T-5 Industry Day Questions Draft RFP 2.0-2.1 Public Release 030921.pdf

T-5 Offeror Consolidated Questions Draft RFP 2.0/2.1 All Workstreams as of 9 March 2021

Question # RFP/Manual Location Subsection/Citation Subject Question Additional Info/Rationale Government Response

1 C.2.11. Management C.2.11.6 Information Systems Security

Do the security requirements just apply to CUI as per contract or apply to both nonpublic DoD information and CUI as per TSM?

C.2.11.6.1 language states "where DoD controlled unclassified information associated with the performance of this contract is processed, stored, or transmitted. " However, the TSM manual 2.0 Cybersecurity Compliance Programs section states "...Contractors operating their covered information systems to store, process, or transmit unclassified nonpublic DoD information or covered defense information shall implement the National Institute of Standards and Technology Special Publication (NIST SP) 800-171."

Both. FAR Clause 52.204-21 requires basic safeguarding of federal contract information (FCI), which is unclassified nonpublic DoD information, on covered contractor information systems. The 15 controls identified in FAR clause 52.204-21 can be mapped to 17 NIST SP 800-171 controls. DoD CUI requires full implementation of the 110 NIST SP 800-171 controls in accordance with DFARS clause 252.204-7012.

2 C.2.11. Management C.2.11.6.1. Information Systems Security

The draft RFP refers to the Contractor providing a security systems plan that satisfies DFARS 252.204-7012: Safeguarding Covered Defense Information and Cyber Incident Reporting. Does the government consider retired military and military family PHI as CUI?

Yes. PHI or "health information" is a category identified in the DoD CUI Registry.

3 C.2.11. Management C.2.11.6.1. Information Systems Security

The draft RFP refers to the Contractor providing a security systems plan that satisfies DFARS 252.204-7012: Safeguarding Covered Defense Information and Cyber Incident Reporting. Will the government share which data elements from the Contract Data Requirements List, DD Form 1423 are considered CUI and which data elements are not for the Competitive demonstration?

CUI requirements for the Competitive Demonstrations are not anticipated to be any different than for the T-5 Managed Care Support Contract. Further details for the Competitive Demonstration will be available as part of a separate procurement process in the future.

4 C.2.11. Management C.2.11.6.2 Information Systems Security

Please provide a definition of Contractor’s first-tier subcontractor(s). The first-tier sub-contractor is not a term defined in the TOM appendix. See TOM, Appendix A - Subcontractors.

5 H.4. Performance Incentives

H.4.3 Customer Satisfaction Incentive

Section H.4.3. Identifies five categories of stakeholders for the purpose of Customer Satisfaction Incentives: beneficiaries, providers, MTF Leadership, DHA customers, and Market Directors. Current sub-Contracted ACOs/Health Plans participating in existing demonstrations are not included as a stakeholder to assess customer satisfaction. DHA risks misunderstanding ACO/Health Plans specific needs and requirements when they rely on MCSC to advocate and translate on their behalf. We recommend Customer Satisfaction Incentives for Competitive Demonstration include ACO/Health Plans as a sixth stakeholder category.

Competitive Demo ACOs/Health Plans are likely industry leading and mature organization with established and refined processes that are closely tied with safe, high-quality outcomes. Participation in TRICARE Programs inevitably requires adjustments to these established procedures and workflows. To ensure long-term relationships with industry leading partners, it is imperative that DHA understand the impact of TRICARE specific procedural changes on ACO/HP performance, costs, and quality as they directly contribute to long-term viability and ACO retention.

For the purpose of the Customer Satisfaction incentive, an ACO would be considered a provider.

6 H.17. Competitive Demonstrations

H.17 Competitive Demonstrations

The draft RFP states that the "Contractor’s network shall include ACOs and other organizations that have demonstrated high-quality outcomes, lower cost, and reduction of waste." We recommend the government consider only including ACOs that have achieved 4 or 5-star ratings from the CMS Five-Star Quality Rating System in the Competitive Demonstration.

Organizations reporting a 4, 4.5, or 5 star CMS score are most likely to achieve DHA's Quadruple Aim. The CMS Five-Star Rating System rates several individual categories that represent a plan's overall performance.

These categories include:

* Staying healthy: screenings, tests, vaccines

* Managing chronic (long-term) conditions

* Plan responsiveness and care

* Member complaints, problems getting services

* Health plan customer service

Thank you for the recommendation. The Government will take that under advisement. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

7 H.17. Competitive Demonstrations

H.17.1 Competitive Demonstrations

Can the government share a roadmap, phases, or major milestones with dates that must be completed before a contract for the Competitive demonstration can be awarded? We recommend an ACO industry day be conducted in the first half of 2021.

We would like to understand the steps in the process to ensure we can prepare the organization to rapidly respond. Additional clarification and detail will allow organizations to develop plans and secure the appropriate resources needed to participate in the Competitive demonstration.

Thank you for the feedback. Further information regarding the Competitive Demonstrations, including the procurement process and steps, is forthcoming as part of an independent contract acquisition process.

