2015_Solicitation_1449_Continuationamend2.pdf

SOLICITATION 15-100-SOL-00011

Emergency Prescription Assistance Program Support

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued. This solicitation is being competed as a Request for Proposal (RFP) under solicitation number 15-100SOL-00011. This solicitation incorporates provisions and clauses through Federal Acquisition Circular 2005-78 effective December 15, 2014. This is a small business set aside, under NAICS code 524291 with a small business size standard of $7M.

The Government intends to award an Indefinite Delivery Indefinite Quantity (IDIQ) single-award contract that provides services as specified in Attachment 1 –Statement of Work. Attachment 2- Pricing Schedule provides the CLIN structure for the solicitation. The period of performance is 12 months from the date of the award, with one (1) 12-month option period.

Contract Line Items – See Attachment 2 This is an IDIQ contract. The Government is under no obligation to over any amount otherthan the guaranteed minimum. The guaranteed minimum will be met by the issuance of services included in task order 1.

ATTACHMENT 1 - STATEMENT OF WORK

EPAP Claims Adjudication and Reimbursement

1. REQUIRING ORGANIZATION

Department of Health and Human Services

OS/ASPR/OEM

2. OBJECTIVE

The purpose of this contract is to obtain services to perform the activities related to adjudicating prescription drug claims for medications, specific medical supplies, and durable medical equipment (DME) and reimbursing pharmacies enrolled in the Emergency Prescription Assistance Program (EPAP) on the Government’s behalf. Additionally, this contract will permit the adjudication and reimbursement for the administration or dispensing of specific medications and vaccines by community pharmacies. This effort will allow any pharmacy in the United States and its territories (Puerto Rico and the US Virgin Islands) to use existing electronic pharmacy systems as an infrastructure to efficiently process prescriptions, specific medical supplies, and DME for individuals that are eligible for the EPAP.

EPAP activities provide “essential assistance” to support state and local jurisdictions as defined in Section 403 and 502 of the Stafford Act, 42 USC 5170b. Program activation will occur under the Robert T. Stafford Disaster Relief and Emergency Assistance Act or under the authorities of the National Disaster Medical System (NDMS) to provide emergency medical care to the victims of public health emergencies and catastrophic events that overwhelm the capacity of state and local emergency medical systems to respond to these disasters. Section 2812 of the PHS Act provides that the Secretary may activate the NDMS to “provide health services, health-related social services, other appropriate human services, and appropriate auxiliary services to respond to the needs of victims of a public health emergency (whether or not determined to be a public health emergency under section 319).

3. BACKGROUND

Section 2811 of the Public Health Service Act establishes within the Department of Health and Human Services the position of the Assistant Secretary for Preparedness and Response (HHS/ASPR) to serve as the principal advisor to the Secretary on all matters related to Federal public health and medical preparedness and response for public health emergencies. ASPR has agreed to accept a subtask from HHS/ASPR to provide pharmaceutical supplies, specific medical supplies, limited durable medical equipment and personnel sufficient to support disaster response operations.

In the aftermath of Hurricane Katrina, community retail pharmacies were ready, willing and able to assist victims and evacuees. Indeed, in many disaster areas, community pharmacists were on the scene before any other medical professionals providing first aid and prescription drug assistance to victims. Through the coordinating efforts of DHHS/ASPR, community pharmacists were able to set up and serve the emergency needs of evacuees from Katrina at the Astrodome, Kelly Air Force Base, the Convention Center and hundreds of other evacuee sites using the existing private drug distribution system.

Conflicting directions from Federal, State, local and private agencies, along with the lack of any established process for enlisting the help from this community resource were among the biggest challenges for these pharmacies. In fact, many pharmacies that dispensed medications to Katrina evacuees were unable to settle claims due to the lack of clarity about what agency is responsible for paying which prescriptions dispensed during the Katrina disaster response.

Prescription drugs, specific medical supplies, and durable medical equipment (DME) are critical first line therapies in treating both acute and chronic conditions. For this reason, assuring an adequate and readily available supply should be a priority for emergency planning.

As a byproduct of our experience with Hurricane Katrina, the federal government established the Emergency Prescription Assistance Program (EPAP) to fully leverage private sector resources for efficient prescription drug, specific medical supplies and DME distribution. The EPAP will provide access to necessary prescription drugs, specific medical supplies, and limited durable medical equipment (DME) for individuals who were affected by a major disaster or emergency and have a need for drug, medical supply, or DME coverage (including co-payments as a separate optional requirement for those underinsured) at any pharmacy in the nation or U.S. territories.

Additionally, the EPAP will facilitate communications between government and private industry to identify and address any potential pharmaceutical and medical supply needs during the initial disaster response.

