T-5 Industry Day Questions Draft RFP 1.0 Public Release 030921.pdf

T-5 Offeror Consolidated Questions Draft RFP 1.0 All Workstreams as of 9 March 2021

Question # RFP/Manual Location Subsection/Citation Subject Question Additional Info/Rationale FINAL GOVERNMENT RESPONSE

1 C.2.11. Management C.2.11.5. Information System/Data Repository

Will the Government articulate the requirements for EHR information transfer for ACOs including network security, network certification, linkages to MEDCOI, and RMF?

If referring to H.17 "Competitive Demonstrations", the requirements will be articulated in a separate contract.

2 H.2. Award Fee H.2.1 Award Fee The draft RFP states, "An Award Fee is available to Contractors as a performance incentive…based on meeting or exceeding the Government's requirements for Access, Readiness and Quality." Clarification is requested around the structure of the Award Fee. Specifically, what measurements will be required and what tools to collect those measurements will be available? How will these be measured and what are the standards themselves?

An award fee plan will be released with the forthcoming Draft RFP #2 or Final RFP.

3 B. Supplies or Services and Prices/Costs

X007 CSA/Resource Sharing CLIN Omission

There does not appear to be a CLIN for CSA or Resource Sharing (included in the TOM). Was this an oversight?

CLIN X007 under T2017 is missing from the draft T-5 CLINs. Clinical Support Agreement (CSA) and/or Internal Resource Sharing Agreement (IRSA) CLINs were not included in Section B of Draft RFP #1; however, since a contract modification is required to implement an individual CSA or IRSA, that contract modification will also add any necessary contract line items.

4 C.2.2. Enrollment C.2.2 Transition to EEE Does DHA intend offerors to include the cost of performing the enrollment requirements described in C.2.2. and TOM Chapter 6 through the life of the contract since the timing of transition to the future EEE contract is unknown?

The cost impact of implementing the future EEE contact could be handled separately through the change order process.

When EEE is implemented, a contract modification will be executed with an opportunity for contractors to submit a priced proposal for any related increases in administrative costs.

5 H.11. Integrated Process Teams

H.11 Integrated Process Teams

The draft RFP states that the government will develop major contract changes Integrated Process Teams (IPTs). Recommend DHA incorporate DHMSM Program contractors if the contract changes relate to integration of direct and purchased care.

DHA will add all contractors involved with DHA/TRICARE programs to IPTs as necessary.

6 J.2. Large Market MTF- West Region

Puget Sound Section Missing Locations In the West Large Market MTF Directory, it states that “AMC MAMC ANNEX” and “EBH SPECIAL FORCES-JBLM” has an address of TBD. Can you please explain? Are these plans for new MTFs or are they existing ones that are relocating?

This DMIS has the same address as Madigan Army Medical Center (MAMC).

7 C.2.10. Claims Processing

C.2.1.10 C3 "The Contractor shall develop and submit a Value-Based Steerage Model/Plan identifying how they will measure their effectiveness at achieving: (1) access to care, (2) high quality, (3) MTF optimization/readiness, and (4) lowering average per capita cost. For plan reporting requirements see DD Form 1423, Contract Data Requirements List (CDRL), located in Section J of the applicable contract."

The Value-Based Steerage Model is not identified in Section M among the evaluation of technical/management sub-factors. How does the Government want offerors to demonstrate their qualifications and competencies in meeting this requirement?

The Government is drafting evaluation criteria and seeks comment on the criteria listed on Chart 17 of the Networks briefing slides.

8 A. Solicitation/Contract Form

Section M.4 Evaluation Factor Relative Importance

IT says that factor 4 will be evaluated on an acceptable/non-acceptable basis, which I think is too soft because it is like the prime is just checking a box and not providing any real opportunities to small business. Will DHA please consider amending this section so that small businesses will have more opportunity?

This would provide incentive for large business to subcontract to small businesses.

DHA encourages the maximum amount of small business participation that is practicable. The Government will consider in the second Draft and Final RFPs.

C.

Description/Specificatio ns/Work Statement Section M.3 Evaluation Factor

There is not anything there for small business participation factor. Will DHA please put the specific small business subcontracting goals in?

DHA encourages the maximum amount of small business participation that is practicable. The Government will consider in the second Draft and Final RFPs.

10 L.4 Proposal Preparation

L.4.3 Paper Copies L.4.3 states Volumes II (Technical) and III (Past Performance) of the proposal shall be double-spaced.

Does double spacing apply to 1) tables/figures, 2) Quality Management/Quality Improvement Program Plan, 3) Integrated Master Schedule and Integrated Master Plan, and/or 4) the List of Offerred Elements Exceeding Mininum Standards/Requirements (10 Pages)? Please clarify.

No. Tables, plans, and references may be single spaced.

11 L.7 VOLUME III, PAST

PERFORMANCE

INFORMATION

L.7.3 Data Breach The Table in Section L.4.5 indicates a 25 page limit for the Narrative response (L.7.2).

Please confirm the responses to Sections L.7.3, L.7.6, L.7.7, L.7.9, L.7.10, and L.7.11 are excluded from the page limitation.

As written in the RFP, offeror responses to items L.7.3., L.7.6., L.7.7., L.7.9., L.7.10., and L.7.11. are intended to be included in the past performance volume and are therefore considered to be part of the past performance volume page limitation of 25 pages. If these items are recommended to be excluded from the page limitation, please provide supporting rationale as well as the additional pages needed to respond to the referenced elements in the past performance proposal narrative.

as of 9 March 2021

12 L.10.7 Offeror's Financial System

L.10.7.2 DCMA/DCAA Approval Status

Please confirm the required summary discription of DCMA/DCAA approval status is to be included in Volume V Financial. The table in L.4.1 currently restricts Volume 5 to L.9 requirements.

