SPECIAL NOTICE
Q -- TRICARE Overseas Program
- Notice Date
- 10/14/2011
- 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
- HT940212RFIT4Overseas
- Point of Contact
- Angie C. Figueroa, Phone: 303-676-3626, ,
- E-Mail Address
-
angie.figueroa@tma.osd.mil,
(angie.figueroa@tma.osd.mil, /div)
- Small Business Set-Aside
- N/A
- Description
- REQUEST FOR INFORMATION The TRICARE Management Activity (TMA) invites potential offerors to provide an industry perspective to the TRICARE Overseas Program (TOP) so that the structure of the next generation of the TOP health care support services contract may be developed to reflect best practices and innovative solutions to military health care challenges in the overseas environment. Input and information may be provided in writing or through one-on-one meetings (in person or via teleconference) with TMA. One-on-one meetings are intended to allow full disclosure in an environment that protects any information shared. The one-on-one meetings will be held face-to-face at the TMA offices in Aurora, Colorado; and will occur between December 1, 2011 and December 16, 2011. If you are interested in providing input into the future of the military health care system through the services provided under the TOP contract, please contact Ms. Angie Figueroa, Contracting Officer, via e-mail at angie.figueroa@tma.osd.mil no later than November 18, 2011 to make arrangements for a one-on-one meeting. If a face-to-face meeting is not feasible, teleconference calls or submission of written information will be permitted. The Government reserves the right to limit the size, content, and format of written information. Participation in this Industry Forum is voluntary and in no way obligates the Government to award any contracts, or pay any costs associated with such participation. Overview: The Defense Health Program (DHP) offers worldwide health care to eligible beneficiaries via the direct care and purchased care systems. Direct care is provided by DoD personnel in Military Treatment Facilities (MTFs) and clinics, and purchased care is provided via four TRICARE regional contracts. In the 50 United States and the District of Columbia, three Managed Care Support Contractors provide purchased care contract services in the North, South, and West regions. Outside the 50 United States and the District of Columbia, purchased care is provided via the TOP contract. This overview describes, in general terms, the purchased care portion of the DHP as it relates to the TRICARE Overseas Program. Additional information is available on the TRICARE Management Activity World Wide Web site at www.tricare.osd.mil. In order to fulfill the purchased care needs of the DHP, potential offerors must provide certain services necessary to fully support DoD's primary wartime readiness mission while supplementing the services provided through DoD owned and/or operated health care facilities. Information from potential offerors should address providing clinical and administrative health care support services that are comparable to the best offered in the host nation civilian community and/or U.S. standards (including U.S. commonwealths and territories) and fulfilling the objectives complying with the scope and structure of TRICARE; i.e., benefits and beneficiary liabilities, including technical requirements specified under the TRICARE uniform health care benefit. Information must address the expertise of health care organizations and health benefit administrators in incorporating and operating the best business model and practices of the private sector in support of DoD healthcare delivery. Any contractor selected for contract award will have to provide the DoD with clinical and administrative services that are comparable to the best offered in the host nation civilian community and/or U.S. practices (including U.S. commonwealths and territories). Information is sought to assure that the services will be delivered in a manner that achieves a fully integrated health care delivery and financing system for all Military Health System (MHS) beneficiaries. Current Status of the Defense Health Program (DHP): The medical mission of the Department of Defense is to maintain readiness through health and medical services provided to the armed forces during military operations, and to provide health and medical services/support to the members of the armed forces, their family members and other entitled to DoD health care. The MHS must be prepared not only to provide a high quality, cost-effective health care benefit to its eligible members during peacetime, but also must be prepared to support the armed forces during exercises, contingencies, operations other than war, and in wartime. In support of its readiness mission, the MHS maintains a system of MTFs and clinics worldwide, located in DoD catchment areas, that provide direct care to active duty personnel and to others who are eligible for military health benefits if space is available. Although the number and size of direct care facilities has declined in recent years, it remains important that MTFs are optimized in order to maintain the clinical skills of military clinical staff to support medical readiness. Currently, the direct care system cannot fully support the total demand for health care services; therefore, TRICARE uses the direct care system as the main delivery system, and through the awarding of the TOP contract overseas, augments the direct care system through civilian network and non-network providers and facilities serving its eligible members. The MHS is organized into three TRICARE areas overseas: TRICARE Pacific; TRICARE Latin America and Canada (TLAC), and TRICARE Eurasia-Africa. TOP services apply to approximately 378,000 Active Duty Service Members (ADSMs) and command sponsored Active Duty Family Members (ADFMs) of the Uniformed Services overseas: the U.S. Army, the U.S. Navy, the U.S. Air Force, the U.S. Marines Corps, the U.S. Coast Guard, the Commissioned Corps of the Public Health Service and the Commissioned Corps of the National Oceanic and Atmospheric Administration. These beneficiaries are eligible for the TOP Prime or TOP Prime Remote option (command-sponsored ADFMs may also choose to use the TRICARE Standard option). Additionally, TOP services apply to approximately 118,000 non-command sponsored ADFMs, retirees, and retiree family members. These beneficiaries are only eligible for the TRICARE Standard option. These options are discussed in more detail below. There is no TRICARE Extra option overseas. TOP Prime and TOP Prime Remote are similar to a Health Maintenance Organization (HMO) with a Point of Service option and requires beneficiary enrollment. TOP enrollees receive all primary care from a Primary Care Manager (PCM), who may be located at the MTF or may be a civilian provider in the TOP contractor's provider network. Enrollees must obtain an authorization from the TOP contractor prior to receiving any non-emergency health care in the civilian community. All ADSMs permanently assigned overseas are required to enroll in TOP Prime or TOP Prime Remote, although they are required to receive all of their care either in the MTF or in the civilian community under special rules that apply to Active Duty healthcare. Command sponsored ADFMs may elect to enroll and are not required to pay an annual enrollment fee or co-pays for care delivered in the network or the direct care system. TRICARE Standard is a fee-for-service option in which the beneficiary is free to use any authorized provider. The two options of TRICARE are described fully in 32 CFR Part 199.17 and 199.18 which may be accessed on the TRICARE Management Activity World Wide Web site at www.tricare.osd.mil. Currently, the TOP contractor is required to establish civilian provider networks (augmented by non-network providers, as necessary to ensure access to care) in all MTF locations and designated remote overseas locations. Networks are sized to accommodate the enrolled population only. The Department of Defense (DoD) requires delivery of a uniform health care benefit in the form of uniform healthcare quality, structure and patient cost-sharing. However, DoD is also interested in taking advantage of the expertise of the civilian sector and incorporating best practices in the overseas health care market. Proposed Contract Performance Objectives: A world-class health system that supports the military mission by fostering, protecting, sustaining and restoring health is our vision for fulfilling the MHS mission. To enhance DoD and our Nation's security by providing health support for the full range of military operations and sustaining the health of all those entrusted to our care. As noted above, this is accomplished through an integrated health care delivery system consisting of our military hospitals and clinics, as well as, services purchased in the civilian sector. The TRICARE Program is accomplishing this mission today through the TOP contract that contains the following contract objectives. These Objectives are not listed by order of importance. Objective 1: Timely and accurate processing of all TRICARE claims that fall within the scope of the contract, to include full compliance with TRICARE's requirements for development, processing, medical review, authorization, and data record submission. Objective 2: Beneficiary and provider 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. Objective 3: Development and management of host nation provider networks (complemented by non-network providers) capable of providing access to the full range of TRICARE covered benefits and services, to include (but not limited to) medical/surgical benefits, mental health services, durable medical equipment, pharmaceuticals, and dental care (for remote active duty service members). Host nation network providers shall be certified in accordance with recognized licensure/certification/ medical malpractice insurance standards for their location. Objective 4: Provision of administrative, management, and customer support services, to include appropriate staffing levels, incorporating commercial practices when practicable to ensure efficient and effective management of all aspects of the contract. Objective 5: Fully operational services and systems at the start of health care delivery with minimal disruption to beneficiaries, providers, and MTFs. These objectives are subject to change in the next TOP contract. Potential sources may have more contemporary information on the proper objectives for achieving our vision and mission while clearly focusing on measurable, high quality clinical and administrative services achieved in the most cost efficient manner for the American taxpayer. The Government is interested in any information potential offerors would like to address in support of achieving high quality, cost effective delivery of health care services overseas. We are also very interested in the industry's thoughts concerning performance requirements. Requirements in this setting represent performance that must occur at or exceed specified performance standards and that achieves outcome based objectives identified in a contract. Examples of TRICARE performance standards may be found in the TRICARE Operations Manual at www.tricare.mil. TMA is very interested in the industry's assessment of the existing performance standards and suggestions for new, revised, and or completely changed performance standards. Note: there are legislative limitations and recommendations conflicting with statutes may not be able to be implemented. However, any of the administrative requirement changes which support a more efficient TRICARE Overseas Program may be acceptable for information presentation. The regulations, TRICARE Operations Manual, TRICARE Policy Manual, TRICARE Systems Manual, and TRICARE Reimbursement Manual are all requirements of the TRICARE Program and uniform benefit. These are available for review at www.tricare.mil and may provide insight to potential sources.
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