ASPE_Revised_SOW.doc

SAQMMA14R0438 A001 – Assessment of ASPE Program

STATEMENT OF WORK

GENERAL DESCRIPTION OF SERVICES:

The Department of State (DOS) requires a vendor with health insurance expertise to assess and review the existing Accident and Sickness Program for Exchanges (ASPE) program as well as other market alternatives and advise the Bureau of Educational and Cultural Affairs (ECA) on multiple options for cost-effective healthcare insurance coverage that meets the unique needs of the DOS exchange participant population. ECA will use this information to inform a later determination on how to structure the provision of future health benefits for its exchange participants. The primary activity and final product resulting from this Statement of Work will be a detailed written assessment, as outlined below, with options and recommendations to ECA Bureau management. There will be involvement from ECA personnel including the Assistant Secretary, Principal Deputy Assistant Secretary, Deputy Assistant Secretaries, Managing Directors, Office Directors, the Executive Office, the Contracting Officer Representative, and ECA program officers. The vendor will be allowed to have scheduled interviews with the ECA personnel to gain a full understanding of program requirements in order to perform analyses and develop at least three healthcare options that will meet ECA’s needs.

ASPE is a self-funded, limited, health care benefit plan designed to pay covered medical expenses for eligible Exchange Participants. An experienced Third Party Administrator provides qualified health services, administrative oversight, clinical and financial support and advice. Covered medical expenses are subject to limitations, and pre-existing conditions are not covered. There is no coverage for vision and dental services, except in limited cases related to a covered injury or emergency care. The ASPE benefit plan provides a U.S.-paid prescription drug program to be used in combination with health benefits. Exclusions apply to both inside and outside U.S. pharmacy programs as referenced in the ASPE guidebook. For the latest information on coverage and exclusions, see the ASPE Guidebook at www.usdos.sevencorners.com.

Please note that ASPE Coverage is provided for exchange program participants only. No dependents of exchange participants are covered under ASPE, however; we do provide participants with information on how to purchase commericial insurannce for their dependents.

The vendor is expected to conduct an assessment of the current ASPE program and other market alternatives, and provide documentation and other deliverables, including a final set of analyses or suggestions on insurance options, along with estimated costs for each. The vendor will also develop a proposed transition and implementaion plan based on the recommended healthcare and insurance options. The vendor will only be required to produce sample orientation and training materials that directly relate to the options they present the Government. This will help the Government to have the information needed to consider all healthcare options provided by the vendor and to determine how to structure future healthcare coverage for exchanges participants.

BACKGROUND:

The Department of State has begun a comprehensive internal review of its Accident and Sickness Program for Exchanges program for selected public diplomacy activities funded by the ECA Bureau. ECA funds and administers more than 60 different exchange and educational programs with upwards of 40,000 U.S. and foreign participants annually, including high school, undergraduate and graduate university students, and professional/faculty/teacher level individuals. Program lengths vary from two days to more than a year. Over 150 foreign host countries and more than 1,000 universities and other institutions send/host ECA exchange participants. The universe of foreign host countries can change, although most remain the same from year to year. The ASPE coverage for ECA exchange participants is currently the same across all programs and U.S. states. Additional coverage required by universities of its enrolled students varies among universities and states.

Foreign participants travel to the United States and U.S. citizens travel overseas on these programs, and all must have access to healthcare services during their exchange. The ECA Executive Office has identified a need for a comprehensive internal review of coverage and services, and recommendation of future options, for a number of reasons, including; (a) increasing costs of healthcare claims to ECA, (b) the need to address risks posed to DOS by the current approach, and (c) the need to determine if the level of coverage offered to program participants is in compliance with recent healthcare reforms such as the Patient Protection and Affordable Care Act, as amended, the (ACA) and with requirements of the U.S. universities or other institutions that enroll and host ECA exchange participants.

Under ECA’s exchange programs, DOS currently self-insures the healthcare costs of most program participants (both U.S. citizens and foreign nationals) through ASPE, which has supported such programs for about 20 years. Under this arrangement, costs are paid directly by ECA as they occur. Repatriation of remains and medical evacuation are also provided. While ASPE was initially established to serve as a supplemental healthcare program for exchange participants, who would maintain their own primary coverage, it has become the primary source of healthcare coverage for nearly all participants.

SCOPE:

DOS, through the ECA Executive Office, requires the services of a vendor to perform a wide variety of tasks associated with the research and development of specific, detailed options with associated cost estimates for cost-effective healthcare programs for exchanges. The vendor should have research and analytical skills and experience, as well as healthcare insurance expertise to search and identify available coverage options, one of which may include self-insurance that may be more cost-effective than the current coverage, that are consistent with the insurance provisions in the Exchange Visitor Program (J-visa) regulations (22 CFR 62.14), and that meet the objectives of the exchange. In addition, the vendor must bring to bear knowledge and understanding of U.S. healthcare reforms, which include the ACA, and their relevance and applicability to foreign nationals who participate in U.S. educational exchange programs and are hosted by U.S. universities or other institutions that may have specific requirements in this area, and to U.S. citizens participating in foreign exchange programs for varying lengths of time.

REQUIREMENTS:

a. Knowledge and expertise regarding:

i. Commercial carriers that provide health insurance for United States citizens and foreign nationals participating in U.S. Government exchange programs.

ii. Commercial carriers that provide accident, sickness, medical evacuation and repatriation of remains’ coverage for U.S. citizens and foreign nationals participating in U.S. Government exchange programs for short-term programs (less than three months in duration) and long-term programs (three months or more in duration).

b. Expertise and skills to research, analyze, and devise multiple options for a workable and cost-effective healthcare plan for the U.S. and foreign nationals participating in ECA exchange programs and/or their dependents.

c. Knowledge and experience with short-term and long-term commercial healthcare insurance programs, and the ability to assess and provide options that could be customized for healthcare packages for U.S. citizens and foreign nationals that are compliant with the U.S. laws and regulations, including the ACA and, the DOS Exchange Visitor Program regulations, and any applicable individual university policies.

d. Ability to analyze healthcare options in terms of coverage, compliance with U.S. healthcare laws, and federal/DOS policies and cost estimates.

e. Ability to review and evaluate the existing ASPE program based on files, interviews with ECA personnel and any other relevant sources to gain a full understanding of program requirements in order to develop at least three healthcare options to meet ECA’s needs.

f. Capability of developing three or more options for insurance/healthcare coverage that comply with ACA and other requirements and meet the needs of ECA-funded exchange participants.

g. Capability of providing guidance and technical advice to ECA Program Offices and Program Managers in relation to healthcare programs, the ACA, and the requirements of U.S. host institutions that receive exchange participants.

h. For options that would require a different healthcare program, provide an assessment and detailed recommendations on the specific operational processes and requirements for exiting the current ASPE program and transitioning to a new program while maintaining healthcare for current and future exchange participants.

KICK OFF MEETING:

The DOS Contracting Officer’s Representative (COR) shall schedule a kick-off meeting within five (5) calendar days of the contract award. Attendees shall include the DOS Contracting Officer, the vendor’s key personnel, the COR, ECA leadership, and selected Executive Office counterparts. The Contracting Officer/COR shall provide an agenda for the meeting. The vendor will be provided a draft copy of its intended schedule and plan to meet the requirements/deliverables as identified in this Statement of Work. Any changes or adjustments to this schedule will be coordinated with the COR.

DELIVERABLES:

All reports shall be submitted in MS Office (i.e., Word, Excel, and PowerPoint) and will be subject to revision in accordance with the designated COR’s instructions. The vendor should note that all reports and briefings should include:

· All project-related materials used to manage the project such as DOS-issued documents, interview notes, reference materials, etc.

· All sources of information collected during the project, including but not limited to healthcare analysis, industry reports, resource materials, data used for estimated costs of options, and relevant healthcare and insurance laws and regulations for this project, which are to be catalogued and turned over to DOS with the final report documents.

A. Project Outline

The project outline will detail the progression of the assessment and options with projected dates for completion of key milestones. It will also list and define each milestone to give ECA management a picture of the expected progress for each Monthly Status/Progress Report. The draft project outline will be submitted to the COR one day prior to the kick-off meeting. During the kick-off meeting the outline will be discussed and any required changes will be noted by the vendor. The revised project outline will then be submitted to the COR the following business day.

B. Weekly Activity Reports and Briefings

The vendor shall provide informal weekly activity reports to the COR by COB Monday of the following week or the next business day. At the COR’s request, a weekly status meeting may be held (COR will notify the vendor at least one (1) day prior).

C. Bi-weekly Activity Briefings

The vendor shall provide informal bi-weekly activity briefings to the COR by COB every other Monday or the next business day. At the COR’s or Contracting Officer’s (COs) request, a bi-weekly status meeting may be held. The bi-weekly activities briefing should include:

· PowerPoint presentations or a written document that summarize the briefing to include multiple audiences: ECA Senior Bureau Management, EX Senior Management, and other stakeholders. The vendor should be prepared to provide comprehensive responses to address questions from the Bureau’s senior management team, EX office and other briefing attendees.

· Oral presentations to the audiences noted above. The presentations will be based on the PowerPoint presentations or a written document created for this assessment.

