36C10G19R0018-A0002004.docx

PERFORMANCE WORK STATEMENT

DEPARTMENT OF VETERANS AFFAIRS

Health Services Medical Claims Processing Fiscal Year 2018 (FY18) Financial Services Center

VA-18-00123165

Date: December 28, 2018

Performance Work Statement Health Services Medical Claims Processing FY18 for the Department of Veterans Affairs Financial Services Center

BACKGROUND

The Department of Veterans Affairs (VA), Financial Services Center (FSC) is authorized by the Government Management Reform Act of 1994 (Public Law 103-356) to provide administrative support services on a reimbursable basis to VA and Other Government Agencies (OGA’s), as a Franchise Fund. The goals of the Franchise Fund organizations include: lowering overhead costs, improving the quality and delivery of services, creating economies of scale, eliminating redundant services, being auditable.

The VA-FSC is committed to developing a performance based culture in the workforce. The agency’s talent management strategy is an integral part of the agency’s business strategy, which supports the strategic plan and priority goals. The standards that support this strategy are based around three principles:

· Plan for and manage current and future workforce needs

· Design, develop, and implement proven strategies and techniques to attract, hire, develop and retain talent

· Make progress toward closing any knowledge, skill, and competency gaps throughout the agency

VA-FSC processes medical claims in support of their customers. Vendors providing medical services and care to individuals send claims to the VA-FSC for adjudication in accordance with appropriate fee schedules based on customer program requirements. The VA-FSC is responsible for processing the associated medical claims submitted by the medical providers in accordance with the Prompt Payment Act and customer program requirements and reimbursing medical care providers on behalf of customers. This acquisition is for staffing to assist with medical claim processing. Current VA-FSC customers include, but are not limited to, 21 Veteran Integrated Service Networks (VISNs) throughout the United States (US), Veterans Choice Program, Department of Health and Human Services, dialysis medical claims (Medicare), and compensation claims resulting from Veterans’ exposure to contaminated water at Marine Corps Base Camp Lejeune, North Carolina. Future growth for FSC product lines may include the processing of all medical claims that will be part of the VA Community Care Network contract. Medical claims adjudication software is not a part of this requirement. All necessary equipment is provided by the Government for onsite work during the period of performance.

SPECIFIC PERFORMANCE REQUIREMENTS

This acquisition is for staffing to support of medical claims processing. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS.

2.1 Medical Claims Processing:

The Contractor shall use the VA-FSC medical claims processing system which incorporates an Internet authorization application, document processing functionality, optical character recognition (OCR) scanning capability, VA medical claims processing software, and VA Purchase Care System functionality. All equipment shall be provided by the Government for onsite work.

The Contractor shall process claims that are submitted individually or multiple claims submitted concurrently (bulk claims). Medical claims processing consist of five sections; VA Choice, Fee Basis Claims Systems (FBCS which will be replaced with Non-Network Community Care Claims during the period of performance), Dialysis, Camp Lejeune and Other Government Agencies (OGA) with FBCS having three subsections. The Contractor shall maintain an hourly claims processing rate for each Medical Claims Processor (MCP) per the designated section as indicated by the chart below.

Per MCP

In addition, the Contractor shall:

Input medical claims data into the VA-FSC medical claims processing system using eCAMS HCE, Plexis Care Manager (PCM) or FBCS. The Contractor shall manually enter any claims which do not scan correctly using OCR.

Examine vouchers, invoices, claims and other payment requests for various types of medical services for authorized patients for completeness, accuracy and compliance with laws and regulations. Review claims for appropriate diagnostic and procedural coding for all Health Care Financing Administration-1500 (HCFA-1500), Uniform Bill-04 (UB-04), Centers for Medicare & Medicare Services (CMS 1450), American Dental Association (ADA), Uniform Bill 92 (UB-92) and other claim forms. Ensure compliance with Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) medical claims coding regulations and guidelines, and Medicare billing standards (or latest version).

Type of claims processed include, but not limited to; Critical Access Hospital (CAH), Long Term Care Hospital, Psych Facility (IPF), Skilled Nursing Facility (SNF), Ambulatory Surgical Center (ASC), General Acute Care (GAC), Ambulance, Anesthesia, Office Visit / Clinic, Inpatient / Outpatient, Surgical, Emergency Room, Physical Therapy, Durable Medical Equipment (DME), Nursing Home, Laboratory, Urgent Care, Rural Health Clinic and Dialysis.

