RFI_Amendment 4_Final.docx

Community Care Network Next Generation Request for Information

Department of Veterans Affairs Integrated Veteran Care Veterans’ Health Administration

Date: July 17, 2023

36C10G23Q0058 Amendment #4

FAR Part 52.215-3 (a) The Government does not intend to award a contract on the basis of this solicitation or to otherwise pay for the information solicited except as an allowable cost under other contracts as provided in subsection 31.205-18, Bid and proposal costs, of the Federal Acquisition Regulation. (b) Although "proposal" and "offeror" are used in this Request for Information, your response will be treated as information only. It shall not be used as a proposal. (c) This solicitation is issued for the purpose of information and planning.

TABLE OF CONTENTS

REQUEST FOR INFORMATION

1.0 INTRODUCTION

THIS IS NOT A SOLICITATION.

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is issuing this Request for Information (RFI) as Market Research used for the potential procurement of services for a contractor to develop and maintain a national or regional network of high-performing licensed healthcare providers and practitioners. In addition to developing and maintaining this provider network, where providers deliver standard healthcare services to include medical, surgical, complementary and integrative services, durable medical equipment, pharmacy, and dental, the contractor shall provide enhanced community care services such as scheduling appointments, case management, disease management, population health management, and other innovative industry best practices and lessons learned. VHA looks to become the trend-setter and standard-bearer for streamlined healthcare services and to deploy an innovative healthcare model throughout the nation via the Community Care Network Next Generation (CCN Next Gen).

This RFI is issued solely for information and planning purposes. There is no obligation for the Government to acquire any products or services described in this RFI. In accordance with the Federal Acquisition Regulations (FAR) Subpart 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. No funds have been authorized, appropriated, or received for this effort. The information provided may be used by VA in developing its acquisition strategy and informing, refining, and finalizing a Performance Work Statement (PWS). Interested parties are responsible for adequately marking proprietary, confidential, restricted, or competition sensitive information contained in their response. Only electronic responses to this RFI will be accepted. The Government will not pay for any time expended or information submitted in response to this RFI. Eligibility in participating in a future acquisition does not depend upon a response to this RFI.

2.0 BACKGROUND

The VA provides care to Veterans through community providers when VA cannot provide the care needed or when Veterans are unable to access local VA medical centers. Community care is based on specific eligibility requirements, availability of VA care, and the needs and circumstances of individual Veterans.

In an effort to streamline VA’s community care programs, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act was signed into legislation on June 6, 2018, providing more choices and robust care coordination for Veterans using one consolidated program instead of multiple programs. Over time, community care program needs evolved with requirements for expanded healthcare services and improvements in customer service, accountability, health information exchange, referrals, scheduling, and provider payments. This evolution led to development of the VA Community Care Network (CCN).

The Contractor shall serve as a third-party administrator with responsibility to provide regional or national managed healthcare services. The Contractor shall (i) provide exemplary customer service; (ii) monitor and manage quality outcomes; (iii) use data and performance metrics to improve services; and (iv) process and pay claims for services ordered against the contract.

CCN is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care. CCN uses industry and VA standard approaches and guidelines to administer services, promptly pay for services, and manage the network to its full potential.

CCN is comprised of five (5) regional networks that serve as the primary contract vehicles for VA to purchase care for Veterans from community providers, covering all U.S. states and territories. VA is currently in its market research phase of its acquisition planning schedule for CCN Next Generation. The solicitation phase is tentatively scheduled for the latter part of fiscal year 2024. These dates are subject to change.

While the CCN program has sought to address expanding Veteran healthcare requirements and needed improvements, VA’s Office of Integrated Veteran Care (IVC) plans to further streamline and enhance community care processes and services through the CCN Next Generation (Next Gen) contract initiative. CCN Next Gen looks to build upon CCN lessons learned and implement industry best practices through extensive market research, innovative acquisition strategies, and review and analysis of acquisition and contract requirements.

3.0 PURPOSE

VA seeks industry’s input regarding potential paths forward and recommendations as to where the VA should focus its efforts in developing a solicitation for proposals. The intent is to gain information from industry relative to the North American Industry Classification Code (NAICS) 524114 and the incorporation of small business size standards that are to be determined.

