TRICARE Dental Program 7/Third Party Administrator Industry Forum

SECTION C DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK TDP6 HT9402-22-R-0001 C1 of C30 Department of Defense Defense Health Agency Performance Work Statement TRICARE Dental Program Six Generation (TDP6) J-10/Deputy Assistant Director, Health Care Operations Dental Program Section Solicitation Number: HT9402-22-R-0001 Date: September 29, 2022 -- 1 of 30 -- SECTION C DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK TDP6 HT9402-22-R-0001 C2 of C30 PART 1 1.0 GENERAL INFORMATION C.1.1 This is a non-personal services contract to provide the TRICARE Dental Program sixth generation (TDP6). C.1.2 Description of services/introduction: The TDP6 contractor shall provide comprehensive dental care services worldwide to eligible TRICARE beneficiaries. The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to fulfill the requirements of TDP6 as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS. C.1.3 Background: The TRICARE Dental contract supports the delivery of the Department of Defense (DoD) dental benefit, which is codified in 10 U.S.C. Chapter 55 § 1076a. The TRICARE Dental contract serves to integrate affordable dental health services to DoD Military Health System (MHS) beneficiaries, by private sector contractors, and driven by greater integration of dental business processes across the MHS. The Defense Health Agency (DHA) supports the MHS in its mission to provide dental health services through TRICARE dental care coverage for all eligible family members of Uniformed Service active duty, members of the Selected Reserve and Individual Ready Reserve (IRR) and their eligible family members. C.1.4 Objectives: • The contractor shall provide worldwide cost effective dental care services for enrollees. • The contractor shall promote the value of utilizing diagnostic and preventive services. • The contractor shall provide data systems in which to monitor dental health plan data and outcome measures for all dental care rendered. C.1.5 Scope: The TDP offers worldwide dental coverage to all eligible family members of Uniformed Service active duty personnel, and to members of the Selected Reserve, the Individual Ready Reserve (IRR), the National Guard, and their eligible family members. Active duty service members, former spouses, parents, in-laws, disabled veterans, foreign personnel, and retirees and their families are not eligible for the TDP. The TDP geographic area of coverage for the Continental United States (CONUS) includes the 50 United States, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. Outside the Continental United States (OCONUS) service area includes all other countries, island masses and territorial waters. In order to fulfill DHA’s mission, TDP6 requires the contractor to establish and maintain a provider network in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, and Puerto Rico. In addition the contractor shall develop and maintain a list of Outside of the Continental United States (OCONUS) providers, referred to as TRICARE OCONUS Preferred Dentists (TOPDs). The contractor shall be responsible for program operations and administration. TDP6 includes all associated administrative services, such as eligibility verification and enrollment, premium -- 2 of 30 -- SECTION C DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK TDP6 HT9402-22-R-0001 C3 of C30 collection, customer service, claims processing, and beneficiary and provider education, which are at a minimum, consistent with the contractor’s commercial practices and industry standards. C.1.6 Period of Performance (PoP): Base Period/Transition-In: 12/01/2023 - 11/30/2024 Ordering Periods (OP) 1 through 5 will be: OP 1: 12/01/2024 - 11/30/2025 OP 2: 12/01/2025 - 11/30/2026 OP 3: 12/01/2026 - 11/30/2027 OP 4: 12/01/2027 - 11/30/2028 OP 5: 12/01/2028 - 11/30/2029 The Residual Phase-Out CLIN (700X), will follow the last dental care delivery/transition out PoP. Residual Phase-Out will begin after the last dental care delivery PoP (OP1, OP2, OP3, OP4, or OP5). The Government will exercise only one Residual Phase-Out CLIN (700X), which will depend on the last OP. The Residual Phase-Out CLIN’s period of performance will have a one year PoP. The Residual Phase-Out PoP is for the contractor to complete processing of all claims, grievances, and appeals from the last OP of dental care delivery. C.1.6.1 Transition-in/transition-out periods. C.1.6.1.1 Transition-in period: Full performance start date is, 1 December 2024 Transition-in performance is defined at C.5.4.1 and Section J, Attachment J-11, Transition-In. C.1.6.1.1.1 The contractor shall comply with transition-in requirements of the DHA, as listed in paragraph C.1.11.1, for contractors needing to be issued Common Access Card (CAC) identification, including Department of Defense (DoD) and DHA-directed training and forms submission, prior to network access. C.1.6.1.2 Transition-out period: Transition-out performance is defined at C.5.4.2 and Section J, Attachment J-12, Transition-Out and Residual Services. C.1.6.1.2.1 The contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC or who generate “records”, as defined by C.5.5. Records Management. C.1.7 Administrative Specifications C.1.7.1 Place of performance: The contractor shall perform work at at the contractor’s facility or in a remote environment as long as the required security precautions are documented and followed. C.1.7.2 Recognized Federal holidays: The contractor is not required to perform services on the following holidays: -- 3 of 30 -- SECTION C DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK TDP6 HT9402-22-R-0001 C4 of C30 New Year’s Day Labor Day Martin Luther King Jr.’s B…