Provide comments to include recommended claims dispositions: acceptance and payment; or rejection due to the need for corrections by the claimant. The claimant is any person who making a claim, especially in a lawsuit or for a government-sponsored benefit

For accepted claims, process all necessary payment transactions through to the U.S. Treasury.

Forward rejected claims to claimants with recommendations for corrections.

Analyze and audit any overpayments or underpayments of claims. Review and edit automated letters to claimants informing them of their obligation to provide payments for underpayments or reimburse overpayments for government signature. Follow up with claimants through phone or email contact as needed until payments are resolved according to the training and procedures provided by the Government. Inform the Government of payments that have not been resolved within a reasonable period of time not to exceed two weeks

2.1.7 Contractor shall provide a monthly report of progress. This report shall delineate the number of claims, and the type of claims, number of accepted claims, rejected, underpayments, and overpayments. The report shall also provide overall rate per hour of staff.

Operational Medical Claims Help Desk (NOT INFORMATION TECHNOLOGY HELP DESK)

In addition to claims processing, Contractor personnel shall be required to provide Help Desk Support (not Information Technology Help Desk) answering inquires (phone calls and emails) about claims previously submitted. The Contractor shall respond to written and oral inquiries that are received from VA-FSC customers by phone or via e-mail.

The Contractor shall use the VA medical claims system and other appropriate software to research customer inquiries. The Contractor shall take information from these locations or systems, , policies and procedures, and analyze information. The Contractor shall interpret that information to provide a response that is accurate and easily understood by the customer.

The Contractor shall determine when requests must be forwarded to their supervisor or elevated to a Government lead for resolution. For issues that require elevation to the Government, the Contractor shall provide clear and concise documentation of the customer’s help desk request and identify or provide the information found during research.

The government representative(s) will monitor performance by the Contractor to determine how the Contractor is performing against performance standards according to the Quality Assurance Surveillance Report. When a Contractor performance issue occurs, the COR will notify the Program Manager and Contracting Officer (CO). The COR/CO will engage the Contractor PM to resolve the discrepancy.

PERFORMANCE DETAILS

Period of Performance

The contract shall be a FFP/LH contract. The period of performance shall be one, 12-month base period with two, 12-month option periods.

· Base Year Sept 13, 2019 – Sept12, 2020

· Option Year 1: Sept13, 2020 – Sept 12, 2021

· Option Year 2: Sept 13, 2021 –Sept 12, 2022

The Contractor shall provide services during the hours of operation (paragraph 4.2 below), except for the following federal holidays set by law (USC Title 5 Section 6103). This list of holidays relates to Government duty days and is not intended to supplement or otherwise alter the provisions of any Wage Determination regarding applicable paid holidays.

There are ten Federal holidays set by law (USC Title 5 Section 6103) that VA follows: New Year’s Day, Martin Luther King Day, President’s Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day, and Christmas.

Under current definitions, four are set by date:

If any of the above falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if one falls on a Sunday, then Monday shall be observed as a holiday.

Place of Performance

Contractors shall work onsite at the Department of Veterans Affairs- Financial Services Center (FSC) locations:

· VA-FSC 7600 Metropolis Drive, Building 5, Austin, Texas 78744, VA-FSC

· VA-FSC Waco Medical Center 4800 Memorial Drive, Building 92, Waco, Texas 76711 Hours of Operation

The Contractor shall provide medical claims processing services Monday through Friday, except Federal Holidays.

· Core Day Shift Hours: Between 6:00am – 5:00pm CST (8-hour shift)

· Night Hours: 4:00pm – 1:30am CST

· Core Weekend Shift Hours: Between 6:00am – 5:00pm CST

It is anticipated there shall be additional staffing required to process medical clams outside of the core days / hours. It shall be incumbent on the contractor to provide staffing support requested by the Government. Examples include but are not limited to overtime and weekends.

The Contracting Officer will provide the Contractor with 48 hours’ notice if there is a need for additional coverage by issuing a modification. Ad hoc Labor/Overtime shall be priced as an optional CLIN.

Contractor Personnel Requirements

Contractor staffing levels for this requirement may increase and/or decrease throughout the performance period based on the following variables:

1. The number of medical claims received. Past claim volumes are not a good indication of future workload.

2. The need for manual review of claims; the complexity depends on the type of claim being reviewed. Manual review consists of approximately 2.5% of all claims received.

