AUP Acceptable User Policy

AVHE Application Virtualization Hosting Environment B2B Business to Business BAA Business Associate Agreement CAC Common Access Card CCSRG Cloud Computing Security Requirements Guide CDD Certificate of Data Disposition CDRL Contract Data Requirements List CLR Clear and Legible Report CMMC Cybersecurity Maturity Model Certification CO Contracting Officer COOP Continuity of Operations Plan COR Contracting Officer’s Representative CUI Controlled Unclassified Information DACA Days After Contract Award DEERS Defense Enrollment Eligibility Reporting System DFARS Defense Federal Acquisition Regulation Supplement DHA Defense Health Agency DC Direct Care DMDC Defense Manpower Data Center DoD Department of Defense DoDC3 Department of Defense Cyber Crime Center DoDD Department of Defense Directive DoDI Department of Defense Instruction

DoDM Department of Defense Manual DoW Department of War DPCLO Defense Privacy and Civil Liberties Office DRP Disaster Recovery Plan DSA Data Sharing Agreements DSAA Data Sharing Agreement Application DUA Data Use Agreement EHR Electronic Health Record EPP Emergency Preparedness Plan FAR Federal Acquisition Regulation FedRAMP Federal Risk and Authorization Management Program FOC Final Operating Capacity FSO Facilities Security Officer GFE Government Furnished Equipment GFIS Government Furnished Information System HIE Health Information Exchange HIPAA Health Insurance Portability and Accountability Act HTTP HyperText Transfer (Transport) Protocol HTTPS HyperText Transfer (Transport) Protocol Secure IAW In accordance with IOC Initial Operating Capability IT Information Technology IVR Interactive Voice Response

LMS Learning Management System MCSC Managed Care Support Contractor MHS Military Health System ML Machine Learning MPR Monthly Progress Review NDA Non-Disclosure Agreement NIST National Institute of Standards and Technology NIST SP National Institute of Standards and Technology Special Publication NLT Not (or No) Later Than ODC Other Direct Costs PAC Post Award Conference PHI Protected Health Information PIEE Procurement Integrated Enterprise Environment PII Personally Identifiable Information PM Program Manager PMO Program Management Office PMO-EMS Program Management Office-Enterprise Medical Services POC Point of Contact PoP Period of Performance PRS Performance Requirements Summary PSC Private Sector Care PWS Performance Work Statement QA Quality Assurance

QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan QRT Quick Response Team RC3 Referral Care Coordination Center RCA Root Cause Analysis RFO Revolutionary Federal Acquisition Regulation Overhaul RM Referral Management RM-ATL Referral Management Alternate Team Leader RMC Referral Management Center RMS Referral Management System RM-TL Referral Management Team Leader ROFR Right of First Refusal SAAR System Authorization Access Request SME Subject Matter Expert SOP Standard Operating Procedure THP TRICARE Health Plan TOM TRICARE Operations Manual TSM TRICARE Systems Manual UM Utilization Management US United States VDI Virtual Desktop Infrastructure

2.3 Applicable Publications, DHA Administrative Instructions (AI), etc.

2.3.1. Public Law

10 U.S.C. §§ 1074a, 10149, 10206 10 U.S.C. §§ 1074f, m, n 10 U.S.C. § 1090a (2023) Pub. L. No. 104-191 (1996) Pub. L. No. 112-81 (2012)

2.3.2. Code of Federal Regulation

48 CFR Federal Acquisition Regulations System 32 CFR 199.17 “TRICARE Program”

2.3.3. Department of War

DoDI 5015.02 "DoD Records Management Program," 24 Feb 2015 DoDI 6025.18-R "DoD Health Information Privacy Regulation," March 13, 2019 DoDI 6200.05, "Force Health Protection Quality Assurance (FHPQA) Program," 16 Jun 2016 DoDI 8580.02-R, "DoD Health Information Security Regulation," 12 Aug 2015

DFARS 207.503

DFARS 252.225-7040

DoD Manual 6025.18 "Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule in DoD Health Care Programs," 13 Mar 2019 IT Level Designation on DD FORM 2875 System Authorization Access Request Memo, 8 September 2020 DOD MANUAL 5200.02 Procedures For The DoD Personnel Security Program (PSP), October 29, 2020 6025.18-R, “Department of Defense Health Information Privacy Regulation,” January 24, 2003, (or its successor) DoD 5400.11-R, “Department of Defense Privacy Program,” May 14, 2007, (or its successor) DoD Directive 5400.11-R, “Department of Defense Privacy Program,” October 29, 2014

DoD Directive 8580.02-R, “Department of Defense Health Information Security Regulation,” July 12, 2007 (or its successor)

Office of the Secretary of Defense Memorandum, “Safeguarding Against and Responding to the Breach of Personally Identifiable Information (PII),” dated June 5, 2009

Title XIII, Subtitle D of Public Law 111-5 (also known as “Health Information Technology for Economic and Clinical Health (HITECH) Act”)

Title 45, Code of Federal Regulations, Part 160, “General…