8 H.17. Competitive Demonstrations

H.17.1 Competitive Demonstrations

How will interested ACOs know how to submit a proposal for a Competitive Demonstration? In the previous RFP government response to industry questions, the government communicated that a formal/organized approach to the contracting process will be undertaken following the standard government procurement procedures, which will likely include Industry Days for Demonstrations. Can you clarify the steps involved in the normal procurement process?

Additional clarification and detail will allow organizations to develop plans and secure the appropriate resources needed to participate in the Competitive demonstration.

The Government will conduct market research, review existing contracts, write requirements, and conduct formal solicitation activities as part of the normal procurement process prior to award.

9 H.17. Competitive Demonstrations

H.17.1 Competitive Demonstrations

We recommend the government include language in the final T-5 RFP that clearly defines the dynamic between Competitive Demonstration participants (ACOs/Health Plans) and MTFs/Markets as complementary, both of which prioritize direct care optimization and readiness requirements. Healthy competition resides exclusively among ACO/Health Plans (i.e. MCSC and Competitive Demonstration ACOs/Health Plans).

Fostering strategic partnerships between two complementary health systems, such as MTFs and private health plans, enable market integration between direct and purchased care, delivering a Readiness Focused Partnership. This would prioritize direct care capability and capacity through local joint operating agreements and ensure high value cases are redirected to MTFs as a standard business practice, resources are bidirectionally integrated in accordance with demand, and KSA and surgical opportunities for military providers are enhanced.

Section H.17 is included simply to make the offerors aware of the Government's intent to conduct these Competitive Demonstrations during the course of the T-5 contract period. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

10 H.17. Competitive Demonstrations

H.17.3 Competitive Demonstrations

We recommend that the government consider a simultaneous rollout of the Beneficiary Choice and Competitive Demonstrations.

Beginning the Competitive Demonstration at the same time as the Beneficiary Choice Demonstration creates less beneficiary confusion, gives the beneficiary more choice, and does not disadvantage the plans who participate in the Competitive Demonstration. By ensuring that the Competitive Demonstration begins at the SHCD, all participating organizations will be on equal terms.

The Government no longer intends to conduct the Beneficiary Choice Demonstration. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

11 H.17. Competitive Demonstrations

H.17.4. Competitive Demonstrations

The markets where the government will consider the Competitive Demonstrations are identified in attachment J-9. We recommend the government consider adding language that will accommodate modifications to the market list throughout the T-5 contract period.

Including final RFP language for additional market options during the T-5 contract period provides flexibility and room for growth. As the Military Health System continues to evolve, it is probable there are markets which may make sense for ACO participation that are currently not listed in Attachment J-9. Leaving the market list as “fluid” provides the government with the necessary flexibility for continuous market improvement.

Thank you for the comment. The Government will take that under advisement. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

as of 9 March 2021

12 H.17. Competitive Demonstrations

H.17.4. Competitive Demonstrations

The markets where the government will consider the Competitive Demonstrations are identified in attachment J-9. We recommend that the government includes language in the final RFP that ACOs can propose additional Markets for Competitive Demonstrations during the period of the T-5 Contract.

By including language in the final RFP that invites proposals, the government can consider additional market options during the T-5 contract cycle to further improve quality, reduce costs, and support readiness.

If the government is concerned with how the inclusion of additional markets and future increased enrollment in Demonstrations and out of MCSCs will affect the bids from MCSCs, we recommend requiring MCSCs to submit bids with sliding scale enrollment

Thank you for the comment. The Government will take that under advisement. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

13 H.17. Competitive Demonstrations

H.17.4. Competitive Demonstrations

The markets where the government will consider the competitive demonstrations are identified in attachment J-9. We recognize and support the government’s desire to optimize direct care and retain readiness currency that supports medical force readiness. In support of DHA's goals, we recommend the government consider incorporating additional Markets with a strong MTF Presence.

High-performing ACOs can support MTF optimization and medical force readiness by partnering with the Direct Care System in a way that increases MTF case complexity and volume. Strategically designed integration between two similar health systems is a transformative approach that drives better financial performance, greater system stability, improved satisfaction, and higher quality.

Thank you for the comment. The Government will take that under advisement. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

14 H.17. Competitive Demonstrations

H.17.4. Competitive Demonstrations

The markets where the government will consider the Competitive Demonstrations are identified in attachment J-9. We recommend the government consider allowing for the inclusion of contiguous counties in Markets listed on Attachment J-9.

Interested ACOs may have service areas that expand beyond the limited counties identified, and in some cases including contiguous counties would better align to “natural markets” based on patterns related to housing, commuting, and commerce. Including more beneficiaries in a market would enable the government to better demonstrate the effectiveness of value-based care options. For example, including contiguous counties near Burlington County, PA would ensure that more beneficiaries have the choice of the Geisinger

Thank you for the comment. The Government will take that under advisement. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

15 L.6. Volume II, Technical Proposal

L.6.2.4.4 Timeline In L.6.2.4.4, the requirement states that "The proposal shall include a planned compliance timeline for each of the 14 requirements."