L.10.7 will be revised to be included with Volume V financial in Draft RFP #2 or the Final

RFP.

13 M.8. Evaluation of Factor 2, Past Performance

M.8.5.4 Evaluation Factors Are offerors with relevant past performance precluded from submitting past performance information from a predecessor company, parent company, or consortium member?

It appears that DHA permits this for companies with no experience but would preclude other Contractors from submitting past performance narratives of parent company's offering we may wish to include in the proposal.

Thank you for your comments. Please see section L.7 for updates.

14 L.4. Proposal Preparation

L.4.1 and L.4.3 Paper Copies of Proposal

The draft RFP includes requirements for submission of paper copies;

however, during the Acquisition/Contract Structure Industry Day Breakout Session, DHA stated that only electronic copies would be required. Will the government revise the RFP to remove the requirement for submitting paper copies of the proposal?

Yes. No paper copies will be submitted. The Government will incorporate this revision in the forthcoming Draft RFP #2 or Final RFP.

15 M.7. Evaluation of Technical/Management Sub-Factors

M.7.5, M.7.6 and M.7.7 Subfactor Evaluation Criteria

The draft RFP includes descriptions of when specified criteria will be considered met for Subfactors 1 through 4. Will the government include similar specifications for Subfactors 5, 6 and 7?

The Government is continuing to evaluate this language.

16 H.17. Competitive Demonstrations

H.17.1 H.17.2 H.17.3 H.17.4

Competitive Demonstrations and Evaluation

Section L does not contain requirements for competitive demonstrations.

Section M does not contain evaluation factors for competitive demonstration. Will the government be requiring contractors to submit a response regarding competitive demonstrations as part of this overall T-5 solicitation and be evaluated on competitive demonstrations based on the language from the agency’s August 13, 2020 report to the U.S. Senate Committee on Armed Services language which states, “From the start of T- 5, we plan to implement an innovative demonstration that will require the MCS contractors to partner with plans within each region (on a localized basis) to test the multiple contract and multiple provider network concept and to identify an optimal configuration”?

DHA’s August 13, 2020 report submitted to the U.S. Senate Committee on Armed Services states that there are going to be two types of demonstration projects, first those being performed by the MCS contractors, followed by direct contracts with DHA.

The Government intends to conduct a new evaluation for requirements in H.17, Competitive Demonstrations.

17 L.4. Proposal Preparation

L.4.5 Exclusions from Page Limits

Would a list of acronyms also be excluded from the page count? An acronyms list would be similar in concept to a Table of Contents or Table of Figures, which should qualify it as outside of the page count.

Yes. A list of acronyms will be excluded from the page count.

18 L.4. Proposal Preparation

L.4.5 Technical Volume Page Count

Would DHA consider expanding the Technical Volume page limit to 300 pages?

Given the complex nature of TRICARE, the additional 100 pages will give bidders a chance to explain more fully their proposed solutions.

The Government will consider expanding the length in the second Draft and Final RFPs.

19 L.5. Volume I, Executed Proposal

L.5.2 Categories in subcontracting plan

In section M.10.2, an Offeror can be evaluated positively for including HBCUs in its subcontracting plan. Would DHA list this in the phrase “small disadvantaged business (including ANCs and Indian tribes)” for consistency?

While most would assume that HBCUs would be expected in section L since it’s listed in the corresponding paragraph section M, we recommend listing in both for consistency.

Yes. The recommended change will be incorporated into Draft RFP #2.

20 L.6. Volume II, Technical Proposal

L.6.2.1 Network Management proposal

The Small Market example for the East is Central Oklahoma. Since that is in the West, would DHA consider changing this to an Eastern market?

While Offerors should be able to provide a visual overlay for any market, it would be more relevant for the answer to focus on the markets within the region in which the Offeror is bidding.

Yes. This will be updated to Ft Polk, LA in Draft RFP #2.

21 L.6. Volume II, Technical Proposal

L.6.2.3.1 Medical Management subfactor

Should the first word of item e) be “interoperability” instead of “inoperability?”

Yes. The correction will be incorporated into Draft RFP #2.

22 L.7 Volume III Past Performance and M.8 Evaluation of Factor 2 Past Performance

L.7.1 L.7.2 L.7.4 L.7.5 L.7.7 L.7.8 M.8.5.4 M.8.5.6

Past Performance submission and evaluation

We respectfully request that the agency alter draft RFP sections L.7.1, L.7.2, L.7.4, L.7.5, L.7.7, L.7.8, M.8.5.4, and M.8.5.6, consistent with the FAR, to permit the submission, consideration, and evaluation of past performance of an offeror’s affiliated entity or parent company, provided that the affiliated entity or parent company will have meaningful involvement in the performance of the contract. See Iyabak Constr., LLC, B-409196, 2014 CPD ¶ 62, 2014 WL 523829 (Feb. 6, 2014); Am. Auto Logistics, LP v. United States, 117 Fed. Cl. 137, 193 (2014); Femme Comp. Inc. v. United States, 83 Fed. Cl.

704, 747 (2008); IAP World Servs., Inc., B-407917.2 (July 10, 2013).

Restricting consideration of past performance information solely to that of the prime contractor and disallowing submission and evaluation of affiliate or parent company past performance will harm competition.

