T-5 Draft CDRL MASTER LIST 03.04.21.docx
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Defense Health Agency
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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.
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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 |
| P120 |
| OPEN |
| 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
| S010 |
| OPEN |
| 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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