Military Health System

1.1  The incoming contractor shall develop and implement a MM Program that addresses all aspects of MM as described in Chapter 7, to include: Referral Management (RM), Case Management (CM), Behavioral Health (BH), Utilization Management (UM) and Population Health (PH).

1.2  The incoming contractor shall ensure that all aspects of their MM Program are fully operational no later than 30 calendar days prior to the start of health care delivery (SHCD).

1.3  The incoming contractor shall report the development and integration progress on an on-going basis at the transition meetings.

1.4  The incoming contractor shall develop and implement a single, consolidated, user friendly, fully electronic, web-based MM data system platform that is available 24 hours a day/seven days a week (24/7), in accordance with Chapter 7, Section 1, and ready for end user training 120 calendar days prior to the SHCD.

2.1  The incoming contractor shall begin the MM validation process by demonstrating its planned web-based application which will provide access, reporting and detailed information to the Government on, all above listed MM areas and pharmacy application 120 calendar days after contract award.

2.2  The outgoing contractor shall transfer to the incoming contractor, in an electronic format, all beneficiary history (both medical and mental health), in accordance with Chapter 9, Section 2.

2.3  The outgoing contractor shall provide information to beneficiaries and providers on how they may obtain assistance and coordinate care during the transition.

2.4  The outgoing contractor shall communicate, collaborate, and coordinate with the incoming contractor all cases involving beneficiary change of provider from network to non-network as a result of transition 30 calendar days prior to the SHCD.

2.5  The outgoing contractor shall communicate, collaborate, and coordinate with the incoming contractor on the authorization episode of care timeframes for inpatient, institutional, Residential Treatment Center (RTC), respite, Home Health Care (HHC), discharge planning and next level of care, outpatient authorized care 30 calendar days prior to the SHCD.

2.6  The outgoing contractor shall communicate and collaborate with the Government Designated Authority (GDA) and incoming contractor in meetings (at least weekly) beginning 60 calendar days prior to the start of service delivery. Meeting topics shall include: CM and Disease Management (DM) high cost, high profile, high visibility, and sensitive medical and mental health cases to ensure seamless continuity of services to those beneficiaries.

2.7  The incoming contractor shall provide MM training twice weekly to the Government (Defense Health Agency (DHA) and Markets/Military Medical Treatment Facilities (MTFs)) in their geographic area of responsibility on the contractor’s electronic MM data system and usage beginning no later than 120 calendar days prior to the SHCD.

4.1  The outgoing contractor shall provide the incoming contractor with all case files in accordance with Chapter 9, Section 2.

4.2  The outgoing contractor shall participate in meetings as stated in paragraph 2.6.

5.1  The outgoing contractor shall provide the incoming contractor with all case files in accordance with Chapter 9, Section 2.

5.2  The outgoing contractor shall participate in meetings as stated in paragraph 2.6.

6.1  The incoming contractor shall ensure health care services are provided in accordance with the contractor’s MM Plan (see Chapter 7).

6.2  The incoming contractor shall fulfill valid authorizations and referrals issued by the outgoing contractor, covering care through 180 calendar days after the start of service delivery under the incoming contract.

6.3  The incoming contractor shall receive complete open and closed case files for appeals and reconsideration documentation regarding all beneficiaries under active UM programs (to include BH) as required above.

6.4  The incoming contractor shall ensure that the Peer Review Organization (PRO) requirements are in place, to include written agreements guidelines in Chapter 2, Section 3.

6.5  The outgoing contractor shall provide the incoming contractor with authorization-related clinical information to preclude requiring a provider or beneficiary to duplicate the paperwork and other efforts related to established authorizations in accordance with Chapter 9, Section 2.

6.6  The outgoing contractor shall issue authorizations as late as midnight on the day prior to the end of its health care delivery (HCD) for inpatient stays that will continue as transitional cases.

6.7  The outgoing and incoming contractors shall interface on the clinical issues of a case where both contractors will, or can reasonably expect to, have periods of liability for the same episode of care.

7.1  The outgoing contractor shall communicate, collaborate, and coordinate with the incoming contractor for all Potential Quality Issue (PQI) cases and make every attempt to close prior to the end of the contract.

7.2  The outgoing contractor shall provide the incoming contractor with all new and open PQI cases the outgoing contractor is unable to close, starting 30 calendar days prior to the SHCD and will continue to send cases on a weekly (or routine) basis for all new cases that come in until midnight on the last day of the outgoing contractor’s HCD.

7.3  The outgoing contractor shall collaborate and be available to discuss any open or new cases until close of business on the first business day of the incoming contractor’s SHCD.