SOLICITATION NOTICE
Q -- TRICARE Quality Monitoring Contract (TQMC)
- Notice Date
- 11/5/2009
- Notice Type
- Presolicitation
- NAICS
- 813920
— Professional Organizations
- Contracting Office
- Other Defense Agencies, Office of the Secretary of Defense, TRICARE Management Activity, 16401 East Centretech Parkway, Aurora, Colorado, 80011
- ZIP Code
- 80011
- Solicitation Number
- H94002-09-R-0004
- Archive Date
- 5/7/2010
- Point of Contact
- Scott J Lamond, Phone: 303-676-3649
- E-Mail Address
-
scott.lamond@tma.osd.mil
(scott.lamond@tma.osd.mil)
- Small Business Set-Aside
- N/A
- Description
- Presolicitation Notice: The Solicitation Website http://www/tricare.mil/contracting/healthcare/solicitations under the solicitation category of Other Health Care/Support Services will only currently be available for vendor registration as a Potential Offeror and for notice as to when the formal Request for Proposal (RFP) will be available for download on or after November 13, 2009. Description The purpose of this contract is to assist Health Affairs, TRICARE Management Activity (TMA), the TRICARE Regional Offices (TRO), the Designated Provider Program Office (DPPO), the TRICARE Overseas (TAO) Europe, Pacific and Latin America/Canada Program Offices, the TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC) COR and the pharmacy and dental program offices, by providing the Government with an independent, impartial evaluation of the care provided to Military Health System (MHS) beneficiaries. The TRICARE Quality Monitoring Contractor (TQMC) shall review care provided by the Designated Providers (DP) under the Uniformed Services Family Health Plan (USFHP), the Managed Care Support Contracts (MCSCs) and the TDEFIC contractor. In addition, the TQMC will review records from other TRICARE contractors (e.g., TRICARE pharmacy and dental contractors) to satisfy requirements to validate the quality of care delivery under the TRICARE benefit. The TQMC is part of TRICARE's Quality and Utilization Review Peer Review Organization Program, in accordance with Code of Federal Regulations 32 CFR 199.15. The Objectives under this contract are: To provide an independent, impartial evaluation of the health care provided to the MHS beneficiaries. To evaluate "best value health care" as defined in the TRICARE Operations Manual. To measure, evaluate, and identify superior quality health care services and recommend means to transfer successes. To provide comprehensive and timely reviews that are consistent with all TRICARE requirements, to ensure receipt of appropriate levels of health care for all beneficiaries. DOCUMENTS Title 10, United States Code, Chapter 55 32 CFR 199 TRICARE Operations Manual (TOM) 6010.56 M, dated February 2, 2008. TRICARE Policy Manual (TPM) 6010.57, dated February 2, 2008. TRICARE Reimbursement Manual (TRM) 6010.58, dated February 2, 2008. TRICARE Systems Manual (TSM) 7950.2, dated February 2, 2008. The TRICARE manuals and CFR are located at: http://manuals.tricare.osd.mil. TECHNICAL REQUIREMENTS General: The TQMC shall establish and maintain sufficient and appropriate management, staff, management support services, resources and facilities necessary to achieve and maintain compliance with the requirements of this contract. The TQMC shall have available to it the services of actively practicing, board certified, licensed doctors of medicine and osteopathy and dentists to assure adequate review of services provided by the various medical and dental specialties and subspecialties, as identified by the American Board of Medical Specialties, the Bureau of Osteopathic Specialists and the National Certifying Boards for Dental Specialties. Active participation means practicing, on a routine basis, a minimum of 20 hours per week. The TQMC shall have procedures for ensuring availability of actively practicing non-physician reviewers of all the provider types set forth in 32 CFR 199.6. Reviewers: The TQMC shall document its review and verification of the credentials, and maintain current and accurate records, for all reviewers under this contract. The TQMC shall conduct the credential verification process when the reviewer is first considered for employment or contract, or every three years, after the individual has assumed reviewer responsibilities. It shall be the TQMC's responsibility to ensure that all staff maintains the required qualifications and certifications while performing under this contract. Credentialing files shall be available for inspection and audit by representatives from the Government upon request. Quality Management: The TQMC shall establish and continuously operate an Internal Quality Management Program (IQMP) covering every aspect of the TQMC's operation to ensure control, accuracy, and timeliness. Records Security and Confidentiality: The TQMC shall operate a system of records in support of the Department of Defense (DoD) Military Health System which requires obtaining, maintaining, and using personal information strictly in accordance with controlling laws, regulations, DoD Policy, and contract requirements. Focused Studies: In general, the TQMC shall accomplish focused studies of TMA selected study issues that have a potential to significantly impact beneficiary health, functional status, and satisfaction. Additionally, focused studies may be related to specific individual providers, provider groups, or institutional providers. Health Care Technology Assessments: The assessments shall utilize published, refereed scientific literature and shall assess individual health care technologies, to include the full range of medical or surgical devices, services or procedures; behavioral health devices, services or procedures; dental health devices, services or procedures; or the use of pharmaceuticals for purposes other than that approved by the U.S. Food and Drug Administration. Health care technology assessments which include full in-depth assessments and short assessments on specific, focused health care topics. Short assessments are those which require less time to complete due to the lower availability of literature to review. Medical Necessity (Reconsideration) Reviews (Second Level Appeal): The TQMC shall conduct medical necessity (reconsideration) reviews and issue decisions consistent with Chapter 12 of the TOM for reviews conducted after the start of health care delivery. These reviews shall include medical necessity appeals from MCSCs, DPs, MTFs (including those from ADSMs), TDEFIC, TRICARE Overseas contractor, dental contractor and the Pharmacy contractor. For TRICARE Overseas components, the TQMC will consider the standard of care available in the outside the continental United States (OCONUS) location when providing medical necessity reconsideration and second level appeals. Internal/External Case Reviews for Appeals and Hearings: The TQMC shall conduct internal and external case reviews and additionally shall provide peer reviewers to serve as witnesses. Mental Health Facility Certification: The TQMC shall be responsible for determining whether Residential Treatment Centers (RTCs), Substance Use Disorder Rehabilitation Facilities (SUDRFs), and Psychiatric Partial Hospitalization Programs (PHPs) meet TRICARE requirements. All interested vendors shall be registered in the Central Contractor Registration (www.ccr.gov) before award can be made. The period of performance includes a base period and four one-year option periods. Source Selection procedures in accordance with FAR Part 15 will be used to determine the successful offeror. All responsible sources submitting a responsive proposal shall be considered by the agency. The solicitation will only be available through electronic media (download from the TRICARE website at http://www.tricare.mil/contracting/healthcare/solicitations/index.cfm. If you wish to receive information regarding the request for proposals during solicitation process, you must register as a Potential Offeror. Questions regarding the solicitation must be submitted using "E-Mail Questions to the Contracting Officer" option on the TRICARE website. POC: Scott Lamond, Contracting Officer, Phone: 303 676-3649, FAX 303 676-3987, email: scott.lamond@tma.osd.mil However, preference is by email.
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/ODA/OSD/TRICAREMA/H94002-09-R-0004/listing.html)
- Record
- SN01998585-W 20091107/091105235231-15826c483595663d9cac4976684e6528 (fbodaily.com)
- Source
-
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
| FSG Index | This Issue's Index | Today's FBO Daily Index Page |