4. SCOPE

The Contractor shall provide access, at any EPAP-enrolled pharmacy in the nation or U.S. territory to ASPR- identified prescription drugs, medical supplies, and limited DME for individuals who were affected by a major disaster or emergency. The activation of this contract for adjudication and reimbursement for the administration or dispensing of specific medications and vaccines by community pharmacies in response to a public health emergency will be by determined by the

ASPR.

5. APPLICABLE DOCUMENTS

• Rate Schedule

6. TECHNICAL REQUIREMENTS/TASKS

Programmatic Goals: Ensure the EPAP program is activated and operational within 12 hours of receiving activation notification.

o Ensure all enrolled Pharmacies are notified of EPAP activation through fax.

o Ensure access to covered prescription drugs, medical supplies, and DME for eligible individuals who present a valid prescription at a pharmacy during a qualifying event, at no cost to the affected individual as defined in Section C-IV.

o Contractor shall limit pharmaceutical, specific medical supplies, and DME written prescription assistance to an individual patient for a one time fill of up to a 30-day supply for a medication to treat an acute condition, to replace maintenance prescription drugs or medical equipment lost as a direct result of the declared emergency or as a secondary result of loss or damage caused while in transit from the emergency site to the designated shelter facility.

o Implement a system that enables real-time point-of-sale eligibility checks and edits for claims where the pharmacist has found no coverage or limit coverage (co-payment) dispensing of EPAP covered drugs, specific medical supplies, and DME to eligible individuals.

o Provide timely reports of EPAP claims, eligibility checks, call-center activities, pharmacy communications and pharmacy payments to ASPR.

o Participate in disaster-related conference calls, as identified by ASPR, to facilitate communications with private industry and volunteer organizations.

o Adjudicate legitimate pharmacy claims from new pharmacy locations and other out of network pharmacies on an as-needed basis.

o Establish and maintain a public website for EPAP information and resources sharing Program Management Plan

• The Contractor shall provide a Program Management Plan (PMP) that fully documents its management approach for this contract. The Contractor shall update its PMP when changes to the required information change. At a minimum, the PMP shall:

o provide information on the Contractor’s management organization, internal management policies and procedures;

o summarize how the Contractor will maintain relationships and conduct regular meetings and reviews with Government personnel related to the activities and deliverables of the Contract;

o provide an organizational chart of the contractor’s organization to be used in performance of the contract and narrative describing how the

Contractor will fully integrate the management of the elements of this contract and if the plan includes subcontractors, other than individual subcontractors, provide organizational information about the subcontractor and include subcontractor organizational elements in the project organization chart;

o describe how activities of subcontractors will be managed and organizational relationship will be maintained between the prime and subcontractors and methods of requirement flow-down and activity progress reporting back to the prime Contractor;

o describe the: Contractor’s approach to selecting subcontractor(s) and maintaining the quality of products produced by subcontractor(s);

subcontractor’s role under the contract, its relationship to the Contractor, and its experience (over the past three (3) years at a minimum); and any subcontractor independent verification and validation process;

o identify key technical and management personnel who will be assigned to the contract;

o describe internal policies and procedures to be used in managing the contract;

o describe management and process for addressing work increases (spikes) and lulls as work priorities and schedules shift;

o describe the approach and method for the identification, assessment, and mitigation of program risks including provisions for identifying risk areas, assessing risk factors, assigning appropriate resources to reduce risk factors, identifying and analyzing alternative actions available, identifying the most promising alternatives, and planning for implementation of risk reduction.

o Contractor shall deliver a Project Plan with schedules and will update on a bi-weekly, or more frequent, basis until system development gets completed.

Specific Tasks:

The Contractor shall provide all labor, supervision, and training to provide qualified personnel to perform the specific tasks stated below.

PRE-ACTIVATION PHASE:

Contractor shall make whatever provisions it considers necessary in order to activate EPAP at the time a Task Order may be issued. We have provided examples of some activities we consider reasonable to ensure EPAP program readiness.

Contractor shall solicit enrollment of existing pharmacy network as the EPAP pharmacy network.

This network should be capable of providing eligible individuals with covered drugs and DME.

Standard terms and conditions of Contractor’s pharmacy enrollment should outlines the terms and condition of pharmacy agreements evidenced by submission of pharmacy signed agreement will be indicative of approval.

Contractor shall validate the legitimacy of all enrolled pharmacies before processing claims from these pharmacies.

The Contractor shall provide to ASPR an updated organizational structure and contact information for staff authorized to activate the EPAP, including back-ups and recommended communications protocols, each January and July and as otherwise updated, to facilitate immediate program activation during an emergency.

ACTIVATION PHASE

The Contractor shall activate the EPAP by request of the ASPR for public health emergencies, allowing EPAP claims processing, within 12 hours of receipt of a Task Order document from ASPR. The Task Order shall include specify the required activities as stated in the overall Contract.

