World Trade Center Health Program Third-Party Administrator (TPA)
ID: 75D301-25-R-73216Type: Solicitation
Overview

Buyer

HEALTH AND HUMAN SERVICES, DEPARTMENT OFCENTERS FOR DISEASE CONTROL AND PREVENTIONCDC OFFICE OF ACQUISITION SERVICESATLANTA, GA, 30333, USA

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

PSC

SUPPORT- MANAGEMENT: OTHER (R799)
Timeline
    Description

    The Department of Health and Human Services, through the Centers for Disease Control and Prevention (CDC), is seeking proposals for a Third-Party Administrator (TPA) to support the World Trade Center (WTC) Health Program. The TPA will be responsible for managing enrollment applications, maintaining member information, overseeing provider networks, administering benefits, and processing medical claims for individuals affected by the September 11th attacks. This program is crucial for delivering comprehensive healthcare services to approximately 132,000 members, ensuring they receive the necessary medical monitoring and treatment for WTC-related conditions. Interested offerors must submit their proposals by April 11, 2025, with a pre-proposal conference scheduled for January 22, 2025, and the contract period expected to commence on September 15, 2025. For further inquiries, contact Joshua Houston at jhouston@cdc.gov.

    Point(s) of Contact
    Joshua Houston
    jhouston@cdc.gov
    Files
    Title
    Posted
    The document details a Request for Proposal (RFP) by the Centers for Disease Control and Prevention (CDC) for a Third-Party Administrator to support the World Trade Center Health Program. The solicitation is unrestricted and includes specific instructions for completion and submission by interested offerors. The period of performance spans from September 15, 2025, to August 14, 2035, with defined options for contract renewal. The RFP outlines various task areas, including Transition-In services, contract management, member services, provider network management, medical benefits administration, claims processing, and data management. Each task is broken down into separate Contract Line Item Numbers (CLINs) and specifies quantities, unit prices, and payment structures. The document is structured into sections, with detailed clauses and provisions drawn from the Federal Acquisition Regulation (FAR) and other contracting requirements. Potential contractors must familiarize themselves with these terms and adhere to rigorous performance expectations to ensure compliance with government standards. This project underscores the government's commitment to providing comprehensive health services to eligible individuals impacted by the events of September 11, 2001.
    The document details a Request for Proposal (RFP) by the Centers for Disease Control and Prevention (CDC) for a Third-Party Administrator to support the World Trade Center Health Program. The solicitation is unrestricted and includes specific instructions for completion and submission by interested offerors. The period of performance spans from September 15, 2025, to August 14, 2035, with defined options for contract renewal. The RFP outlines various task areas, including Transition-In services, contract management, member services, provider network management, medical benefits administration, claims processing, and data management. Each task is broken down into separate Contract Line Item Numbers (CLINs) and specifies quantities, unit prices, and payment structures. The document is structured into sections, with detailed clauses and provisions drawn from the Federal Acquisition Regulation (FAR) and other contracting requirements. Potential contractors must familiarize themselves with these terms and adhere to rigorous performance expectations to ensure compliance with government standards. This project underscores the government's commitment to providing comprehensive health services to eligible individuals impacted by the events of September 11, 2001.
    The document serves as an amendment to solicitation number 75D301-25-R-73216 issued by the Centers for Disease Control and Prevention (CDC). Effective January 31, 2025, the amendment modifies the original solicitation by revising Section 4.4.4 of the Performance Work Statement, specifically detailing the requirements for the creation and maintenance of a Provider Directory by the TPA Contractor. The directory must include comprehensive provider information accessible to program members while ensuring role-based visibility, meaning members can view relevant providers based on location. Key details required in the directory encompass provider names, genders, appointment availability, specialties, contact information, and participation in health information exchanges. The TPA Contractor is responsible for keeping the directory accurate and up to date, performing regular verifications every 90 days, and updating the system promptly upon changes in provider participation. This amendment aims to ensure clarity and precision in delivering healthcare services through an organized provider directory, thereby enhancing the overall effectiveness of the program's service provision.
    The World Trade Center Health Program's Business Associate Agreement outlines the responsibilities and obligations of both the Covered Entity (the WTC Health Program) and the Business Associate regarding the handling of Protected Health Information (PHI) as per HIPAA regulations. Key aspects include prohibiting unauthorized use or disclosure of PHI, implementing strict safeguards to prevent security breaches, timely reporting of any incidents, and ensuring that any subcontractors adhere to similar privacy standards. The agreement also stipulates processes for accessing, amending, and accounting for disclosures of PHI. Furthermore, it establishes the conditions for the termination of the agreement, ensuring that upon termination, all PHI is either returned or destroyed, with a continued obligation to safeguard any retained information. This document is critical for ensuring compliance with federal privacy laws and protecting the confidentiality of health data, demonstrating the government's commitment to public health and legal accountability.