In addition, please note that DHA recently made such changes to the RFP for the TRICARE Medicare Eligible Program.

Thank you for your comments. Please see section L.7 for updates.

as of 9 March 2021

23 L.7. Volume III, Past Performance Information

L.7.5 Past Performance Section L.7.5 instructs the Offeror to submit its "three largest federal and/or state Government contracts….". Is the Agency seeking the three largest federal contracts and the three largest state contracts, or the three largest contracts where the other contracting party is either the federal government or a state government?

The current wording of Section L.7.5 does not clearly restrict the Offeror to a total of three contracts for itself and three contracts for each first-tier subcontractor. The "and/or" in Section L.7.5, without further clarification, is ambiguous and may lead some Offerors (and each first-tier subcontractor) to submit the three largest federal Government contracts and the three largest state Government contract, for a total of six contracts.

The Government revised the language for clarity.

24 M.7. Evaluation of Technical/Management SubFactors

L.7.1.3 Value Based steerage evaluation

The draft RFP states the following:

The Offeror’s proposal will be evaluated for the Offeror’s approach for directing beneficiaries to providers with demonstrated high quality outcomes while meeting health plan administrative standards (such as electronic claims processing, return of clear and legible consultation reports when requested, appointment availability, and secure communications with patients).

This is absent from both section C.2.1.10’s requirements for a value-based steerage model and section L.6.2.1’s requirements for what to include in the RFP response. We recommend that DHA add the italicized paragraph to section L.6.2.1 if that is their expectation.

Recommend consistency between the descriptions of L and M to reduce the chance of an Offeror misinterpreting DHA’s expectations during the procurement cycle.

Thank you for your input. Updated network requirements will be incorporated into Draft RFP #2.

25 M.9. Evaluation of Factor 3, Price/Cost

M.9.6 Reasonableness Would DHA define “reasonableness” as it’s used here? Thank you for the feedback. The Government will consider providing additional information in the forthcoming Draft RFP #2 or the Final RFP.

26 M.10. Evaluation of Factor 4, Small Business Participation

M.10.2 Small Disadvantaged Businesses

Will ANCs and American Indian owned businesses be included in the category of small disadvantaged businesses, as noted in section L.5.2? If so, we recommend DHA lists those in this paragraph.

While most would assume that ANCs and American Indian groups would be expected in section M since it’s listed in the corresponding paragraph section L, we recommend listing in both for consistency.

Yes. The recommended change will be incorporated into Draft RFP #2.

27 C.2.2. Enrollment C.2.2.1 Enrollments The draft RFP includes requirements for performing enrollment. There are no correlating requirements in Sections L or M. Will the Government consider making enrollment services an evaluated function?

Timely, accurate enrollment services are a vital foundational step in engaging beneficiaries into the program.

Thank you for the feedback. The Government will consider in the forthcoming second Draft or Final RFPs.

28 H. Special Contract Requirements

H.16 Organizational Conflict of Interest

Will the Government allow MCSCs to subcontract high value health plans that are owned and operated by the same parent company as the MCSC in the "Beneficiary Choice" demonstration?

The Government will not restrict the offeror's choice of subcontractors.

29 H. Special Contract Requirements

H.17 Organizational Conflict of Interest

Will the Government allow high value health plans that are owned and operated by the same parent company as the MCSC to contract directly with the DHA in the H.17 Competitive Demonstrations? Please provide guidance as to how the Government would like industry to mitigate potential conflicts of interest in cases where a parent company could have more than one subsidiary participating in T-5?

The Government will likely place restrictions on the competitive demonstrations to keep conflicts of interest from occurring and to ensure market competition.

30 H. Special Contract Requirements

H.17 Organizational Conflict of Interest

Will the Government allow MCSCs and ACOs/High Value Health Plans that could be offerors in the H.17 Competitive Demonstrations to bid on the Enrollment, Eligibility, and Encounter Data Processing contract? Please provide guidance as to how the Government would like industry to mitigate potential conflicts of interest in bidding on the Enrollment, Eligibility, and Encounter Data Processing to assure they remain viable offerors for the H.17 demonstrations?

The Government will likely place restrictions on the EEE competition to keep conflicts of interest from occurring and to ensure market competition.

31 L.3. Information L.3.3 Detail Level Data During the T2017 procurement, claims and other data was released by the Government which enabled competitors to estimate existing discounts from the then-current Managed Care Support Contractors (MCSCs). When and how will the detail level data sets become available? Will the information be released in a way that allows incumbent MCSCs to keep this information proprietary? If not yet available, please provide the file layouts and data dictionary for the detail level datasets.

For the T2017 RFP, DHA provided purchased care claim allowed amounts net of contractor discounts. Doing so again will allow competitors to calculate provider discount amounts and rates achieved by the incumbents.

A comprehensive data set is available under section L.3.3, with instructions to request the data.

32 L.4. Proposal Preparation

L.4.5 Page Limitations If an Acronym List is submitted with each proposal volume, will it be excluded from the Page Limits?

Yes, a list of acronyms is excluded from the page count.

33 L.6. Volume II, Technical Proposal

L.6.1 Enhancements The draft RFP allows for "elements of the offer that exceed the Government's minimum requirements including performance standards that exceed the minimum standard or additionally offered performance standards ("enhancements")." Is it the Government's intent to limit enhancements to performance standards? If not, will the Government be concerned about the potential for enhancements that create differing beneficiary experiences between the two Regions?

Enhancements shall only apply to performance standards.