Contractor shall notify network pharmacies of EPAP activation via fax, web, call center and other reasonable means immediately upon program activation.

Contractor shall allow any willing retail pharmacy to file claims provided they accept the standard EPAP network contract terms and conditions.

Contractor shall provide network pharmacies with claims processing instructions, including updated payer sheets, eligibility criteria, approved drug, specific medical supplies, and DME lists (to be provided), and program limitations within 12 hours of EPAP activation.

ASPR may further restrict covered drugs, specific medical supplies, and DME, eligibility, data required in the payer sheet and other program limitations in the Task Order activating the EPAP provided those further restrictions reflect the sub task issued by HHS.

Contractor will provide program software to interface with and establish dedicated EPAP server link to RxHub for Third Party Liability (TPL) adjudication.

Contractor shall require participating pharmacies to verify patient’s eligibility prior to submitting the claim by inquiring if the patient is from the affected area and checking patient eligibility for other drug or DME coverage.

Applying the TPL services, contractor shall reject claims for affected individuals who have other prescription drug, specific medical supplies, or DME coverage identified through the TPL program unless the option to cover co-payments is specifically activated. When available, the correct payer information shall be provided to the pharmacies.

Contractor shall administer the EPAP for prescription drugs, specific medical supplies and limited DME as defined by the ASPR.

Formulary Design and Implementation – Contractor shall load and administer a Formulary that follows Medicare Part D guidelines for a Formulary (see attached Formulary). The following exclusions shall be implemented and administered regardless of whether covered under a Medicare

Part D Formulary unless otherwise indicated in the Contractor Plan Implementation document for EPAP. Reference appendix entitled Plan Implementation document.

Cosmetic Agents Contraceptives Fertility Agents Erectile Dysfunction Weight Loss Medications Over-The-Counter (OTC) medications

Contractor shall approve claims for prescriptions written by an appropriately licensed clinical provider or prescription refills on file at the pharmacy provided doing so is within the authority provided by the state, and the drug or medical item is on the approved list. Prescription bottles with refills remaining on a current prescription are considered adequate proof of an existing prescription where such prescription is not for a controlled substance and Pharmacy has a commercially reasonable ability to verify the existing prescription, except if such prescription otherwise meets applicable state law requirements for emergency refills.

Contractor shall make reasonable efforts to review and monitor the cost effectiveness, interaction and resulting therapeutic implications of various drugs, specific medical supplies, and DME.

Contractor shall implement a mandatory fill program for the lowest price alternative between brand and generic, unless prescribed Dispense As Written (DAW) for a brand medication.

Contractor may request ASPR facilitate necessary coordination with FEMA for transportation or security logistical support if it is required to perform an individual task order.

Contractor shall provide telephonic Customer Service Representative (“CSR”) support using an existing (“CSR”) 800 number, including an Interactive Voice Response (“IVR”) phone system or similar non-IVR decision tree phone system, immediately (within 24 hours) of activation, or in the case of OCONUS , including Alaska, Hawaii, Puerto Rico and the US Virgin Islands, area, within 72 hours, to provide automated information concerning the EPAP to:

Pharmacy Providers Affected Individuals/Beneficiaries

POST-ACTIVATION / MAINTENANCE PHASE

Contractor shall provide EPAP progress reports to the Project Officer, on an as needed basis, or at a minimum weekly, containing the following information:

Total contract cost, including detail claims adjudicated and other operational costs.

Notification when EPAP expenditures reach 75% of allowable contract cost

Total donated manufacturer product, by manufacturer, if such amount reaches 75% of a previously agreed upon donation limit.

Suspicions of fraudulent EPAP billing activity among network pharmacies.

ASPR acknowledges and agrees that, in addition to any pharmacy reimbursement funds for prescription drugs, specific medical supplies, and DME as required by this Contract, it shall pay Contractor for transaction costs, reports, pharmacy communications, and other necessary operational expenses incurred at the direction of ASPR.

7. BILLING and REPORTING SCHEDULE

• Contractor shall provide EPAP progress reports to the HHS/ASPR Project Officer, on an as needed basis, or at a minimum weekly, containing the following information:

a. Total contract cost, including detail claims adjudicated and other operational costs.

b. Notification when EPAP expenditures reach 75% of allowable contract cost

c. Total donated manufacturer product, by manufacturer, if such amount reaches 75% previously agreed upon donation limit.

d. Suspicions of fraudulent EPAP billing activity among network pharmacies.

e. Invoice reports should contain the following information: payee information (name and contact information), a unique identifier (such as an invoice number) from the payee, and an accounting of the payments that were/are to be made for each recipient of payment, transaction date of claim.

