Active Duty Dental Plan (ADDP4)

Statement of Work (SOW) / Performance Work Statement (PWS)

To provide worldwide, cost-effective dental care services to eligible Active Duty Service Members (ADSMs) through the Active Duty Dental Program's fourth generation contract (ADDP-4).

• Provide worldwide dental coverage to ADSMs of all U.S. Uniformed Services, including Reserve Component members with delayed activation or those discharged after serving more than 30 days on active duty.

• Offer diagnostic and preventive dental services for enrolled ADSMs referred for private sector care.

• Establish data systems to monitor usage and outcome measures for all dental care rendered.

• Timely and accurately process claims and reimburse providers.

• Provide accessible customer service in accordance with the TRICARE Operations Manual (TOM).

• Ensure all services and systems are fully tested during the transition-in period.

• Supplement ADSM care provided in DoD's Dental Treatment Facilities (DTFs) and provide care to ADSMs in regions without DTF access.

• Develop and maintain a dental provider network in the 50 United States, District of Columbia, U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and the Northern Mariana Islands (CONUS).

• Develop and maintain agreements with TRICARE OCONUS Preferred Dentists (TOPDs) for OCONUS remote care.

• Provide OCONUS routine, urgent, and emergency dental care services to ADSMs in remote areas (over 50 miles from nearest MTF) and to ADSMs on Temporary Duty/Temporary Additional Duty (TDY/TAD), deployed, or on authorized leave in remote overseas locations.

• Compliance with the American Dental Association's (ADA) Current Dental Terminology (CDT) manual, including system updates within specified timeframes.

• Processing of remote ADSM enrollments with high accuracy and completeness (99% within 5 business days).

• Establishing and maintaining general and specialty dental networks with specific access standards for ADSMs based on location (Rural, Suburban, Urban) and dental specialty (dentist, orthodontist, oral surgeon, endodontist, periodontist, prosthodontist).

• Maintaining a network provider retention rate of 95% annually.

• Developing and maintaining an up-to-date directory of network providers, updated within 5 business days of receipt of updated information.

• Completing agreements with TOPDs, with 95% of identified providers secured.

• Processing referrals, appointments, and authorizations with high success rates (e.g., 90% of appointments scheduled within 5 business days).

• Processing claims to completion within specified calendar days (e.g., 95% of CONUS claims within 14 days, 95% of OCONUS claims within 21 days).

• Accurately paying claims (98% on initial submission) and correcting errors (99% within 10 days).

• Processing appeals and grievances within strict timelines.

• Providing comprehensive customer service, with high percentages of calls answered promptly and issues resolved.

• Promoting the value of diagnostic and preventive services and educating ADSMs and providers.

• Providing data systems for care coordination and monitoring, with high system availability (99%).

• Ensuring system interfaces are HIPAA and PKI compliant.

• Correcting data submission mistakes within specified timeframes.

Worldwide, with specific requirements for CONUS and OCONUS locations.

• Compliance with applicable laws, regulations, and directives (e.g., 10 USC, 32 CFR, 36 CFR, HIPAA, TRICARE Policy Manual, NIST SP 800-171).
• Proper identification of contractor personnel.
• Government and Contractor visits/meetings with advance notice.
• System security requirements, including CMMC Level 2 certification and adherence to NIST SP 800-171.
• Health Insurance Portability and Accountability Act (HIPAA) compliance.
• Transition-in and transition-out activities in accordance with specified attachments.
• Utilization of Government-furnished information and purchase of necessary software.
• Development and implementation of a Quality Control Program (QCP) and adherence to clinical quality standards.
• Reporting of adverse clinical events.
• Contract surveillance and records management.
• Implementation of a Fraud and Abuse program.
• Coordination with the Military Health System (MHS) Data Repository (MDR) and MHS Mart (M2).
• Development of a Disaster Action Plan.
• Provision of price structure reports and ad hoc reports as requested.

Questions & Answers / Clarifications

This document contains questions posed by potential offerors regarding the Active Duty Dental Program (ADDP) 4, seeking clarification on various aspects of the program and potential future solicitations. Responses are to be submitted via a specified form.

• Service Standards & Innovation: Inquiries about incorporating new dental care standards, optimizing military patient dental record retrieval and integration with the DoD EHR, and ensuring equitable and efficient scheduling processes.
• Provider Management & Quality: Questions regarding the contractor's responsibility for reporting adverse events, motivating providers to update network status, enforcing clinical/restorative quality standards, and managing providers with substandard care.
• Provider Incentives & Performance: Seeking information on performance-based incentive programs, online provider designations (e.g., 'high performing'), and the effectiveness of incentives used in other contracts.
• OCONUS Operations: Requests for details on OCONUS regions served, international provider credentialing, OCONUS claim adjudication/payment timeframes, language barrier protocols, and claim translation turnaround times.
• Contract & Proposal Process: Questions about whether the services qualify as 'commercial services' per FAR 2.101, administrative barriers to competition, the pros/cons of different option year structures, clarity of draft documents, reasonable proposal preparation time, forecasting future dental care costs, and any additional questions for the Government.

This RFI aims to gather feedback to refine requirements and potentially influence future solicitation documents. Offerors are asked to provide input on the clarity of draft documents and suggest changes that would better define requirements. The deadline for submitting questions is implied by the context of an RFI, and offerors are also asked to list any questions for the Government to answer in a provided spreadsheet.

Form / Attachment / Pricing Sheet

This document appears to be a template or form for collecting feedback, comments, questions, or discussions related to a Performance Work Statement (PWS) or Statement of Work (SOW). It is structured to allow for specific PWS section feedback as well as general comments.

• Fields for 'Company Name'.
• Columns for 'PWS Section Number', 'Page Number', and 'Comment, Question, or Discussion related information'.
• A section for 'General Comments/Questions'.

This document is likely intended for potential bidders to provide input or ask clarifying questions during a pre-solicitation or draft SOW/PWS review period. Bidders should use this form to submit any feedback or inquiries they have regarding the work statement to the government.