34 L.6. Volume II, Technical Proposal

L.6.1.2 Cross-References The draft RFP indicates that no part of the technical proposal shall incorporate by reference portions of other volumes of the proposal. Is it acceptable to cross-reference between subfactors within the technical volume?

Yes, cross references are acceptable, but only within the same proposal volume.

as of 9 March 2021

35 L.6. Volume II, Technical Proposal

L.6.2 Technical subfactors Will an offeror's ability to execute pilots in H.16 be included in Section L? Unclear how ability to execute H.16 fits with Sections L and M. Yes, updates to H.16 will be included in the forthcoming Draft RFP #2.

36 L.6. Volume II, Technical Proposal

L.6.2.1.1 Visual Overlay The draft RFP requires a visual overlay addressing each element of the sizing model. Please clarify what elements are to be presented on the visual overlay.

The Government will change the visualization requirement to a spreadsheet detailing the service area and type of providers in the forthcoming second Draft or Final RFP.

37 L.6. Volume II, Technical Proposal

L.6.2.1.1 Visual Overlay Given the number of visual overlays requested, will the Government consider including these as an Attachment to the Technical Volume that is excluded from the page count?

Yes. A new draft attachment has been developed to specify the number of providers in each service area.

38 L.6. Volume II, Technical Proposal

L.6.2.1.1 Visualization Map The draft RFP requires a visualization map of the current networks against the network adequacy methodology across the entire region to determine a percentage of new network build required by the offeror. Is the expectation that visualization maps would be provided to show numbers of providers or members with access? Please provide additional details.

The Government will change the visualization requirement to a spreadsheet detailing the service area and type of providers.

39 L.6. Volume II, Technical Proposal

L.6.2.1.1 Visualization Map Does the Government desire separate visualization maps for various provider types (e.g., primary care, medical specialist, behavioral health providers and facilities)? Please provide additional detail.

The Government will change the visualization requirement to a spreadsheet detailing the service area and type of providers.

40 L.6. Volume II, Technical Proposal

L.6.2.1.1 Visualization Map Are the visualization maps to be included as an attachment to the Technical volume and excluded from the page count? Will the Government consider allowing these maps to be printed on 11 x 17 paper to enhance its ability to view and evaluate the information presented?

The Government will consider the suggested change, however, paper copies have now been eliminated.

41 H.5. Performance Guarantees (PGs)

H.5.7.1 - H.5.7.5 Referral Management

PG

How will referral accuracy be objectively defined? Referral Accuracy is defined at CDRL M030.

42 H.5. Performance Guarantees (PGs)

H.5.7.5 Referral Management

PG

The draft RFP states, " Independent Application of Referral Management PG: A PG assessment will be applied independently to each referral that fails to meet the minimum performance standard for timeliness or accuracy.

The standards under Section H.4.7.1 will be assessed independently, and a performance guarantee will apply to each instance when a referral fails to meet a minimum performance standard. For example, a referral that received a performance withhold because the 90% timeliness standard/2 working business days was not met, is again subject to withhold if it fails to meet the 100% timeliness standard/3 working business days or the 95% accuracy rate."

We are unable to locate H.4.7.1.

The Government has updated the PG in Section H referenced.

43 H.5. Performance Guarantees (PGs)

H.5.7.2 Accuracy Rate To confirm, is the Contractor expected to demonstrate the 95% accuracy rate for processing both 90% within 2 business days and 100% within 3 business days?

Could be interpreted as only applying to the 100% measurement. The Government has updated the PG in Section H referenced.

44 H.3. Healthcare Underwriting Incentives

H.3.2.2 Network Usage Incentive

In the Option Period Two data, the incentive for less than 75% and more than 73% is listed as $14. In section H.3.2.2.1, the narrative gives the amount as 15% in two different sentences. Should the amount in the narrative be 14%? If not, where is the 15% given as the incentive amount?

The Government will clarify this requirement in the forthcoming second Draft or Final

RFP.

45 H.16. Future Potential Demonstrations

H.16.1 Demonstrations If DHA is forced to push back the T5 procurement timeline shared in the recent Industry Day, does it envision moving forward with competitive bidding for demonstration opportunities as a prime contracting opportunity with DHA?

DHA will not release contingency plans on unknown events.

46 A. Solicitation/Contract Form

A. Solicitation/Contract Form

Procurement Timeline Can the government provide an estimated or target RFP Date? On Chart 49, the Government provided a high level acquisition schedule targeting the first quarter of CY21. The Government will refine this date in the coming months depending on feedback from stakeholders, volume of questions from industry and developmental time for responses.

47 A. Solicitation/Contract Form

A. Solicitation/Contract Form

Procurement Timeline Can the government provide an estimated procurement timeline to include any additional drafts, industry days, RFP date, review period, and award date?

To keep potential bidders informed to be prepared to present the best offer possible.

Chart 49 details these time periods. We plan to release draft RFP #2 in the 4th quarter of 2020 and the RFP in the first quarter 2021. We plan on allowing 90 days for proposal submission. Contract award is scheduled for 3rd quarter 2022 but that is largely dependent on how many proposals are received.

48 M.10. Evaluation of Factor 4, Small Business Participation

M.10.2 Subcontracting Goals Are the subcontracting goals a percentage of Total Subcontracted Value or Total Contract Value?