• Contractor shall submit all claim reports within 3 days after each individual billing cycle.

a. Contractor shall prepare an itemization of Claims accepted and shall forward such itemization (1) to the Participating Pharmacies in the form of a remittance advice; and (2) to HHS/ASPR in the form of a Paid Claims file. Contractor shall also provide timely reports of eligibility checks, pharmacy communications, manufacturer donations, management and financial reports and any other operational activities to HHS/ASPR.

Specific reports of product utilization, by manufacturer, will be necessary to facilitate charitable product donation.

b. Submission of invoices will be in accordance with 52.212-4(g).

7. GOVERNMENT FURNISHED RESOURCES AND INFORMATION

N/A

8. REQUIREMENTS FOR HANDLING SENSITIVE/PROPRIETARY INFORMATION

All documents that contain information covered under the Privacy ACT, 5 USC 552(a), and/or the Health Insurance Portability and Accountability act (PL 104-191) and its various implementing regulations and must be protected in accordance with those provisions.

Healthcare information is personal and sensitive and must be treated accordingly.

9. DELIVERABLES

a. Processing of prescription, specific medical supplies, and DME claims in real time at enrolled pharmacies.

b. System for the enrollment of pharmacies and real time web based tracking of enrolled pharmacies.

c. Notification via multiple mechanisms of activation and de-activation of claims processing.

d. Establish and maintain a public website for EPAP information and resources sharing

(see attachment A)

10. PERFORMANCE/DELIVERY PERIOD

12 month Base period with one (1) 12 month option

11. PLACE/LOCATION OF PERFORMANCE/DELIVERY

The contractor shall perform all work at the contractor’s site.

12. TRAVEL REQUIREMENTS

No travel requirements.

13. GOVERNMENT POINTS OF CONTACT

Contract Officer Representative: TBD

Contracting Issues: Jonah Lerman, Contract Specialist Department of Health and Human Services Jonah.Lerman@hhs.gov 202-260-3580

14. SPECIAL REQUIREMENTS

Attachment A- EPAP Website

15. Security and Building Access Requirements.

N/A

Attachment A - EPAP Web Site The intended audience will be pharmacies and individuals who may be eligible for EPAP prescription assistance. This will be a public site, and may be used by the general public and by members of the media.

The site will enhance communication by making the various public documents associated with EPAP easily available. This will include the current approved formulary and the limited DME listing, as well as documents specific to each declared event.

Information and documents to be included on the EPAP site:

• Searchable database to locate participating pharmacy o search in variety of ways

• Program name and general description

• The approved prescription-drug formulary

• The listing of limited Durable Medical Equipment available for EPAP recipients

• A listing of currently-active EPAP events, including o Dates of eligibility o Payer Sheet o Links to public documents specific to each event, including:

General program information Dates of eligibility Eligible geography Instructions for claim submission Deadline for submission of claims Number of EPAP help line

• Frequently Asked Questions

• Links to web sites with information related to EPAP events o FEMA – Current Federal Disaster Declarations o HHS – Disasters and Emergencies o American Red Cross – Disaster Alerts

• Contact information, including the toll-free number for the EPAP help line. This information will only be displayed while at least one event is active or is within the timely-filing period.

The EPAP web site will be designed by contractor in consultation with ASPR. ASPR will provide contractor with information needed to keep the website content current and accurate. Contractor will post information to the website. All website content will be approved by ASPR before appearing on the site.

Contractor will provide web hosting and site maintenance.

The provision at 52.212-1, Instructions to Offerors—Commercial, applies to this acquisition with the following Addendum

INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (APR 2014)

52.212-1 Addendum https://acquisition.gov/far/current/html/52_212_213.html%23wp1179124

Questions regarding the Request for Proposal (RFP)

Answers to questions submitted are available in the attachment entitled “questions and answers”

Instructions for Submitting Proposals

A. General Instructions

1. Proposal Purpose and Obligations

Offerors are requested to demonstrate their ability to perform the statement of work successfully through a written proposal. It is the Offeror’s responsibility to ensure the completeness of its proposal. Except as otherwise provided in this RFP, the evaluation of proposals will be conducted on the basis of information contained in the proposal, and the Government will not assume that an Offeror offers a product or possesses any capability not specified in the proposal. Offerors that fail to provide in their initial proposal all information required by this RFP may not be further considered, especially if the Contracting Officer determines that substantial revisions or addenda to the Offeror’s proposal would be required to permit initial evaluation or if the incomplete proposal appears to be due to a lack of diligence or competence of the Offeror.

HHS will rely substantially on the information provided by the Offerors to evaluate the proposals.

Offerors must follow the instructions set forth in this RFP, providing all requested information.

The HHS intends to make award based on the offeror’s initial proposal submissions. Offerors are advised that deviations from the requirements of the RFP will render the proposal unacceptable, unless: (1) the HHS elects to establish a competitive range in which the Offeror is included, and the Offeror revises its proposal to comply with the RFP as currently written.