3. A combination of a manual and software automation review to process a claim.

Potential increases and/or decreases in contractor staffing levels will be subject to a contract modification. The Contracting Officer will provide direction to the Contractor on staffing changes.

The Contractor shall provide medical claims processing services at the Austin, TX location and the Waco, TX locations. Additional staffing shall be supported under separate optional labor hour CLINs which are grouped according to labor category with individual optional CLINs with not to exceed ceiling amounts listed on the price schedule. Based on current and historical claim volumes, the Government recommends the following base level of effort to support annual claims processing;

Austin Location

1,920 hours for Program Manager 1,920 hours for Site Supervisor 176,640 hours for Acct. Clerk II 11,520 hours for Acct. Clerk III (leads) 1,920 hours for Clerical Asst (Acct. Clerk II)

Waco Location

63,360 hours for Acct. Clerk II 3,840 hours for Acct. Clerk III (leads)

Should the Government exercise optional CLINs for additional hours, 92,160 hours for Acct. Clerk II and 3,850 hours for Acct. Clerk III (24 Optional CLINS) can be accommodated at the Austin, Texas location during the core day shift hours and during the night hours at the Austin, Texas location.

3.4.1 Personnel

The Contractor shall provide the personnel needed to satisfy the services performed under this contract and subsequent option years (if exercised). All contractors shall conduct business within VA according to the ICARE values. The Contractor shall provide personnel that meet all qualifications. Any substitutes or replacements by the Contractor shall have qualifications that meet the requirements herein. The following positions are applicable to this requirement:

3.4.2 Program Manager (PM) or Equivalent (Equiv)

The Program Manager (PM) or Equivalent (Equiv) shall provide the supervision needed for all Contractor personnel to perform the scope of work accurately, efficiently and within established time frames to attain the required performance metrics in this PWS. The PM or Equiv shall be the primary interface with the Government. The PM shall ensure this contract is sufficiently staffed and there is no lapse in services.

Minimum Experience: The PM or Equiv shall possess at least 5 years of experience supervising personnel on processing medical claims and vouchers using numerous database applications in accordance with medical claims coding regulations and guidelines. The PM or Equiv shall have demonstrated success leading a large team focused on meeting organizational goals, continuous improvement and implementing human capital management strategies.

The PM or Equiv shall possess in-depth subject matter knowledge and judgement to direct the performance of the personnel. In addition, the PM or Equiv shall have proven capability and experience to supervise a team of the size needed to perform the scope and accuracy of work and to attain the required performance metrics in the PWS. The PM shall have an in depth understanding of billing and follow up regulations as it relates to Medicare. The PM or Equiv shall have an in depth understanding of electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system.

The PM shall have a thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version).

The PM shall have knowledge and expertise in the use of Microsoft Office Products such as Word, Excel, and Project.

Minimum Education: Bachelor’s Degree.

3.4.3 Medical Claims Processor (MCP) Lead (Supervisor) or Equivalent (Equiv)

The MCP Lead functions as the team supervisor and subject-matter expert for a claims area. Responsible for creating reports, distributing workload and training new employees. Responds accurately and timely to inquiries from team members, including management, concerning claims processing and other technical issues. Investigates and initiates resolutions to complex claim problems. Identifies training gaps and assists employees to ensure consistent application of established guidelines. Identifies issues with procedures or processes and provides feedback to management on changes and development. Serves as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed.

Responsible for the accurate and timely processing of medical claims in addition to their supervision duties. Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved policies, procedures or reference training materials. Coordinates with internal/external departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Determines whether to return, deny or pay claims following organizational policies and procedures. Corrects processing errors by reprocessing, adjusting, and/or recouping claims. Ensures claims are processed according to established quality and production standards (see section 8.0, Performance Measures). Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints.

Minimum Experience: 2 years of experience processing, researching and adjudicating medical claims.

The Lead or Equiv shall have demonstrated success working in a team environment focused on meeting organizational goals, objectives, and strong customer service skills. Additionally, the Lead or Equiv shall have an in depth understanding of billing and follow up regulations as it relates to Medicare. Shall have an in depth understanding of electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system.

Minimum Education: High School Diploma or t Equivalent (Equiv)

The Lead or Equiv shall have a high school diploma and at least 2 years of experience processing medical claims and vouchers. The Lead shall work to have a thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, and Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version) within three months from their date of hire. Additionally, the Lead shall possess working knowledge of Microsoft Office Suite.

