1.0 GENERAL
All TRICARE requirements regarding
Government and contractor interfaces shall apply to the Managed
Care Support Program (MCSP) unless specifically changed, waived,
or superseded by the provisions of this section; the TRICARE Manuals;
or the TRICARE contract for Managed Care Support Services (MCSS)
in the 50 United States (US) and District of Columbia (hereinafter
referred to as the MCS contract).
2.0 GOVERNMENT/CONTRACTOR RESPONSIBILITIES
2.1 The contractor shall enter
into a Memorandum of Understanding (MOU) with the Healthcare Operations (HCO)
Directorate prior to the start of health care delivery (SHCD) to
coordinate health care delivery (HCD) for optimization of Markets
and MTF capacities.
2.1.1 In this MOU the contractor
shall describe the Market and MTF support processes which are standard throughout
the contractor’s geographic area of responsibility. This MOU is
expected to be executed in good faith by each party to operate the
TRICARE Program in accordance with the performance-based objectives
of the MCS contract and TRICARE Manuals.
2.1.2 Prior
to the start of each subsequent option period the contractor shall
initiate a review of the MOU to determine if changes are warranted.
2.1.2.1 If the contractor or the Government
Designated Authority (GDA) determines the MOU warrants revision
during the review, a new MOU will need to be renegotiated by both
parties. The contractor shall generate the new MOU and submit to
the GDA for renegotiation.
2.1.2.2 If changes are not necessary,
the MOU remains in effect as previously negotiated.
2.1.3 If a situation
occurs prior to the annual review which warrants a modification,
a new MOU will need to be renegotiated by both parties. Either the
contractor or the GDA can request a revision to the MOU. The contractor shall
prepare a new MOU and submit to the GDA for renegotiation.
2.1.4 For reporting
requirements, see DD Form 1423, Contract Data Requirements List
(CDRL), located in Section J of the applicable contract.
2.2 The contractor
shall also enter into Statement of Responsibility (SOR) with each
Market Director and each standalone MTF Director to address individual
Market and MTF specific issues and procedures.
2.2.1 Each standalone
MTF with oversight and control of subordinate military clinics (a
parent and child Defense Medical Information System (DMIS) relationship)
shall provide a single SOR between the parent MTF and the contractor.
For reporting requirements, see DD Form 1423, CDRL, located in Section
J of the applicable contract.
2.2.2 Signed
SORs shall be in effect for the duration of the contract or until
the GDA, or the contractor determines a change is warranted but
not more frequent than quarterly.
2.2.3 SORs shall
include a process for ongoing, regular communication between each
Market Director or standalone MTF Director, and the contractor regarding
anticipated changes that may affect HCD for beneficiaries (e.g.,
deployments, increase or decrease in Market or MTF capacity and
capabilities, change in troop strength or number).
2.2.4 SORs executed
with each standalone MTF shall identify MTF hours and days of operation,
to include any holiday or training days, and other unique issues
regarding MTF operation (e.g., inclement weather procedures) and
ensure that the SOR is updated as such changes occur.
2.3 All contact
information shall be maintained separately and not be included in
the SOR or MOU.
2.4 The contractor shall maintain
contact information of key personnel for contractor facilities and
all Government entities within the contractor’s geographic area
of responsibility (names, telephone numbers, fax numbers, and email
addresses) and notify the GDA of any changes within one business
day.