About this file
Written by GovTribe AI
· Dec 28, 2023
This document contains a draft request for proposals for the fifth-generation TRICARE Managed Care Support Contracts. The Defense Health Agency seeks to procure administrative and support services to receive healthcare from private sector providers and integrate that care with the direct healthcare system. Key details include updated clinical quality and award fee criteria to better align private and direct care metrics; a new transition-out award fee and phased referral management approach; and prioritized innovations for virtual networks, advanced primary care and care collaboration tools. Interested parties are requested to submit any comments on the revised requirements and terms using the provided response template by the stated due date. No further information is provided on response dates or contract award timing.
Other files for this federal contract opportunity
Other files attached to Draft RFP 3 TRICARE Managed Care Support (T-5) HT9402-20-R-0005, newest first.
File
Type
Posted
T-5 Draft RFP 3.0 Final Government Responses.pdf PDF
May 20, 2021
Tracked Changes Comparison From Draft RFP 2.0.-2.1 to Draft RFP3.zip ZIP file
Mar 10, 2021
T-5 Draft RFP 3 Section E 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section F 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section K 3.9.21 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft Section L - Attachments.zip ZIP file
Mar 9, 2021
T-5 Draft RFP 3 MANUALS.zip ZIP file
Mar 9, 2021
T-5 Industry Day Questions Draft RFP 2.0-2.1 Public Release 030921.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section G 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft CDRLs SEMIANNUAL.zip ZIP file
Mar 9, 2021
T-5 Draft CDRLs QUARTERLY.zip ZIP file
Mar 9, 2021
T-5 Draft CDRLs DAILY.zip ZIP file
Mar 9, 2021
T-5 Draft RFP 3 Section A 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section H 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section I 3.9.21 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section J 3.9.21 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section L 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft CDRLs ANNUAL.zip ZIP file
Mar 9, 2021
T-5 Draft RFP 3 Section B 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section C 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Section D 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft Section J - Attachments.zip ZIP file
Mar 9, 2021
T-5 Draft RFP 3 Section M 3.9.2021 FINAL.pdf PDF
Mar 9, 2021
T-5 Draft CDRLs MONTHLY.zip ZIP file
Mar 9, 2021
T-5 Draft CDRLs WEEKLY.zip ZIP file
Mar 9, 2021
T-5 Draft CDRLs AS REQUIRED.zip ZIP file
Mar 9, 2021
T-5 Draft CDRLs PLANS.zip ZIP file
Mar 9, 2021
T-5 Industry Day Questions Draft RFP 1.0 Public Release 030921.pdf PDF
Mar 9, 2021
T-5 Industry Day Questions Draft RFP 1.1 Public Release 030921.pdf PDF
Mar 9, 2021
T-5 Draft RFP 3 Response ORGANIZATION NAME.xlsx XLSX spreadsheet
Mar 9, 2021
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T5 CDRL MASTER LIST