To clarify subcontracting goals. It is total subcontract goals. The sub types are into the rollup of the 32% of the goal.

as of 9 March 2021

49 H.4. Performance Incentives

H.4.3 Customer Satisfaction Incentive

The draft RFP states "The Government will measure the satisfaction among five categories of stakeholders (beneficiaries, providers, DHA customers and Market Directors) via independently administered surveys." Section H.4.3.1 references surveys of beneficiaries, providers and MTF Commanders and Section H.4.3.2 states the results of the MTF Commander Surveys will carry the greatest weight and the results of provider surveys will carry the least with a references to paragraph H.3.3.3. Would the government clarify the categories of stakeholders who will be measured for purposes of the customer satisfaction incentive, describe the weighting incentive calculation process and provide language for the referenced H.3.3.3 paragraph which appears to be omitted.

Thank you for identifying this issue; we will update this in the second Draft or Final RFP.

50 H.17. Competitive Demonstrations

H.17.2 Eligibility, Enrollment and Encounter Contractor

The draft RFP states "The Contractor shall interact with the Government's eligibility enrollment and encounter (EEE) Contractor and any demonstration Contractors for the purposes of enrollment and jurisdiction of claims. Would the government clarify the responsibilities of the EEE contractor related to the Managed Care Support Contractors and local / regional plans. Would the government provide additional details on the approach and timeline for implementing the EEE contract.

The EEE contract will be a separate contract. The Government will notify offerors of the plan to implement EEE.

51 C.1. General N/A Award Date What is the estimated award date? In the Industry Day slides for Draft RFP #1, the Government identified an estimated award date of Q3 CY2022.

52 C.1. General N/A Terminology What does DHA consider a Government Designated Authority (GDA)? There are frequent mentions of a GDA being involved in the TRICARE work, and it would be helpful to understand what constitutes a GDA and how they would interface with a Contractor.

The GDA table links requirements in the T-5 Contract to the Government Designated Authority responsible for the referenced paragraph.

53 H.17. Competitive Demonstrations

H.17.4 Competitive Demonstrations

Section H refers us to Annex J, which is empty. Please tell us when you plan to conduct these competitions.

There is no information related to the Competitive Demonstrations to assist potential bidders.

Reference Attachment J-9

54 H.17. Competitive Demonstrations

H.17.4 Competitive Demonstrations

Will a Prime Contractor in one Region be permitted to compete for the Competitive Demonstrations in the other Region?

There is no information related to the Competitive Demonstrations to assist potential bidders

For demonstrations, it is not contemplated that there would be a restriction.

55 H.17. Competitive Demonstrations

H.17.4 Competitive Demonstrations

Do you plan to conduct an Industry Day related to the Competitive Demonstrations prior to the solicitation?

There is no information related to the Competitive Demonstrations to assist potential bidders

Yes. DHA sees value in having industry days for the competitive demonstrations.

56 C.1. General C.1.4 Documents - order of precedence

Will DHA publish an order of precedence or ranking for contract, procurement, operations manuals or any other pertinent documents should there be a conflict or ambiguity the documents.

C.1.4.1Details order of precendence or ranking for TPM, TRM, TSM and TOM but it does not reference other contract, procurement or RFP documents. Is there a master schedule of precendence?

Contract takes precedence over the manuals. C.1.4.1 TPM, TRM, TSM, TOM. Also, reference Section I. FAR Clause 52.215-8, Order of Precedence.

57 B. Supplies or Services and Prices/Costs

CLINS X003, X003AA,

X003AB, X003AC

Pricing Section B of the draft RFP outlines four series of CLINS for PMPM pricing (CLINs X003, X003AA, X003AB, and X003AC. These CLINs were described during the industry day as being, roughly, “PMPM prices for administration of the program.” Section B says to refer to Section C, Performance Requirements, but it is not clear how this section maps to each of the four X003 series CLINs. Which specific Performance Requirements do each of these CLINs map to in Section C or other Section of the draft RFP?

Administrative costs refer to all other costs related to performance of contract except those that can be billed as healthcare costs.

59 OTHER Industry Day Slide 33

CEE & EEE Contractors Please elaborate on your thinking regarding the differences between CEE and EEE contractors?

CEE is only enrollment while EEE includes process of encounters into DHA's clinical repository.

60 OTHER Industry Day Slide 47

EEE Contractors The illustration you shared yesterday implies there could be three different Triple E contractors. Is this DHA’s intent, and if so, can you please explain your rationale?

In order to stay on schedule, each regional contract will be required to process its own eligibility, enrollment and encounter/claims data. DHA will then implement its own EEE contract to enable the competitive demonstrations.

61 OTHER Industry Day Slide 47

Beneficiary Choice Demonstration & Competitive Demonstration

What does the government see as the advantages and disadvantages of starting the Competitive Demonstration later than the Beneficiary Choice Demonstration? How do you expect timing differences to affect ACO participation?

The advantage is that the T-5 award stays on schedule; disadvantage is that DHA will have to conduct another competition to make it work.

In regards to timing, DHA seeks feedback from ACOs on participation in each demonstration.

62 OTHER Industry Day Slide 30

KSAs What are the specific Knowledge, Skills and Ability (KSA) requirements?

Where can they be found?

The contractor will be responsible for ensuring that a percentage of high value codes (CPT/ICD 10) are performed in the MTF's. The list will be available with the Award Fee criteria with the final RFP.

as of 9 March 2021

63 OTHER Industry Day Slide 27

Service Area-Hawaii The Contract Structure slide does not show Hawaii in either region. Is this an oversight?

Yes. Hawaii was identified in the West Large Market attachment - J.2.

