Accident and Sickness Program for Exchanges (ASPE) Health Benefits Plan

This Sources Sought Notice is posted under SAM.gov, under North American Industry Classification System (NAICS) code 524292. This notice is issued solely for information and planning purposes — it does not constitute as a Request for Quotation (RFQ), Invitation for Bid (IFB), or Request for Proposal (RFP) or a promise to issue an RFQ, IFB, or RFP in the future. This notice does not commit the U.S. Government to contract for any supply or service. Further, the U.S. Government is not seeking quotes, bids, or proposals at this time and will not accept unsolicited proposals in response to this notice. The U.S. Government will not pay for any information or administrative costs incurred in response to this notice. Submittals will not be returned to the responder and will become government property. Not responding to this notice does not preclude participation in future RFQ, IFB, or RFP, if any is issued. The U.S. Department of State, Bureau of Educational and Cultural Affairs (ECA) seeks to procure a third-party administrator (TPA) for the Accident and Sickness Program for Exchanges (ASPE) health benefits plan. ASPE is a self-funded, limited health care benefit plan available worldwide to participants in ECA-sponsored programs. The TPA will conduct a detailed analysis and processing of claims spanning from medical care, mental health care, crisis support, pharmacy services, and more, ensuring adherence to the ASPE program policy. This involves advanced data management for comprehensive reporting on both paid and denied claims, supported by specific categorization for analytical accuracy and reporting precision. We are interested to understand how respondents approach the operational and technical challenges involved in managing a self-funded benefits plan and program administration services on a global scale. A vital component to the administration of this program are secure systems capable of handling all aspects of claims administration seamlessly, along with a care coordination framework to perform worldwide claims-related services. Additionally, we want to learn respondents’ strategies for executing a robust, multi-dimensional, cost-effective, and innovative education and marketing campaign. Special Note: At any given time, there are over 24,000 active enrolled participants in the ASPE program. In calendar year 2023, there were approximately 30,000 claims filed (approximately 2500 per month). Medevacs are requested typically 3-4 per month. Mental health support usage/claims are anticipated to increase. Please see attached ASPE’s Performance Work Statement (PWS) for specific requirements and details. All size categories of businesses are encouraged to respond. Responding to this Sources Sought Responses are limited to no more than 20 pages in length, single spaced and 12-point, Time New Roman font, demonstrating capabilities in reference to this requirement. The Government prefers that your firm submit its response in Microsoft Word, Adobe Acrobat, or a combination of both and the document must be searchable. Send the capability package by email to: Contracting Officer Alexander Bring ([email protected]) A Cover Sheet that identifies the following: Accident and Sickness Program for Exchanges (ASPE) Sources Sought #SS_ASPE Name of Company, Unique Entity ID (UEI), and CAGE Code. Point of contact name, phone number, and email address. Company’s business size standard classification relative to NAICS Code for this requirement, which is 524292. Business Type: Small Business Small Disadvantaged Business 8(a) – certified Small Disadvantaged Business HUBZone Veteran Owned Small Business (VOSB) Service-Disabled Veteran Owned Small Business (SDVOSB) Woman Owned Small Business (WOSB) Economically Disadvantaged Woman Owned Small Business (EDWOSB) Other than small business Whether your services are available through an existing Government contract vehicle (i.e. GSA contract - please provide the contract number) or on the Open Market. Provide a brief statement on the capabilities of your organization, including services currently provided, and key personnel to perform the services described in the attached draft PWS. Include information on your capabilities related to the following: Educating participants/enrollees about a health benefits plan and the mechanism used. Your current call center structure (or length of time to create and operate a call center) that can receive inquiries from participants domestically and overseas. Include an explanation regarding your linguistic/translation capabilities to support your current call center allowing them to effectively address non-English speaking customer needs. Claims administration process, including accuracy rate for large, international groups. The system used to secure participants/enrollees personal and claim information. Current Quality Assurance (QA) procedures used for a large group, including QA for the monitoring of calls. Relationships with providers world-wide and ability to generate Guarantee of Payments (GOP)? Description of the weekly, monthly, quarterly, bi-annual, and annual reporting requirements typically provided for this type of project, including method of transmitting reporting requirements. Description of existing management dashboards providing real-time data on claims support. Ability to offer medical advice and expertise for potential outbreaks of communicable diseases, civil unrest, and natural disasters worldwide. Identify and provide insight for emerging and existing technical solutions to provide web-based resolutions for claims submissions, records submissions for claims, online customer chat features, etc. Summary of the centralized computerized file storage system, including hardware and software, that is currently used to receive, record, locate, and sort claims and related data. Provide existing Privacy Impact Assessments and Statements of Record Notice from comparative customers. Summary of the current billing and accounting processes for tracking and reporting on contract billing. Provide brief examples of relevant experience, within the last three (3) years, that demonstrates your company’s capabilities and business capacity to perform the requirements included in the attached PWS. Experience to include the respondent’s role, primary contractor, or sub-contractor. Identify agency/company name, point of contact, dollar value, period of performance, and contract type. Identify existing relationships (contractual or other) with the following types of services: Air Ambulance Networks (International and inclusive of Medical Escorts as well as Air Ambulance Staffing). Physician and Specialist Coverage Networks (provide at least two) and address domestic and international processes. Mental Health Care Networks (Telehealth) should be differentiated to both international and domestic provider capabilities. Identify availability of U.S. based Mental Health Care Counsellors (Telehealth) for U.S. based exchange participants. Pharmacy Coverage Networks (Please provide at least two) and address domestic and international processes. Respondents should address the following questions in their responses: Will your company be able to provide “rolling acceptance” into coverage based on the annual mission and non-standard programmatic requirements of the Department? Will your company be able to provide pricing for the execution of all the services in the draft PWS? If not, what information needs to be included to provide the pricing? What do you envision as the staffing needs and the qualifications needed to perform the services identified? What do you envision as the optimal communication plan to ensure reliable and timely distribution of information between all relevant stakeholders. Does your company have any feedback on the draft PWS that can enhance the solicitation if and/or when it’s issued? Response Submission Deadline No phone calls will be accepted. Please provide your responses to this Source Sought by June 7, 2024. Sources Sought Submissions will be accepted as email attachments only. All responses must be sent to Alexander Bring ([email protected]), with Accident and Sickness Program for Exchanges (ASPE) Sources Sought #SS_ASPE in the subject line.