ANNUAL
A010 Clinical Quality Management Program (CQMP) Report TOM C7 S6 P3.1, P4.3.1 & P7.0
A020 Indirect Medical Education (IDME) Ratio for Children's Hospitals Report TRM C6 S8 P3.2.7.5.3
A030 Third Party Recoveries for Fiscal Year Report TOM C10 S4 P8.0
A040 State Prevailing Annual Update Report TRM C5 S3 P3.7.5.2
A050 Service Organization Control Report (SOC1) - SSAE No. 18 (Prime with Subservice Organization) CTR G.13.1
A055 Bridge Letter in Support of Service Organization Control Report (SOC1) - Statement on Standards for Attestation Engagements, SSAE No. 18 (Prime with Subservice Organization) CTR G.13.2
A060 Service Organization Control Report (SOC1) - Statement on Standards for Attestation Engagements, SSAE No. 18 (Subservice Organization) CTR G.13.1
A065 Bridge Letter in Support of Service Organization Control Report (SOC1)-Statement on Standards for Attestation Engagements, SSAE No. 18 (Subservice Organization) CTR G.13.2
A070 Comprehensive Autism Care Demonstration (A) TOM C18 S3 P9.3.5
A080 Fetal Surgery and Procedures Toll-Free Number or Call Tree Option Report TPM C4 S18.5 P5.3
A090 Disaster Recovery Test Results Report TSM C1 S8.0 P8.3.5
A100 Risk Assessment Letter of Assurance TOM C19 S3 P2.2.2
A110 Evaluation of Population Health (PH) Care TOM C7 S3 P1.3
A120 MOU with (Nurse Advice Line Contractor Name) CTR C.2.11.9.3.1
A130 MOU with (TRICARE Claims Review Services Contractor Name) CTR C.2.11.9.3.1
A140 MOU with (TRICARE Quality Monitoring Contractor Name) CTR C.2.11.9.3.1
A150 MOU with (MCSC(s) Contractor Name) CTR C.2.11.9.3.1
A160 MOU with (TPharm Contractor Name) CTR C.2.11.9.3.1
A170 MOU with (TMEP Contractor Name) CTR C.2.11.9.3.1
A180 MOU with (TOP Contractor Name) CTR C.2.11.9.3.1
A190 MOU with (Active Duty Dental Program Contractor Name) CTR C.2.11.9.3.1
A200 MOU with (TRICARE Dental Program Contractor Name) CTR C.2.11.9.3.1
A210 Provider Credentialing and Privileging File Audit Report TOM C4 S1 P6.1
A220 Prescription Monitoring Program (PMP) Geographic Area of Responsibility Summary Status Report TOM C28 S2 P5.2.1
A230 Performance-Based Maternity Payments (P-BMP) Report TOM C18 S6 P6.5
A240 Listing of High Volume Providers Report TRM C7 S1 P3.6.1.2.1
A250 Organ Standard Acquisition Costs TRM C1 S40 P1.4.1
A260 Residential Treatment Center (RTC) List TRM C3 S2 P5.0
A270 TRICARE Select Survey Report TOM C11 S2 P3.2
A280 Alternative Payment Models (APM) Report CTR H.18 & TRM C18 S1 P4.7
A290 NIST SP 800-171 DoD Assessment Methodology TSM C1 S1.1 P3.4.4.1
PLAN
P010 Enrollment Plan TOM C2 S4 P1.1
P020 Medical Management (MM) Program Plan TOM C7 S1 P1.4
P030 Clinical Quality Management Program (CQMP) Plan TOM C7 S6 P2.1
P040 MTF/Market Optimization Support Plan TOM C2 S1 P5.2 and TOM C15 S2 P3.6
P050 Contingency Plan CTR C.2.11.4.1
P060 Education Plan TOM C11 S1 P2.0
P070 Value-Based Steerage Model/Plan CTR C.2.1.10.1
P080 Network Implementation Plan (NIP) TOM C2 S3 P1.4
P090 Continuity of Operations Plan (COOP) TSM C1 S8.0 P8.1.1
P100 Quality Management/Quality Improvement (QM/QI) Program Plan CTR C.2.11.2.5
