36C10G24R0038.pdf

Contract Opportunity Combined Synopsis/Solicitation Notice

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Contract Opportunity Combined Synopsis/Solicitation Notice

R408

Actuarial Support Services

22408-2697

36C10G24R0038

09-01-2025 15:00 EASTERN TIME, NEW YORK, USA

N

524298

U.S. Department of Veterans Affairs OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

Contract Specialist Betsy Lawrie Priscilla Burke Betsy.Lawrie@va.gov Priscilla.Burke@va.gov 202-697-3629 804-243-0740

Throughout the VA Enterprise; United States, Nationwide https://www.va.gov

To learn more about SAC and its mission, please click https://www.va.gov

Betsy.Lawrie@va.gov; Priscilla.Burke@va.gov mailto:Betsy.Lawrie@va.gov mailto:Priscilla.Burke@va.gov https://www.va.gov/ https://www.va.gov/ mailto:Betsy.Lawrie@va.gov

TABLE OF CONTENTS

SECTION A

A.1 COMBINED SYNOPSIS/SOLICITATION FOR COMMERCIAL SERVICES

A.2 GENERAL INFORMATION

SECTION B

B.1 CONTRACT ADMINISTRATION DATA

B.2 ACKNOWLEDGMENT OF AMENDMENTS:

B.3 PERFORMANCE WORK STATEMENT

B.4. PRICE/COST SCHEDULE / ITEM INFORMATION

SECTION C - CONTRACT CLAUSES

C.1 NOTICE OF CONTRACT

C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (NOV 2023)

ALTERNATE I (NOV 2021)

C.3 ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND

CONDITIONS—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

C.4 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (FEB 2024)

(DEVIATION) (FEB 2025)

C.5 52.215-6 PLACE OF PERFORMANCE (OCT 1997)

C.6 52.216-18 ORDERING (AUG 2020)

C.7 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.8 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.9 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.10 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT

(MAR 2000)

C.11 52.232-9 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR

(APR 1984)

C.12 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT

FOR DATA BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.13 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.14 VAAR 852.222-71 COMPLIANCE WITH EXECUTIVE ORDER 13899.

(DEVIATION) (APR 2025)….………………………………………………………...100

C.15 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT

REQUESTS (NOV 2018)

C.16 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER

(OCT 2020)

C.17 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

ATTACHMENT A: SAMPLE REPORT WRITER

ATTACHMENT B: SAMPLE BUDGET IMPACT

ATTACHMENT C: VA ENROLLEE HEALTH CARE PROJECTION MODEL (EHCPM)

AND ADVANCED APPROPRIATION TIMELINE

ATTACHMENT D: ACTUARIAL RESPONSIBILITIES GRID

ATTACHMENT E: 2023 (BY22) MODEL DOCUMENTATION AND ANALYSES

REPORT

ATTACHMENT F1: DELIVERABLES SCHEDULE TABLE

ATTACHMENT F2: ONE YEAR OF DELIVERABLES UNKNOWN AT TIME OF

AWARD

ATTACHMENT G: MODEL UPDATE FLOW CHART

ATTACHMENT H: PAST PERFORMANCE QUESTIONNAIRE

ATTACHMENT I: HISTORICAL LABOR MIX

ATTACHMENT J: CONTRACTOR RULES OF BEHAVIOR FROM 6500 APPENDIX D

ATTACHMENT K: LABOR MIX PROPOSED BY VENDOR

ATTACHMENT L: COST BREAKDOWN OF SOLICITATION

ATTACHMENT M: CLINS AND SUBCLINS

DOCUMENT 1: BUSINESS ASSOCIATE AGREEMENT

LINK A: FIPS PUB 201-3

LINK B: DEPARTMENT OF VETERANS AFFAIRS (VA) DIRECTIVE 0710

LINK C: VA DIRECTIVE 0710

LINK D: VA HANDBOOK 6500

LINK E: VA DIRECTIVE 6500

LINK F: VA HANDBOOK 6500.10

LINK G: VA HANDBOOK, 6500.5

LINK H: VA HANDBOOK 6500.6

LINK I: VA DIRECTIVE 6508

SECTION E - SOLICITATION PROVISIONS

E.1 NOTICE OF CONTRACT TYPE

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR

EQUIPMENT (NOV 2021)

E.3 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT

ORDERS—REPRESENTATION AND DISCLOSURES (DEC 2023)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS

(OCT 2018)

E.5 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (SEP 2023)

E.6 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (FEB 2024)

(DEVIATION) (FEB 2025)

E.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE (FEB 1998)

E.9 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (SEP 2018)

E.10 PROPOSAL SUBMISSION INSTRUCTIONS

E.11 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2021)