2. Preliminary Inventory

The Government will conduct a physical inventory of each proposal to insure receipt of the required documentation and information. Proposals submitted that provide too little information to preclude an informed initial evaluation will not be further considered.

3. Proposal Parts

Written proposals shall be submitted in two distinct Parts respectively labeled as "Part I" and, "Part II", and submitted as two distinct, clearly labeled electronic files. Each proposal Part shall be further divided into sections as described.

4. Formatting

Proposal text must be formatted for 8 ½ by 11 inch paper. Minimum margins for top, bottom, and sides are (1) inch, excluding headers and footers. The font and print size selected shall make the quotation easily readable. Information may be formatted for single or double-sided sheets, but shall not exceed the applicable page limitations. The type color for all documents submitted (including charts and graphs) shall be black. Bolding, underlining, and italics may be used to identify topic demarcations or points of emphasis. Graphic presentations, including pricing and other tables, while not subject to the margin and page size restrictions, shall use spacing and text that is easily readable. Information that exceeds the applicable page limitations will not be considered.

5. Proposal Content

1. Part I: Price and Administrative Information. (no page limit)

Part I shall address pricing and Administrative Information. The offeror shall include a Cover Letter and the information addressed below. The cover letter shall include, at a minimum, the offeror’s name, address, and point of contact with phone number and email address. There is no page limit for Part I.

. a. General Information Required

In Part I, Offerors shall use the Contract Pricing Table provided as part of this RFP. Each Offeror’s proposal shall also, as appropriate, disclose, describe, or submit the following information in Part I:

• Any pricing assumptions made in development of such proposal (pricing assumptions that deviate from requirements in the SOW will be regarded as deficiencies in the proposal);

• Contact information for the person most responsible for composing this proposal, including his or her name, telephone number and e-mail address; and

• Pricing information submitted in the format of Attachment 2 entitled: “pricing schedule”

2. Part II: Technical Approach, Business, and Past Performance (See each section for page limit)

The Offeror shall provide the information specified below, divided into sections corresponding to bulleted information. Part II must not exceed 40 pages. Past Performance Questionnaires do not count against the page count limitation.

FACTOR 1: TECHNICAL APPROACH

Sub Factor 1.1 – Approach to Handling Multiple Disasters or Large Scale Events (3 pages maximum):

The offeror shall describe its approach to adjudicating claims. Your approach should include your approach to handling multiple disasters, to include managing claims payments, processing, and adjudication. This should include identification of your organization to include any intended sub-contractors and how they fit within your proposed organization, Sub Factor 1.2 – Claims Processing Technology (4 pages maximum The Offeror shall name their network of partner(s) in which they will utilize for claims processing and shall detail how this network of partner(s) will be utilized. The most accurate, efficient, and innovative systems shall receive the highest ratings.

Sub Factor 1.3 – Claims Adjudication Process (5 pages maximum):

The Offeror shall detail the proposed workflow for processing claims once received. The workflow should outline how the Offeror intends to validate that the pharmacies have validated to participate in the EPAP. Plans that utilize the most logical, efficient distribution of resources shall receive the highest ratings.

Sub Factor 1.4 – Provider Payment Processing (4 pages maximum) The Offeror shall detail how it will make payments to pharmacies for adjudicated claims approved by the Government. The response should describe the payment techniques available and any vendor registration process required by the Offeror from pharmacies.

Please describe the content of a remittance advice and other communication to be provided by the Offeror to pharmacies that will facilitate payment posting and reconciliation by pharmacies. The Offeror should describe what documents will be submitted to the Government as proof of payment for reimbursement purposes.

Sub Factor 1.5 – Data Access and Reporting (2 pages maximum):

The offeror shall detail how the adjudication of claims and remittance advices will be generated. The Government’s assumption is that the adjudication of claims and production of remittance advices will occur using systems from the Offeror. Please describe the content and format of any information regarding claims, remittance advices and payments that can be supplied to the Government in electronic format to facilitate tracking, claim denial reviews and further investigation as needed.

Sub Factor 1.6 – Customer Service and Communication Process (2 pages maximum): The offeror shall demonstrate how they will deal with communications from both pharmacies and the government. Describe the mechanisms and processes for how program related information will be provided during steady state and an emergency response to increase the public awareness of the emergency prescription program.

Describe how inquiries from pharmacies will be tracked, serviced and escalated as needed. The Offeror shall detail all other customer service techniques and tools it plans to implement to support the program.

Sub Factor 1.7 – Fraud and Abuse Prevention (3 pages maximum):

The Offeror shall detail those processing and due diligence steps required to meet or exceed the Government’s minimum requirements for Fraud and Abuse Prevention.

Using the assumptions about access to patient lists and previous claims as outlined in the Statement of Work, the Offeror shall describe how these data sources will be combined with the Offeror’s own processes and tools to facilitate Fraud and Abuse Prevention before claim payment is made.