P110 Comprehensive Program Integrity Plan TOM C13 S1 P1.1.5
P130 Beneficiary Outreach Plan TOM C11 S6 P10.5
P140 Integrated Master Plan (IMP) TOM C2 S1 P6.1
P150 Telehealth Network Implementation Plan TOM C2 S10 P7.2 and C27 S1 P2.1.1
P160 Call Center Risk Management Plan TOM C2 S5 P5.1.1.2
P170 System Security Plan and Associated Plans of Action for a Contractor’s Internal Unclassified Information System TSM C1 S1.1 P3.4.4.3
P180 Integrated Master Schedule (IMS) TOM C2 S1 P6.2
P190 Transition Out (Phase Out) Plan TOM C2 S1 P7.2
P200 Access to Care Plan TOM C5 S1 P3.2.2
P210 Systems Integration Test Plans TSM C3 S4.4 P1.2.5
SEMI-ANNUAL
S020 Access Standards Summary Report TOM C5 S1 P3.2.4
S030 Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) Report TOM C7 S6 P7.0
S040 Retrospective Review for Other Than Diagnostic Related Group (DRG) Validation Report TOM C7 S4 P13.0
S050 Population Health Outreach and Interactive Capability Report TOM C7 S3 P3.4, P3.6 & P4.2
S060 Diabetes Prevention Program Report TOM C7 S3 P5.3
S070 Clinical Quality Data Report (S) TOM C7 S6 P3.1
QUARTERLY
Q010 End-of-Process Quality Review Report TOM C1 S4 P4.2
Q020 Beneficiary Publications Use Report TOM C11 S5 P10.4
Q030 Clinical Quality Data Report (Q) TOM C7 S6 P3.1
Q040 Fraud and Abuse Summary and ROI Reporting TOM C13 S1 P6.2.1.1.5
Q050 Referrals Received by Specialty Report TOM C7 S5 P8.4
Q060 Evolving Practices Report TPM C1 S2.1 P8.0
Q070 Quality Assessment Report TOM C1 S4 P4.1
Q080 Behavioral Health Network Status Report TOM C2 S3 P1.7
Q090 MTF/Market Level Contingency Exercise Participation Report CTR C.2.11.4.2
Q100 Comprehensive Autism Care Demonstration Report (Q) TOM C18 S3 P9.3.5
Q110 Mental Health Counselor Status Report TPM C11 S3.11 P2.2.4.5
Q120 Beneficiary Satisfaction Survey Report TOM C11 S2 P3.2
Q130 Predictive Analytics/Modeling Report TOM C13 S1 P1.2.10
Q140 Listing of Prime Service Areas (PSA) Zip Codes CTR C.2.1.6.1
Q150 Health System Area Assessment Report TOM C5 S1 P3.2.1
Q160 TRICARE Quality Monitoring Contract (TQMC) Findings Response Report TOM C7 S7 P4.0
Q170 Prescription Monitoring Program (PMP) Geographic Area of Responsibility Response Report TOM C28 S2 P2.8 & TOM C28 S3 P1.4
Q180 Ambulatory Retrospective Review Report TOM C7 S4 P11.3
Q190 Advanced Rehabilitation Center and Amputation Referrals TOM C7 S4 P5.4
Q200 Network Status Report - Telehealth (NSR - T) TOM C27 S1 P2.1.2
Q210 Provider Prescription Monitoring Program Report TOM C28 S3 P5.1
Q220 Behavioral Health Standardized Measures Report TOM C7 S6 P8.2
Q230 Beneficiary Publications Return Report TOM C11 S5 P10.3
Q240 Tobacco and Vaping Quit Line Staff Report TOM C7 S3 P4.3.2
Q250 Tobacco and Vaping Quit Line Report TOM C7 S3 P4.3.8
Q260 Beneficiary Outreach Report TOM C11 S6 P6.4.2
Q270 Low Back Pain Physical Therapy Demo Report TOM C18 S10 P5.6
Q280 Clinical Quality Management (CQM) Data Dashboard TOM C7 S6 P3.2.1
AS REQUIRED
R010 Beneficiary Email List Report TOM C11 S5 P10.1
R020 Serious Reportable Events (SREs) Report TOM C7 S6 P4.4 and P4.5
R030 Accreditation Reports and Documentation CTR C.2.3.4.2 and CTR C.2.8.2
R040 Service Assist Team (SAT) After Action Report TOM C11 S2 P3.2
R050 Designated Standards Maintenance Organization (DSMO) Meeting Summary Report TOM C19 S2 P7.2.4.2
R060 DHA/MTF Fraud and Abuse Referral Cover Sheet TOM C13 S4 P3.5.1.1
R070 Fraud/Abuse Patient Harm-Initial Notification Checklist TOM C13 S4 P4.1.5
R080 Audit Detail Worksheet TOM C13 S3 P4.4.1.1
R090 Program Integrity Standard Operating Procedures TOM C13 S1 P1.4.7.1
R100 MOU with Healthcare Operations Directorate (HCO) TOM C15 S1 P2.1.3 & CTR C.2.11.3.3
R110 Breach Report TOM C1 S5 P2.5.8
R120 Appeals Processing Guidelines, Desk Instructions and Reference Materials TOM C12 S1 P3.2.1 & TOM C2 S10 P4.0
R130 Purchased Care MTF Prime Enrolled Inpatient Report TOM C7 S1 P2.7
R140 Market Capability and Capacity Report TOM C7 S5 P4.6.1
R150 Declaration of Transfer and Destruction of Records TOM C2 S6 P2.8.5 & TOM C9 S5 P1.2.3
R160 SOR with (Market Name/Standalone MTF Name) TOM C15 S1 P2.2.1
R170 HA/DHA Custodial Ownership of Records TOM C2 S6 P3.9
R180 Telehealth Network Accreditation & Certification Report TOM C27 S1 P2.1.3
R190 Special Programming Ad Hoc Reports TOM C1 S4 P5.6
R200 CHCBP Ad Hoc Reports (CHCBP Contractor) TOM C26 S1 P6.3
R210 Quality Management/Quality Improvement (QM/QI) Report CTR C.2.11.2.9
R220 Provider Credentialing and Privileging File Audit Corrective Action Report TOM C4 S1 P6.4
R230 B2B Gateway Questionnaire TSM C1 S6.0 P6.1.3
R240 Clinical Quality Data Performance Improvement Strategies TOM C7 S6 P3.2
MONTHLY
M010 Value-Based Steerage Plan Performance Report CTR C.2.1.10.1
M020 Provider Directory Accuracy Report CTR C.2.1.13.5.4 - C.2.1.13.5.6
M030 Referral Accuracy Report TOM C1 S3 P5.2.2.2
M040 Resource Sharing Program (ERSA, IRSA, CSA) Report TOM C15 S2 P10.1.5.1 & TOM C15 S3 P3.2
M050 HIPAA Privacy Complaint Report TOM C19 S3 P2.1.2.1.2
M060 TRS/TYA/TRR Premium Activity Report CTR G.11.6 & TOM C22 S1 P12.1.1 & TOM C25 S1 P9.2.5
M070 Beneficiary Services Report TOM C6 S1 P11.0
M080 Un-activated Referrals TOM C7 S5 P1.10
M090 Management Report TOM C1 S3 P1.3
M100 Medical Management Programs Report TOM C7 S1 P3.0 & TOM C7 S3 P2.2
M110 Network Status Report (NSR) TOM C2 S3 P1.5
M120 Network Inadequacy Report TOM C5 S1 P3.2.4.5
M130 Non-Financially Underwritten Accounts Receivable Summary Report (Government) CTR G.9.5.1.2
M140 Non-Financially Underwritten Accounts Receivable Summary Report (Non-Government) CTR G.9.5.1.2 & TOM C13 S5
M150 Non-Financially Underwritten Bank Account Reconciliation Report CTR G.7.2.5 & TOM C10 S3
M160 Non-Financially Underwritten Bank Cleared Payment Data CTR G.4.1.2.1
M170 Financially Underwritten Bank Cleared Payment Data CTR G.4.1.2.1
M180 Non-Financially Underwritten Bank Account Statement Report CTR G.9 & G.7.2.5
M190 Overpayment Cases Against VA Facilities TOM C10 S4 P33.3
M200 Customer Support Hours Used Report TOM C11 S2 P1.2 & P2.0
M210 Access Standards Report TOM C5 S1 P6
