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Bonzai

Champva Dental Pilot Rfi Is Out

Question

Found this while searching for CHAMPVA Dental Pilot, so the wheels are turning:

April 6, 2011 Synopsis

Notice Type: Request for Information/Sources Sought

Introduction

This market research is issued for information and planning purposes only and does not constitute a solicitation nor does it restrict the Government as to the ultimate acquisition approach. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Any contract that might be awarded based on information received or derived from this market research will be the outcome of a competitive process.

The purpose of this RFI is to identify qualified contractors who are able to meet VA's requirements, determine if commercial items are available or, could be modified to meet VA's requirements, determine the appropriate contract type i.e., firm fixed-price or cost-reimbursement or time and material, understand commercial pricing practices and other market information readily available.

The Veterans Health Administration (VHA) is seeking potential sources to enter into a contract for a Dental Pilot Program as required by Section 510 of Public Law (P.L.) 111-163, the “Caregiver and Veterans Omnibus Health Services Act of 2010”, which requires the Department to conduct a pilot program, by contract, for the purposes of offering a dental insurance plan to certain beneficiaries.

Background

Section 510 of P.L. 111-163 requires that the Secretary of Veterans Affairs (VA) shall carry out a pilot program, by contract with a dental insurer to administer a dental insurance plan, in order to assess the feasibility and advisability of providing a dental insurance plan to enrolled veterans and survivors and dependents of veterans eligible for CHAMPVA purposes. This pilot is to be conducted in such Veterans Integrated Service Networks (VISNs) as the Secretary considers appropriate for purposes of the pilot program.

Note: The Veterans Health Administration (VHA) has 21 geographic VISNs numbered 1-23 (in January 2002 VISN 13 or 14 were integrated and renamed VISN 23).

At the end of fiscal year 2009, there were just over 7.7 million Veterans enrolled in VA’s Health Care System. In fiscal year 2009, VA provided care for over 5.74 million Veterans. The median age of Veterans is 60; 20% are under age 45, 41% are between 45 and 64 and 39% are 65 or older.

In 2007, 5.5% of enrolled Veterans were women. VA projects that by 2013, 7.4% of enrollees will be women.

The CHAMPVA community consists of adults that are either the spouse, surviving spouse or helpless child of a qualifying Veteran sponsor.

Spouses and surviving spouses make up the majority of the community, with more than 266,000 eligible individuals. They make up about 82% of the CHAMPVA-eligible community and range in age from 19 to 108. They are predominantly female, but male spouses are much more common in the youngest ages for this group. The remaining members are surviving spouses of Veterans that have either died with a permanent and total disability award or died from a service-connected disability. There are about 83,000, with only 3% of this group being male.

Children make up 15% of the CHAMPVA community. They range in age from newborn (about 250 each year) to 17. This group is about equally divided between males (24,976) and females (24,326). Students make up 3% of the CHAMPVA community.

Requirements

VA is interested in recommendations of the commercial sector (dental insurance plan administrators) in meeting its charge as tasked by Section 510, P.L. 111-163. Among the specific requirements and considerations are:

1. The dental insurance plan will include diagnostic services, preventative services, endodontics and other restorative services, surgical services, and emergency services. VA is interested in learning what additional coverage of services would be appropriate for such dental insurance plan.

2. Since enrollment in the dental insurance plan under the pilot program will be voluntary and in such VISNs as may be considered appropriate, VA is interested in understanding whether there would be a recommended minimum period for enrollment and minimum number of potential enrollees in such dental insurance plan.

3. VA is interested in recommended costing mechanisms that may be used to develop premiums, to include any recommended annual adjustments to premiums, for coverage under the dental insurance plan that would cover all costs, inclusive of government costs, associated with the pilot program.