Please clarify the timeline. Will this be shared at the time of the submission of the bid or at the time of award?

The Government intends for the offeror's (including all subcontractors handling CUI) IT system to have a basic assessment completed and posted in Supplier Performance Risk System prior to award in accordance with DFARS 252.204-7019 and 252.204-7020 for each covered information system.

16 M.7. Evaluation of Technical/Management SubFactors

M.7.2.2.1 Competitive Demonstrations

Does the MTF have ROFR capabilities for specialty care delivered within an ACO/Health Plan participating in the Competitive Demonstration? We recommend Competitive Demonstration ACO/Health Plans retain specialty care within their respective health systems, unless recapture/readiness need is identified in a market-specific MOU or Joint Operating Agreement.

Taking a market by market approach to specialty referral management will maximize MTF capacity and KSA requirements, while maintaining efficiencies inherent in integrated health system workflows that drive quality outcomes and a consistent patient experience.

Thank you for the comment. The Government will take that under advisement. Further information regarding the Competitive Demonstrations is forthcoming as part of an independent contract acquisition process.

17 TRICARE Operations Manual (TOM)

CH 1, Section 4, 4.3 Quality Control Chapter 1, Section 4, 4.3 states that the contractor shall retain copies of various files for no less than four months following submission of contract deliverables. Is electronic file storage an acceptable form of storage?

Yes, electronic file storage is an acceptable form of storage. All stored files shall have an tamper-proof date attached for version control purposes. The requirement has been updated to indicate that electronic file storage is acceptable.

18 TRICARE Operations Manual (TOM)

CH 2, Section 3, 1.3 Critical Processes (CPs) - Provider Networks

Chapter 2, Section 3, 1.3 states that the contractor shall ensure the network of providers have the capability and capacity to enroll all beneficiaries in accordance with Chapter 5, Section 1. Can the government provide more information regarding how capacity and capability are measured?

Capability and capacity will be measured based on the MCSC's Network Implementation Plan, Network Sizing model, and their prescribed calculated provider targets for primary care, specialty care, behavioral health, and hospital facilities.

19 TRICARE Operations Manual (TOM)

CH 2, Section 3, 4.2.1 Provider Network PRV Chapter 2, Section 3, 4.2.1 states that the contractor shall validate they have an adequate network. Is there a requirement to continually report network adequacy? If so, what is the frequency?

Network adequacy is reported during transitions IAW TOM C5, S2, Par.

4.2. After SHCD, Network adequacy is reported monthly via CDRLS. Yes, network adequacy is reported monthly. See Section C: C.2.1.6.1.

20 TRICARE Operations Manual (TOM)

CH 2, Section 3, 4.2.3.2 Provider Network PRV In order to ensure that we understand the requirements to validate the provider loading standards, can the government provide more detail on how the accuracy rate is measured?

Contractor is to demonstrate proof of accuracy of their loading and it will be verified via Government crosswalk with enrollment and claims testing.

21 TRICARE Operations Manual (TOM)

CH 2, Section 3, 4.2.3.2.1 Provider Network PRV Chapter 2, Section 3, 4.2.5.2.1 states that at a minimum, the required number of specialists will be loaded. Can the government provide more detail on the provider types for which this requirement applies?

This applies to all provider types as required in the Network Status Report.

22 TRICARE Operations Manual (TOM)

Ch 2, Section 9, 1.0 Medical Management Will ACOs be encouraged and allowed to use evidence-based medical management practices which may differ from the traditional TRICARE approach, but which will demonstrate the ACO’s ability to better manage the health and care for the Beneficiaries?

If ACOs will be required to follow all traditional TRICARE medical management rules and practices, DHA and the beneficiaries would not be able to realize the full benefit of the ACO’s care delivery model, and the ACOs would be forced to work within a structure which may not allow them to demonstrate the full potential of their model.

ACOs in the Competitive Demonstrations will be required to offer the full TRICARE benefit and comply with all TRICARE Manuals, but will be afforded the opportunity to utilize their own programs to fulfill the requirement. Further details will be available after the Government finishes developing the ACO demonstration project requirements.

23 TRICARE Operations Manual (TOM)

CH 5, Section 1, 2.0.2 Geographic Availability Chapter 5, Section 1, 2.0.2 states that the contractor shall establish minimum health care provider-to-beneficiary ratios. Can the government define the minimum health care provider-to-beneficiary ratios?

Contractor's network sizing model will define and provide their own provider-to beneficiary ratio in their Network Implementation Plan and Access to Care Plan.

24 TRICARE Operations Manual (TOM)

Ch 5, Section 1, 2.0.4 Predictive analytics for network plan

Will the government require specific time/distance requirements for the ACO’s network based on disease prevalence, and if so, what are the specific time/distance requirements for each specialty or care delivery mode?

We recommend ACOs must be able to demonstrate to the government that its network meets the standards for Purchased Care, with adjustments allowed for specific markets based on overall membership density and geography.

ACOs will typically operate in a specific geographic area. The access/time/distance standards should reflect that Market and not be tied solely to disease prevalence.

The time and distance requirements are the same for all specialties as listed in 32 CFR 199.17 (p)(5).

as of 9 March 2021

25 TRICARE Operations Manual (TOM)

CH 5, Section 1, 4.5 Network Requirements and Standards

Chapter 5, Section 1, 4.5 states that the contractor shall not refer beneficiaries to providers with poor outcomes. Can the government provide greater detail on how they define poor outcomes?

As stated in Section C: C.2.1.12.4.1 "The Contractor shall not steer beneficiaries to providers on the HHS exclusion list or medical facilities with a LeapFrog Safety Grade of D or F or medical facilities where national accrediting agencies have suspended or revoked accreditation within the preceding 12 months."

26 TRICARE Operations Manual (TOM)

CH 7, Section 4, 6.1.5.1 Mental Health (MH) and Substance use Disorder (SUD) Preadmission and Preauthorization

Please clarify the outreach requirement in Chapter 7, Section 4, 6.1.5.1. Is the contractor required to make three separate attempts on three separate dates or three separate attempts at three separate times, possibly in the same day?

The expectation is to make three separate attempts on three separate days and three separate times.

27 C.2.5. Population Health C.2.5.1 Pop Health The Contractor shall, to the extent permitted by law and regulation develop whole person, PH care IAW TOM Chap 7, Sec 3: The phrase "to the extent permitted by law and regulation" is an addition from RFP#1. What law and regulation is the government referring to?

Since PH is a new clinical section for T5, the Government wanted to clarify that PH care, as all other benefits, must be in compliance with 32 CFR 199.17 and 10 USC 55.

28 H. Special Contract Requirements

Section H Table APM Need additional clarity on how we should define this “Standard % of network health care payments made under alternative payment models.”

Is it % of providers who have a contract including APM or payments made under APM? Most incentive programs have a payout per provider once or twice per year. In contrast, a provider may be paid for hundreds of claims per day. Percent of payments is not a good measure of penetration for Alternative Payment Models.

Thank you for the feedback. The Government will modify the requirement in the next Draft RFP.

29 C.2.1. Provider Networks C 2.1.3.2 Telehealth Would the 10% reduction in minimum appointment access standards require Telehealth services for all provider specialties in the network, specific specialties, or a minimum percentage of overall providers?

Future RFP language will be revised. If there are no providers in a geographic area, the Government will consider the drive time standards met through telehealth for designated providers types in attachment J-7.

30 C.2.1. Provider Networks C.2.1.4.1 ATC Drive Times We need to ensure we understand exactly what is expected that we take into account when calculating beneficiary drive times. It mentions average daytime traffic and other impediments. What would be considered "other driving impediments?"

We use the Quest analytics software industry standard to calculate drive/distance. Quest applies an algorithm to determine the estimated driving distance, then based on the MPH values and zip code classes the route passes through, determines the travel time.

The Government is reviewing the use of "driving impediments". Future RFP language will be revised based on review.

31 C.2.1. Provider Networks C.2.1.13.1 Directory Can we get additional details regarding eligibility criteria that would classify a provider as having "TRICARE Provider Readiness Designation"?

"TRICARE Provider Readiness Designation" applies to TRICARE Network Providers who furnish proof (i.e. certificates) that they have completed:

(a) the military culture course; and (b) the three specific courses in evidence-based treatments. See TOM, Chapter 5, Section 1, Par. 1.

32 C.2.1. Provider Networks C.2.1.1.1 Networks Are there any providers who are ineligible for Medicare that would be eligible or desirable for TRICARE?

Can the government provide examples of non Medicare-certified providers that should be eligible to support TRICARE? Any that should not be eligible?

No, the Government relies on the MCSC to vet providers via their recruiting and credentialing process.

33 TRICARE Operations Manual (TOM)

TOM Ch 5 Network Development, 7. Urgent Care Centers (UCCs) Network Requirements and Standards

Networks What would classify an urgent care center as a "TRICARE authorized UCC?"

Could we obtain a list of these centers?

A TRICARE authorized UCC is a qualified corporate services provider under 32 CFR 199.6(f) with a location distinct from a hospital Emergency Room (ER), an office, or a clinic; and whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. The Government does not have a specific UCC listing. The TRICARE authorized UCCs are part of the MCSC Network Implementation Plan (TOM Appendix A). The Government does not maintain a UCC listing.

34 TRICARE Operations Manual (TOM)

Chap 7 Sec 2.4.5 MM What transition of care/services are we expected to provide for ADSM separating/retiring from Active Duty Service beyond information related to continued care benefits?

Assistance with care in a new location, information and resources to ensure a warm hand-off at the new location. Additional resources & contact information for care inside/outside of the TRICARE, i.e., VA, state, county or other resources.

35 H.16. Future Potential Demonstrations

H.16.1.11.9 COE The government states that the MCSC will be required to notify them of providers losing COE designation. Is there an expected timeframe?

The contractor is expected to notify the Government of providers losing their COE designation as soon as the contractor is made aware of the change in status.

36 C.2.11. Management C.2.11.10.2 Networks Regarding the use of commercially available web-based mapping software, is there a particular software expected to be used?

No, the Government will not dictate and rely on best industry practices for mapping software.

37 H.16. Future Potential Demonstrations

H.16.1.4.1. Digital What is meant by "information sharing and collaboration via synchronous and asynchronous modalities?" What types of data will be shared and in what formats? Will this requirement be met by allowing access to the same data?

It is expected that providers will be able to collaborate in real-time (i.e.

via video, audio, messaging, etc. connections (synchronous)) as well as not in real-time (i.e. by leaving messages that can be responded to at a later time (asynchronous)). The collaboration is used to facilitate consultations that will support patient care, so whatever information is necessary to effectively consult will be required to be shared. This requirement will not be met by simply allowing access to the same data.

38 TRICARE Operations Manual (TOM)

TOM Ch 7 S 5 Referral Management (RM) 1.0 Referral Management Program

Digital What types of files are expected to be viewable, uploaded or downloadable? What are expected size restrictions?

Files which include information necessary to process a referral or authorization to completion are expected to be available to the Government, these files are not limited to clinical information.

39 TRICARE Operations Manual (TOM)

TOM Ch 20 S 11 Communications and Customer Service (C&CS),

2.0 Government Staff and

Beneficiary Education

Digital When can we receive the Cascading Style Sheets (CSS) files? These will be provided after contract award.

as of 9 March 2021

40 TRICARE Operations Manual (TOM)

TOM Chapter 27 Section 1 2.2.1.:

Telehealth/Web Services/Network Providers

TOM Chapter 27 Section 1, 2.2.1 makes reference to the TSM Chapter 1, Section 1.1. as the location for specifications about the interoperability with DoD mobile applications. However, in TSM Chapter 1, Section 1.1., there is no reference to mobile applications. Please clarify where the specifications can be found for interoperability with DoD mobile applications.

The reference refers to connectivity with the Defense Enrollment Eligibility Reporting System (DEERS). DMDC will assist the contractor with DS Logon instructions for mobile applications.

41 TRICARE Operations Manual (TOM)

TOM Chap 1 Section 3 5.1.1 Urgent Auths Change made reduces time standard for processing urgent authorizations from 1 business day to 8 business hours. Do the current pre-authorization requirements apply or does the government expect this turnaround time with pre-authorizations included? Could the government please define/clarify 8 business hours, as in, is a request received near the end of a business day expected to be processed by the end of that business day?

The Government has updated this paragraph for the Draft 3 as follows:

5.1.1 The contractor shall issue determinations on at least:

• 90% of all requests for preauthorization/authorization within two business days following receipt of the request and all required information

• 100% of such requests within five business days following receipt of the request and all required information

• 100% of all Urgent authorizations, excluding those requiring peer review or factual determination, shall be processed within 24 hours.

Exclusions shall be processed within two business days.

42 OTHER Draft Award Fee Plan Award Fee The subject draft plan includes calculation methodologies for each of the four scored categories comprising the potential award fee. The description of the methodology to calculate Contractor performance for meeting the RoMF (Readiness of the Medical Force) appears to contain flawed logic. It states that the Contractor will be evaluated based on its ability to send all "Readiness-coded" workload in the network via ROFR to the MTF. The formula must consider the MTF's capacity to accept that workload.

Consider modifying the language to state that the Contractor's performance will be measured by the percentage of overall readiness-coded workload that is offered to the MTF via ROFR. Where the workload is ultimately performed will be a function of what the MTF accepts.

The T-5 Contractors are in the position to optimize the MTF's ability to accept readiness-coded workload. The contractor will have opportunity in its application for the Award Fee to explain any mitigating circumstances for not meeting goals.

43 L.8. Volume IV, Price/Cost Organization/Instructions

L.8.16 Demonstration Programs Where will the cost of these demonstrations be captured within Schedule B?

The costs will be captured in a separate CLIN established by modification incorporating each demonstration.

44 OTHER MOU with Navigator Contractor

Navigator Does the presence of a CDRL to complete an MOU with the Navigator Contractor indicate that the Select Navigator function will remain carved out of the T-5 MCSC?

Because the navigator requirement is currently carved out, the requirement exists to establish an MOU. The Government has not made a decision on the future sourcing of this contract.

45 L.3. Information L.3.2. Access to Administrative Workload Data

We respectfully request the government provide selected content from the T2017 contractors’ CDRL M090-Management Reports (see tab CDRL Data Request). We request totals separately by Region for each month in 2020 and 2019. Providing only the following list of selected counts from M090 would not reveal any information about the incumbents’ performance. The government should have ready access to this data. Providing this information will help offerors accurately calculate staffing to fine-tune pricing for the T-5 bid. We understand the volume under T-5 will be different because the Region construct is not the same as T2017.