M220 Network Adequacy/Access-Referrals to MTF and Network Report TOM C1 S3 P4.2
M230 CHCBP Adjusted Premiums Report (CHCBP Contractor) TOM C26 S1 P6.3
M240 CHCBP Enrollment Premium Report (CHCBP Contractor) TOM C26 S1 P6.3
M250 CHCBP Enrollment Report (CHCBP Contractor) TOM C26 S1 P6.3
M260 CHCBP Premiums Summary Report (CHCBP Contractor) TOM C26 S1 P6.3
M270 CHCBP Workload Report (CHCBP Contractor) TOM C26 S1 P6.3
M280 Referrals from Contractor to Market/MTF Report TOM C7 S5 P4.6.2
M290 Call Center Quality Monitoring Report TOM C2 S5 P5.1.1.1
M300 Referrals and Authorizations Transferred Between Contractors Report TOM C7 S5 P4.3.2.5
M310 Capital and Direct Medical Education Cost Report TRM C6 S8 P3.2.4.3.2.8 & CTR G.10.1.2
M320 Market/MTF/Network Directed Referrals Report TOM C7 S5 P4.4.4
M330 Clinical Quality Management (CQM) Quality Intervention Report TOM C7 S6 P4.3.1 & P5.3 & P5.5
M340 Contractor Records Accountability Report TOM C7 S7 P3.2
M350 Access to Data Training CTR C.2.11.5.6.2
M360 DHA-GL Deferred Claims Report TOM C17 S2 P3.2.1 & TSM C1 S13.0 P13.1.4
M370 Outgoing Records Transfer Report TOM C2 S6 P2.1
M380 Incoming Records Transfer Report TOM C2 S6 P3.1
M390 Preauthorizations/Authorizations and Referral Timeliness Report TOM C1 S3 P5.2.2.2
M400 Access Authorizations to Government Personnel CTR C.2.11.5.3.2
M410 Adjudicated Referral/Claims Report TOM C8 S5 P6.1.3
M420 TRICARE Prime and Select Enrollment Fees Wire Transfers Report CTR G.11.6 & TOM C6 S1 P6.1.2.5
M430 Rare Disease & Treatment Review Report TPM C1 S3.1 P2.4
M440 Ad-hoc Report Requests CTR C.2.11.5.3.5.1
M450 Load File Completion Report TOM C2 S3 P4.2.3.1
M460 Freestanding Behavioral Health Facility Report TOM C2 S3 P1.8
M470 Beneficiary Access Assistance Report TOM C5 S1 P3.2.3.5
M480 Inpatient Admissions Summary Report TOM C7 S1 P2.7
M490 Concurrent Review Report TOM C7 S4 P10.3
M500 Employee Access to DoD IS/Networks Report TSM C1 S6.3 P6.3.5
M510 Provider Moonlighting and Claims TOM C8 S2 P8.2.1.5
M520 Rejected/Returned Referrals Report TOM C7 S5 P4.4.3.1
M530 Performance Assessment Report CTR C.2.11.2.7
M540 Network Appointment Availability Report CTR C.2.1.3.1, C.2.1.6, & C.2.1.6.2
M550 Bed Availability Report CTR C.2.1.7
WEEKLY
W010 Integrated Master Plan (IMP) Status Report TOM C2 S1 P6.4 & CTR H.9.1.2
W020 Transition Out (Phase Out) Status Report TOM C2 S1 P7.4
W030 Integrated Master Schedule (IMS) Status Report TOM C2 S1 P6.5 & CTR H.9.1.2
W040 Deferred Claims Report TOM C1 S3 P6.4.2 & P6.4.3
W050 Risk and Mitigation Report TOM C2 S1 P6.6
W060 Program Integrity Cases (Work Products) TOM C2 S6 P4.3
DAILY
D010 Non-Financially Underwritten Contractor Payment/Check Issue Data CTR G.4.1.2
D020 Financially Underwritten Contractor Payment/Check Issue Data CTR G.4.1.2
D030 Prime Travel Benefit Program Attestation Report TRM C1 S30 P1.2
D040 Daily Rolling Authorizations Inventory Report TOM C2 S7 P1.5.2
D050 Daily Rolling Referral Inventory Report TOM C2 S7 P1.5.2
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Updated Mar 10, 2021 .