The information included in this RFI looks to:

0. Communicate a vision of the scope of services that VHA would ideally like to implement; to convey context regarding VHA’s needs.

0. Review approaches that VA might pursue to accomplish its priorities.

0. Collect information about market capabilities and state of practice.

0. Understand the processes, procedures, resource requirements, operations, and systems used in developing and maintaining a network of healthcare providers.

VA’s goal in this exercise is to 1) communicate the challenges/opportunities faced by the VA, and 2) gather input on how industry would address these challenges and opportunities. To that end, the more specific your answers are, the more useful your response will be to the VA. This RFI is for market research and informational purposes only. This RFI doesn’t represent the Governments requirements for the final RFP and that any such requirements are subject to change.

4.0 INFORMATION SOUGHT

The VA is seeking the following information to be provided by the vendors when responding to the RFI:

· Vendor Information

· Vendor Responses to Questions

4.1 Vendor Information

Vendors shall provide the following information:

· Vendor Name

· Vendor Address

· DUNS Number

· Vendor Website

· Vendor Point of Contact name, telephone number, and email address

· Unique Entity Identifier (EUID), number under which the vendor is registered in SAM.gov and/or VetBiz.gov

· Vendor Socioeconomic Status; Business Size and Status [e.g., Large Business, Service-Disabled Veteran-Owned Small Business (SDVOSB), Veteran-Owned Small Business (VOSB), Small Business (SB), etc.]

· GSA or similar Governmentwide contract vehicle to include contract number, schedule, and SIN category(s), if applicable.

· The number of years in business operating under NAICS 524114, if applicable.

4.2 Vendor Responses to Questions

The vendor shall provide answers to each question in the List of Questions in Paragraph 6.0 below of this RFI. The Vendor’s response shall address the company’s approach to satisfy the objectives, constraints, and requirements described in this notice and shall consider all additional information contained in this RFI.

5.0 SUBMISSION INSTRUCTIONS

Please submit responses via email only to NextGenRFI_Industryday@va.gov. Submissions are due no later than August 4, 2023 at 4:00 p.m. EST. The email subject line must contain the following: “Response to RFI 36C10G23Q0058 Amendment #4, Community Care Network Next Generation.” VHA reserves the right to not reply to any emails, responses, questions, and materials submitted in response to the RFI.

Mark your response as “Proprietary Information” if the information included is considered to be business sensitive and/or includes trade secrets. Interested vendors are directed to respond to this RFI with documents in PDF format and RFI responses shall not exceed 20 pages total (exclusive of the title/cover page, and table of contents). VA will not review any other data or attachments that are in excess of the 20-page limit. All documents must measure 8.5 x 11-inches (charts may be landscaped but must be 8.5 x 11-inches) and shall be in Times New Roman, font size (12), with 1” margins. All pages of the response shall be appropriately numbered, and identified with the RFI number (i.e., 36C10G23Q00058 Amendment #4). Any documents not in conformance with these requirements may not be reviewed.

6.0 LIST OF QUESTIONS

When responding to the questions below, please provide examples from within the last five (5) years, if applicable. If you have addressed or partially addressed answers to any of these questions in your prior Next Generation CCN responses, feel free to include what you previously provided in your response.

Network

1. Please provide examples of any tools, processes, or products which you can provide to assist VA in steering Veterans to high performing, high quality providers. Do you have recommendations regarding the utilization of said tools, processes or products while leveraging industry accepted quality measures and indicators or other publicly available quality data (e.g., CMS’s Five-Star Quality Rating System used to compare Nursing Home Care)? Is there a balance between propriety data vs. public data? Do you incorporate clinical data or do you use standard in-house administrative data?

Contract Structure

2. In a typical insurance/TPA model, the contracted TPA would receive an administrative Per Member Per Month (PMPM) fee, based on enrolled members. Since VA does not have "enrolled members," and the number of Veterans seeking care in the community fluctuates from month to month and year to year, and as such, how would you recommend VA calculate and pay PMPM fees? Additionally, what other considerations regarding PMPM fees as it relates to authorized services which are provided to secondary beneficiaries (e.g., spouse, newborns, etc…) should VA take into account?