FACTOR 2: MANAGEMENT APPROACH

Sub Factor 2.1 – Management Structure (3 pages maximum) The Offeror shall identify the management structure for this project--including the project manager and the corporate executive who will be responsible for the account. The management structure should address all aspects of the work so that the Government can determine how the contractor will surge for multiple disasters.

Sub Factor 2.2 – Project Management Plan (Draft Project Management Plan) (8 pages maximum):

A draft Project Management Plan shall be provided as an attachment to the proposal.

The Project Management Plan shall include the Offeror’s approach for risk management, and identify the top risks and associated mitigation strategies that the Offeror sees for the project.

FACTOR 3: RELEVANT PAST PERFORMANCE

The Offeror shall send the past performance survey (See Attachment 3) to up to three references and have them submit completed surveys to the contracting officer via email prior to the date for submission of proposals. Offerors shall provide surveys to references for which they provided work similar in size, scope, and nature to that required in the statement of work as prime contractors or significant subcontractors, whether for Government or private entities. The surveys will not count towards the page limitation. The Offeror shall submit with its proposal the name and address of the firms to whom the questionnaires were sent. If the Offeror has no relevant past performance, it should state so in this section. Under this factor, the Government shall consider information made available in the questionnaires and may consider information from Government databases and other Government sources.

The provision at 52.212-2, Evaluation—Commercial Items is applicable to this solicitation.

52.212-2 Evaluation—Commercial Items (Oct 2014)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

TECHNICAL EVALUATION CRITERIA (FACTORS 1 AND 2):

FACTOR 1: TECHNICAL APPROACH

Sub Factor 1.1 – Approach to Handling Multiple Disasters or Large Scale Events: The offeror will be evaluated based on their ability to expand their solution to accommodate a large scale disaster or the possibility of multiple disasters requiring reimbursement services simultaneously.

https://acquisition.gov/far/current/html/52_212_213.html%23wp1179178

Sub Factor 1.2 – Claims Processing Technology: The evaluation will be based on how well your technologies capability to adjudicate claims is, Sub Factor 1.3 – Claims Adjudication Process: The evaluation will be based on how well the process utilizes resources. Plans that utilize the most logical, efficient adjudication process shall receive the highest ratings.

Sub Factor 1.4 – Provider Payment Processing: The evaluation will be based on how well the Offeror addresses all the necessary documentation and provides an efficient reimbursement system that pays pharmacies as efficiently as possible.

Sub Factor 1.5 – Data Access and Reporting: The evaluation will be based on how well the electronic format information from offerors systems facilitates tracking, claim denial reviews and further investigation as needed.

Sub Factor 1.6 – Customer Service and Communication Process: The evaluation will be based on how well the proposed communication process keeps pharmacies and the general public informed regarding the program; and how it reduces the risk of customer complaints. The most comprehensive customer service communication plans will be rated most highly.

Sub Factor 1.7 – Fraud and Abuse Prevention: The evaluation will be based on how well the offerors plan reduces/mitigates fraud and abuse. The comprehensiveness of the plans and its relation to the Government’s minimum standard shall be the basis for this rating.

FACTOR 2: MANAGEMENT APPROACH

Sub Factor 2.1 – Management Structure: This will be evaluated based the manner in which those roles and responsibilities will affect the desired outcomes of the statement of work shall be the basis for this rating.

Sub Factor 2.2 – Project Management Plan (Draft Project Management Plan).

The clarity and the relation with how the plan will aid in achieving the goals of this program shall be the basis for the rating of this element.

FACTOR 3: RELEVANT PAST PERFORMANCE

PAST PERFORMANCE WILL BE EVALUATED BASED ON THE

FOLLOWING

• Record of conforming to contract requirements and to standards of good workmanship;

• Record of forecasting and controlling costs;

• Adherence to contract schedules, including the administrative aspects of performance;

• History of reasonable and cooperative behavior and commitment to customer satisfaction;

• business-like concern for the interest of the customer and ability to meet the customer’s needs and keep the customer informed of project status; and

• Any other matter addressed in the questionnaire.

FACTOR 4: PRICE

The Government will evaluate the Price Factor by examining the total price of each firm’s proposed line item prices listed. The Government may determine that a proposal is unacceptable if the quoted prices are significantly unbalanced. In addition to pricing the line items, the government will use the tab in the attachment for price proposals entitled “Price Eval” to evaluate what the contract may cost based on the mock quantities in that tab for the base year and all option years.

Evaluation Ratings for non-price factors. Technical Evaluation.