D. Monthly Status/Progress Reports

The vendor shall provide a monthly status report to the COR, EX Director and Deputy Director regarding activities of the previous month, by the 10th of the following month At the CO’s or COR’s request, a monthly status meeting may be held. The monthly report shall include:

· Findings and recommendations about the current ASPE program and its benefits and other available healthcare programs able to meet the Bureau’s needs;

· Information regarding commercial carriers for health care coverage for participants that are in the United States for semester or longer programs and for those participants not eligible for coverage under a university or other host institution policy.

· Hours and dollar amount to be invoiced for employee(s).

· Summary of activity by employee(s) and any issues to be addressed.

· Offer analyses, options and recommendations that will help guide the Bureau in moving forward with its healthcare program for exchanges.

· Invoices will not be paid until the Monthly Status/Progress Report has been received by all required parties, or a meeting has been held if called, whichever comes later.

E. Ad Hoc Meetings The vendor shall meet as necessary with government representatives to discuss progress and problems. These meetings shall allow any problems to be identified and resolved quickly. The vendor shall document the problems and the solutions.

F. Quality Assurance Plan

The vendor shall deliver a Quality Assurance Surveillance Plan (QASP) Plan and procedures within thirty (30) calendar days after contract award. The DOS COR or CO will notify the vendor of concurrence or required modifications to the QASP within ten calendar days of receipt. The vendor shall make the appropriate modifications within five calendar days of the DOS COR’s notification and provide to the COR for final review and concurrence. The QASP will define the Vendor’s acceptable quality level and will be a tool to gauge vendor performance of tasks. The QASP will be provided as an attachment to the monthly status/progress reports.

G. Final Report

The vendor shall deliver the Final Report no later than fifteen (15) calendar days prior to the end of the period of performance. The DOS COR will notify the vendor of concurrence or required modifications to the Final Report within five (5) calendar days of receipt. The vendor shall make the appropriate modifications within five (5) calendar days of the DOS COR’s notification and provide them to the COR for final review and concurrence. The Final Report will comprehensively define the Vendor’s research, assessment and findings in identifying available coverage options that are cost-effective, consistent with J-visa regulations in 22 CFR 62.14, ACA and other requirements, and meet the unique needs of ECA’s exchange participant populations. The Final Report will include an assessment of the cost of offering ACA-compliant coverage versus other levels of commercially-available coverage and/or ECA self-insurance. The vendor will (1) issue a final set of analyses and options for healthcare/insurance coverage(s) for ECA-funded participants beyond Fiscal Year 2014 (2) create a specific, detailed transition plan for exiting the current ASPE program while maintaining healthcare for current and future exchanges, and (3) develop an implementation plan for DOS on healthcare/insurance coverage option the bureau can pursue beyond Fiscal Year 2014 for exchange participants. Key areas that should be addressed in the Final Report are the following:

(1) Commercial carriers that will provide accident, sickness and medical evacuation coverage (in addition to ACA-compliant health insurance) for all participants inbound to the United States for a program of less than three months in duration.

(2) A master policy for medical evacuations, repatriation of remains, and gap coverage, (during travel and other approved activities, for example, activities that are not on a foreign exchange participant’s primary U.S. host campus, such as short term pre-program training on a different U.S. campus) for all inbound (foreign) and outbound (U.S. citizen) participants during their programs.

(3) An assessment of coverage provided by universities or other host institutions to determine whether supplementary medical evacuations and repatriation of remains coverage is needed in all or most cases, where gaps in coverage may exist (during travel to/from the host university, orientation and enrichment program attendance, summers, school breaks, etc.), and where/if ACA requirements may change based on the length of stay/study in the United States.

(4) Commercial carriers for health care coverage for participants that are in the United States for semester or longer programs and for those participants not eligible for coverage under a university or other host institution policy.

(5) Commercial carriers for accident, sickness and medical evacuation coverage or for ACA-compliant health care coverage for United States participants who are overseas for a period of less than three months in duration.

(6) Commercial carriers for health care coverage (including repatriation of remains and medical evacuation) for United States participants who are overseas for semester or longer programs, taking into consideration the coverage that some countries provide to all residents including foreigners, and whether this coverage is of a quality that would be acceptable for use by U.S. exchange participants.

(7) An assessment of coverage options for United States citizens on their return to the United States from an overseas exchange program, specifically in instances where a participant may be ineligible to obtain immediate coverage based on state residency requirements for ACA.

8) The final invoice will not be paid until the final report has been received by all required parties, and accepted as final.

TRAVEL

Travel may be required to offices in the Washington, D.C. and New York City areas. Travel must be pre-approved by the designated COR.