TRICARE Managed Care Support Services

Note that the correct email address for the Secondary Point of Contact for this presolicitation notice is charles.l.hargett.civ@mail.mil. 

The media to be used for Detail Level Claims Data will be encrypted hard drives.

This is the PRESOLICITATION NOTICE for the TRICARE Managed Care Support (MCS) Program. THIS IS NOT A REQUEST FOR PROPOSALS. The DRAFT RFP was posted on November 3, 2014 under a SPECIAL NOTICE for information purposes only. DHA anticipates posting the formal Request for Proposals on or about 15 days from this notice.

The Information contained herein does not necessarily reflect all requirements to be found in any future solicitation. Neither unsolicited proposals nor any other kinds of offers will be considered in response to this PRESOLICITATION Notice. Responses to this notice are not offers and will not be accepted by the Government to form a binding contract. Responses to the PRESOLICITATION Notice will not be returned.

Potential offerors may submit requests for confidential and protected information (Detail Level Claims Data) at this time. The ordering instructions for confidential and protected information are located in Attachment 1 as an attachment to the notice. Upon release of the RFP, Detail Level Claims Data will be sent via overnight mail (to U.S. addresses only) to parties who fulfill the requirements outlined in the ordering instructions.

OVERVIEW OF MANAGED CARE SUPPORT FOR THE TRICARE PROGRAM

The Department of Defense (DoD) is responsible for administration of medical, dental, and pharmacy programs that provide healthcare to active duty, active duty family members and retired military members and their families as well as family member survivors. In order to fulfill this responsibility, DoD provides healthcare through the direct care system (DCS) or the purchased care system (PCS). The DCS is composed of hospitals and clinics that are operated by military medical personnel, also referred to as military treatment facilities (MTFs). The PCS is composed of civilian hospitals/clinics or physician or provider offices where healthcare is provided to TRICARE beneficiaries. DoD provides healthcare directly through MTFs; or through care furnished by PCS healthcare providers. This acquisition is to purchase healthcare support services and for the integration of that private sector healthcare with the DoD direct care system. The total eligible population for this acquisition is approximately 9.2 million beneficiaries.

Contracts for managed care support services are authorized under Title 10 United States Code, Chapter 55. Contract services include establishing civilian provider networks in designated geographic areas that meet statutorily-defined access standards for TRICARE Prime enrollees; assisting MTF Commanders/eMSM Managers in optimizing healthcare delivery in the direct care system; providing referrals for specialty services to an MTF provider prior to a civilian provider; enrolling beneficiaries in PRIME; paying healthcare claims for private sector care services rendered to TRICARE eligibles; providing customer service and beneficiary/provider education activities for all TRICARE eligibles; and medical management.

The base period, consisting solely of transition-in requirements, will consist of a minimum of nine months and maximum of twelve months . Healthcare delivery and related administrative support services are for five (5) one-year option periods. The transition-out period is approximately 270 days after the start of healthcare delivery for the incoming contractor.

Based on 10 USC 1073a, an outcome of this acquisition is to obtain "best value to the United States to the maximum extent consistent with furnishing high-quality healthcare in a manner that protects the fiscal and other interests of the United States."

There will be one solicitation with two awards, one award for each of two TRICARE regions. The North and South regions under the current T3 contract, HT9402-12-C-0001, will be combined into an East Region and the current West Region will remain intact for this procurement. The intent is to have no more than one region per contractor in order to maintain two separate suppliers. All offerors may propose on one or two regions; however, no one offeror will be awarded more than one contract. The following capabilities are required to meet the requirements of this acquisition: experience in the healthcare industry with qualified healthcare administrators to properly oversee the administration of a highly complex healthcare system; ability to establish and maintain healthcare networks of institutional and non-institutional providers across a multi-state geographical area; ability to provide a network of healthcare providers and monitor the utilization of services; ability to apply medical management principles; ability to establish and operate a claims processing system with an approximate volume exceeding 39.0 million claims for the East Region and 16.6 million claims for the West Region; ability to meet the defined customer needs for enrollment, referrals, telephone service, and written inquiries; and capability to assist the military healthcare delivery system in its military mission.