The technical evaluation will be based on a best value determination. The evaluation will be based on the following criteria: Factor 1) technical approach; Factor 2) management approach. See below for elaboration on the factors. The proposals will be evaluated using the following rating scale:

1) Excellent. Exceeds the requirements in a way which yields significant benefits to the Government;

weaknesses, if any, are of small impact and NO significant weaknesses or deficiencies.

2) Satisfactory. Meets all requirements; proposal offers no significant benefits beyond the stated requirements, yet NO significant weaknesses or deficiencies exist.

3) Marginal. Fails to meet the minimum requirements or has one or more significant weaknesses. Deficiencies and significant weaknesses are correctable without major revisions to the proposals.

4) Unsatisfactory. Fails to meet the requirement; one or more deficiencies for which correction would require a major revision or redirection of the proposal.

Past performance:

1) Excellent. Based on an offeror’s past performance record, essentially no doubt exists that the offeror will successfully perform the required effort.

2) Satisfactory. Based on an offeror’s past performance record, some doubt exists that the offeror will successfully perform the required effort.

3) Unsatisfactory. Based on an offeror’s past performance record, extreme doubt exists that the offeror will successfully perform the required effort.

4) Neutral rating. No relevant performance record is identifiable upon which to base a meaningful performance rating. A search was unable to identify any relevant past performance information for the offeror or key team members/subcontractors or their key personnel.

This is neither a negative or positive assessment.

Technical and past performances, when combined, are more important than price.

(b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

(c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision)

Please include a completed copy of the provision at 52.212-3, Offeror Representations and Certifications—Commercial Items, with its offer.

Clause at 52.212-4, Contract Terms and Conditions—Commercial Items ALT 1, applies to this acquisition with the following addendum:

Contract Clauses

(1) Department of Health and Human Services Acquisition Regulation (HHSAR) (48

CFR Chapter 3) Clauses incorporated by reference:

https://acquisition.gov/far/current/html/52_212_213.html%23wp1179194 https://acquisition.gov/far/current/html/52_212_213.html%23wp1179465

HHSAR 352.232-72 (Jan 2010) Salary Rate Limitation HHSAR 352.227-70 (Jan 2006) Publications and Publicity

(2) Federal Acquisition Regulation (FAR) (48 Chapter 1) Clauses in full text:

FAR 52.252-2 Clauses Incorporated by Reference (Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Full text of the FAR clauses may be accessed electronically at:

https://www.acquisition.gov/far/index.html

52.217-9 Option to Extend the Term of the Contract.

As prescribed in 17.208(g), insert a clause substantially the same as the following:

OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) ) The Government may extend the term of this contract by written notice to the Contractor within 10 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 10 days; before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed One (1)year.

(End of clause)

52.216-18 Ordering.

As prescribed in 16.506(a), insert the following clause:

ORDERING (OCT 1995)

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule.

Such orders may be issued from the beginning of the period of performance through the end of the period of performance .

(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.

(c) If mailed, a delivery order or task order is considered “issued” when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.

https://www.acquisition.gov/far/index.html http://www.acquisition.gov/far/html/Subpart%2017_2.html%23wp1078175 http://www.acquisition.gov/far/html/Subpart%2016_5.html%23wp1093261

(3) 52.216-19 Order Limitations.

As prescribed in 16.506(b), insert a clause substantially the same as follows:

ORDER LIMITATIONS

(OCT 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than the quoted activation fee, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor—

(1) Any order for a single item in excess of $1M ];

(2) Any order for a combination of items in excess of $1M _; or

(3) A series of orders from the same ordering office within 1 days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section.

(c) If this is a requirements contract (i.e., includes the Requirements clause at subsection

52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section.

(d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within _2 days after issuance, with written notice stating the Contractor’s intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.

52.216-22 Indefinite Quantity.

As prescribed in 16.506(e), insert the following clause:

INDEFINITE

QUANTITY (OCT 1995)

(a) ) This is an indefinite-quantity contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies and services specified in the Schedule are estimates only and are not purchased by this contract.

(b) Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. The Contractor shall furnish to the Government, when and if ordered, the supplies or services specified in the Schedule up to and including the quantity designated in the Schedule as the “maximum.” The Government shall order at least the quantity of supplies or services designated in Task Order One as the “minimum.”

(c) Except for any limitations on quantities in the Order Limitations clause or in the Schedule, there is no limit on the number of orders that may be issued. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations.

(d) Any order issued during the effective period of this contract and not completed within that http://www.acquisition.gov/far/html/52_216.html%23wp1115057 period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor’s and Government’s rights and obligations with respect to that order to the same extent as if the order were completed during the contract’s effective period;

provided, that the Contractor shall not be required to make any deliveries under this contract after The end of the period of performance.

Clause at 52.212-5, Contract Terms and Conditions Required To Implement Statutes or Executive Orders—Commercial Items, applies to this acquisition and is included.

