SOURCES SOUGHT
Q -- TRICARE Applied Behavior Analysis (ABA) Benefit Program - DoD Comprehensive Autism Care Demonstration
- Notice Date
- 7/24/2017
- Notice Type
- Sources Sought
- NAICS
- 524114
— Direct Health and Medical Insurance Carriers
- Contracting Office
- Other Defense Agencies, Defense Health Agency, Contracting Office - Aurora, 16401 E. CenterTech Pkwy., Aurora, Colorado, 80011, United States
- ZIP Code
- 80011
- Solicitation Number
- DHA-RFI-17-TRICARE_ABA_Program
- Point of Contact
- Yvette H. Dluhos, Phone: 3036763994
- E-Mail Address
-
yvette.h.dluhos.civ@mail.mil
(yvette.h.dluhos.civ@mail.mil)
- Small Business Set-Aside
- N/A
- Description
- Department of Defense (DoD) Comprehensive Autism Care Demonstration DHA-RFI-17- TRICARE Applied Behavior Analysis (ABA) Benefit Program Defense Health Agency (DHA) is exploring options as to how it could best provide ABA services to TRICARE beneficiaries in the future and is contemplating the award of a single, stand-alone contract to serve as the "Service Provider" for the Military Health System's (MHS) TRICARE ABA Benefit Program worldwide. The contract will include cost reimbursable line items and fixed price line items. The contract will provide the DHA with a single "Service Provider" responsible for all aspects of the ABA Benefit Program (benefit administration, customer services, provider networks, and claims processing) as outlined in the TRICARE Operations Manual, Chapter 18, Section 4 (Refer to Attached Draft Revised Version) The ABA Benefit is available to all eligible TRICARE beneficiaries diagnosed with Autism Spectrum Disorder (ASD): active duty family members (ADFMs); retired service members and their eligible family members; survivors; Medal of Honor recipients; qualified former spouses; eligible North Atlantic Treaty Organization (NATO) beneficiaries, and eligible National Guard and Reserve 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 TRICARE Program supplements the health care provided in Department of Defense (DoD) Medical Treatment Facilities (MTFs) and provides access to health care to those eligible beneficiaries living in areas without an MTF. The period of performance is anticipated to be a transition-in phase of 15 months, plus five one-year options, and phase-out (if exercised). This RFI solicits industry's feedback on capabilities currently available to meet the DHA requirement described. The intent of this RFI is to accomplish the following: To gather information from potential offerors to be utilized by the DHA TRICARE Program to support our market research for an upcoming contract requirement. The information will not be utilized for any purpose other than for market research in determining the proper acquisition strategy, type of contract, if any, and to achieve the overall objectives of the TRICARE Program. PROGRAM BACKGROUND: DISCUSSION: TRICARE is comprised of two health care plan options: TRICARE Prime and TRICARE Select. Both programs provide eligible beneficiaries access to the ABA Benefits described in the above referenced and attached TOM, Chapter 18, Section 4. ABA benefits are currently provided under a demonstration project approved by the Secretary of Defense per Section 1092, Chapter 55, Title 10 of the United States Code (USC). (1) TRICARE Prime is similar to a Health Maintenance Organization (HMO), with a Point of Service Option, requiring beneficiary enrollment and use of a primary care manager (PCM) to provide or arrange all medically and psychologically necessary and appropriate health care. (a) ADFMs may elect to enroll in TRICARE Prime. They are not required to pay an annual enrollment fee or cost-shares when obtaining care from their PCM or when referred by their PCM to a specialist. (b) All other eligible beneficiaries pay an annual enrollment fee to enroll in TRICARE Prime and cost-shares when using non-MTF providers, network or non-network. TRICARE Prime is not available to retired beneficiaries in overseas locations (outside of the 50 United States or District of Columbia). Cost-shares are limited to an annual catastrophic cap of $3,000, depending on the beneficiary category. (2) TRICARE Select, which also requires enrollment, is similar to a Preferred Provider Organization (PPO) health plan, providing beneficiaries the option of using network or non-network, TRICARE authorized providers. (a) All beneficiaries (active or retired) electing to enroll in TRICARE Select pay a calendar year deductible and cost-shares for all care received from non-MTF providers. (b) Cost-shares are limited to an annual catastrophic cap of either $1,000 (ADFMs), or $3,000 (Retired beneficiaries). The TRICARE health plan options are fully described in 32 Code of Federal Regulations (CFR) Parts 199.17 and 199.18. The MHS is organized into three TRICARE Regions: TRICARE East (USA), TRICARE West (USA) and TRICARE Overseas Program. Each region has a "Regional Contractor" to support the DHA and MTF efforts to provide TRICARE eligible beneficiaries access to high quality health care. The Regional Contractors administer TRICARE benefit plans by providing program management, benefit determinations, medical care management, customer services, provider networks, and claims processing. CONTRACT PURPOSE: DHA is contemplating the award of a stand-alone contract utilizing full and open competition to provide global management of the TRICARE ABA Benefit Program. The ABA Benefit Program, currently managed by the three Regional Contractors, would be removed from those contracts. The anticipated contract will provide those same services and result in a single "Service Provider" for the ABA Benefit described in the attached Revised Draft of TOM, Chapter 18, Section 4. The ABA Benefit is available to all TRICARE eligible beneficiaries regardless of the TRICARE plan option they elect to use (TRICARE Prime or TRICARE Select) or their residential address. CONTRACT OBJECTIVES: The anticipated contract will require: (a) A strong partnership with the DHA, MTFs and regional Managed Care Support Contractors (MCSCs) to optimize the delivery and quality of ABA services provided in the 50 United States, District of Columbia, and possibly at overseas locations near MTFs. (b) Establishment of a single Service Provider for consistent benefit administration for TRICARE beneficiaries receiving ABA services and for ABA providers, nationwide and possibly at overseas locations near MTFs. (c) Creation of a worldwide ABA provider network comprised of credentialed providers for beneficiaries' use. (d) Beneficiary satisfaction throughout the period of performance by providing access to high quality ABA providers and customer-friendly program services. (e) Utilization of best commercial practices when practicable and as allowed by laws, regulations, and policies governing the TRICARE program. (f) Fully operational services and systems at the start of health care delivery, with minimal disruption to beneficiaries and MTFs as services transition from the MCSCs. (g) Full and real-time access to the contractor's maintained data to support health system planning, medical resource management, clinical management, disease management, contract administration activities, and DoD financial planning. MAJOR TASKS AND SERVICES: The following tasks and services are anticipated to be the major parts of the contract's scope: (a) Designation of a single "Service Provider" to work directly with and build a strong partnership with the DHA, MTFs and MCSCs. (b) Creation and continual maintenance of a worldwide ABA provider network in the 50 United States, District of Columbia, and possibly at designated overseas locations near MTFs. The network must meet the TRICARE access to care standard for specialty care not available at the MTF: appointments within 28 calendar days and within 1-hour travel time from the beneficiary's residence. (c) Customer Services support for all beneficiaries Monday through Friday, exclusive of federal holidays. (d) TRICARE eligibility confirmations and, as appropriate, assistance with Extended Care Health Option (ECHO) registration for Active Duty family members. (e) Seamless transition for claims processing for beneficiaries and providers (the same explanation of benefits, online access, allowed rates, required interfaces with current DHA systems, etc., as those currently provided). (f) Medical management/discharge planning for beneficiaries. REQUEST FOR INFORMATION: The following questions are provided for consideration during this "market research" phase of the acquisition: Please review the questions and provide your responses to the Government for possible consideration and include any alternatives you would recommend that satisfies mission needs of the TRICARE Program. Question #1: What solicitation characteristics would encourage or discourage an organization from submitting an offer to serve as the "Service Provider" for the TRICARE ABA Benefit Program as described in the TOM, Chapter 18, Section 4 (Refer to Attached Draft Revised Version)? Question #2: What economies of scale and other cost savings could the Government expect to achieve by consolidating the TRICARE ABA Benefit Program under one global contract? Are these economies of scale outweighed by the increased overhead associated with a new contract? Question #3: How have non-governmental healthcare organizations and health plans changed their management of the ABA benefit and provider networks in recent years as States have mandated coverage of ABA services? Question #4: In light of evolving coverage models, what changes would you recommend for the management of the TRICAREABA benefit (as outlined in the TRICARE TOM, Chapter 18, Section 4 (Refer to Attached Draft Revised Version)) in order to provide a forward-leaning program model for delivering TRICARE ABA services in the future? Question #5: Aside from the traditional fee-for-service model, what reimbursement methodologies could be useful to improve value and quality of care (i.e., value-based purchasing) for TRICARE ABA services? Question #6: What actions could an organization take to achieve better performance outcomes and what types of benchmark measures could be used to measure/monitor contractor performance outcomes when providing TRICARE ABA services? Question #7: What utilization management tools could an organization use to determine medically or psychologically necessary and appropriate delivery of care for TRICARE ABA services? Question #8: What commercial industry resources, contract approach, requirements, and policies could TRICARE apply to ensure high quality and the most efficient system of care for TRICARE ABA services? Question #9: What would be the advantages or disadvantages of writing a stand-alone contract for TRICARE ABA services as opposed to keeping this requirement under the T2017 Managed Care Support Contracts? RESPONSES REQUIRED: (a) Responses to this RFI should be no more than 15 pages (including cover page). (b) Direct technical questions to Mr. Terry McCullough at terry.m.mccullough.civ@mail.mil or (303) 676-3767. (c) Responses should be submitted to Mr. Todd Young at todd.m.young.civ@mail.mil no later than August 14, 2017, 1500 MST. Please include reference data for a designated point of contact (name, title, address, phone/fax, email). Government Point of Contact: Mr. Todd Young Defense Health Agency Contracting Office- Aurora Branch 16401 East Centretech Parkway Aurora, Colorado, USA 80011-9066
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/notices/34a2644e7b719ec952585623c82a60d2)
- Place of Performance
- Address: 50 United States, District of Columbia, and possibly at overseas locations near MTFs., United States
- Record
- SN04592975-W 20170726/170725085516-34a2644e7b719ec952585623c82a60d2 (fbodaily.com)
- Source
-
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