3.4.4 Medical Claims Processor (MCP) or Equivalent (Equiv)

The MCP is responsible for the accurate and timely processing of medical claims. Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Coordinates with internal/external departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Determines whether to return, deny or pay claims following organizational policies and procedures. Performs research on claim problems by utilizing approved policies, procedures, reference training materials, forms and coordinates with various internal support areas. Corrects processing errors by reprocessing, adjusting, and/or recouping claims. Ensures claims are processed according to established quality and production standards (see section 8.0, Performance Measures). Assists the lead medical claims processor in training or mentoring new contractor staff members. Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints.

Minimum Experience: 1 year of experience processing, researching and adjudicating medical claims.

The MCP or Equiv shall work to have a thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version) within three months from their date of hire. Additionally, the MCP or Equiv shall work to understand billing and follow-up regulations as it relates to Medicare within three months from their date of hire. The MCP or Equiv shall understand electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system.

Minimum Education: High School Diploma or equivalent.

The MCP or Equiv shall possess working knowledge of Microsoft Office Suite.

3.4.5 Administrative Personnel or Equivalent (Equiv)

The Administrative Personnel or Equiv performs a variety of moderately complex general support duties under general supervision. The Supervisor normally provides general instructions and work priorities. Completed work may be reviewed by Supervisor for accuracy. Typical duties include but not limited to; coordinating / scheduling activities, tracking inventory, reviewing training for compliance, coordination of security clearances, record keeping and assisting in the preparations of reports. Acting as a liaison with staff members and disseminating information.

The Administrative Personnel or Equiv shall have high school diploma or its equivalent with 2 or more years of experience in the field or in a medical field or a professional working environment. Additionally, the Administrative staff shall possess working knowledge of Microsoft Office suite.

3.4.6 Key Personnel

The Contractor shall assign lead personnel to supervise performance of the work in this PWS with the goals to meet performance measures. The Key Personnel are the PM or Equivalent and MCP Lead. Key Personnel are essential for successful Contractor accomplishment of the work to be performed. Key personnel are those persons whose resumes are submitted with the proposal. The Contractor shall not remove, divert, or replace any Key Personnel without written approval of the Contracting Officer (CO).

Requests to substitute Key Personnel shall be provided to the CO for approval no later than thirty (30) calendar days prior to making any change. The request shall be in writing and shall provide a detailed explanation of the circumstances necessitating the proposed substitution of key personnel. The Contractor shall submit a complete resume for the proposed substitute Key Personnel, and any other information requested by the CO in order to approve or disapprove the proposed substitution. The CO will evaluate such requests and notify the Contractor of approval or disapproval thereof in writing.

Training

VA-FSC Government Led Training:

All Contractors shall attend up to 85 hours of Government led training prior to beginning work. This training shall include the following;

· 3 hours of VA-FSC’s newcomer’s orientation held onsite at the Austin, Texas location and virtually for the Waco, Texas location.

· 2 hours of computer based training using the VA Talent Management System (TMS).

· VA Contractor Rules of Behavior

· Privacy and Information Security Awareness

· Prevention of Workplace Harassment/No Fear

· 40 hours of classroom training on VA medical claim processing systems and standard operating procedures held onsite at the Austin and Waco, Texas locations.

· 40 hours of on the job training processing medical claims held onsite at the Austin and Waco, Texas locations. (Dependent on favorable SAC background check and completion of 40 hour of Government led classroom training)

Records of contractor employee completion of this training shall be maintained by the Contractor and made available to the COR upon request. Contractors who successfully complete their initial agency background investigation and Government led trainings shall be able to commence work.

Contractor Led Training:

The Contractor shall be responsible for providing up to 40 hours of training to its staff (preferably by a trained or certified expert in the field) on Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version), and Medicare billing and regulations for each employee within one (1) month from the date of hire. The number of training hours required should be dependent on an individual’s work experience that align with PWS requirement 2.1. The Contractor shall provide a training plan with course syllabus with their proposal. The plan shall be presented during the kick-off meeting.

Training may be provided onsite or virtual. Training certification shall be maintained by the Contractor and made available to the COR upon request.

Ongoing Supplemental Contractor Led Training:

The Contractor shall implement a Train the Trainer education model whereby trained contractors or contractor employees teach, mentor or train its contractors on current or future VA systems and procedures.

In addition, Contractors shall be responsible for completing all annual VA mandatory training courses using the VA Talent Management System (TMS); course completion will be tracked therein for compliance. Annual TMS Courses Include: VA Contractor Rules of Behavior, VA Privacy and Information Security Awareness, VA Prevention of Workplace Harassment/No Fear.

Security

The position sensitivity impact for this effort has been designated as Moderate Risk and the level of background investigation is Tier 2 / Moderate Background Investigation (MBI) (see PWS Section 6.2. Personnel Security Requirements for details). The current cost for this is $1,747.00 per contractor employee, plus $30.00 for the SAC Adjudication. Refer to Section 11.0 for more information regarding security requirements and policies.

The typical time for initial SAC background checks to be completed is 30 – 60 days if all information provided by the contractor is accurate.

Continuity of Operations Plan (COOP)

Should the Government implement its Continuity of Operations Plan (COOP), Contractor personnel that are approved for telecommute or virtual work shall work from their approved alternate work site. The contracted employees shall receive guidance directly from the contractor’s supervisor which shall be directed by COR. All other personnel shall attain guidance from the Contractor Program Manager or COR.

Continuity of Operations planning is a federal initiative to encourage people and departments to plan to address how critical operations will continue under a broad range of circumstances. COOP is important as a good business practice and because the planning fosters recovery and survival in and after emergency situations.

A COOP plan addresses emergencies from an all-hazards approach. A continuity of operations plan establishes policy and guidance ensuring that critical functions continue and that personnel and resources are relocated to an alternate facility in case of emergencies. The plan should develop procedures for:

•alerting, notifying, activating and deploying employees •identify critical business functions •establish an alternate facility •roster personnel with authority and knowledge of functions

Travel

Travel is not authorized for this effort. The Contractor shall be responsible for any expenses incurred for Contractor personnel to train or work.

Kick-Off Meeting

The Government will conduct a kick-off meeting within seven (7) calendar days after award with the Contractor Team. The Government Team will include the COR, CO and the Government Program Manager. The Contractor shall brief the Transition In / Out Plan (including a staffing plan), Training Plan to include syllabus, Human Capital Management Plan and Quality Assurance Plan using the guidance contained in the Quality Assurance Surveillance Plan (QASP). The Contractor shall provide briefing material no later than two (2) working days prior to the kick-off meeting. The kick-off meeting will be held onsite at the Austin, Texas location.

Transition Planning & Human Capital Management

3.10.1 Transition in Plan:

The Contractor shall provide a plan for transition and orientation services to ensure medical claims processing services to VA-FSC are not severed or degraded. Specifically, the Contractor shall address how the contract will be staffed from contract commencement and throughout the period of performance to ensure attainment of performance metrics. This plan shall include the management and oversight for hiring/onboarding (including security checks) staff, Government led and Contractor led trainings. The Contractor shall provide a draft transition plan with their proposal. The Government shall work with the awardee to finalize the plan NLT 5 calendar days after the contract award date. After acceptance, the plan shall be presented during the kick-off meeting.

3.10.2 Human Capital Management Plan

The Contractor shall provide a plan for implementing proven strategies and techniques for attracting, hiring, developing and retaining talent. Specifically, the Contractor shall address overtime and personnel surge capabilities. The Contractor shall provide plan with their proposal and it shall be presented during the kick-off meeting.

3.10.3 Transition Out Plan:

The Contractor shall provide a plan for transitioning out to either the Government or subsequent Contractor at the time the services under this contract conclude. In the Transition Out Plan, the Contractor shall address how the Contractor intends to maintain a level of services required to meet performance metrics individually, or in coordination with the subsequent provider. The Contractor shall provide a draft transition plan with their proposal. The Government shall work with the awardee to finalize the plan NLT calendar 5 days after the contract award date. After acceptance, the plan shall be presented during the kick-off meeting.

Telework / Virtual Work

Virtual or telework is not currently offered at this time. work. Virtual or telework may be offered at a later date. Consequently, the Contractor will be responsible for providing all equipment for virtual or telework to include:

Telecommute Equipment:

· Laptop w/card reader

· Laptop Case

· Additional Monitor(s) – COR Approval Required

· Docking Station

· Keyboard

· Mouse

· Lock set cable

· Head set

· Internet sufficient to process medical claims IAW 2.1, Medical Claims Processing

The Government shall provide the gateway for remote access to VA specific systems/network in accordance with VA Handbook 6500, which requires the use of a VA approved method to connect external equipment/systems to VA’s network. Citrix Access Gateway is the current and only VA approved method for VPN access users when using or manipulating VA information for official VA Business. VA permits remote access through contractor furnished equipment that meets all applicable 6500 Handbook requirements. The Contractor shall provide proof to the COR for review and approval that their equipment meets all of the VA Handbook 6500 requirements and VA Handbook 6500.6 Appendix C, herein incorporated as Addendum B, before use. Authorized remote users shall not be permitted to copy, print or save any VA information accessed via remotely at any time. VA prohibits remote access to VA’s network from non-North Atlantic Treaty Organization (NATO) countries. The exception to this are countries where VA has approved operations established (e.g. Philippines and South Korea). Exceptions are determined by the COR in coordination with the Information Security Officer (ISO) and Privacy Officer (PO).

Personnel Roster

The Contractor shall provide an initial personnel roster within fifteen business days after award the Contractor shall provide an initial personnel roster of Contractor and Subcontractor personnel to the COR to begin their background investigations. The roster shall contain each contractors title (PM, MCP Lead, MCP, Administrative), location (Austin, Waco) full name, date of birth, place of birth, email address and individual background investigation level requirement (to support Section 6.3, Personnel Security Requirements). The Contractor shall submit full social security numbers either within the personnel roster or under separate cover to the COR. The Personnel Roster shall be updated and provided to VA within one day of any changes in employee status, training certification completion status, background investigation level status, additions/removal of employees, etc. throughout the Period of Performance. The Contractor personnel roster shall remain a historical document indicating all past information and the Contractor shall indicate in the comment field whether the employee is no longer supporting this contract. The preferred method to send the personnel roster or social security number is by encrypted e-mail. If unable to send encrypted e-mail, other methods which comply with FIPS 140-2 are to encrypt the file, use a secure fax, or use a traceable mail service. The final roster shall be provided 5 calendar days after the Period of Performance (POP) begins.

The Contractor shall update the roster monthly; not later than the 10th calendar day of the month for subsequent rosters. Updates are not required if no changes occur.

POSITION/TASK RISK DESIGNATION LEVEL(S) AND CONTRACTOR

Security and Privacy Requirements

Protected health information may be disclosed or accessed and a signed Business Associate Agreement (BAA) shall be required. The Contractor shall adhere to the requirements set forth within the BAA, referenced in Section D of the solicitation.

Personnel Security Requirements

The position sensitivity and the level of background investigation required for each Contractor personnel are commensurate with the required level of access for the tasks defined in this PWS. As indicated in Table 2 below, the Contractor shall deem all tasks in this PWS as Position Sensitivity “Moderate” (also referred to as Tier 2 or MBI.)

Table 2. Background Investigation and Task Risk Designation Levels

Contractor Personnel Security Requirements

The Contractor shall prescreen all personnel requiring access to the computer systems to ensure they maintain the appropriate Background Investigation, and are able to read, write, speak and understand the English language.

The Contractor shall bear the expense of obtaining background investigations.

The Contractor should coordinate the location of the nearest VA fingerprinting office through the COR. Only electronic fingerprints are authorized.

For a Moderate Risk designation the following forms are required to be completed: 1.OF-6, VA Form 0710 and 2. DVA Memorandum – Electronic Fingerprints. These initial documents should be submitted to the COR within five business days after award or date of hire; final documents shall be submitted no later than 30 calendar days before the POP.

The Contractor personnel shall submit all required information related to their background investigations (completion of the investigation documents (SF85, SF85P, or SF 86) utilizing the Office of Personnel Management’s (OPM) Electronic Questionnaire for Investigations Processing (e-QIP) after receiving an email notification from the Security and Investigation Center (SIC).

The Contractor personnel shall certify and release the e-QIP document, print and sign the signature pages, and send them encrypted to the COR for electronic submission to the SIC. These documents shall be submitted to the COR within three business days of receipt of the e-QIP notification email. (Note: OPM is moving towards a “click to sign” process. If click to sign is used, the Contractor personnel should notify the COR within three business days that documents were signed via eQIP).

A Contractor may be granted unescorted access to VA facilities and/or access to VA Information Technology resources (network and/or protected data) with a favorably adjudicated Special Agreement Check (SAC) or “Closed, No Issues” (SAC) finger print results, training delineated in VA Handbook 6500.6 (Appendix C, Section 9), and, the signed “Contractor Rules of Behavior.” However, the Contractor will be responsible for the actions of the Contractor personnel they provide to perform work for VA. The investigative history for Contractor personnel working under this contract must be maintained in the database of the OPM.

The Contractor, when notified of an unfavorably adjudicated background investigation for Contractor personnel as determined by the Government, shall withdraw the personnel from consideration in working under the contract.

Failure to comply with the Contractor personnel security investigative requirements may result in loss of physical and/or logical access to VA facilities and systems by Contractor and Subcontractor employees and/or termination of the contract for default.

Identity Credential Holders must follow all HSPD-12 policies and procedures, as well as, use and protect their assigned identity credentials in accordance with VA policies and procedures, displaying their badges at all times, and returning the identity credentials upon termination of their relationship with VA.

DOCUMENTATION

Data Rights

All information reviewed, acquired and documents developed during this contract shall belong to VA. The Government shall retain all rights and privileges, including those of patent and copy, to all Government furnished data. The Contractor shall neither retain nor reproduce for private or commercial use any data or other materials furnished under this contract. The Contractor agrees not to assert any rights at common law or in equity or establish any claim to statutory copyright in such data. These rights are not exclusive and are in addition to any other rights and remedies to which the Government is otherwise entitled elsewhere in the contract.

Deliverables

The Contractor shall provide the documentation identified in Table 2 below. The Contractor shall deliver the documents in electronic (e.g., searchable PDF and source application format such as Microsoft Office Word or Excel) and/or hard copy (e.g., bound or notebook, etc.) formats as specified below.

Table 2 - Deliverables

CO, COR

Electronic format

CO, COR

Electronic format

PERFORMANCE MEASURES

The Government will evaluate contractor performance and deliverables against the following criteria to determine interim and final acceptance of the services provided:

of random sampling of bulk claims submissions

DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE

The Government shall document acceptable performance accordingly. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE

When unacceptable performance occurs, the COR shall inform the CO. This will always be in writing although when circumstances necessitate immediate verbal communication, that communication will be followed in writing. The COR shall document the discussion and place it in the COR file.

When the CO determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the Contractor's program manager.

The Contractor shall acknowledge receipt of the CDR in writing to the CO. The CDR will state how long after receipt the Contractor has to take corrective action. The CDR will also specify if the Contractor is required to prepare a corrective action plan to document how the Contractor shall correct the unacceptable performance and avoid a recurrence. The CO shall review the Contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

CYBER AND INFORMATION SECURITY REQUIREMENTS FOR VA IT SERVICES:

The Contractor shall ensure adequate LAN/Internet, data, information, and system security using VA Handbook 6500 as guidance with VA standard operating procedures and standards as set forth within the PWS, conditions, laws, and regulations. The Contractor’s firewall and web server shall meet or exceed VA minimum requirements for security. All VA data shall be protected behind an approved firewall. Any security violations or attempted violations shall be reported to the VA Program Manager and VA Information Security Officer as soon as possible. The Contractor shall follow all applicable VA policies and procedures governing information security.

Contractor supplied equipment, PCs of all types, equipment with hard drives, etc. for contract services must meet all security requirements that apply to Government Furnished Equipment (GFE) and Government Owned Equipment (GOE). Security Requirements include: a) VA Approved Encryption Software must be installed on all laptops or mobile devices before being placed into operation, b) Bluetooth equipped devices are prohibited within VA; Bluetooth must be permanently disabled or removed from the device, c) VA approved anti-virus and firewall software, d) Equipment must meet all VA sanitization requirements and procedures before disposal. The CO, COR, the Project Manager, and the Information Security Officer (ISO) must be notified and verify all security requirements have been adhered to.

Contractor employees shall complete a VA Systems Access Agreement if they are provided access privileges as an authorized user of the computer system of VA.

VA Enterprise Architecture Compliance

The applications, supplies, and services furnished under this contract must comply with One-VA Enterprise Architecture (EA), available at http://www.ea.oit.va.gov/index.asp which is enforced at the time of issuance of this contract, including the Program Management Plan and VA's rules, standards, and guidelines in the Technical Reference Model/Standards Profile (TRMSP). VA reserves the right to assess contract deliverables for EA compliance prior to acceptance.

PHYSICAL SECURITY and SAFETY REQUIREMENTS:

The Contractor and their personnel shall follow all VA policies, standard operating procedures, applicable laws and regulations while on VA property. Violations of VA regulations and policies may result in citation and disciplinary measures for persons violating the law.

The Contractor and their personnel shall wear visible identification at all times while on VA premises.

The VA does have available parking at the Austin and Waco, Texas locations. It is the responsibility of the Contractor to park in the appropriate designated parking areas. VA will not invalidate or make reimbursement for parking violations of the Contractor under any conditions.

Smoking is prohibited inside/outside any building other than in designated smoking areas.

The possession of weapons is prohibited.

The Contractor shall obtain all necessary licenses and/or permits required to perform the work, with the exception of software licenses that need to be procured from a Contractor or vendor in accordance with the requirements document. The Contractor shall take all reasonable precautions necessary to protect persons and property from injury or damage during the performance of this contract.

Confidentiality and Non-Disclosure The Contractor shall follow all VA rules and regulations regarding information security to prevent disclosure of sensitive information to unauthorized individuals or organizations. The Contractor may have access to Protected Health Information (PHI) and Electronic Protected Health Information (EPHI) that is subject to protection under the regulations issued by the Department of Health and Human Services, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA); 45 CFR Parts 160 and 164, Subparts A and E, the Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”); and 45 CFR Parts 160 and 164, Subparts A and C, the Security Standard (“Security Rule”). Pursuant to the Privacy and Security Rules, following contract award the Contractor must agree in writing to certain mandatory provisions regarding the use and disclosure of PHI and EPHI.

The Contractor will have access to some privileged and confidential materials of VA. These printed and electronic documents are for internal use only, are not to be copied or released without permission, and remain the sole property of VA. Some of these materials are protected by the Privacy Act of 1974 (revised by PL 93-5791) and Title 38. Unauthorized disclosure of Privacy Act or Title 38 covered materials is a criminal offense.

The VA Contracting Officer will be the sole authorized official to release in writing, any data, draft deliverables, final deliverables, or any other written or printed materials pertaining to this contract. The Contractor shall release no information. Any request for information relating to this contract presented to the Contractor shall be submitted to the VA Contracting Officer for response.

Contractor personnel recognize that in the performance of this effort, Contractor personnel may receive or have access to sensitive information, including information provided on a proprietary basis by carriers, equipment manufacturers and other private or public entities. Contractor personnel agree to safeguard such information and use the information exclusively in the performance of this contract. The Contractor shall follow all VA rules and regulations regarding information security to prevent disclosure of sensitive information to unauthorized individuals or organizations as enumerated in this section and elsewhere in this Contract and its subparts and appendices.

The Contractor shall limit access to the minimum number of personnel necessary for contract performance for all information considered sensitive or proprietary in nature. If the Contractor is uncertain of the sensitivity of any information obtained during the performance this contract, the Contractor has a responsibility to ask the VA Contracting Officer.

Contractor shall train all of their employees involved in the performance of this contract on their roles and responsibilities for proper handling and nondisclosure of sensitive VA or proprietary information. Contractor personnel shall not engage in any other action, venture or employment wherein sensitive information shall be used for the profit of any party other than those furnishing the information. The sensitive information transferred, generated, transmitted, or stored herein is for VA benefit and ownership alone.

The Contractor shall maintain physical security at all facilities housing the activities performed under this contract, including any Contractor facilities according to VA-approved guidelines and directives. The Contractor shall ensure that security procedures are defined and enforced to ensure all personnel who are provided access to patient data must comply with published procedures to protect the privacy and confidentiality of such information as required by VA.

The Contractor shall adhere to the following:

The use of “thumb drives” or any other medium for transport of information is expressly prohibited.

Controlled access to system and security software and documentation.

Recording, monitoring, and control of passwords and privileges.

All terminated personnel are denied physical and electronic access to all data, program listings, data processing equipment and systems.

VA, as well as, any Contractor (or Subcontractor) systems used to support the PWS herein, shall provide the capability to cancel immediately all access privileges and authorizations upon employee termination.

Contractor PM and VA PM and/or COR shall be informed within 24 hours of any employee termination.

Acquisition sensitive information shall be marked "Acquisition Sensitive" and shall be handled as "For Official Use Only (FOUO)".

The Contractor does not require access to classified data.

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY…