TCRS Draft RFP -- HT940221R0002.pdf

HT940221R0002

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 138

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ______________ calendar days (60 calendar days unless a different period is inserted

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

X

HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011

1200 MS

NICHOLAS R. CECILIANI 303

NICHOLAS.R.CECILIANI.CIV@

MAIL.676-3997

X

X

X

X

X

X

X

X

X

X

X

X

X

PAGE(S)

NICHOLAS R. CECILIANI

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

2-13

C1-C48

F1-F4 G1-G5 H1-H12

I1-I13

J1

K1-K10

L1-L22

MM1-M8-M8

303-676-3997

NICHOLAS.R.CECILIANI.CIV@MAIL.MIL

D1 E1

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940221R0002

(A) (B) (C) (D) (E) (F)

Delivery Location Code: HT9402

DEFENSE HEALTH AGENCY

DEFENSE HEALTH AGENCY-AURORA

16401 E CENTRETECH PARKWAY

AURORA CO 80011-9066 USA

Base Period - Transition-in

Period of Performance: June 1, 2022 - August 31, 0001 Transition-In (Section C Paragraph 6.3.1) 1 LO

(Fixed-Price)

0002 Base Period Deliverables (DD Form 1423-1, 1 LO

Contract Data Requirements List (CDRLs), Section

F Paragraph 6.2)

(Not Separately Priced)

Option Period 1

Period of Performance: September 1, 2022 - August

31, 2023

1001 Managed Care Support Contracts (MCSCs) Quarterly EA

Compliance Reviews (Section C Paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

1002 TRICARE Medicare Eligible Program (TMEP) EA

Quarterly Compliance Reviews (Section C Paragraph

6.4)

Fixed Price Per Claim

(Option Line Item)

1003 TRICARE Oversees Program (TOP) Quarterly EA

Compliance Reviews (Section C Paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

1004 TRICARE Pharmacy Program (Tpharm) Quarterly EA

Continued ...

3 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F)

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

1005 Active Duty Dental Program (ADDP) Semiannual EA

Compliance Reviews (Section C, Paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

1006 Managed Care Support Contracts (MCSCs) Annual EA

Health Care Cost Audits (Section C paragraph 6.4)

(Option Line Item)

1007 Focus Studies (Section C paragraph 6.5.1) EA

(Option Line Item)

1008 Medical Record Reviews (Section C paragraph 6.5.2) EA

(Option Line Item)

(Not Separately Priced)

1009 Transition-Out (Section C paragraph 6.3.2.1) LO

(Option Line Item)

1010 Deliverables (DD Forms 1423-1, Contract Data LO

Requirements List (CDRLs))

(Option Line Item)

(Not Separately Priced)

Option Period 2

Period of Performance: September 01, 2023 -

August 31, 2024

2001 Managed Care Support Contracts (MCSCs) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

4 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F)

2002 TRICARE Medicare Eligible Program (TMEP) EA

Quarterly Compliance Reviews (Section C Paragraph

6.4)

Fixed Price Per Claim

(Option Line Item)

2003 TRICARE Overseas Program (TOP) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

2004 TRICARE Pharmacy Program (Tpharm) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

2005 Active Duty Dental Program (ADDP) Semiannual EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

2006 Managed Care Support Contracts (MCSCs) Annual EA

Health Care Cost Audits (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

2007 Focus Studies (Section C Paragraph 6.5.1) EA

(Option Line Item)

2008 Medical Record Reviews (Section C paragraph 6.5.2) EA

(Option Line Item)

(Not Separately Priced)

5 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F)

2009 Transition-Out (Section C paragraph 6.3.2.1) LO

(Option Line Item)

2010 Deliverables (DD Forms 1423-1, Contract Data LO

Requirements List (CDRLs))

(Option Line Item)

(Not Separately Priced)

Option Period 3

Period of Performance: September 01, 2024 -

August 31, 2025

3001 Managed Care Support Contracts (MCSCs) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

3002 TRICARE Medicare Eligible Program (TMEP) EA

Quarterly Compliance Reviews (Section C Paragraph

6.4)

Fixed Price Per Claim

(Option Line Item)

3003 TRICARE Overseas Program (TOP) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

3004 TRICARE Pharmacy Program (Tpharm) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

3005 Active Duty Dental Program (ADDP) Semiannual EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

6 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940221R0002

(A) (B) (C) (D) (E) (F)

3006 Managed Care Support Contracts (MCSCs) Annual EA

Health Care Cost Audits (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

3007 Focus Studies (Section C paragraph 6.5.1) EA

(Option Line Item)

3008 Medical Record Reviews (Section C paragraph 6.5.2) EA

(Option Line Item)

(Not Separately Priced)

3009 Transition-Out (Section C paragraph 6.3.2.1) LO

(Option Line Item)

3010 Deliverables (DD Forms 1423-1, Contract Data LO

Requirements List (CDRLs))

(Option Line Item)

(Not Separately Priced)

Option Period 4

Period of Performance: September 01, 2025 -

August 31, 2026

4001 Managed Care Support Contracts (MCSCs) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

4002 TRICARE Medicare Eligible Program (TMEP) EA

Quarterly Compliance Reviews (Section C Paragraph

6.4)

Fixed Price Per Claim

7 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940221R0002

(A) (B) (C) (D) (E) (F)

4003 TRICARE Overseas Program (TOP) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

4004 TRICARE Pharmacy Program (Tpharm) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

4005 Active Duty Dental Program (ADDP) Semiannual EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

4006 Managed Care Support Contracts (MCSCs) Annual EA

Health Care Cost Audits (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

4007 Focus Studies (Section C paragraph 6.5.1) EA

(Option Line Item)

4008 Medical Record Reviews (Section C paragraph 6.5.2) EA

(Option Line Item)

(Not Separately Priced)

4009 Transition-Out (Section C paragraph 6.3.2.1) LO

(Option Line Item)

4010 Deliverables (DD Forms 1423-1, Contract Data LO

Requirements List (CDRLs))

(Option Line Item)

8 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940221R0002

(A) (B) (C) (D) (E) (F)

Option Period 5

Period of Performance: September 01, 2026 -

August 31, 2027

5001 Managed Care Support Contracts (MCSCs) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

5002 TRICARE Medicare Eligible Program (TMEP) EA

Quarterly Compliance Reviews (Section C Paragraph

6.4)

Fixed Price Per Claim

(Option Line Item)

5003 TRICARE Overseas Program (TOP) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

5004 TRICARE Pharmacy Program (Tpharm) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

5005 Active Duty Dental Program (ADDP) Semiannual EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

5006 Managed Care Support Contracts (MCSCs) Annual EA

Health Care Cost Audits (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

5007 Focus Studies (Section C paragraph 6.5.1) EA

9 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940221R0002

(A) (B) (C) (D) (E) (F)

(Option Line Item)

5008 Medical Record Reviews (Section C paragraph 6.5.2) EA

(Option Line Item)

(Not Separately Priced)

5009 Transition-Out (Section C paragraph 6.3.2.1) LO

(Option Line Item)

5010 Deliverables (DD Forms 1423-1, Contract Data LO

Requirements List (CDRLs))

(Option Line Item)

(Not Separately Priced)

Option Period 6

Period of Performance: September 01, 2027 -

August 31, 2028

6001 Managed Care Support Contracts (MCSCs) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

6002 TRICARE Medicare Eligible Program (TMEP) EA

Quarterly Compliance Reviews (Section C Paragraph

6.4)

Fixed Price Per Claim

(Option Line Item)

6003 TRICARE Overseas Program (TOP) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

6004 TRICARE Pharmacy Program (Tpharm) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

10 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940221R0002

(A) (B) (C) (D) (E) (F)

Fixed Price Per Claim

(Option Line Item)

6005 Active Duty Dental Program (ADDP) Semiannual EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

6006 Managed Care Support Contracts (MCSCs) Annual EA

Health Care Cost Audits (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

6007 Focus Studies (Section C paragraph 6.5.1) EA

(Option Line Item)

6008 Medical Record Reviews (Section C paragraph 6.5.2) EA

(Option Line Item)

(Not Separately Priced)

6009 Transition-Out (Section C paragraph 6.3.2.1) LO

(Option Line Item)

6010 Deliverables (DD Forms 1423-1, Contract Data LO

Requirements List (CDRLs))

(Option Line Item)

(Not Separately Priced)

52.217-8, Option to Extend Services

Period of Performance: September 01, 2028 -

February 28, 2029

7001 Managed Care Support Contracts (MCSCs) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

11 12

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT940221R0002

(A) (B) (C) (D) (E) (F)

7002 TRICARE Medicare Eligible Program (TMEP) EA

Quarterly Compliance Reviews (Section C Paragraph

6.4)

Fixed Price Per Claim

(Option Line Item)

7003 TRICARE Overseas Program (TOP) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

7004 TRICARE Pharmacy Program (Tpharm) Quarterly EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

7005 Active Duty Dental Program (ADDP) Semiannual EA

Compliance Reviews (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

7006 Managed Care Support Contracts (MCSCs) Annual EA

Health Care Cost Audits (Section C paragraph 6.4)

Fixed Price Per Claim

(Option Line Item)

7007 Focus Studies (Section C paragraph 6.5.1) EA

(Option Line Item)

7008 Medical Record Reviews (Section C paragraph 6.5.2) EA

(Option Line Item)

12 12

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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(A) (B) (C) (D) (E) (F)

7009 Transition-Out (Section C paragraph 6.3.2.1) LO

(Option Line Item)

7010 Deliverables (DD Forms 1423-1, Contract Data LO

Requirements List (CDRLs))

HT940221R0002 Page 13

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

1.0 GUARANTEED CONTRACT MINIMUM AND CONTRACT MAXIMUM: The

resultant contract will be an Indefinite Delivery/Indefinite Quantity (ID/IQ) type contract with Firm Fixed Price (FFP) Task Orders.

1.1 Minimum Guarantee: The guaranteed minimum is $2,900,000.00 and will be satisfied under the first task order.

1.2 Maximum Contract Value: The value of all task orders placed under the resultant contract maybe not exceed $49,500,000.00

(End of Section)

SECTION C

DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

HT940221R0002 Page C1 of C48

Department of Defense Defense Health Agency

Performance Work Statement

TRICARE Claims Review Service (TCRS)

J-8/Deputy Assitant Director, Financial Operations (DAD-FO)

Improper Payment Evaluation Branch

Solicitation Number: HT940221R0002 Version: 1

Date: October 2021

HT940221R0002 Page C2 of C48

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide TRICARE Claims Review Services

(TCRS).

1.2 Description of services/introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform TCRS as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

1.3 Background: The Defense Health Agency (DHA) supports the delivery of integrated, affordable, and high quality health services for more than 9.6 million beneficiaries of the Military Health System (MHS) and is responsible for shared services, functions, and activities of the MHS and other common clinical and business processes in support of the Military Services.

The MHS is a complex integrated healthcare system that consists of healthcare delivery, medical education, public health, private sector partnerships and innovative medical research and development. The MHS has two major care delivery systems. The direct care system provides care through military treatment facilities (MTFs). The purchased-care system, TRICARE, is comprised of two health care options, Select and Prime. TRICARE Prime is similar to a health maintenance organization (HMO) with a Point of Service Option and requires beneficiary enrollment. All Active Duty Service Members (ADSM) are TRICARE Prime enrollees; Active Duty family members may elect to enroll in TRICARE Prime; other eligible beneficiaries pay an enrollment fee to enroll in TRICARE Prime. TRICARE Select is a fee for service type plan in which the beneficiary (non-ADSM) may choose to use a TRICARE-authorized provider without a referral or pre-authorization, in most situations. The two options of TRICARE are described fully in 32 Code of Federal Regulations (CFR) Part 199.17. TRICARE provides care through six purchased-care support contractors, including two Managed Care Support Contracts (MCSCs) (East and West Regions), TRICARE Overseas Program (TOP), TRICARE Medicare Eligible Program (TMEP), Active Duty Dental Program (ADDP) and TRICARE Pharmacy Program (TPharm) contracts. The purchased-care system has more than 400,000 network individual providers (primary care, behavioral health, and specialty care providers) and more than 3,200 TRICARE network acute care hospitals.

1.4 Objectives: The objectives of this contract are to support the missions of the MHS which enable the National Defense Strategy by providing a Medically Ready Force, a Ready Medical Force, and improving the health of all those entrusted to its care. The objectives below represent the performance outcomes for this contract and are supported by technical requirements. The acceptable performance standards are explained further in the contract.

Objective 1, Compliance Reviews. Provide independent, impartial reviews of claims to include timely and accurate evaluations of each purchased care contractor’s healthcare claims processing and payment record coding procedures.

HT940221R0002 Page C3 of C48

Objective 2, Focused Studies. Assist the IPEB in studying areas of the TRICARE health benefits program with the potential for incurring a higher than average risk of improper payments.

Objective 3, Medical Record Reviews. Validate healthcare services documented in a patient’s medical record is correctly invoiced to the Government for payment.

Objective 4, Continuity of Review Services. Maintain effective management solutions to provide the necessary claims review services, incorporating DHA and healthcare standards and best practices.

1.5 Scope: The purpose of this contract is to assist the Office of the Assistant Secretary of Defense for Health Affairs (OASD-HA), the Office of Management and Budget (OMB), and the DHA Improper Payment Evaluation Branch (IPEB), in identifying and reporting improper payments and discrepancies in payment record coding. This contract provides an independent, impartial review of claims processing procedures and reimbursement methodologies utilized by purchased-care contractors, assesses purchased-care contractor compliance with TRICARE policies and directives, and monitors the claims processing performance of DHA TRICARE purchased-care support contractors. The contractor shall evaluate the accuracy of claims payment and payment record coding for the six purchased-care contractors.

This contract also supports IPEB’s requirement to assess the potential risk of improper payments, identify, and report improper payments to the Office of Management and Budget (OMB) for publication in the Department of Defense (DoD), Agency Financial Report (AFR) pursuant to Public Law (PL) 116-117 – Payment Integrity Information Act (PIIA) of 2019.

1.6 Period of Performance (PoP): The anticipated period of performance is as follows:

Base Period 06/01/2022-08/31/2022 Option Period 1 09/01/2022-08/31/2023 Option Period 2 09/01/2023-08/31/2024 Option Period 3 09/01/2024-08/31/2025 Option Period 4 09/01/2025-08/31/2026 Option Period 5 09/01/2026-08/31/2027 Option Period 6 09/01/2027-08/31/2028

1.6.1 Transition: Transition-in/transition-out period

1.6.1.1 Transition-in period: Full performance start date is September 1, 2022. Transition-in performance is defined at PWS paragraph 5.3.1.

1.6.1.1.1 The contractor shall comply with transition-in requirements of the DHA, as listed in paragraph 1.11.1, for contractors needing to be issued Common Access Card (CAC)

HT940221R0002 Page C4 of C48 identification, including Department of Defense (DoD) and DHA-directed training and forms submission, prior to network access.

1.6.1.2 Transition-out period: The transition-out plan shall facilitate the accomplishment of a seamless transition from the incumbent to an incoming contractor/Government personnel at the expiration of the contract. See PWS paragraph 5.3.2.

1.6.1.2.1 The contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC or who generate “records”, as defined by DoD (records manual), including DoD-directed disposition of records, and others displayed on the In/Out (I/O) Processing Portal.

1.7 Administrative specifications

1.7.1 Place of performance: The work shall be performed at the contractor’s facility.

1.7.2 Recognized Federal holidays: The contractor is not required to perform services on the following holidays.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Day Christmas Day Independence Day

1.7.3 Hours of operation: The contractor is responsible for conducting business Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. The contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons.

1.7.4 Emergency Services:. Reserved.

1.8 Contractor travel: The contractor shall be required to travel within the Continental United States (CONUS) to attend meetings held by DHA. Generally, a 14 day notice will be provided for all meetings hosted by DHA, at one of its Government locations. Contractor should assume two meetings per year. All contractor travel costs associated with any of these meetings shall be the responsibility of the contractor.

1.9 Other Direct Costs (ODC): Reserved.

1.10 Quality

1.10.1 Quality Control (QC): The contractor shall develop and maintain an effective QC program to ensure services are performed in accordance with this PWS. The contractor shall

HT940221R0002 Page C5 of C48 develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services. The contractor’s QC program is the means by which the work complies with stated requirements. Please see PWS paragraph 5.2 for additional information on Quality Control.

1.10.2 Quality assurance (QA): The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan provides a systematic method for the Government to evaluate performance and to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.11 Contractor personnel

1.11.1 CAC requirements: For all contractors who will work in Government facilities, the Facilities Security Officer (FSO)/Company's Security point of contact (POC) will provide the Government all the required information per the DHA CAC request process current version 2.1, January 2018, or more recent when updated. See process attached at Part 7 Section 7.1.1 of the PWS. A CAC is the standard identification for eligible DoD contractor personnel.

1.11.1.1 The contractor shall return all CACs to the COR upon the departure of the contractor(s).

1.11.2 Contractor onboarding and training. The contractor shall complete all requirements, training, and forms as prescribed in the following requirements:

1.11.2.1 The DHA’s “Onboarding Checklist for Contractor Employees” is located at the DHA Onboarding and Offboarding Portal at https://info.health.mil/cos/admin/hr/IO/SitePages/Home.aspx

1.11.2.2 The DHA’s contractor training instructions embedded at Part 7 Section 7.1.2.

1.11.2.3 The contractor shall comply with onboarding requirements of the DHA for contractors needing to be issued CAC identification, including DoD- and DHA-directed training and forms submission, prior to network access, as displayed in the In/Out-Processing Portal at:

https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx (note: Public Key Infrastructure (PKI)-restricted, printed versions available).

1.11.3 Physical Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured.

1.11.4 Key control: Reserved

1.11.5 Lock combinations: Reserved

1.12 Key personnel (Contractor): Reserved

https://info.health.mil/cos/admin/hr/IO/SitePages/Home.aspx https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx

HT940221R0002 Page C6 of C48

1.13 Data rights: Reserved

1.14 Reporting

1.14.1 Contractor Manpower Reporting (CMR): Reserved.

1.14.2 Non-Disclosure Agreement (NDA): All contractor personnel who will obtain access to proprietary, classified, or confidential information or any information release of which is protected or governed by law or regulation associated with DHA acquisitions shall be required to complete and sign a DHA contractor NDA (DHA Form 49) prior to beginning work on the subject contract. The contractor shall execute an NDA on behalf of the company and shall ensure that all staff assigned to, including all subcontractors and consultants, or other personnel performing on contract/Task order execute an NDA protecting the procurement sensitive information of the Government and the proprietary information of other contractors. The NDA shall be executed not later than first day of employment and to be renewed upon exercising a contract option period. Assignment of staff who has not executed this statement or failure to adhere to this statement shall constitute default on the part of the contractor. The contractor shall maintain originally signed NDAs of individual employees and provide copy to the COR.

1.14.3 Government’s COR: The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the contractor performs the technical requirements of the contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor contractor's performance and notifies both the CO and contractor of any deficiencies; coordinate availability of government furnished property; and provide site entry of contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting contract.

1.14.4 Post award conference/periodic progress meetings: The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with FAR Subpart 42.5. The CO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance.

At these meetings the CO will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.15 Contractor Identification

1.15.1 Contractor personnel performing services in a contractor capacity in a Government facility are required to possess and wear an identification badge that displays his or her name and the name of their company. All contractor personnel shall identify themselves as contractor

HT940221R0002 Page C7 of C48 support personnel in all forms of communication with all entities with whom DHA/Deputy Assistant Director for Acquisition (DAD-A)/Head of the Contracting Activity (HCA) has business dealings. The contractor shall: Answer all telephone calls and have a personalized voice message with an introductory statement that includes the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting the DAD-A understands that the person is contractor support personnel.

Include a title block in all emails that states the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting DHA/DAD-A/HCA understands that the person is contractor support personnel.

1.15.2 Contractor personnel will be required to attend meetings or otherwise communicate with Government and/or other contract representatives to meet the requirements of this order.

Contractor personnel shall make their contractor status known during introductions.

1.15.3 Contractor personnel, while performing in a contractor capacity, are prohibited from using their retired or reserve component military rank or title in any written or verbal communications associated with the contracts in which they provide services.

1.16 Contractor Access to Health Affairs (HA)/DHA Network(s)

1.16.1 FSO/Company's Security POC shall notify the DHA Personnel Security Office after being awarded a contract that requires access to a DoD system . Contractor personnel requiring access to the HA/DHA networks for performance of their tasks require a background investigation and the security awareness training. The contractor shall be prepared for this process as it could take two (2) or more weeks. The FSO/Security POC shall submit a Standard Form (SF) 85/86 to DHA's Personnel Security Office for a background investigation.

1.16.2 Company's FSO/Security POC must notify the Personnel Security Office when the contractor has submitted the SF-85/86. The FSO/Security POC, or the COR must notify the DHA Personnel Security Office in writing of a contractor's termination from the contract, including the termination date.

1.17 Personnel Security

1.17.1 The contractor shall comply with DoD 8570.01-M, “Information Assurance Workforce Improvement Program, CH4” November 10, 2015 as amended; 8500.01, “Cybersecurity”, dated March 14, 2014; DoD Manual (DoDM) 6025.18, “Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Compliance in DoD Health Care Programs” dated March 3, 2019, Department of Defense Instruction (DoDI) 6025.18 “HIPAA Privacy Rule Compliance in DoD Health Care Programs”, dated March 13, 2019; and DoDM

5200.02 “Procedures for the DoD Personnel Security Program (PSP),” incorporation change 3, effective September 24, 2020. Contractor responsibilities for ensuring personnel security include, but are not limited to, meeting the following requirements:

1.17.1.1 Follow the DHA Personnel Security Office guidelines for submittal of security clearances. Contact the DHA Personnel Security Office for guidance on the appropriate

HT940221R0002 Page C8 of C48 background investigation required for personnel on the contract. The DHA Personnel Security Office can be reached at (703) 275-6038.

1.17.1.2 Initiate, maintain, and document personnel security investigations appropriate to the individual’s responsibilities and required access to Controlled Unclassified Information (CUI).

1.17.1.3 DHA Personnel Security Office does not deny any access to any automated information system (AIS), network, or Controlled Unclassified Information (CUI). If a contractor receives an unfavorable background investigation, the request for access will be sent back to the FSO for further action. Any unfavorable adjudication will result in DHA Personnel Security Office not signing off on any access request.

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PART 2

2.0 DEFINITIONS, ACRONYMS, AND APPLICABLE

PUBLICATIONS/INSTRUCTIONS

2.1 Definitions:

2.1.1 Category D: Information Technology (IT) and Telecommunications Services (called D- Services)

2.1.2 Category R: Support (Professional/Administrative/Management) Services (called R- Services)

2.1.3 Contracting Officer (CO): A person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.1.4 Contracting Officer’s Representative (COR): An individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the CO to perform specific technical or administrative functions. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.5 Nonpersonal services contract: a contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

2.1.6 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance. The Government may either prepare the QASP or require the offerors to submit a proposed quality assurance surveillance plan for the Government’s consideration in development of the Government’s plan.

2.1.7 Additional definitions are listed in the TRICARE Operations Manual (TOM), Appendix A.

2.2 Acronyms:

AIS Automated Information System APL Approved Products List APL AQL Acceptable Quality Level ARRT Acquisition Requirements Roadmap Tool ATO Authority to Operate B2B Business-2-Business CAC Common Access Card CAP Cloud Access Point CCEVS Common Criteria Cybersecurity Evaluation and Validation Scheme CDI Covered Defense Information CE Computer Environment

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CDRL Contract Data Requirement List CIO Chief Information Officer CJCSM Chairman of the Joint Chiefs of Staff Manual CMMC Cybersecurity Maturity Model Certification CMR Contractor Manpower Reporting CNSSI Committee on National Security Systems Instruction CO Contracting Officer(s) CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer's Technical Representative CSP Cloud Service Provider CSSP Cyber Security Service Provider CUI Controlled Unclassified Information DAD-A Deputy Assistant Director for Acquisition DC3 DoD Cyber Crime Center DD Form 254 Department of Defense Contract Security Requirement List (if applicable) DB Design-Build DBB Design-Bid-Build DFARS Defense Federal Acquisition Regulation Supplement DHA Defense Health Agency DISA Defense Information System Agency DoD Department of Defense DoDD Department of Defense Directive DoDI Department of Defense Instruction DSAs Data Sharing Agreements DSAA Data Sharing Agreement Application DMZ Demilitarized Zone DoDM Department of Defense Manual DPCLO DHA Privacy and Civil Liberties Office DUA Data Use Agreement eMSM Enhanced Multi-Service Markets EULA End User License Agreement EVM Earned Value Management FAR Federal Acquisition Regulation FCI Federal contract information FE Facilities Enterprise FedRAMP Federal Risk Authorization and Management Program FISMA Federal Information Security Modernization Act FRCS Facility Related Control Systems FSO Facilities Security Officer HA Health Affairs HIPAA Health Insurance Portability and Accountability Act HCA Head of the Contracting Activity HIT Health Information Technology IGCE Independent Government Cost Estimate IA Information Assurance

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IO Initial Outfitting I/O In/Out Processing Portal IPv Internet Protocol Version IS Information System ISP Internet Service Provider IT Information Technology ISCM Information Security Continuous Monitoring IV&V Independent Verification & Validation MedCOI Medical Community of Interest MHS Military Health System MIL-STD Military Standard MTFs Military Treatment Facilities NCR National Capitol Region NDA Non-Disclosure Agreement NIAP National Information Assurance Partnership NIST National Institute of Standards and Technology OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs OPM Office of Personal Management OSD Office of the Secretary of Defense P-ATO Personal Authorization to Operate P&R Personnel and Readiness PGI Procedures, Guidance and Information PDT Project Delivery Team PHI Protected Health Information PII Personally Identifiable Information PIT Platform Information Technology PK Public Key PKI Public Key Infrastructure POA&M Plan of Action and Milestones POC Point of Contact PMO Program Management Office PoP Period of Performance PP Personal Property PPSM Ports, Protocols, and Services Management PRS Performance Requirements Summary PSP Personnel Security Program PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan RFP Request for Proposal RFQ Request for Quotation RMF Risk Management Framework

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SP Special Publication SPRS Supplier Performance Risk System SRM Sustainment, Restoration and Modernization SRG Security Requirements Guides STIG Security Technical Implementation Guides TOS Terms of Service US United States UFC Unified Facilities Criteria VPN Virtual Private Network XML Extensible Markup Language

Additional Acronyms are listed in the TOM as a .pdf attachment “Acronyms”.

2.3 Applicable Publications, DHA Administrative Instructions (AI), etc. The contractor shall abide by the current version of all applicable regulations, publications, manuals, and local policies and procedures. The list below includes key directives and websites related to the contract. The list not intended to be all inclusive. The following documents are hereby incorporated by reference to the contract:

Title 10, United States Code (USC), Chapter 55

Title 32 Code of Federal Regulations (CFR) National Defense, Parts 199.3, 199.6, 199.9, 199.10 and 199.13.

Title 36 CFR Part 1222 Creation and Maintenance of Federal Records.

Title 45 CFR, Parts 160, 162 and 164 of Health Insurance Portability and

Accountability Act (HIPAA) of 1996.

National Institute of Standards and Technology (NIST) 800-171 Rev 2, Protecting

Controlled Unclassified Information in Nonfederal Systems and Organizations.

DoD 6025.18, Implementation of the Health Insurance Portability and

Accountability Act (HIPAA) Privacy Rule in DoD Health Care Programs.

DoD Instruction 8582.01, Security of Non-DoD information Systems Processing

Unclassified Nonpublic DoD information.

DoD 8580.02-R, Department of Defense Health Information Security Regulation.

DODD 5000.01, Defense Acquisition Systems.

DoD Directive 8500.01, Cybersecurity.

DoD Directive 5400.11-R, DoD Privacy Program.

DoD Instruction 5200.02, DoD Personnel Security Program .

Federal Information Security Management Act of 2002.

2.3.1 TRICARE Manuals. The TRICARE Manuals apply to this contract as referenced in Section C, Section J attachments, and in the DD Forms 1423-1, Contract Data Requirements List (CDRL). The contractor shall utilize the most appropriate versions of the TRICARE Manuals when evaluating healthcare claims. TRICARE Manuals are located at http://manuals.health.mil.

http://manuals.health.mil/

HT940221R0002 Page C13 of C48

PART 3

3.0 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

The Requiring Activity Authority has assessed the need for Government Furnished Property, Equipment, and Services and determined:

3.1 Services: The Government:

☒ Will NOT provide Government Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Government Furnished Services required in support of this contract/task orders. These Services are described below:

3.2 Facilities: The Government:

☒ Will NOT provide Facilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Facilities in support of this contract/task orders. The Government provided Facilities are described below:

3.3 Utilities: The Government:

☒ Will NOT provide Utilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Utilities in support of this contract/task orders. The Government provided Utilities are described below:

3.4 Equipment: The Government:

☒ Will NOT provide Equipment in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Equipment in support of this contract/task orders. The Government provided Equipment is described below:

3.4.1 Procurement Integrated Enterprise (PIEE), GFP Module Application. Reserved.

3.5 Materials: The Government:

☐ Will NOT provide Materials in support of this contract/task order. As a result, this paragraph is Not Applicable.

HT940221R0002 Page C14 of C48

☒ IS providing Materials in support of this contract/task orders. The Government-provided Materials are described below:

TRICARE Purchased-Care Contracts. The Contracting Officer’s Representative (COR) will provide redacted and conformed copies of TRICARE purchased care contracts deemed pertinent to the performance of the compliance reviews. The purchased-care contractor information is provided as reference material and is integral to the contractor’s ability to successfully evaluate the claims processing performance of the MCSCs, TMEP, TPharm, TOP, and ADDP contracts.

The Government will provide copies of Common Letters issued by DHA Contracting Officers (COs) to purchased-care contractors. A “common letter” is any written correspondence, to multiple contractors, that has the same content and is used by all affected COs to convey information, data, or request a response. The common letter may or may not be in response to a contractor’s inquiry. It may originate from any organization involved with administration of TRICARE purchased-care contracts and their inherent requirements. A common letter addresses technical and/or administrative information within the existing scope and dollar value of affected TRICARE purchased-care contracts. Common letters can impact claims processing procedures or reimbursement determination utilized by a TRICARE purchased-care contractor which are not published in TRICARE manuals or regulations, yet requires the purchased-care contractor to comply with the letters directive.

Department of Health and Human Services (DHHS) Sanctioned Provider List. The contractor shall use the DHHS sanctioned healthcare provider list at https://oig.hhs.gov/exclusions/exclusions_list.asp to determine if purchased-care contractors are erroneously reimbursing sanctioned healthcare providers.

Access to the following Government System(s) and/or Application(s). The Government will grant access to the following systems only after the contractor and its subcontractor’s staffs that utilize systems are compliant with the enhanced safeguarding methods for unclassified DoD information, personnel security, and clearance requirements.

Defense Manpower Data Center (DMDC) Defense Enrollment Eligibility Reporting System (DEERS). The Government will provide the contractor with access to the DMDC’s General Inquiry DEERS (GIQD) and the Catastrophic Cap and Deductible Research Application (CCD Web Research) interface environment for the use of validating medical eligibility and beneficiary deductible and cost-share liability under the TRICARE benefit program. Connectivity to DEERS shall be in accordance with TSM, Chapter 1, Section 1.1.

The Government will provide the contractor with access to the TRICARE Patient Encounter Processing and Reporting (PEPR) portal to access the TRICARE Encounter Data (TED) Audit (TA) application and the PEPR Care Detail Information System (PCDIS) web-based applications (Section J, Attachment J-1, PEPR Account Activation Request Form (AARF)).

TA Application. The TA application is the primary online application used by the contractor and Government. Reports generated from the TA application are used to assess the claims processing performance of TRICARE purchased-care contractors against Government claims

HT940221R0002 Page C15 of C48 processing performance standards and to support the Agency’s reporting of PIIA activities. (See Section J, Attachments J-10 for examples of TA reports). The TA application provides:

A mechanism for the contractor and Government to track and monitor the claims processing performance of TRICARE purchased care contractors;

Allows for the retention of a compliance review trail with the appropriate error codes and error amounts; and

Facilitates the input of a detailed explanation for error code and error amount assessment.

PCDIS. The PCDIS functions as a “search window” into the purchased care claims database.

PCDIS data includes all processed TED claims for care provided to TRICARE beneficiaries by civilian network or non-network providers. PCDIS is utilized to:

Verify provider information (i.e. Provider Identification/National Provider Identification numbers, Medicare numbers, Area Wage Index, etc.);

Verify provider network/non-network status;

Identify duplicate claim submissions;

Query TED detail claims and summary data for institutional and professional purchased-care data; and, to Query patient or sponsor healthcare medical and pharmacy claims history.

HT940221R0002 Page C16 of C48

PART 4

4.0 CONTRACTOR FURNISHED ITEMS AND SERVICES

4.1 Services: The Contractor:

☒ Will NOT provide Contractor Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ WILL provide Contractor Furnished Services required in support of this contract/task orders.

These Services are described below:

4.2 General: The contractor shall furnish all supplies, equipment, facilities and services required to perform work listed under Section 5 of this PWS.

4.3 Secret Facility Clearance: Reserved.

4.4 Materials: Reserved.

4.5 Equipment: Reserved.

4.6 Facilities: Reserved.

HT940221R0002 Page C17 of C48

PART 5

5.0 SPECIFIC TASKS

These technical requirements represent specific tasks, outcomes, and/or standards to which the contractor shall perform in support of the above objectives.

5.1 Staffing/Program Management

5.1.1 Staffing. The contractor shall designate a single point of contact (POC) to oversee the tasks of this contract, supervise staff assigned to the tasks, and ensure that the tasks of the contract are performed efficiently, accurately, on time, and in compliance with the requirements of this document. The POC shall provide the Contracting Officer’s Representative (COR) with on-going status updates of the tasks and any issues relating to the contract.

5.1.1.1 The contractor shall ensure all personnel, to include subcontractors, are qualified to perform their assigned responsibilities (i.e. claims auditing, medical record reviews, etc.), including credentials, certifications (for those positions requiring such accreditation), education, training, and experience consistent with industry standards and best practices.

5.1.1.2 The contractor shall ensure that a sufficient number of qualified staff with the appropriate knowledge, skills, experience and credentialing are available to meet all aspects of the contract.

In addition, the contractor shall ensure that staff assigned to conduct medical record reviews have the appropriate knowledge, skills, experience, and credentialing such as Certified Professional Coder (CPC), Certified Professional Coder - Outpatient Hospital (COC), Certified Coder-Payer (CPC-P), Evaluation and Management Certified Coding Specialists and Certified Professional Medical Record Auditor (CPMA) (this is not an all-inclusive list), necessary to form an opinion consistent with industry standards and best practices.

5.1.2 Program Management: The contractor shall develop a Program Management Plan (PMP) (CDRL AP020). The PMP shall consist of control policies and procedures for project administration, execution and tracking consistent with program management best practices and standards.

5.1.2.1 The contractor shall notify the COR of key milestones and issues that are directly related to the scope of the contract both verbally and in writing. At a minimum, the contractor shall address the following in its PMP:

All technical activities (including documentation development) An estimate of the timing, and level of effort (by labor category) for all performance elements A matrix of all personnel assigned to the program and total aggregate level of effort for each performance element Project plan with a detailed schedule that identifies all tasks and key milestones in a format agreed to by the COR Quality assurance processes and monitoring methods Risk management procedures HIPAA risk assessment (CDRL A100, Risk Assessment Letter of Assurance)

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The contractor’s training program which ensures the accurate evaluation of healthcare claims under the TRICARE health benefits program

The contractor’s process for tracking the status of deliverables The contractor’s Data Use Agreements (DUA)/Data Share Agreement (DSA) The contractor's personnel clearances to…