    The CDC Contractor Non-Disclosure Agreement outlines the responsibilities and obligations of contractors regarding non-public and procurement-sensitive information related to their work with the Centers for Disease Control and Prevention. Contractors must ensure their employees sign a Non-Disclosure Agreement (NDA) prior to accessing government information. Non-public information includes confidential and privileged data that must not be disclosed without CDC consent. The agreement further emphasizes the prohibition against sharing procurement-sensitive information, which encompasses details from Requests for Proposals (RFPs), Statements of Work (SOW), and other sensitive communications that could lead to a conflict of interest. Additionally, it mandates the identification of contractor employees in their communications, stating that they must disclose their contractor status and affiliation with the CDC in all interactions. It also highlights legal repercussions for unauthorized handling of public records, reinforcing the seriousness of safeguarding sensitive information. This agreement serves to protect the integrity of procurement processes and the confidentiality of sensitive data within federal contracts.
    The Centers for Disease Control and Prevention (CDC) Contractors’ Employee Non-Disclosure Agreement outlines the responsibilities of employees of CDC contractors regarding the handling of non-public and procurement-sensitive information. The agreement emphasizes that confidential and privileged information must only be used for fulfilling work duties and prohibits disclosure to unauthorized individuals. Employees must also recognize potential conflicts of interest stemming from access to procurement-sensitive data related to Requests for Proposals (RFPs) and other relevant documents, which may disqualify them and their employers from future government acquisition opportunities. Additionally, the agreement mandates identification as a contractor employee in interactions with CDC personnel and stipulates guidelines for communication and representation. Employees are backed by federal laws that hold significant penalties for mishandling public records. This document underscores the importance of confidentiality and proper conduct within government contracting contexts, ensuring the integrity of the procurement process and compliance with regulatory standards. Overall, it serves to protect sensitive government information while clarifying the roles and responsibilities of contractor employees to maintain transparency and ethical conduct within their operations.
    The document outlines the terms of a Non-Disclosure Agreement (NDA) for offerors seeking access to confidential and privileged information related to the World Trade Center Health Program as part of the solicitation for a Third-Party Administrator. It emphasizes that offerors will receive non-public information not generally available to the public and are obligated to protect this information from unauthorized disclosure. Key requirements include timely reporting of any unauthorized disclosures, deletion of non-public information upon termination of the competition or contract award, and restrictions on sharing information with teaming partners or subcontractors, who must also sign the NDA. The document serves to ensure the security and confidentiality of sensitive information essential for the proposal development process in response to the RFP 75D301-25-R-73216. Overall, the NDA aims to safeguard government information while facilitating the request for proposals mechanism.
    The document outlines the Centers for Disease Control and Prevention (CDC) Implementation of the Department of Health and Human Services (HHS) Rules of Behavior (RoB) for the use of HHS Information Technology resources. Its main purpose is to establish acceptable use policies governing access to CDC information systems by all employees and personnel. It delineates three categories of users: General Users, Privileged Users, and System-Specific Users, each with distinct responsibilities and guidelines. Key elements of the policy include guidelines for acceptable use, security requirements, user responsibilities, and consequences for non-compliance, which may range from suspension of access to criminal charges. Emphasis is placed on protecting sensitive information, maintaining professional conduct, and the prohibition of personal use that disrupts productivity or violates privacy policies. The document also mandates formal acknowledgment of RoB by all users, ensuring awareness of security obligations. In the context of government RFPs and grants, this document reinforces the CDC's commitment to safeguarding information systems while ensuring that all personnel understand their roles in maintaining cybersecurity and compliance with federal regulations. It functions as a foundational framework essential for operational integrity across CDC information technology platforms.
    The SYSTEM SECURITY PLAN outlines the security protocols for a designated government information system categorized as having a moderate impact on confidentiality. It details the identification of the system, including responsible organization contacts, purpose, user roles, and types of Controlled Unclassified Information (CUI) processed. A comprehensive system environment description includes hardware and software inventory, ensuring ownership and maintenance by the organization. The document elaborates on security requirements sourced from NIST Special Publication 800-171, covering critical areas such as access control, training, incident response, media protection, and personnel security. It specifies implemented and planned security measures, including monitoring systems to control access, employing multi-factor authentication, and maintaining audit logs. Furthermore, the plan addresses the physical and environmental protections required for systems, including the safeguarding of sensitive information during maintenance and the management of physical access. A risk assessment and ongoing security control evaluations are mandated to ensure system integrity. The structure emphasizes a thorough approach to safeguarding information and compliance with federal regulations, showcasing commitment to security in government operations.
    The document is a detailed proposal for a government Request for Proposal (RFP) primarily related to health care management services, outlining various contract periods, pricing, and service categories. It specifies a structured timeline that includes a Base/Transition-In Period, multiple Option Periods (up to Option Period 9), and Transition-Out periods. Each period entails various Contract Line Item Numbers (CLINs) that elucidate services such as contract management, member services, provider network management, medical benefits administration, utilization management, and claims processing. The document lists a total of 12 service categories, each highlighting its contract type (e.g., Time and Materials, Cost-only, Firm Fixed Price) and specified quantities. It reflects a commitment to provide extensive administrative services to enhance healthcare delivery, compliance, and operational efficiency. The purpose is to invite qualified contractors to submit proposals for delivering tailored services to meet government healthcare needs. The comprehensive structure and detailed financial representations underscore accountability, transparency, and adherence to federal contracting regulations. This document will serve as a critical guideline for potential bidders in their proposal preparations, ensuring alignment with the government’s objectives in healthcare management.
    The HHS Subcontracting Plan Template provides a structured format for contractors whose projects may exceed $750,000 (or $1,500,000 for construction) to outline their subcontracting strategies, particularly focused on small and disadvantaged business inclusion as mandated by the Small Business Act. It emphasizes the need for submitting detailed subcontracting goals categorized by business types, including Small Business, Small Disadvantaged, Women-Owned, and Veteran-Owned enterprises, among others. The document includes sections for contractors to input project specifics, such as the total contract amount and periods of performance. Clear guidelines require contractors to develop goals based on historical performance and offer strategies for outreach and compliance with federal regulations. It mandates that all subcontractors, except small ventures, adopt similar plans. The overall goal is to ensure equitable opportunities for various business concerns while detailing procedural commitments to monitor, report, and maintain compliance throughout the contract, thus enhancing participation of small businesses in federal contracts.
    The document concerns RFP No. 75D301-25-R-73216, which pertains to the World Trade Center Health Program's selection of a Third-Party Administrator. It includes a questions and answers template (ATT109) indicating the government's solicitation for clarifications regarding the proposal requirements. The RFP outlines the federal program's intent to identify qualified administrators responsible for managing health benefits for individuals affected by the World Trade Center disaster. The emphasis is likely on ensuring that interested parties submit comprehensive proposals that meet specified criteria. This document is part of the federal government's efforts to secure services that effectively support public health initiatives, reflecting a structured approach to procurement in line with federal regulations governing grants and requests for proposals.
    The document outlines the Request for Proposals (RFP) for the World Trade Center Health Program Third-Party Administrator (TPA). It encompasses critical questions and authorizations related to the TPA’s role in managing healthcare services for members affected by the September 11 attacks. Key topics include the TPA’s responsibilities in utilization management, concurrent and retrospective reviews, interactions with Clinical Centers of Excellence, data governance, claims processing, and establishing a Nationwide Provider Network (NPN). The TPA is expected to perform comprehensive administrative duties, including provider network management, medical benefits administration, and claims processing, ensuring accurate and timely claims adjudication aligned with federal guidelines. Concerns around data accuracy, provider credentialing, and compliance with privacy laws are also addressed. The RFP emphasizes flexibility for the TPA to innovate and improve service delivery while ensuring clear communication and coordination with existing contractors. It highlights the importance of documenting processes in an Operations Manual and maintaining adequate network adequacy standards. The overall aim is to develop an effective healthcare service model that meets the unique needs of the Program's beneficiaries while adhering to regulatory standards and best practices.
    The RFP No. 75D301-25-R-73216 seeks a Third-Party Administrator (TPA) for the World Trade Center Health Program, which serves approximately 132,000 members across the U.S. and its territories. The Corporate Experience Questionnaire asks offerors to demonstrate prior experience in delivering TPA services for health benefit plans, emphasizing the need for substantial corporate-level experience, rather than individual qualifications. Offerors are required to document relevant experiences, including the use of subcontractors and affiliations, in specified areas such as coordination of benefits, provider network management, and claims processing on a similar scale to the Program's 500,000 to 600,000 annual claims. Additionally, offerors must showcase their capabilities in technology utilization, data management, and compliance with regulations like HIPAA. The evaluation focuses on corporate experience's predictive ability for successful service delivery, reflecting the importance of a robust and experienced contractor for the Program's operational needs.
    This document pertains to RFP No. 75D301-25-R-73216 for the World Trade Center Health Program, in which a company is submitting a proposal to be either the prime contractor or a subcontractor for the CDC’s Third-Party Administrator contract. It includes a Past Performance Authorization Form that allows the CDC to evaluate the company's past performance on a referenced contract. The form requires the company to provide details about a specific contract performed for another organization and authorizes that organization to discuss the company’s past performance with the CDC, either through a phone call or by supplying written information. The completion of this form is essential for the CDC's evaluation of the company's proposal, emphasizing the importance of past performance in the selection process for government contracts. The document concludes with request lines for authorization signatures and contact information for both the past performance reference point of contact and the submitting company. Overall, it underscores the procedural requirements and importance of past performance in the federal contracting process.
    The government document outlines the user stories for a secure self-service portal intended for members and providers of the World Trade Center Health Program (WTCHP). The main goal is to enhance communication and access to information regarding health coverage. For WTCHP members, the portal will allow convenient communication with the Third-Party Administrator (TPA), access to their member profile, timely updates on enrollment and certification status, retrieval of Program information (such as explanation of benefits and claims), and easy identification of in-network providers. Similarly, WTCHP providers will benefit from the ability to communicate with the TPA, access member profiles and clinical histories, find necessary Program materials, and submit prior authorization requests. The acceptance criteria establish clear functionalities for both members and providers, requiring 24/7 access (excluding maintenance) and functionalities like downloadable formats and notifications. This document is part of the RFP process, essential for developing an effective health management interface that prioritizes user experience and service efficiency.
    The document outlines the evaluation criteria for proposals related to the World Trade Center Health Program's need for a Third-Party Administrator, under RFP No. 75D301-25-R-73216. The Government will rate each proposal based on its confidence in the offeror's ability to successfully meet contract requirements, using a five-tier rating system: substantial confidence, high confidence, moderate confidence, some confidence, and low confidence. Each level indicates the degree of risk associated with the offeror’s performance, ranging from low risk (substantial confidence) to high risk (low confidence). Offerors must address specific aspects outlined in individual technical sub-factor evaluations, which will influence the Government's confidence level. This structured assessment ensures that qualified bidders are selected to fulfill the program's needs effectively, minimizing reliance on Government oversight during execution.
    The document outlines the evaluation criteria for past performance in response to RFP No. 75D301-25-R-73216, which pertains to the World Trade Center Health Program's Third-Party Administrator. The government employs a singular integrated rating system based on three factors: recency, relevancy, and quality of an offeror’s past performance. Offerors will receive one of five ratings: "Substantial confidence" indicates high expectations for successful performance; "Satisfactory confidence" reflects reasonable expectations; "Neutral confidence" is assigned when no relevant performance records exist; while "Limited confidence" suggests a low expectation of success. This approach ensures a comprehensive assessment of potential contractors, emphasizing the importance of a strong past performance record in awarding government contracts. The document is structured to define these ratings clearly, ensuring that all offerors understand how their performance history will be evaluated to foster transparency and accountability in the procurement process.
    The document pertains to RFP No. 75D301-25-R-73216, which concerns the World Trade Center Health Program and sets forth requirements for offerors regarding proprietary and non-public data. It mandates that offerors certify possession or lack thereof of any such data that might relate to the scope of work under the solicitation or previous contracts. If they possess such data, a detailed mitigation plan must accompany their proposal. The offerors must ensure that no proprietary information is used in preparing their submissions and affirm compliance with federal laws concerning access to confidential data. Furthermore, they must take adequate steps to mitigate risks associated with any previous possession of sensitive information. Overall, the certification process is aimed at maintaining the integrity of the proposal submissions and safeguarding sensitive information related to the World Trade Center Health Program.
    The document outlines a Controlled Unclassified Information (CUI) Plan of Action for a specific system, detailing weaknesses identified within its framework. It specifies responsible offices, resource estimates (funded, unfunded, or reallocated), and scheduled completion dates for addressing these weaknesses. Additionally, it lists milestones with interim completion dates and notes any changes to these milestones. The means by which each weakness was identified is also documented, along with the current status of the remediation efforts, indicating whether they are ongoing or complete. This plan serves as a critical tool for ensuring compliance, security, and effective management of sensitive information in line with federal standards, particularly relevant in the context of government RFPs and grants which often necessitate stringent information security measures. The overall focus is on systematically addressing identified vulnerabilities to enhance the integrity and security posture of the system involved.
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