4. VA is interested in understanding other conditions that would permit the voluntary disenrollment of an individual in the dental insurance plan (but only to the extent such disenrollment does not jeopardize the fiscal integrity of the dental insurance plan) aside from allowing voluntary disenrollment of an individual in the dental insurance plan if:

• the disenrollment occurs during the 30-day period beginning on the date of the enrollment of the individual in the dental insurance plan or;

• If an individual enrolled in the dental insurance plan relocates to a location outside the jurisdiction of the dental insurance plan that prevents use of the benefits under the dental insurance plan or;

• If an individual enrolled in the dental insurance plan is prevented by a serious medical condition from being able to obtain benefits under the dental insurance plan.

5. VA is interested in suggested approaches for marketing and enrollment for the purposes of offering this dental insurance plan.

Submittal Information

It is requested that interested contractors submit a response (electronic submission) of no more than 20 pages in length, single spaced, 12 point font minimum that addresses the above information and includes the following information by August 23, 2010 to Elena.jenkins@va.gov.

1. Capabilities/Qualifications - Description of the capabilities/qualifications/skills your company possess to perform the work.

2. Teaming Arrangements - Description of Teaming Partners, Joint Ventures that your company would consider to perform the work.

3. Commercial availability - Description of the length of time your product/solution has been commercially available or, if necessary to modify your commercial product/solution, what is the impact to the commercial price, availability and magnitude of modification.

4. Socio-Economic Status - Indicate whether your company, subcontractors, teaming partners, joint ventures have a Federal Socio-Economic status, e.g., Small Business, Service-Disabled Veteran Owned Small Business, Veteran Owned Small Business, Woman-Owned Small Business, Disadvantaged Small Business, and Hub Zone. If Service-Disabled or Veteran Owned Small Business, is your company and or partners registered in VA's VetBiz repository?

5. Price information - Provide your commercial price history and rough order of magnitude for the same or similar products/solutions.

6. Other Market Information - Provide any other relative information, however this information must be included within the 20 page limitation.

Responses are requested by close of business on August 23, 2010, via email to Elena.jenkins@va.gov.

Contracting Office Address

Department of Veterans Affairs;Health Administration Center;3773 Cherry Creek Drive North, Suite 450;Denver CO 80209

Contact

Elena Jenkins, Procurement Analyst elena.jenkins@va.gov Elena Jenkins

Place of Performance

2957 Clairmont Road;Atlanta, GA 30329 USA

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2 answers to this question

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Just wanted to throw this out there.

There is a loophole for spouses and children of veterans that are eligible for dental at the VA, who ARE covered by CHAMPVA already.

This is through the TRDP (Tricare Retiree Dental Plan) through Delta Dental.

There have been a lot of people stating that Champva spouses are only eligible if there are tricare eligible, but the TDRP plan states specifically ChampVA Spouse eligibility requirements:

A current spouse and/or eligible child of a non-enrolled member with documented proof the non-enrolled member is: (a) eligible to receive ongoing comprehensive dental care from the Department of Veterans Affairs; (b) enrolled in a dental plan through employment and the plan is not available to family members; or © unable to obtain benefits through the TRDP due to a current and enduring medical or dental condition. Written documentation supporting any of these three situations must be submitted with your enrollment application.

Now the kicker is that if you are eligible for tricare then you are not eligible for champva. So why would they have a provision for champva eligible spouse in the TRDP program if they have to be eligible for tricare to get it in the first place?????

Still trying to figure that one out. Anyone have any thoughts?

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Ad

"The Veterans Health Administration (VHA) is seeking potential sources to enter into a contract for a Dental Pilot Program as required by Section 510 of Public Law (P.L.) 111-163, the “Caregiver and Veterans Omnibus Health Services Act of 2010”, which requires the Department to conduct a pilot program, by contract, for the purposes of offering a dental insurance plan to certain beneficiaries."

The Caregiver Act is so messed up already that the new April AARP magazine has an article on it under the Title:

"What A Disgrace" on page 6

The Caregiver Act and VA's implementation of the Act was intended to offer assistance in the way of cash stipends, training ,support,and respite care to caregivers of any veteran wounded after Sept 11,2001.

The article properly states "But today that assistance is nowhere to be found."

Pressure has been put on the Secretary by a group of 18 Senators to get this program going.

Edited by Berta

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