64 OTHER Draft Feedback Quality of Feedback

We appreciate the condensed schedule under which DHA is operating for the T-5 procurement and we greatly appreciate the level of detail and the number of documents released with the first draft RFP. The complexity of the requirements presented by the current draft RFP demands a significant investment of time and resources for potential offerors (particularly non-incumbents) to truly understand the requirements presented therein. There are an extraordinary number of interdependencies which require detailed review and meetings across multi-disciplinary teams to truly quantify and rationalize the requirements to enable the quality feedback DHA desires.

Put simply, the amount of time DHA has allowed offerors to provide the desired feedback is inadequate. While offerors can, and will, continue reviewing the draft requirements, we strongly encourage DHA to allow a second round of feedback on the draft RFP on 02 October 2020.

The Government updated the beta.sam.gov posting for Draft RFP #1 and granted additional time to provide responses. Responses were due 2 OCT 2020.

65 OTHER Plenary Session CEE/EEE In the plenary session Day 1, on slide 40, it shows that a Centralized Enrollment and Eligibility (CEE) contract might be an option. However slide 47 states that planned demonstrations for beneficiary choice includes a DHA EEE contract being enacted. Is it DHA’s intent to have a separate CEE contract that proceeds a EEE contract? Or would the CEE contract be changed/evolve to eventually include encounters and claims processing to become a EEE contract? Please explain the likely options between these two very different types of standalone contracts as it could significantly affect a bidder’s response to the T-5 RFP.

DHA's intent is to contract for a EEE contract that would facilitate the competitive demonstrations.

TRICARE

Reimbursement Manual

(TRM)

Question on material presented during the Acquisition and Contract Structure breakout session

Will the government provide a reference to the comment made during the Acquisition/Contract break out session regarding a recent change by the DOL regarding the Service Contract Act applying to subcontractors?

DOL issued a final rule clarifying the scope of its authority over TRICARE providers. See:

https://www.dol.gov/agencies/ofccp/faqs/tricare.

68 C.1. General

Pilot Authority

In the slides 33-47 from the morning sesssion, It is discussed about doing innovative things as part of the RFP. What section of the RFP will address this?

If the government is serious about utilizing many of the innovative things in slides 33-47, pharmacy will have to be carved into that item. Without phamacy the clinical management is incomplete, and the cost of care will be higher

H.16 and H.17

69 C.1. General

Presciptions under the medical benefit

The government spends over $1B on pharmaceuticals through the Medical benefit annually. This can be significantly reduced by accessing the Federal Supply Schedule. Why isn't the government leveraging the Federal Supply Schedule like they do under TPharm4 and for specialty pharmaceutical under Tpharm5?

Spending for Pharmaceuticals continues to increase dramatically due to new technologies. As this is a 10 year contract, the Government should authorize the MCSC access to the Federal Supply Schedule (FSS) and allow for a replenishment model for pharmaceuticals dispensed under the Medical Benefit. At a minimum the Government should put the requirement into the RFP as a place holder for future capabilities.

DHA will consider adding the MCSCs to the agreement with the Defense Logistics Agency if a proposal submitted in response to the T-5 RFP clearly demonstrates how the process will work in the TRICARE network and the offeror is awarded a contract.

70 H.16. Future Potential Demonstrations

Day 1 Industry Forum Slide 47 The Eligibility and Enrollment vendors are identified as subcontractors to the Regional MCSCs. With regards to small business participation: in order for small businesses to support Eligibility and Enrollment functions, this model would require them to be 2nd-tiered subcontractors to the MCSCs.

Will 2nd- tiered subcontracting be allowable under this contract?

The Government has not defined parameters for subcontracting of EEE related requirements, and as such subcontracting is at the discretion of the prime contractor.

71 H.16. Future Potential Demonstrations

Day 1 Industry Forum Slide 47 Will Regional MCSC contractors be able to recognize the small business spend for 2nd-tiered subcontractors under the EEE subcontracts in order to meet their small business subcontracting goals?

No, subcontracting is tracked by the Government at the first tier of subcontracting only.

72 H.16. Future Potential Demonstrations

Day 1 Industry Forum Slide 47 Would you please consider removing the requirement that the Eligibility and Enrollment function be performed under separate subcontracts to the Regional MCSCs?

If 2nd-tiered subcontracting is not allowable under this contract, or if the Regional MCSC contractors may not recognize small business subcontracting spend from 2nd-tiered subcontracts, a significant barrier would be created for small business participation in the area of Eligibility and Enrollment support.

The Government does not direct subcontracting activities.

as of 9 March 2021

73 H.1. Contractor Financial Underwriting of Healthcare Costs

H.1.1 Underwriting The draft RFP states, "The Managed Care Support (MCS) Contractor shall underwrite the cost of civilian healthcare services (also referred to as “purchased care” which is defined as care rendered outside the Direct Care System) provided to all TRICARE-eligible beneficiaries who are enrolled in the contract region, or for non-enrollees who reside in the contract region, except for the following non-underwritten categories:"

Does the SCHP include all cost of care for ADSMs or is only as defined in what used to be TOM 17/3 as care not otherwise covered under the TRICARE benefit? In other words, are ADSMs now underwritten for care covered under the TRICARE benefit?

All SHCP is non-underwritten. All care for ADSM is non-underwritten.

74 H.1. Contractor Financial Underwriting of Healthcare Costs

H.1.2 Underwriting The draft RFP states, "In this contract, these underwritten beneficiaries may be referred to as “underwritten beneficiaries” or “non-TRICARE/Medicare dual-eligible CHAMPUS eligible beneficiaries.” In this contract, the healthcare costs the Contractor underwrites may be referred to as “healthcare cost” or “underwritten healthcare cost.”"

