CCN Region 5 Alaska Conformed RFP 36C10G20R0014 Amendment 0003 (changes highlighted in green) 6.3.20.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. DUNS: DUNS+4:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 213

36C10G20R0014 05-11-2020

Tamela Grandberry 202-875-9529 06-08-2020

1:00PM EST

36C10G

U.S. Department of Veterans Affairs

OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400

Fredericksburg VA 22408-2697 x

524292

$32.5 Million

N/A

X

36C10G

OPAL

36C10G

OPAL | Strategic Acquisition Center

VAFSC

Financial Services Center

PO BOX 149971

(See section B.8 Invoices)

Austin TX 78714-8917

1 (877) 489-6135

See CONTINUATION Page

Title: Community Care Network Region Five (Alaska)

See B.5 Price/Cost Schedule for details

Questions Due NLT: May 15, 2020 1:00PM EST.

See CONTINUATION Page

X

X 1

Christopher Green

Contracting Officer

36C10G20R014

TABLE OF CONTENTS

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 IT CONTRACT SECURITY

B.3 PERFORMANCE WORK STATEMENT

1.0 GENERAL INFORMATION

1.1 Introduction

1.2 Background

1.3 Scope of Services

2.0 PROJECT MANAGEMENT

2.1 Post Award Meeting

2.2 Kickoff Meeting

2.3 Project Management Plan (Project Plan)

2.3.1 Implementation Strategy

2.3.2 CCN Deployment Plan

2.4 Risk Management Plan

2.5 Operational Quality and Reporting Requirements

2.6 CCN Communications Plan

2.7 Accreditation

2.8 Services

2.9 Transition

3.0 HIGH PERFORMING NETWORK

3.1 Network Access Standards

3.2 Provider Networks

3.3 Out-of-Network Providers

3.4 Identification of High-Performing Providers

3.5 CCN Region

3.6 Network Adequacy Management

4.0 CCN HEALTH BENEFIT PACKAGE

4.1 CCN Healthcare Services

4.2 CCN Complementary and Integrative Healthcare Services

4.3 Excluded CCN Healthcare Services

4.4 CCN Assisted Reproductive Technology Services

5.0 ELIGIBILITY

6.0 CUSTOMER SERVICE

6.1 Contractor VA Support Call Center Functions

6.2 CCN Provider Call Center Function

6.3 Reserved

6.4 Contractor Customer Service Technology

6.5 Veteran Complaints and Grievances and Customer Service Procedure

6.6 Congressional and VA Inquiries

6.7 CCN Provider Satisfaction Surveys

6.8 Call Center Operations and Customer Service Technology Performance

Requirements and Metrics

7.0 REFERRALS

7.1 Notification of Emergent Healthcare

7.2 Referrals from VA to CCN Provider

7.3 Referrals Requested from a CCN Provider for VA Provided Care or Another

CCN Provider

7.4 Reserved

7.5 Urgent Care

.......................................................................................... …62

7.5.7 Durable Medical Equipment (DME) …………………………………...62

7.5.8 Medical Records…………………………………………………………... 62

7.5.9 Communications……………………………………………………………63

8.0 SCHEDULING OF APPOINTMENTS

9.0 MEDICAL DOCUMENTATION

9.1 Medical Documentation Submission Process

9.2 Medical Documentation Data Elements

9.3 Medical Documentation Submission Timeframes

9.4 Medical Documentation Submission Format

9.5 Reserved

9.6 Critical Findings

9.7 Identification and Documentation of Transplant Candidates

9.8 Medical Documentation and Audit

10.0 TRAINING – CONTRACTOR PROCESSES, SYSTEMS, AND INTERFACES .. 65

10.1 Training Plan

10.2 Contractor Training Materials

10.3 VA Provided Training

10.4 Training Programs for Administration of CCN Healthcare as Required Under the MISSION Act, Section 122

10.5 Opioid Training Requirements Under the MISSION Act, Section 131

10.6 Military Culture and Key Issues in Providing Care to a Veteran Population

Training

11.0 RESERVED

12.0 CLAIMS PROCESSING AND ADJUDICATION FOR CCN HEALTHCARE

SERVICES RENDERED ……………………………………………………………………..74

12.1 Claims Processing System Functions

12.2 Paper Claims

12.3 Signature Requirements

12.4 Claims Submission and Processing Timeframes

12.5 Issuance of EOB

12.6 Issuance of Remittance Advice

12.7 Coordination of Benefits

12.8 Claims for Services Rendered to Veterans Assigned to Other CCN Region

12.9 Claims Auditing

12.10 Reserved

12.11 Reserved

12.12 Claims Reporting

12.13 Federal Codes and Regulations

12.14 Improper Payments Elimination and Recovery Improvement Act

12.14.4 Error Determination Rebuttals

12.14.7 Reduction of improper payment performance goals

13.0 VETERAN CLAIM APPEALS AND PROVIDER RECONSIDERATIONS

13.1 Veteran Appeals

13.2 Practitioner and Provider Reconsiderations

14.0 CLINICAL QUALITY AND PATIENT SAFETY MONITORING

14.1 Clinical Quality Monitoring Plan (CQMP)

14.2 Clinical Quality and Patient Safety Issues Identification

15.0 PHARMACY

15.1 Urgent/Emergent Prescriptions

15.2 Urgent/Emergent Prescription Network Adequacy

15.2.1 Urgent/Emergent Prescription Performance Metrics

15.3 Routine/ Maintenance Prescriptions

15.4 Contingency Plan for Disaster..………………………..………………….100

15.5 Urgent Care Prescriptions.……………………………………..………….101

15.6 Tribal Health Pharmacies Participating in CCN…………………………101

16.0 DURABLE MEDICAL EQUIPMENT

16.1 Urgent/Emergent Prescriptions for DME and Medical Devices

16.2 Routine Prescriptions for DME and Medical Devices

16.3 Reserved

16.4 Oral Appliance Therapy (OAT) for Obstructive Sleep Apnea (OSA)

17.0 DENTAL

17.1 Dental Network Adequacy

17.2 Dental Network Provider Credentialing

17.3 Dental Network Compliance

17.4 Dental Care Referrals

17.5 Return of Dental Records

17.6 Dental Clinical Quality Management

18.0 TECHNOLOGY

18.1 Contractor Software Configuration Management Requirements

18.2 Continuity of Operations

18.3 Contractor System Access

18.4 VA System Integration Requirements

18.5 Veteran Demographic and Administrative Data

18.6 IT Customer Service

18.7 VA Community Care Provider Portal

18.8 Contractor Self Service Website

18.9 Contractor Reporting and Data Submission

18.10 Email Communication

18.11 Reserved

18.12 Submission of EDI Transactions

18.13 Submission of Medical Documentation

18.14 Submission of OHI

18.15 Provider Data Transfer

18.16 Section 508 – Electronic and Information Technology Standards

19.0 DATA ANALYTICS

19.1 Data Specification

19.2 Data Repository and Data Repository Relational Database Schema

19.3 Reserved

19.4 Data Transmissions

19.5 Data Integrity

B.4 SCHEDULE OF DELIVERABLES

B.5 PRICE/COST SCHEDULE

B.6 PERFORMANCE INCENTIVE PLAN

B.7 REFERRAL PROCEDURES

B.8 INVOICES

SECTION C - CONTRACT CLAUSES

C.1 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS

(MAR 2020)

C.2 52.216-18 ORDERING (OCT 1995)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR

2000)

C.7 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.8 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.9 815.215-71 EVALUATION FACTOR COMMITMENTS (OCT 2019)

C.10 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM

REQUIREMENTS (DEC 2009)

C.11 852.219-71 VA MENTOR-PROTÉGÉ PROGRAM (DEC 2009)

C.12 852.219-72 EVALUATION FACTOR FOR PARTICIPATION IN THE VA

MENTOR-PROTÉGÉ

PROGRAM (DEC 2009)

C.13 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018) (DEVIATION)

C.14 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.15 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019))

C.16 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (OCT

2019)

C.17 MANDATORY WRITTEN DISCLOSURES

C.18 GUARANTEED CONTRACT MINIMUM AND CONTRACT MAXIMUM... 167

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS……………………………………………..170

E.1 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—

COMMERCIAL ITEMS ……………………………………………………………..170

1.0 GENERAL INSTRUCTIONS…………………………………………………170

2.0 COMMUNICATIONS ……………………………………………………………171

3.0 QUESTIONS AND SUBMISSION …….………………………………………171

4.0 VOLUME SUBMISSIONS ……………………………………………………...174

4.1 VOLUME I – SF1449, AMENDMENTS & OTHER DOCUMENTS…………174

4.2 VOLUME II- TECHNICAL………………………………………………………177

4.3 VOLUME III – PAST PERFORMANCE……………………………………….180

4.4 VOLUME IV – PRICE

4.5 VOLUME V – VETERANS INVOLVEMENT.…………………………………184

4.6 VOLUME VI – SMALL BUSINESS SUBCONTRACTING PLAN …………184

E.2 52.216-1 TYPE OF CONTRACT (APR 1984)

E.3 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.4 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

E.5 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008) 186

E.6 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.7 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.8 ADDENDUM 52.212-2 EVALUATION FACTORS …………………………..187

E.9 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS –

COMMERCIAL ITEMS (MAR 2020)

36C10G20R0014

SECTION B - CONTINUATION OF SF 1449 BLOCKS

1 B.1 CONTRACT ADMINISTRATION DATA

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer 36C10G

OPAL | Strategic Acquisition Center

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

U.S. Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-8917 (see Section B.8 invoices)

5. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

A. TERM OF CONTRACT

Contractor shall take no action unless directed by the Contracting Officer. VA shall not be liable for any services performed or costs incurred by Contractor outside of these terms. The remarks, explanations, and answers provided by Government representatives, whether orally or in writing, shall not change or qualify any of the terms or conditions of the solicitation. The solicitation can only be changed by a written amendment issued by the CO.

The contract base period will begin 21 days after contract award. The base period will be 12 months followed by seven 1-year option periods that may be exercised by VA. The Contractor shall not take any action unless directed by the Contracting Officer.

PERIOD OF PERFORMANCE

The Contracting Officer will revise the base period of performance based on the actual date of award. Base Period: October 12, 2020 - October 11, 2021.

Option Period 1: October 12, 2021 – October 11, 2022

Option Period 2: October 12, 2022 – October 11, 2023

Option Period 3: October 12, 2023 – October 11, 2024

Option Period 4: October 12, 2024 – October 11, 2025

Option Period 5: October 12, 2025 – October 11, 2026

Option Period 6: October 12, 2026 – October 11, 2027

Option Period 7: October 12, 2027 – October 11, 2028

B.2 IT CONTRACT SECURITY

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

1. GENERAL

The CCN Contract will not require direct access to VA information or VA systems to meet the requirements of the CCN contract. VA will legally disclose a copy of the required sensitive Government Furnished Information to the CCN Contractor under the authority of the Privacy Act System of Records “Non-VA Care (Fee) Records-VA”, 23VA10B3 Routine Use 10 ( 80 FR 146, July 30, 2015), Privacy Act System of Records

“Patient Medical Records-VA”, 24VA10P2 Routine Use 43 (79 FR 157, August 14, 2014), 38 U.S.C. 5701, HIPAA Privacy Rule provision 45 CFR § 164.506(c) and The

Veterans Choice Program Improvement Act, Public Law 115-26 and 38 U.S.C.

7332(b)(2)(H). The data will be sent via FIPS 140-2 encrypted transmission. The CCN

Contractor will then receive, retain and then own that data copy. When the CCN

Contractor submits back to VA the agreed upon information, VA will then own that copy.

2. INFORMATION CUSTODIAL LANGUAGE

The CCN Contractor, duly owning the received data, will then be solely responsible for ensuring the privacy and security protection of the information in accordance with all applicable federal, state and local laws and provisions afforded sensitive and personally identifiable healthcare information.

3. INFORMATION SECURITY

The CCN Contractor shall be capable of sending and receiving this sensitive data to and from VA using NIST FIPS 140-2 validated encryption. The CCN Contractor must also attest that they are capable of protecting the Government Furnished Information in accordance with the HIPAA Security Rules. If an Electronic Healthcare Network

Accreditation Commission (EHNAC) certification has been obtained, provide the assigned certification number. If a Federal Government Authority to Operate (ATO) has been obtained within the past three years, provide a copy of the ATO obtained, and the agency issuing the ATO). If the CCN Contractor has neither of these, the Contractor must provide a synopsis of their network security controls environment as part of their proposal. The Contractor must fully cooperate and assist in a government-sponsored security controls assessment; including those initiated by the Office of Inspector

General. The Government may conduct a security control assessment on shorter notice

(to include unannounced assessments) as determined by VA in the event of a security incident or at any other time.

4. INFORMATION SECURITY INCIDENT / BREACH

a. The term "security incident" means an event that has, or could have, resulted in unauthorized access to sensitive data, or an action that breaches agreed upon security procedures as outlined in B.2. The Contractor shall immediately notify VA’s COR and simultaneously, the designated VA ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive data related to this contract.

b. To the extent known by the Contractor, the Contractor's notice to VA shall provide all relevant information surrounding the incident and identify the information involved within

10 business days of the event.

c. The Contractor shall adhere to their applicable law whether HIPAA Breach

Notifications Rule, 45 CFR §164.400-414 or and Federal Trade Commission FTC section 13407 of the HITECH Act.

d. The Contractor shall submit a final Security Incident Investigation Report

5. DATA RIGHTS

1. The VA Data Repository Schema, the MVI Identity Management Data along with a copy of individually identifiable health information or personal health information of Veterans (hereinafter collectively known as “Government

Furnished Information”) will be provided to the Contractor in order for the

Contractor to administer the services set forth in this contract. The CCN

Contractor will own the copy it receives from VA of the individually identifiable health information or personal health information of Veterans.

2. Government Furnished Information modified, updated, revised or changed in any manner by the Contractor during performance of the contract is technical data as that term is used in FAR 52.227-14, Rights in Data—General (May 2014) and VA shall receive unlimited rights to all such data.

3. All data, and any and all data elements, first produced by the Contractor during performance of this contract that is contained in the Contractor’s data reports, VA

Data Repository, and in the Contractor’s Interactive Dashboard shall be deemed technical data as that term is defined in FAR 52.227-14, Rights in Data—General

(May 2014) and VA shall receive unlimited rights to all such data. With respect to

Contractor’s provider reimbursement rates, in the event the Contractor notifies

VA in writing of the proprietary nature of the rates, VA agrees that it will not disclose such rates outside the Federal Government in connection with a competitive acquisition for same or similar services to the CCN

4. During the period of performance of the contract, VA shall have unlimited access to both Government Furnished Information and any and all technical data produced by the Contractor.

5. At the conclusion of the contract, Contractor shall return to VA in a format acceptable to VA all data, including but not limited to the Government Furnished

Information and technical data, entered into and processed by the Contractor in performance of this Contract in order that such data can be used, stored, and/or maintained by the Government. The parties agree that the technical data generated, stored, and processed by the Contactor pursuant to this Contract may contain both Sensitive Information and identifiable health information or personal health information of Veterans such that the disclosure thereof would violate the right of privacy or publicity of the individual to whom the information relates or the right of privacy and publicity of VA. Accordingly, the Contractor relinquishes its reservation of rights set forth in FAR 52.227-14 (b) (2) for all technical data delivered to the Contracting Officer at the conclusion of this contract.

6. The Contracting Officer will be the sole authorized official to release verbally or in writing, any VA Government Furnished Information, technical data or any other written or printed materials pertaining to the solicitation (resulting award) maintained and provided by Contractor pursuant to the requirements of the contract. The Contractor will not release any such information.

B.3 PERFORMANCE WORK STATEMENT

1.0 GENERAL INFORMATION

1.1 Introduction

Community Care Network (CCN) services and healthcare resources, purchased under the authority of 38 United States Code (U.S.C.) § 8153, “Sharing of Health-care

Resources”. The Contractor shall provide a network of licensed healthcare providers and practitioners for medical, surgical, complementary and integrative health services

(CIHS), durable medical equipment (DME), pharmacy, and dental services.

1.2 Background

Department of Veterans Affairs (VA) is committed to providing Veterans with timely, accessible, and high-quality care. VA intends to honor this commitment by improving performance, promoting a positive culture of service, increasing operational effectiveness and accountability, advancing healthcare innovation through research, and training future VA clinicians.

VA recognizes that while the healthcare landscape is constantly changing, VA’s unique population and broad geographic demands will continue to require community-based care for Veterans. A Veteran enrolled in the patient enrollment system of VA, established and operated under 38 U.S.C. § 1705, and the Collateral of Veteran (in conjunction with the Veteran’s treatment), may receive services under this contract.

Healthcare services will be provided in each State as defined in 38 U.S.C. § 101(20).

In June 2018, the United States (U.S.) Congress passed VA Maintaining Internal

Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act).

This legislation consolidates VA’s community care programs into a new Veterans

Community Care Program that will help to ensure Veterans choose VA by getting them the right care at the right time from the right provider. Veterans and their families, CCN providers, and VA staff can expect ongoing improvements and regular engagement as

VA creates this new Community Care Program.

VA currently has 26 reimbursement agreements with Alaska Tribal Health Programs

(THP) Alaska to provide healthcare services to native and non-native Veterans. VA intends to maintain those existing agreements. Additionally, VA has included provisions in the CCN Request for Proposal to allow for Tribal healthcare providers and facilities participation in the CCN network.

This contract will not be used to acquire services for inherently governmental functions as defined by Federal Acquisition Regulation (FAR) 7.503 or personal services as defined by FAR 37.104. The Contractor will not perform work reserved for performance by Federal employees, and the government will manage the Contractor consistent with its responsibility to perform all inherently governmental functions and maintain control of its mission and operations in accordance with requirements of Office of Federal

Procurement Policy Letter 11-01.

Network providers are not considered subcontractors for this acquisition, the network providers are still required to protect patient information and are required to be compliant with the Health Insurance Portability and Accountability Act of 1996.

1.3 Scope of Services

The Contractor shall provide a CCN per the requirements defined in this Performance

Work Statement (PWS).

The Contractor will receive enrollment and eligibility information provided by VA. The

Contractor shall establish and maintain a network of high performing licensed healthcare providers as well as healthcare practitioners capable of delivering patient-centered care.

The Contractor shall:

(i) provide exemplary customer service (measured by Veteran satisfaction surveys);

(ii) monitor and manage quality outcomes;

(iii) use data and performance metrics to improve services;

(iv) process and pay claims in order to enhance Veterans’ healthcare experiences.

VA will conduct Veteran satisfaction surveys and provide the results to the Contractor.

VA does not expect the Contractor to survey Veterans. The Contractor shall deliver healthcare services by the use of tools and practices that drive efficiencies, cost savings, and a positive Veteran experience. The Contractor shall serve as a third-party administrator (TPA) with responsibility to perform the requirements herein.

2.0 PROJECT MANAGEMENT

2.1 Post Award Meeting

Within two weeks after Contract award, the Contractor shall lead a Post Award meeting for the effort to be held with the government and Contractor representatives. The purpose of the meeting is to do the following:

• Initiate the communication process between the government and Contractor o Introduction of Contractor and government personnel performing work related to this project o Identification of stakeholder’s roles and responsibilities

• A brief overview of project administration and reporting

• Set expectations and discuss agenda for Kickoff meeting

2.2 Kickoff Meeting

The Contractor shall participate in a kickoff meeting within thirty (30) days after contract award. The Contractor shall create a Kickoff Meeting Presentation describing the details of the approach, for all deliverables and services under this contract as defined in

Section 2.2, in accordance with the expectations defined in the Schedule of

Deliverables.

During the Kickoff Meeting the Contractor shall explain its approach to achieving the full

Healthcare Delivery (HCD) within the timelines specified. The Contractor shall explain their implementation strategy in detail such that VA stakeholders can provide meaningful feedback.

The Contractor shall present and be prepared to walk though in detail all the deliverables due at the Kickoff Meeting. Those deliverables that are due in draft form at kickoff (See B.4 Schedule of Deliverables, for details) shall be of sufficient detail to define the full approach such that the deliverables can be presented to and reviewed by

VA Contractor Subject Matter Experts (SME) for them to provide real time feedback.

The plans submitted by the Contractor shall be incorporated into the contract upon VA approval.

The kickoff meeting may include breaking into multiple working groups of VA stakeholders for the various deliverables. The Contractor will coordinate the agenda and need for any working group sessions with the Contracting Officer's Representative

(COR) ahead of time to ensure adequate SME participation to present, explain, and collect feedback on all the deliverables.

The Contractor shall coordinate with the Contracting Officer (CO) to establish dates, location, and agenda for the kickoff meeting. The Contractor shall take meeting minutes, which shall be provided to VA in accordance with the Schedule of Deliverables.

Deliverables: (See B.4 Schedule of Deliverables, for details.)

A. Kickoff Meeting Presentation B. Meeting Minutes

2.3 Project Management Plan (Project Plan) The Contractor shall be responsible for project management and performance of the requirements of this contract. The

Contractor shall create a Project Plan to be approved by VA to capture all elements of managing the CCN. The Project Plan shall be submitted in accordance with the

Schedule of Deliverables. The plan submitted by the Contractor shall be incorporated into the contract upon VA approval.

As part of the Project Plan, the Contractor shall create an Integrated Master Schedule

(IMS) that depicts the implementation and deployment of the CCN pursuant to the contract. For inclusion in the Project Plan, the Contractor shall:

1. Create and maintain a Work Breakdown Structure (WBS) to a minimum of three (3)-levels to define the activities, tasks, and outcomes.

2. Identify and include all applicable project milestones in the IMS. The Contractor shall identify and document discrete events necessary to complete the project, identify and document the definition of the relationship between and among these events, and determine the expected duration of each event and resources required for each. The Contractor shall then create a schedule that depicts this information as a cohesive whole in the IMS. The Contractor shall deliver a detailed-level schedule, critical path depiction, and a what-if analysis, with breakouts of subsections for individual groups/teams. When data is provided/entered that creates overall critical path slippage, the Contractor shall notify VA Project Manager within one (1) business day. The notification should occur by email and phone.

3. Ensure that a fully resource-loaded and baselined schedule in Microsoft Project is in place as part of the submission of the initial Project Plan.

4. Generate schedule reports containing the planned versus actual program/project performance against the Project Plan and updated critical path information for the project. The Contractor’s schedule reports shall include identification and documentation of project risks that may jeopardize any imminent milestones or the overall project timeline. The reports shall be provided to, and accepted by VA.

5. Create and maintain a Change Control Process Plan. The Change Control Process Plan shall always address any variance from the baseline plan.

The Contractor shall always obtain VA approval for all proposed changes to the IMS.

6. Deliver a Project-Level Communications Plan to outline the communications required to manage the overall CCN project. The Contractor shall include, as part of the Project Level Communications Plan, an approach to communicating action items and issues that require immediate response.

7. Include reference to, and management approach for, the Continuity of Operations Plan requirements described in Section 18.2 “Continuity of Operations.”

Deliverable: (See Section B.4 Schedule of Deliverables, for details.)

A. Project Management Plan

2.3.1 Implementation Strategy

The offeror shall meet HCD requirements no later than nine (9) months from contract award. VA will not accept a phased approach to HCD or HCD earlier than 90-days from contract award. The Contractor shall develop an Implementation Strategy to detail how the CCN will be implemented within CCN Region 5. The Implementation Strategy shall be submitted in accordance with the Schedule of Deliverables. The Implementation

Strategy submitted by the Contractor shall be incorporated into the contract upon

VA approval.

The Implementation Strategy and high-level IMS shall be submitted in accordance with the Request for Proposals (RFP). The Implementation Strategy shall outline the strategy for management of the following:

1. VA’s Data Access Service (DAS) Integration

2. The provider network, including identification of high performing providers

3. Provider education

4. Credentialing new and existing CCN providers

5. Data exchanges referenced in Section 19.0, “Data Analytics”

6. Claims processing

7. Invoicing for administrative services

8. Customer service

9. Technologies referenced in Section 18.0, “Technology”

10. Transitioning dialysis services from expiring VA contracts

11. Transitioning out (see section 2.8.2)

Also, the Implementation Strategy shall contain the Contractor’s transition plan that includes, but not limited to:

1. Planned transition meetings and schedule

2. Transition execution steps with associated milestones ensuring continuation of healthcare delivery with minimal disruption to Veterans and VA

3. What the Contractor will need from VA to effectively transition

At the kickoff meeting, the Contractor shall also provide a listing of its transition team members and team lead. This transition team shall be responsible for coordinating with

VA and the incumbent Contractor(s) to identify the documentation, access to personnel

(both VA and incumbent Contractor), and system access necessary to begin the process of reaching operating capability for full HCD. The Contractor shall provide a

Twice Monthly Status Report on all activities related to implementation in accordance with the Schedule of Deliverables: (See B.4 Schedule of Deliverables, for details.)

A. Twice Monthly Status Reports (during implementation period)

B. Implementation Strategy

2.3.2 CCN Deployment Plan

The Contractor shall develop a deployment strategy that achieves HCD in Region 5 no later than nine (9) months from contract award. Full healthcare shall be implemented in its entirety at HCD, VA will not accept a phased approach to HCD. HCD cannot start before 90-days from contract award. Successful deployment of Region 5 shall ensure site operational readiness, provider network adequacy, completed training, and management of risks and mitigation strategies. The plan submitted by the Contractor shall be incorporated into the contract upon VA approval.

The Contractor shall develop a CCN Deployment Plan describing the strategy and procedures associated with deploying the CCN in Region 5 identified in Attachment A, “VA Medical Center Catchment Area by CCN Region”. The CCN Deployment Plan shall be submitted in accordance with the Schedule of Deliverables. The CCN Deployment

Plan shall contain details on the Contractor’s method to:

1. Prepare for deployment of CCN

2. Participate in site readiness planning activities and deployment activities to ensure operational readiness and provider network adequacy

3. Complete training requirements

4. Identify and manage additional documentation proposed by the Contractor supporting CCN Deployment plans

5. Activate provider networks to achieve full HCD

6. Identify, monitor, and manage a series of risks and mitigation strategies specific to CCN deployment

Deliverable: (See B.4 Schedule of Deliverables, for details.)

A. CCN Deployment Plan

2.4 Risk Management Plan

The Contractor shall create and adhere to a Risk Management Plan (RMP), which consists of risk and issue management processes. The Contractor shall report risks and issues to VA for all CCN activities. In addition, the RMP shall describe these impacts and describe measures to either minimize or eliminate the potential impact on the CCN.

The Contractor shall submit updated risk responses and actions, to include mitigation strategies, in each Quarterly Progress Report (QPR). The RMP shall be submitted in accordance with the Schedule of Deliverables.

The Contractor shall track and manage risks and issues and report them to VA in the

Contractor Project Risk Register throughout the period of performance (PoP). In addition, the Contractor shall collaborate with VA to establish the priority, scope, bounds, and resources for managing project risks and issues, and/or assess the courses of action related to them. The Contractor shall inform VA of relevant deliberations and recommendations to mitigate and resolve project risks and issues as they are identified. VA shall have final approval of items in the Project Risk Register.

The Project Risk Register shall be submitted in accordance with the Schedule of

Deliverables.

Deliverables: (See B.4 Schedule of Deliverables, for details.)

A. Risk Management Plan B. Project Risk Register

2.5 Operational Quality and Reporting Requirements

The Contractor shall establish and maintain a Quality Assurance Plan (QAP). The QAP shall be submitted in accordance with the Schedule of Deliverables.

The Contractor’s QAP shall demonstrate how the Contractor’s performance will adhere to the Quality Assurance Surveillance Plan (QASP) (see Attachment B-T, “Quality

Assurance Surveillance Plan (QASP) and Incentives/Disincentives Plan” and

Attachment B-A, “QASP Performance Requirement Summary”). The Contractor shall meet performance targets established by the QASP. To provide for changing quality assurance and quality performance conditions, the Contractor may request changes to the components of QASP measurement and reporting. VA will utilize the QASP to monitor the quality of the Contractor’s performance. The oversight provided for in the

QASP will help to ensure that service levels reach and maintain the required levels throughout the contract term. The QASP will be finalized upon award and a copy provided to the Contractor after award. The QASP is a living document and may be updated by VA as necessary. The Contractor shall address all QASP performance metrics and whether the performance threshold missed, met and/or exceeded for each standard in a section entitled: “QASP Summary Report” within its Monthly Progress

Report (MPR) (see Section 2.4.2, “Supplemental Project Management Reporting

Requirements”).

Deliverable: (See B.4 Schedule of Deliverables, for details.)

A. Quality Assurance Plan

The Contractor shall establish and maintain QPRs. The Contractor shall provide the designated VA Project Manager and COR with QPRs in electronic form in Microsoft

Word, Project, PowerPoint, or Excel formats upon approval by VA. The QPRs shall include:

1. Task Summary – This section includes a high-level summary narrative of the work that is being performed at all levels within the Project Plan.

2. QASP Summary Report – This section shall document the Contractor’s performance against the performance metrics identified in the QASP during the reporting period.

3. High Level Schedule Summary – This section reports high-level summary of schedule elements that correspond with the reporting period.

4. Actual Activities for the Preceding Quarter – This section describes the activities performed in the preceding quarter.

5. Planned Activities for the Next Quarter – This section describes the activities planned for the following quarter.

6. High Level Risks and Issues Summary – This section includes the Risk Register, risk scores, probability, impact, and responses.

7. Corrective Actions and Improvements – This section lists the corrective actions and improvements that were executed during the reporting period.

These reports shall reflect data as of the last day of the preceding quarter and submitted in accordance with the Schedule of Deliverables. The Contractor shall participate in quarterly Program Management Reviews (PMRs) with VA at VA designated locations to support the presentation of information contained in the QPR.

The Contractor shall utilize Attachment C, “QPR Template” to populate and submit the

QPRs.

The Contractor shall create MPRs. The Contractor shall provide VA with an MPR in electronic form in Microsoft Word, PowerPoint, or Excel formats upon approval by VA.

The Contractor shall utilize Attachment D, “MPR Template” to populate and submit the

MPR. The MPR shall include:

1. Task Summary – This section includes a high-level summary narrative of the work that is being performed, both at the Indefinite Delivery/Indefinite Quantity (IDIQ) level and at the Task Order level.

2. QASP Summary Report – This section shall document the Contractor’s performance against the performance metrics identified in the QASP during the reporting period.

3. Schedule Summary – This section reports summary of schedule elements that correspond with the reporting period.

4. Actual Activities for the Preceding Month – This section describes the activities performed in the preceding month.

5. Planned Activities for Next Month – This section describes the activities planned for the following month.

6. Risks and Issues Summary – This section includes the Risk Register, risk scores, probability, impact, and responses.

7. Corrective Actions and Improvements – This section lists the corrective actions and improvements that were executed during the reporting period.

The report shall identify any performance problems that arose and a description of how those problems were resolved. If problems have not been completely resolved, the

Contractor shall provide an explanation, including its plan and timeframe for resolving the issue. The Contractor shall keep in communication with VA so issues that arise are transparent to both parties to prevent escalation. The Contractor shall participate in ad hoc project related meetings with VA. The MPRs shall reflect the data as of the last day of the preceding month and be submitted in accordance with the Schedule of

Deliverables. The MPRs shall identify the sources from which the data are pulled and include notifications when updates to technical documents are made.

Deliverables: (See B.4 Schedule of Deliverables, for details.)

A. Quarterly Progress Reports B. Monthly Progress Reports

2.6 CCN Communications Plan

The Contractor shall develop a CCN Communications Plan to document the

Contractor’s approach to communicating with Community Care stakeholders as approved by VA and ensure coordination with VA OCC, Veterans Integrated Service

Network (VISN) leadership and the VA facility in Alaska. The plan shall be delivered to

VA in accordance with the Schedule of Deliverables.

The Contractor shall follow the CCN governance structure (to be provided at award) for all communications to ensure consistency with CCN goals and processes. The

Contractor shall coordinate communications with the hierarchy of VA OCC Program

Office, the VISN Director then the VAMC Director.

The CCN Communications Plan shall detail the key messages that shall be articulated to the Community Care stakeholders, as well as the timing associated with the delivery of those messages. In addition, the CCN Communications Plan shall contain the desired outcomes for the communications, as well as the vehicles for communications distribution. Attachment AL, “Community Care Network (CCN) Stakeholders List”, provides the current list of roles that shall be included, but not be limited to, in the

Communication Plan.

Deliverable: (See B.4 Schedule of Deliverables, for details.)

A. CCN Communications Plan

2.7 Accreditation

Except as described in Section 3.7.1, “Credentialing Requirements,” healthcare delivery cannot commence until the CCN meets accreditation standards set forth herein.

The CCN shall be accredited by a nationally recognized accrediting organization for the healthcare services and providers that are within scope of an accreditation. The

Contractor shall ensure that all services, facilities, and CCN providers are in compliance with the accrediting organizations’ standards or applicable Federal and State laws, where accreditation is not required, and VA approves, for a service provider prior to serving Veterans under this contract. With the exception of THPs, national certification, in lieu of accreditation, is insufficient to meet this requirement. With the exception of

THPs, in the event that this contract and the accrediting organization have different standards for the same activity, the more stringent standard shall apply for the services under this contract. A final determination of the more stringent standard will be made by

VA in any instance of uncertainty.

To encourage THP participation and pursuant to 25 U.S.C. 1647a, THPs participating in

CCN shall satisfy only those generally applicable State or other requirements for participation as a provider of healthcare services, provided THP, and its providers, may not be subject to licensure by the State of Alaska as provided for in 25 U.S.C.

1621d(a)(1)(A), 162 It, and 1647a(2) or other applicable State or Federal law. THP satisfies the Centers for Medicare and Medicaid Services ("CMS") conditions of participation/conditions of coverage. THP providing inpatient services shall be accredited by The Joint Commission or another equivalent accrediting body.

The Contractor shall maintain accreditation, where available, on the following components or programs of the CCN:

1. Provider Network (Section 3.2) or Health Network: Accredited prior to HCD.

Accreditation Documentation to be submitted prior to HCD.

2. Credentialing Process: Documentation to be provided no later than date of award.

3. The Contractor shall also attest that it is capable of protecting the government Furnished Information VA data in accordance with the Health Insurance Portability and Accountability Act (HIPAA) Security Rules.

The Contractor shall maintain documentation of all accreditation, certification, credentialing, delegation of credentialing, privileging, and licensing for its accredited components or programs and providers performing services under this contract. The

Contractor shall provide a copy of its accreditation documentation in accordance with the Schedule of Deliverables. The Contractor shall notify VA if its accreditation is put on probation, suspended, or revoked within three (3) business days along with a corrective action plan (CAP). VA reserves the right to perform random reviews of the accreditation, certification, credentialing, delegation of certification agreements, privileging/competency measures, and licensing files for the accredited programs and providers within the CCN. The Contractor shall provide access to these files within five

(5) business days of notification of such review.

Deliverable: (See B.4 Schedule of Deliverables, for details.)

A. Documentation of Accreditation

2.8 Services

The Contractor shall engage an unaffiliated external auditing firm to conduct a Service

Organization Controls (SOC) 1, Report on Controls at a Service Organization Relevant to User Entities Internal Control over Financial Reporting, Type 2 Report, in accordance with Statement on Standards for Attestation Engagements No. 18 (SSAE 18) or in accordance with the current guidance issued by the Auditing Standards Board and shall provide VA with a written copy of the SOC 1 Type 2 examination report (the “Prime

Report”). The independent auditing firm shall have prior experience in conducting SSAE audits. In addition, the Contractor shall provide a written copy of the SOC 1 Type 2 report, completed in accordance with SSAE 18, for any subservice organization (the

“Subcontractor Report”). The Prime Reports and Subcontractor Reports shall address the specific services provided by the Contractor to VA under this contract. The current guidance for SSAE 18 was issued in April 2016. Reference:

https://www.aicpa.org/Research/Standards/AuditAttest/DownloadableDocuments/SSAE_

No_18.pdf. This guidance may be updated during the performance of the contract. The

Contractor shall comply with updates to SSAE 18 and provide new reports as required by any changes to the updated SSAE guidance.

The Contractor shall engage an unaffiliated external auditing firm to conduct a SOC 2, Report on Controls at a Service Organization Relevant to Security, Availability, Processing Integrity, Confidentiality and Privacy, Type 2 Report, (the “Prime Report”) in accordance with SSAE 18 and Trust Service Principles Criteria. The unaffiliated external auditing firm may be the same firm that provides the SOC 1 Type 2 report. The report shall cover all trust principles to include: Security, Availability, Processing

Integrity, Confidentiality and Privacy and ensure compliance with the HIPAA under those principles.

VA’s fiscal year begins October 1 and ends on September 30. The Contractor shall submit an initial Prime Report and Subcontractor Report (SOC 1, Type 2 and SOC 2

Type 2) for current business and financial operations. The initial report shall cover a minimum of nine (9) months from contact award in accordance with the Schedule of

Deliverables. Any deviation to the initial report minimum must be approved by VA.

Subsequent Prime Reports and Subcontractor Reports shall cover a minimum of 12 months; with a bridge letter covering the gap between the end date of the period covered by the Prime Reports and the end of VA’s fiscal year and be submitted in accordance with the Schedule of Deliverables. Such subsequent reports shall cover the processes outsourced to the Contractor and that align to VA contractual requirements.

When a SOC 1 and SOC 2 report covers only a portion of the Federal government fiscal year (initial and subsequent reports), the Contractor shall provide a bridge letter between the end date of the review period of the SOC 1 and SOC 2 and the end of the

Federal government fiscal year.

All Prime Reports and Subcontractor Reports shall clearly indicate the services, systems, and locations covered by the review, as well as the nature and type of control testing performed. The Contractor shall also account for controls over subservice organization (Subcontractor) services and performance. The Contractor shall include a cover letter on all Prime Reports and Subcontractor Reports clearly identifying that the

Contractor that is performing services within the scope of the contract. The cover letter shall be addressed to VA and shall summarize the results of the audit and the audit https://www.aicpa.org/Research/Standards/AuditAttest/DownloadableDocuments/SSAE_No_18.pdf.

https://www.aicpa.org/Research/Standards/AuditAttest/DownloadableDocuments/SSAE_No_18.pdf.

tests performed. The letter shall highlight unusual items, deficiencies, qualifications, and any inconsistencies with professional standards and provide an indication of actions being taken to address, remedy, or mitigate these or other weaknesses noted in the applicable report.

In the event a Prime Report or Subcontractor Report includes any deficiencies material to the Contractor’s performance under this contract or relevant to VA’s internal controls over financial reporting or operational controls to achieve VA’s mission, as determined by VA in its sole discretion, VA will notify the Contractor in writing of the need for a CAP within thirty (30) days of receipt of the Prime Report. The Contractor shall submit the

CAP to VA in accordance with the Schedule of Deliverables. The CAP shall describe, in detail, actions that will be taken by the Contractor to resolve the deficiencies and the timeline (begin and end dates) for completing each action. The Contractor shall implement recommendations as suggested by its auditor and the audit report within ninety (90) days from report issuance and shall cure any deficiencies to VA’s satisfaction within a reasonable period, but no later than ninety (90) days from report issuance, and at no cost to VA.

The Contractor shall provide a bridge letter in accordance with the Schedule of

Deliverables to cover the “gap” between the applicable Prime Report’s and

Subcontractor’s Report period end date and VA’s fiscal year end date (September 30).

The Contractor shall address the Bridge Letters to VA from Contractor senior management and shall specify the coverage begin and end dates. The letter shall include Contractor management’s assertion that the processes and internal controls that were in effect during the period covered by the applicable Prime Report and

Subcontractor Report remain in effect, and/or summarize any material changes in the control environment and the impact to VA. The Bridge Letter shall provide an acknowledgement that it is not a replacement for the actual Prime Report or

Subcontractor Report.

Deliverables: (See B.4 Schedule of Deliverables, for details.)

A. SOC 1, Type 2 – Prime Report B. SOC 2, Type 2 – Prime Report C. SOC 1, Type 2 – Subcontractor Report D. SOC 2, Type 2 – Subcontractor Report E.