Contract Terms and Conditions Required to Implement Statutes or Executive Orders -- Commercial Items (Mar 2015)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (Dec 2014)

(2) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

(3) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Public Laws 108-77, 108-78 (19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the contracting officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

[Contracting Officer check as appropriate.]

__x_ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

__x_ (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Apr 2010) (41 U.S.C. 3509).

___ (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (Jun 2010) (Section 1553 of Pub L. 111-5) (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009).

_x__ (4) 52.204-10, Reporting Executive compensation and First-Tier Subcontract Awards (Jul 2013) (Pub. L. 109-282) (31 U.S.C. 6101 note).

___ (5) [Reserved] https://acquisition.gov/far/current/html/52_212_213.html%23wp1203358

__x_ (6) 52.204-14, Service Contract Reporting Requirements (Jan 2014) (Pub. L. 111- 117, section 743 of Div. C).

_x__ (7) 52.204-15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts (Jan 2014) (Pub. L. 111-117, section 743 of Div. C).

_x__ (8) 52.209-6, Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment (Aug 2013) (31 U.S.C.

6101 note).

___ (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Jul 2013) (41 U.S.C. 2313).

_x__ (10) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (May 2012) (section 738 of Division C of Public Law 112-74, section 740 of Division C of Pub. L. 111-117, section 743 of Division D of Pub. L. 111-8, and section 745 of Division D of Pub. L. 110-161).

___ (11) (i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (Nov 2011) (15 U.S.C. 657a).

___ (ii) Alternate I (Nov 2011) of 52.219-3.

___ (12) (i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (Oct 2011) (if the offeror elects to waive the preference, it shall so indicate in its offer)(15 U.S.C. 657a).

___ (ii) Alternate I (Jan 2011) of 52.219-4.

___ (13) [Reserved]

__x_ (14) (i) 52.219-6, Notice of Total Small Business Aside (Nov 2011) (15 U.S.C. 644).

___ (ii) Alternate I (Nov 2011).

___ (iii) Alternate II (Nov 2011).

___ (15) (i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C.

644).

___ (ii) Alternate I (Oct 1995) of 52.219-7.

___ (iii) Alternate II (Mar 2004) of 52.219-7.

___ (16) 52.219-8, Utilization of Small Business Concerns (Oct 2014) (15 U.S.C.

637(d)(2) and (3)).

___ (17) (i) 52.219-9, Small Business Subcontracting Plan (Oct 2014) (15 U.S.C. 637 (d)(4)).

___ (ii) Alternate I (Oct 2001) of 52.219-9.

___ (iii) Alternate II (Oct 2001) of 52.219-9.

___ (iv) Alternate III (Oct 2014) of 52.219-9.

___ (18) 52.219-13, Notice of Set-Aside of Orders (Nov 2011) (15 U.S.C. 644(r)).

_x__ (19) 52.219-14, Limitations on Subcontracting (Nov 2011) (15 U.S.C. 637(a)(14)).

___ (20) 52.219-16, Liquidated Damages—Subcontracting Plan (Jan 1999) (15 U.S.C.

637(d)(4)(F)(i)).

___ (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (Nov 2011) (15 U.S.C. 657f).

___ (22) 52.219-28, Post Award Small Business Program Rerepresentation (Jul 2013) (15 U.S.C. 632(a)(2)).

___ (23) 52.219-29, Notice of Set-Aside for Economically Disadvantaged Women-Owned Small Business (EDWOSB) Concerns (Jul 2013) (15 U.S.C. 637(m)).

___ (24) 52.219-30, Notice of Set-Aside for Women-Owned Small Business (WOSB) Concerns Eligible Under the WOSB Program (Jul 2013) (15 U.S.C. 637(m)).

_x__ (25) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

_x__ (26) 52.222-19, Child Labor—Cooperation with Authorities and Remedies (Jan 2014) (E.O. 13126).

_x__ (27) 52.222-21, Prohibition of Segregated Facilities (Feb 1999).

_x__ (28) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246).

_x__ (29) 52.222-35, Equal Opportunity for Veterans (Jul 2014) (38 U.S.C. 4212).

__x_ (30) 52.222-36, Equal Opportunity for Workers with Disabilities (Jul 2014) (29 U.S.C. 793).

_x__ (31) 52.222-37, Employment Reports on Veterans (Jul 2014) (38 U.S.C. 4212).

x___ (32) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O. 13496).

_x__ (33) (i) 52.222-50, Combating Trafficking in Persons (Mar 2015) (22 U.S.C. chapter 78 and E.O. 13627).

___ (ii) Alternate I (Mar 2015) of 52.222-50, (22 U.S.C. chapter 78 and E.O. 13627).

_x__ (34) 52.222-54, Employment Eligibility Verification (Aug 2013). (Executive Order 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.)

_x__ (35) (i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA- Designated Items (May 2008) (42 U.S.C.