Precertification (Prior Authorization) Public Law 99-272, the Consolidated Omnibus Budget Reconciliation Act of 1985, required VA to bill health insurance companies for non-service-connected care and collect co-payments from certain eligible Veterans. VA’s regulation 38 CFR Part 17.108-11, Part 17.4010 which can be found here: Precertification Requirements - Community Care (va.gov), provides further information and details surrounding VA’s precertification requirements. As it relates to this requirement, please provide a response to the following precertification questions:

3. How would your organization incorporate VA’s precertification requirements without generating delays in care for Veterans?

4. What suggestions to precertification practices in the VA Community Care referral process do you have on how the VA would obtain the required medical records and health information insurers/payers frequently require?

5. How does your organization obtain precertification requests and how are precertification reviews from network providers conducted?

6. How does your organization obtain precertification requests and how are precertification reviews from non-network providers conducted?

7. What percentage of your existing network of providers have contracts that currently require precertification of services prior to rendering care?

8. What are your organization’s precertification compliance rates for network providers?

9. What actions does your organization take to improve awareness and compliance with precertification requirements?

10. What claim processing actions does your organization take when services are rendered by a network provider who did not obtain an approved precertification prior to rendering services?

11. What timeliness and quality key performance indicators would you recommend VA use to monitor precertification compliance?

12. Precertification is a process that many providers find burdensome. What system/process improvements and technologies does your organization utilize to mitigate this burden on providers?

13. Do you have access to host a precertification technology on a FedRAMP approved cloud platform?

14. What is your organization doing to prepare for compliance with Federal/State precertification “Gold Card” programs?

15. How would your organization suggest VA align its precertification process with CMS, Medicaid and commercial payer standards?

Operations

16. What impact ] would requiring non-standard data, such as CPT/HCPC billed with all revenue codes on outpatient UB04 claims, have on your organization??

17. VA is considering a solution where community care provider claims would first be routed to a VA EDI clearinghouse pending a data review that would either accept or reject claims. Claims would be adjudicated accepted using industry and VA definitions of a “clean claim.” Accepted claims would then continue on to the TPA for claims processing. Rejected claims (277CA) would be sent back to the provider. Additionally, a copy of the 277CA would be sent to the TPA to help mitigate calls from providers inquiring why a particular claim was denied. Do you recommend that VA pursue this solution? Why or why not? What risks would there be to VA managing this process that might impact the contractor?

18. VA is considering implementing Electronic Visit Verification (EVV) as was mandated for Medicaid programs in section 12006(a) of the 21st Century Cures Act, for home health providers. Have you previously implemented this procedure? If yes, which vendor(s) have you used? How would you recommend that VA implement this procedure. For example, would you suggest the TPA use their own vendor or for VA to contract directly with an EVV vendor?

19. VA is considering implementing a payment and policy manual which would be similar to the TRICARE manuals. Given the complexities in developing a manual of this magnitude, VA is considering publishing an initial draft with multiple revisions throughout the life of the contract. Considering such revisions, what challenges may potential offerors face during the proposal development and subsequent updates? What recommendations should VA consider regarding pricing for such manual requirements and subsequent updates?

20. The VA is considering additional ways to ensure payment integrity. For example, VA could directly contract for recovery audit services and other post-payment integrity validations. VA could require the Next Gen contractor(s) to work with the recovery audit contractor to recoup any identified overpayments from providers that need to be repaid back to VA. Alternatively, VA could have the contractor obtain their own payment integrity vendor to independently conduct recovery audits. For appropriate oversight, it is essential for VA to have direct access to the recovery audit contractor to validate methodology and test samples. When considering this need, what does your company recommend would best serve VA and what else should VA consider for it to be effective?

21. VA would like to incentivize providers to sign up on VA’s direct scheduling platform. With that in mind, what do you recommend VA include in the CCN Next Generation contract to enable TPAs to get as many of their providers to sign onto VA’s direct scheduling platform?

22. Please provide recommendations on pricing strategies that support the delivery of complex healthcare services, such as dialysis, in rural or highly rural areas or where there are otherwise scarce resources.

Information & Technology

23. Provide examples of your organization’s capabilities related to conducting 278, 278I and 278NI EDI transactions.

24. Are your claims processing and any other cloud-based platforms you use FedRAMP approved?

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