E.12 BASIS FOR AWARD

THIS SECTION INTENTIONALLY LEFT BLANK / SEE NEXT PAGE

CONTINUATION PAGE 36C10G24R0038 Page 4 of 152

SECTION A

A.1 COMBINED SYNOPSIS/SOLICITATION FOR COMMERCIAL SERVICES

Document Type: Combined Solicitation/Synopsis

Solicitation Number: 36C10G24R0038

Posted Date: July 1, 2025

Original Response Date: September 1, 2025

Current Response Date: September 1, 2025

Product or Service Code: R408

Set Aside: NONE

NAICS Code: 524298

A.2 GENERAL INFORMATION

Contracting Office Address:

Office of Procurement, Acquisition and Logistics (OPAL) Strategic Acquisition Center (SAC) 10300 Spotsylvania Ave, Suite 400 Fredericksburg, VA 22408

Description:

This is a combined synopsis/solicitation for commercial services prepared in accordance with the format in Federal Acquisition Regulation (FAR) subpart 12.6, “Streamlined Procedures for Evaluation and Solicitation for Commercial Items,” as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested, and a written solicitation document will not be issued.

The associated North American Industrial Classification System (NAICS) code for this procurement is 524298, with a small business size standard of $30.5M.

This solicitation is a Request For Proposals (RFP). The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular (FAC) 2021-05 published in the Federal Register on March 10, 2021.

Type of Contract:

The Government will award a single Indefinite Delivery / Indefinite Quantity (IDIQ) contract with both Fixed Price and Labor Hour Contract Line Item Numbers (CLINs) that will be most advantageous to the Government, price and other factors considered.

Number of Contracts to be Awarded:

The Government intends to select one contractor for this acquisition. However, the Government reserves the right not to award a contract at all, depending on the quality of the proposals, prices submitted, and the availability of funds.

CONTINUATION PAGE 36C10G24R0038 Page 5 of 152

Acquisition Office:

The Office of Procurement, Acquisition and Logistics Strategic Acquisition Center 10300 Spotsylvania Ave, Suite 400 Fredericksburg, VA 22408

All interested companies shall provide proposal for the following Actuarial Health Services.

SYSTEM FOR AWARD MANAGEMENT (SAM) NOTICE

System updates may lag policy updates. The System for Award Management (SAM) may continue to require entities to complete representations based on provisions that are not included in agency solicitations. Examples include 52.222.25, Affirmative Action Compliance, and paragraph (d) of 52.212-3, Offeror Representations and Certifications – Commercial Products and Commercial Services. Contracting officers will not consider these representations when making award decisions or enforce requirements. Entities are not required to, nor are the able to, update their entity registration to remove these representations in SAM.

CONTINUATION PAGE 36C10G24R0038 Page 6 of 152

SECTION B

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

Contractor Name:

Address City, State Zip

CAGE:

DUNS Number:

SAM IEU:

Tax Identification Number (TIN):

Contractor POC Point of Contact/Title:

Phone: xxx-xxx-xxxx Email:

b. GOVERNMENT:

Contracting Officer 36C10G Primary: Mauricio Vazquez, Mauricio.Vazquez@va.gov Alternate: Rodney Burgos Cabassa, Rodney.burgoscabassa@va.gov Alternate: Anna Norcross, Anna.Norcross@va.gov

Contact Specialist 36C10G Primary: Betsy Lawrie, Betsy.Lawrie@va.gov Alternate: Nicole Lowther, Nicole.Lowther@va.gov

Alternate: Priscilla Burke, Priscilla.Burke@va.gov

U.S. Department of Veterans Affairs OPAL | Strategic Acquisition Center 10300 Spotsylvania Ave | STE 400 Fredericksburg VA 22408-2697

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. [ ] Monthly

b. [ ] Quarterly

b. [ ] Semi-Annually

c. [X] Upon completion of work; quantities identified per CLIN; and/or monthly.

mailto:Mauricio.Vazquez@va.gov mailto:Rodney.burgoscabassa@va.gov mailto:Anna.Norcross@va.gov mailto:Betsy.Lawrie@va.gov mailto:Nicole.Lowther@va.gov

CONTINUATION PAGE 36C10G24R0038 Page 7 of 152

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

5. FSC MANDATORY ELECTRONIC INVOICE SUBMISSION: Contractors are required to submit payment requests in electronic form in accordance with the submission instructions.

TUNGSTEN ELECTRONIC INVOICE SUBMISSION

FSC e-INVOICE PROGRAM THRU AUSTIN PORTAL

FSC MANDATORY ELECTRONIC INVOICE SUBMISSION FOR AUSTIN PAYMENTS

Contracting POC: Mr. Mauricio Vazquez COR (Contracting Officers Representative): Ms. Carolyn Stoesen Contract/Task Order Number: TBD Purchase Order Number: TBD

a. Vendor Electronic Invoice Submission Methods: Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests.

Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below.

1. VA’s Electronic Invoice Presentment and Payment System – The FSC uses a third-party contractor, Tungsten, to transition vendors from paper to electronic invoice submission. Please go to this website: http://www.tungsten-network.com/US/en/veterans-affairs/ to begin submitting electronic invoices, free of charge.

2. A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI