SPECIAL NOTICE
Q -- Request for Information: Military Health System Managed Care Support Services
- Notice Date
- 2/6/2013
- Notice Type
- Special Notice
- NAICS
- 524114
— Direct Health and Medical Insurance Carriers
- Contracting Office
- Other Defense Agencies, TRICARE Management Activity, Contract Operations Division - Aurora, 16401 E. CenterTech Pkwy., Aurora, Colorado, 80011, United States
- ZIP Code
- 80011
- Solicitation Number
- RFIforT2017
- Archive Date
- 3/23/2013
- Point of Contact
- Laura L. Sells, Phone: 3036763894
- E-Mail Address
-
laura.sells@tma.osd.mil
(laura.sells@tma.osd.mil)
- Small Business Set-Aside
- N/A
- Description
- Special Notice: Request for Information T2017 Agency/Office: TRICARE Management Activity Location: Contract Operations Division - Aurora (Colorado) Title: TRICARE MANAGEMENT ACTIVITY - MANAGED CARE SUPPORT SERVICES DESCRIPTION: TRICARE MANAGEMENT ACTIVITY (TMA) is contemplating the future generation of managed care contracts which includes cost reimbursable line items, fixed price line items, and requirements line items for the TRICARE Program of the Military Health System (MHS) in the United States to support active duty service members (ADSMs); active duty family members (ADFMs); retired service members and their eligible family members; survivors; Medal of Honor recipients; qualified former spouses; National Guard and Reserve members and their family members (including qualified non-active duty members of the Selected Reserve of the Ready Reserve, Retired Reserve, and certain members of the Individual Ready Reserve). TRICARE supplements the care provided in Department of Defense (DoD) Medical Treatment Facilities (MTFs), as well as provides care to those eligible beneficiaries living in regions without access to MTFs. The period of performance is anticipated to be a transition-in phase of one year, plus five one-year options, and phase-out (if exercised). This Request for Information (RFI) solicits industry's feedback on capabilities currently available to meet the later described MHS requirement. The North American Industry Classification System (NAICS) Class Code is 524114. The intent of this RFI is to accomplish the following: To gather information from potential offerors to be utilized by the TMA TRICARE Program as support in our continuous market research for upcoming contract requirements. The information will not be utilized for any purpose other than for market research in determining the proper acquisition strategy, type of contract, and to achieve its overall objectives under the TRICARE Program. PROGRAM BACKGROUND: DISCUSSION: TRICARE is comprised of three health care options: Prime, Standard, and Extra. TRICARE Prime is similar to a Health Maintenance Organization (HMO) with a Point of Service Option and requires beneficiary enrollment. All ADSMs are TRICARE Prime enrollees, although they are required to receive all care either in the MTF or under special rules that apply to Active Duty health care, further explained in the TRICARE Operations Manual, Chapter 17. ADFMs may elect to enroll and are not required to pay an annual enrollment fee; other eligible beneficiaries pay an annual enrollment fee to enroll in TRICARE Prime. TRICARE Extra, which requires no enrollment, is an option in which the beneficiary may choose to use a provider in a TRICARE contractor-developed network, at a reduced cost-share for a particular instance of care, but is not restricted to use of the provider network. TRICARE Standard is a fee-for-service option, essentially the program formerly called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), in which the beneficiary is free to use any authorized provider. The three options of TRICARE are described fully in 32 Code of Federal Regulations (CFR) Parts 199.17 and 199.18. The MHS is organized into three TRICARE Regions within the United States and coverage extends overseas. CONTRACT PURPOSE: TMA is contemplating the award of a contract utilizing a full and open competition acquisition approach to provide support to MTFs in providing health care services in the United States to ADSMs; ADFMs; retired service members and their eligible family members; survivors; Medal of Honor recipients; qualified former spouses; National Guard and Reserve members and their family members (including qualified non-active duty members of the Selected Reserve of the Ready Reserve, Retired Reserve, and certain members of the Individual Ready Reserve). The Uniformed Services include the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marine Corps, the U.S. Coast Guard, the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA), and the Commissioned Corps of the Public Health Service (PHS). The anticipated future contract will supplement DoD MTFs by providing medical care provider networks and support services in required Prime Service Areas (PSAs) in the following location: United States. CONTRACT OBJECTIVES: The following performance-based objectives are to be accomplished in an anticipated future contract: • Objective 1 - In partnership with the MHS, optimize the delivery of health care services in the direct care system (see the definition of Military Treatment Facility Optimization in the TRICARE Operations Manual, Appendix B) for all MHS beneficiaries (active duty personnel, MTF enrollees, civilian network enrollees, and non-enrollees). • Objective 2 - Beneficiary satisfaction at the highest level possible throughout the period of performance, through the delivery of world-class health care as well as customer-friendly program services. Beneficiaries must be completely satisfied with each and every service provided by the Contractor during each and every contact. • Objective 3 - Attain "best value health care" (See TRICARE Operations Manual, Appendix B) services in support of the MHS mission utilizing commercial practices when practical. • Objective 4 - Fully operational services and systems at the start of health care delivery and minimal disruption to beneficiaries and MTFs. • Objective 5 - Full and real-time access to Contractor maintained data to support DoD financial planning, health system planning, medical resource management, clinical management, disease management, and contract administration activities. MAJOR TASKS AND SERVICES: The following tasks and services are anticipated to be the major parts of the contract's scope: • General medical care provider networks in the location(s) stated above. • Claims processing and provider reimbursement (cashless/claimless for the ADSM and ADSM beneficiaries). • Customer service • Program enrollment and processing related fees/premiums • Beneficiary and provider education REQUEST FOR INFORMATION: The following questions and request for information are provided for consideration during this "market research" phase of the acquisition. Please review and provide your responses to the Government for possible consideration/alternatives for satisfying mission needs of the TRICARE Program. Question #1: What can industry recommend to lower costs of the TRICARE Program if there is: • No change in TRICARE's current policies (as documented in the TRICARE manuals at http://manuals.tricare.osd.mil ), • No change in the Government's business systems (i.e., TMA, Defense Manpower Data System (DMDC), TRICARE Encounter Data System (TEDS), etc.), and • No change in the requirements for interfacing with the Government's business systems. Within these stated constraints, present any minor or major operational TRICARE Program recommendations for process efficiencies, along with the associated potential cost savings. Applying known and innovative industry "best practices" and new technologies to your recommendations is welcomed and encouraged. Question #2: Are there changes to TRICARE policies you would recommend to achieve improved operational efficiencies which have related cost savings for the Government? Please limit your recommendations to those policies which could be changed within the TMA regulations and manuals, without the need for statutory CFR changes. RESPONSES REQUIRED: Responses to this RFI should be no more than 15 pages total (including cover page). Responses should be submitted to Laura.Sells@tma.osd.mil no later than 8 March 2013. Please include reference data for a designated point of contact (name, title, address, phone/fax, email). Government Primary Point of Contact: Laura Sells Contracting Office Address: 16401 East CentreTech Parkway Aurora, Colorado 80011-9066 United States Place of Contract Performance: United States Classification Code: Q - Medical Services NAICS Code: Insurance Carriers and Related Activities/524114 - Direct Health and Medical Insurance Carriers
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