Please confirm good faith payments (TOM Chapter 10, Section 3, paragraph

6) should be included in the non-underwritten funds as per TOM Chapter 10, Section 3, Para 6 that states, "6.2.2 The Contractor shall not be financially responsible for making good faith payments. The Contractor’s costs will be separately reimbursed by the Government."

Confirmed.

75 H.1. Contractor Financial Underwriting of Healthcare Costs

H.1.3.1 The draft RFP states, "Beneficiaries may enroll in TRICARE Prime with a Military Treatment Facility (MTF) Primary Care Manager (PCM). Even though they may have an MTF PCM, Prime enrolled non- TRICARE/Medicare dual-eligible CHAMPUS beneficiaries’ costs outside of the MHS direct care system are underwritten by the Contractor, except for ADSMs."

Does the sentence, "Even though they may have an MTF PCM, Prime enrolled non- TRICARE/Medicare dual-eligible CHAMPUS beneficiaries’ costs outside of the MHS direct care system are underwritten by the Contractor, except for ADSMs." mean that ADSM costs are not underwritten?

Yes.

76 H.3. Healthcare Underwriting Incentives

H.3.2.1.2.5 Does the calculation include claims runout? The incentive is calculated at the time designated by the Government, using all submitted claims up to the period ending in the calculation. The Government will clarify this requirement to include a claims runout of 120 days following the end of the option period.

77 H.3. Healthcare Underwriting Incentives

H.3.2.1 Network Discount Incentive

The draft RFP states, "The purpose of this incentive is to encourage Contractors to proactively negotiate discounts with network providers and thereby reduce underwritten healthcare costs. The incentive will be calculated based on total Underwritten Healthcare Cost."

The abiltity to achieve deep discounts may be limited by the co-existance of a PPO and HMO product using the same network and by the fact that federal and commercial programs are moving in the the direction of value-based contracting with large volume preferred providers.

Thank you for your feedback.

79 C.1.2. Contract Objectives

C.1.2.3 Contract Objectives Objective 3 Manage Per Capita Cost: Create value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual healthcare activity.

Existing TRICARE Policy and operations manuals provide for the allowance of 'best business practices' to be conducted by MCSCs in the execution of providing benefit services. Without a mechanism or more prescriptive language in place, unwarranted variation and the tracking of total cost of care will be extremely difficult to enforce and identify. Recommendation:

Allow for regional contractors the flexibility to incorporate 'best business practices' in pursuit of a better beneficiary experience at a reduced cost and add a mechanism or function (independent of regional contract obligation) that would be responsible for standardization/ nuance identification as the TRICARE Select Navigator does today. With beneficiaries constantly moving from region to region, it will be critical to identify regional benefit execution differences and evaluate if they result is increased costs by region

Thank you for your feedback.

80 H.3. Healthcare Underwriting Incentives

H.3.1. Healthcare underwriting incentives

The draft RFP states that "There is no limit on the dollar amount, positive or negative, of the underwriting incentives that may be accrued for the Network Discount Incentive or the Network Usage Incentive."

Current incentive structure weighted so heavily towards network discounting does not address/ utilize quality outcome metrics Recommendation: add incentive structure that rewards outcomes based results (higher quality, reduced infection rates, etc.)

Please see H.2.3.1.2.2: "In calculating its Guaranteed Provider Discounts, the Government will not credit more than 5% discount to individual professional providers.

The purpose of this limit is to ensure that discount guarantees do not affect quality or access."

as of 9 March 2021

81 B. Supplies or Services and Prices/Costs

Extension Period Extension Period The draft RFP Sch. B for CLIN9003 states "6-MONTH OPTION PERIOD EXTENSION, IF REQUIRED" but the EXTENSION PERIOD is listed as "1 JAN 2033 - 1 JUN 2033" which is 5 months. Please clarify. Is the extension period

1 JAN 2033 - 30 JUN 2033?

Thank you for identifying; the Government will correct Section B to reflect 6 months for the Option to Extend Services.

82 B. Supplies or Services and Prices/Costs

CLINX004 Earned Performance Incentive

The draft RFP Sch. B for CLINX004 states, "Earned Performance Incentive for Section H.2 and H.3"; however, Section H.3 and H.4 are related to the Performance Incentive and Section H.2 is related to award fee. Please clarify whether this CLIN should be related to Section H.3 and H.4.

Thank you for identifying; the Government will correct Section B to the correct references for incentives.

83 G. Contract Administration Data

G.5.9.7.1 Clinical Support Agreements

There is discussion of Clinical Support Agreements but no relevant CLIN.

Please confirm a Clinical Support Agreement CLIN will be added to the final

RFP.

The Government will add a CSA CLIN via contract modification at the time of exercise of its first CSA.

84 G.2. PMPM Military Health System (MHS) Eligible Beneficiaries

G.2.2 & G.2.2.1 PMPM The determination of eligible beneficiaries is done prospectively and states that it is based on an "average of six of the seven previous months". What is the proximity of the calculation to the period for which the result will be applicable? Which month is dropped from the calculation of the average?

Are other factors considered such as expected changes in the covered population?

The months cannot be determined because the contract start date is variable. The lowest month is dropped from the average.

85 H.3. Healthcare Underwriting Incentives

H.3.2.2 Network Usage Incentive

Please confirm this calculation applies only to original claims and excludes adjusted claims.

The calculation will be made based on original claims only.