Nevertheless, having this information as the incumbents reported it to the government will allow offerors to more accurately understand the T-5 workload. As offerors will need at least 120 days to ingest, analyze and refine their staffing models, could the government please provide the data prior to the final RFP release to allow pre-proposal staffing analytics to occur?

Administrative workload data will be provided.

46 L.3. Information L.3.2. Access to Administrative Workload Data

Would the government provide access to specific workload statistics for both regions for the past two calendar years for the following specific workloads by month:

Enrollments Disenrollments Primary Care Manager Changes 24/7 provider lookup calls All other workload data not captured in a CDRL that will have a direct impact on an offeror's staffing plan

Knowing most offerors will need time to analyze the data and incorporate it into their proposals, could the government please publish this data 120 days prior to the release of the final RFP?

The following data are not available: disenrollment by month, 24/7 provider look-up calls.

47 L.2. General Instructions L.2.6 Convincing Rationale Please provide an example or additional description of the definition of "convincing rationale."

The Government can only give an example of what is not convincing rationale. Parroting back the Government's requirement is an example of a rationale that would not meet the requirements to explain the bidder's capabilities.

48 L.2. General Instructions L.2.9.1 Electronic vs. hard copy L.2.9.1 appears to include conflicting instructions regarding electronic or hard copy submission. Please clarify.

Only electronic copies will be accepted.

49 L.3. Information L.3.2. Access to Administrative Workload Data

Please allow offerors a minimum of four (4) months between the release of the administrative workload data and the proposal submission.

The Government will consider the suggestion in its acquisition timelines.

as of 9 March 2021

50 M.7. Evaluation of Technical/Management SubFactors

M.7.2.1.2 Network evaluation criteria

Elements of an offeror's network will be scored based upon quantitative factors including ratios of providers required and provider counts. Can the government provide guidance or targets to allow offerors to optimize their proposals? An over-established network could result in administrative cost overages, and a narrow network can be viewed as a technical risk.

government guidance to help all offerors to build the optimal networks would benefit all.

An optimal proposal demonstrates, through provider counts and ratios compared to beneficiary populations, the ability to meet access to care standards for all enrolled beneficiaries.

51 M.7. Evaluation of Technical/Management SubFactors

M.7.2.1.3 Network evaluation criteria

As the incumbents will have a vast majority of their provider networks contracted and credentialed, this evaluation criteria will provide an unfair disadvantage to a new offeror. A new offeror will need to have built a TRICARE network established prior to the final RFP to mitigate any proposal risk.

The requirement will be revised to consider an offeror's network development plan as mitigation for network gap.

52 L.4. Proposal Preparation L.4.1 Grammatical errors L.4.1 includes several grammatical errors and repeated phrases. The draft RFP was published for comment with the understanding it was not a final version. DHA put a priority on putting the major requirements out for comment over minor and clerical errors.

53 L.6. Volume II, Technical Proposal

L.6.1 Written Technical Proposal Submission

Given the technical proposal submission requires a narrative for only a small subset of the overall contract requirements, and understanding that the government typically has each subfactor evaluated by a different team, we recommend the government require offerors to submit a Contract Overview description. This section should be limited to 15 pages and should require a description of the overall contract management organization, an overview of the technology platform to support the contract, and a listing of key systems and technologies. This document could be provided to each subfactor evaluation team and would eliminate the need for offerors to repeat information at the beginning of each subfactor. We believe this new section will greatly streamline the proposal responses and help offerors avoid the temptation of repeating the same information over and over.

The Government finds value when each section of the proposal is self-contained, even if some information is repeated. This ensures evaluators have access to the proposal information that pertains to each evaluation factor. The page count is reflective of the repetition required. An overall approach may be shared through Overview Presentations at L 6.3.

54 L.6. Volume II, Technical Proposal

L.6.2.2.2 Medical Management To enhance the clarity of proposal instructions, please define "integrated medical management programs" as used in this paragraph. Of note, there is a stand-alone medical management section at C.2.3 and then additional performance requirements at the same outline level that may, or may not, be considered medical management (for example C.2.4 Case Management, C.2.5 Population Health, C.2.6 Utilization Management, and C.2.8 Clinical Quality Management. Some offerors may consider C.2.4, C.2.5, C.2.6, and C.2.8 (and potentially other requirements) as part of an integrated medical management program. Other offerors may consider those stand-alone.

Later sections within L.6.2.2 ask for separate descriptions on UM and CM.

To enhance offerors' understanding of what the government would like described in each section, please clarify the instructions and eliminate any ambiguity.

Medical Management (as described in Appendix A) of the TRICARE Operations Manual is "an integrated managed care model that includes Utilization Management (UM), Referral Management (RM), Case Management (CM), Behavioral Health (BH), and Population Health (PH) programs to manage patient care and the clinical and social needs of eligible beneficiaries." Each component of the MM program has requirements in and of themselves, hence the integration into a full program.

55 L.6. Volume II, Technical Proposal

L.6.2.2.2 MTF MM Please provide a list of the medical management services at each MTF so offerors are able to accurately and adequately describe how their medical management programs "will complement the medical management services available at the MTFs."

Please reference DHA-PI 6025.20, published August 27, 2019 regarding standardization of the Medical Management Program within the Military Health System. Offerors are able to propose approaches to close gaps between direct and private section care.

56 L.6. Volume II, Technical Proposal

L.6.2.3.2 First time appointments If the government is unable to provide actual information, please provide a plug number to enable offerors to develop their approach and cost based on the same set of assumptions.

This is a new TRICARE requirement and data are not available. Offerors should use appointment center information from similar requirements in commercial and Government contracts.

as of 9 March 2021

57 L.6. Volume II, Technical Proposal

L.6.2.3.2 (c) Episode of Care Please provide a reference to the PWS requirements that detail an "episode of care."

As described in Appendix A:

Episode of Care -Referrals are normally processed as “Episodes of Care.”

An EOC is defined as “A treatment period that begins with the initial assessment, follow up interventions and reassessments necessary to provide reasonable medical services related to a specific condition.” The episode includes associated lab, radiology, Durable Medical Equipment (DME), and ancillary therapies (Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST)), all of which is care that may be recaptured by the direct care system to maintain readiness. An episode of care generally involves evaluation and/or treatment of one disease or condition and may allow for specialist to specialist (secondary) referrals.

Episodes are generally categorized as ”evaluate (only)” or “evaluate and treat.”

59 L.6. Volume II, Technical Proposal

L.6.2.3.5 Key personnel Please clarify and provide additional detail on what the government expects for the instruction to "describe how it will ensure it has the key personnel with this knowledge and experience." Does the government want a description of the personnel recruiting and evaluation process, a qualitative measure of how many years an offeror believes is required to have "this knowledge and experience," or some other description of the process and approach? Given the government does not wish to receive resumes, it seems ineffective to ask offerors to describe their recruiting approach to meet the true meaning of this requirement.

Presumably the Contractor is responsible for ensuring it has the right staff deployed to the contract but describing the process of recruiting or salary ranges or years of experience would have little true meaning given the underlying need to have the right people with the right experience in the right roles. We recommend the government not attempt to compare the recruiting, hiring and salary ranges to determine if an offeror will have the right staff. We see no benefit in including this as part of the proposal given the companies with the other requisite qualifications to submit a proposal for this contract would have very similar processes that would lead to a similar result.

A qualitative measure of the knowledge, skills, abilities and experience for each position would meet the requirement without submitting a resume. Note: The Government does not require the submission of resumes because personnel may not be available at award.

60 L.7. Volume III, Past Performance Information

L.7.7 Past Performance Questionnaires

Please confirm that the government would like a past performance questionnaire (PPQ) completed for each contract identified in L.7.4. In the instance of an offeror choosing to group like contracts, the government could receive a significant number of PPQs for each reference. For example, some large health plans might have Medicaid operations in 20 states so the government would then receive 20 PPQs. Please confirm that if an offeror groups like contracts for the purpose of the L.7.4 narrative, they are required to submit a PPQ for every like contract contained in the group.

Not adding this requirement could result in some offerors choosing only the most advantageous PPQs for submission.

The Government will clarify L 7.7.

61 L.7. Volume III, Past Performance Information

L.7.7 Past Performance Questionnaires

Please describe how the government plans to reconcile multiple PPQs received in a group. Will the scoring from each PPQ be aggregated and averaged? Will the evaluation of each PPQ be subjective? How will the offeror identify potentially different detailed requirements that may have an impact on the PPQ evaluation. For example, if one Medicaid contract required the implementation of a completely new system and that implementation didn't go well should that score be considered of equal importance as the score for a contract that simply re-used old technology and solution?

The Government will clarify L 7.7.

62 M.2. Basis of Evaluation M.2.1.1 Regions Please state the government's rationale to award the West region contract to the best value offeror.

The T-2017 contract chose to award the East Region first due to its relative size over the West Region. The T-5 regions are now approximately equal in beneficiary population, MTF's and markets.

However, the West Region is more challenging due to its geography and therefore, the Government reserves the right to award regions in the order that is determined to be in the Government's best interests.

63 M.2. Basis of Evaluation M.2.3 and M.5.1.2 Strengths Please describe the relationship between exceeding a requirement (M.2.3) and a strength (M.5.1.2). Specifically, does a strength also have to be something that exceeds a requirement? How does "the quality of service that is likely to result" relate to a strength?

A strength would not be something that is unrelated a requirement. For example, the Government could not award a proposal strength to an offer of a benefit outside of the TRICARE statute and regulations. The test for a strength is that is must exceed a requirement and be of benefit to the Government.

64 M.5. Evaluation of Factor 1, Technical/Management Functions

M.5.1.2 Strengths Is an offeror permitted to identify what it believes are proposed strengths within the technical proposal?

An offeror may identify perceived strengths by identifying how the proposal exceeds a particular requirement to the benefit of the Government. The Government is not required to accept the offeror's determination.

65 M.6.

Technical/Management Risk Rating

M.6.1 and M.5.1.2 Strengths and Risk As currently described in the Draft RFP, the evaluation of technical risk is separate from the evaluation of a strength. It is possible that a particular feature of an offeror's proposal could be considered both a strength and a feature that is considered moderate or high risk. Please describe the relationship between strengths and the technical risk rating.

The evaluation of strengths and technical risk are separate findings pursuant to the RFP. It is possible that a proposal feature could benefit the Government to result in a strength, but also contribute to risk. The Government must evaluate both strengths and technical risk pursuant to the evaluation criteria.

as of 9 March 2021

67 M.7. Evaluation of Technical/Management SubFactors

M.7 Technical Evaluation The technical evaluation criteria essentially restate the proposal instructions without any quantitative or qualitative thresholds for what the government considers more or less advantageous. These instructions result in an entirely subjective evaluation. Please include objective, measurable evaluation criteria and thresholds. For example, in M.7.2.2.3, the UM system would be evaluated for identifying at least 50% of potential occurrences of over and under utilization.

Contract performance is bound by minimum contractual requirements stated elsewhere in the contract and TRICARE Manuals. Section L & M do not repeat these requirements.

68 M.7. Evaluation of Technical/Management SubFactors

M.7.2.1.2 Network Evaluation Given the government will evaluate "whether a network is accurately sized based on both population and previous utilization in the markets" non-incumbent offerors will require a minimum of six months between the receipt of the detailed data from the data tapes until proposal submission.

Could the government provide offerors with the data tapes at least six months before the proposal is due? Non-incumbent offerors will be at a significant competitive disadvantage without adequate time to analyze the data and develop adequate network sizing models based on the criteria contained in M.7.2.1.2.

Data identified in Section L will be shipped via hard drive. Additional administrative data will be posted prior to the next draft.

69 L.6. Volume II, Technical Proposal

L.6.2.1.3 Attachment L-X Please confirm that attachment L-X is required only for the sample markets identified in L.6.2.1.3 and not the entire network across the region.

Yes attachment L-X is required only for the sample markets.

70 M.7. Evaluation of Technical/Management SubFactors

M.7.2.1.3 Network Build We have significant concerns with the evaluation criteria as presented in M.7.2.1.3. While we appreciate the real impact of a provider network not being ready for the start of healthcare delivery (SHCD), we believe the evaluation criteria as presented herein is ambiguous and unfairly advantages the incumbent contractors. To solve these issues we recommend the government clarify several key components of a network build as follows:

• What does the government consider a “new network build?” The reality of the T-5 requirements means that even current contractors will have to amend their existing agreements with the provider network delivering services to TRICARE beneficiaries today. Therefore, one could argue that no company has an “existing network” that meets T-5 requirements. To ensure adequate competition and an equal playing field, we recommend that the government:

o Identify an “existing network” as any provider under a current agreement (for all lines of business, for example Medicaid) that would have to be amended to include the requirements of T-5.

o Clarify that there is no evaluative benefit to having a network that delivers services to TRICARE beneficiaries today, since all awarded contractors will need to complete paperwork with any network to include T- 5 requirements.

o Require offerors to identify the percentage of their current network under bilateral contracts versus unilateral contracts.

o Please confirm that the incoming contractor will receive detailed information on the outgoing contractors’ networks (in an electronic, ingestible format) within 15 days of contract award to facilitate additional network development efforts for continuity of care.

Thank you for your suggestions. The Government will consider incorporating the first three and check on the timeline for the 4th.

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

M.8.3.1 Relevancy Please confirm that relevancy extends only to the scope of work the provided reference performs directly. We can anticipate a scenario whereby either the current East or West TRICARE contractor makes a decision to replace their current claims processing subcontractor for a different solution and chooses to process TRICARE claims with an in-house solution for T-5 (in other words, a different solution that is being deployed in T-2017 today). In that scenario, please confirm that the reference for the existing T-2017 contract would not include Very Relevant for the claims processing portion of that scope. Therefore, would the overall contract reference be considered Somewhat Relevant? If this scenario is true, from an evaluation perspective the only way to ensure a Very Relevant rating is to continue the exact same operational construct as delivered in the contract reference. This evaluative reality as Past Performance is currently written seems to conflict with the government's stated desire to modernize the TRICARE program. We are concerned that the evaluation criteria, as written, will result in much the same program as it operating today.

Relevancy is related to the scope, magnitude and complexity of the overall T-5 effort. The RFP does not call for giving relevancy ratings for each aspect of the past performance.

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

M.8.4.2 Small Business Utilization In the assessing quality of performance and the government's consideration of the offeror's past performance in compliance with the cited small business requirements, is that assessment done at the total aggregate across all references, the group level, or the individual contract level?

Please clarify.

They are evaluated at the individual level.

as of 9 March 2021

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

M.8.3.1 Relevancy Please clarify the difference between scope and complexity. Presumably, if a contract reference "involved essentially the same scope" it would also involve…