86 H.3. Healthcare Underwriting Incentives

H.3.2.2 Network Usage Incentive

Please identify if ancillary providers are excluded from this calculation. The calculation will be made based on provider claims only.

87 L.8. Volume IV, Price/Cost Organization/Instructio ns

L.8.4.1 Price Evaluation Template

The draft RFP Section L.8.4.1 states, "The solicitation includes two Price Evaluation Templates: one for the East Region (Attachment L-5e) and the other for the West Region (Attachment L-5w). The Templates are labeled either East or West Region." Please provide Attachments L-5e and L-5w.

The Government will provide templates in the forthcoming draft RFP #2.

88 L.8. Volume IV, Price/Cost Organization/Instructio ns

L.8.19.4 Risk This section states that "The Offeror shall further agree that the guaranteed network provider discount shall not be adjusted for any action by the Government, including unilateral contract changes, allowable rates, and payment methodology." Please reconsider this language as it appears to place all the risk on the Contractor for actions squarely within the Government's control.

The intent of the requirement is to ensure that offerors do not "buy in" using network discount guarantees only to change those guarantees with minor adjustments to the contract. The Government welcomes language that can reduce this risk.

89 H.12. Cost-Plus-Fixed- Fee Change Order Implementation Costs and Firm-Fixed-Price Recurring Costs

H.12 Change Order Implementation and Recurring Costs

Will the government provide additional information on requirements for this section?

The Government will provide additional details regarding the CPFF implementation of change orders in the forthcoming draft RFP #2.

90 L.8. Volume IV, Price/Cost Organization/Instructio ns

L.1, L.8.1, and M.9 Submission requirements associated with the Price/Cost volume

The following sections from the solicitation pertain to the submission requirements associated with the Price/Cost volume. Section L.1. (a) Submission of certified cost or pricing data is not required. Section L.8.1. - “Data Other than Certified Cost or Pricing Data” shall be submitted by the Offeror to support the price reasonableness of its proposal. Section M.9.6. - Reasonableness. The Government will evaluate the Offeror’s TEP for reasonableness. FAR 52.215-20, referenced in RFP Section L.1., states that the submission of certified cost or pricing data is not required. FAR 15.404- 1 states that price analysis shall be used when certified cost or pricing data are not required. Price analysis is the process of examining and evaluating a proposed price without evaluating its separate cost elements and proposed profit. RFP Section M.9.6. states that the Government will evaluate the Offeror’s TEP for reasonableness. In addition, FAR 15.402(a)(3) states that “Contracting officers shall . . .obtain the type and quantity of data necessary to establish a fair and reasonable price, but not more data than is necessary. Requesting unnecessary data can lead to increased proposal preparation costs, generally extend acquisition lead time, and consume additional contractor and Government resources.” However, RFP Section L.8. contains requirements to provide numerous schedules, templates, narratives, and other documentation regarding the individual cost element components of the offered price. Will the government consider removing these requirements since they are not needed in order to determine price reasonableness?

The language has been removed from Section L and M.

91 H.16. Future Potential Demonstrations

H.16.1 Demonstrations Last year, DHA released an opportunity to develop a Patient Navigator program. This opportunity was solicited directly by DHA opposed to the 2 current MCSC contractors. Does DHA plan to release direct opportunities similar to this one between now and the award of T5?

This question is outside the scope of the T-5 RFP.

as of 9 March 2021

92 H.16. Future Potential Demonstrations

H.16.1 Demonstrations In February of 2020, GAO released the report, “DEFENSE HEALTH CARE:

Plans Needed to Ensure Implementation of Required Elements for TRICARE’s Managed Care Support Contracts. In its findings, GAO indicated 13 elements of the original T-2017 that have been either not or partially been implemented since contract award in July, 2016. Furthermore, DODs August 2020 report to the Senate Armed Services Committee states, "DHA has taken affirmative steps to modify the T-2017 contracts and to conduct demonstrations to meet certain section 705 requirements." With that being said, can DHA share their plans to implement these elements before the expiration of T-2017?

DHA intends to execute the demonstrations as described in the RFP, and after evaluation of the results of the demonstrations, make decisions on whether or not to implement demonstrations as contract requirements.

93 OTHER Other List of Attendees Does the government intend to release the list of attendees to this virtual event?

Yes, the Government released a list of organizations attending the Industry Day on the beta.sam.gov posting.

94 OTHER DOD Report to Senate Armed Services - August

DODs August 2020 report to the Senate Armed Services Committee states on page 5, "we note that DHA cannot use its TRICARE MCS contracts as the vehicles for directly implementing changes to the TRICARE program. With that being said, what is the basis of DHA's reasoning to conduct demonstrations as part of a modification to a prime TRICARE contract where the party conducting the demonstration has a subcontracting relationship with the prime?

DHA is seeking proof of concept under the existing and/or future TRICARE Managed Care Support contracts, and will use the results of demonstrations to support the decision on whether to amend the program.

95 OTHER General Questions Submission Extension

While the draft RFP was released on August 28th, there was an extraordinary amount of detail that was released at the Industry Day. With that said, we would respectfully request additional time to examine the information released this week.

An extension was granted for two weeks, through 2 OCT 2020.

96 B. Supplies or Services and Prices/Costs

CLINs 1003 AA, AB, and AC; 2003 AA, AB, and AC, etc.

Supplies or Services and Prices/Costs

What specific activities are priced under CLINs 1003 AA, AB, and AC; 2003 AA, AB, and AC, etc.?

The languauge in…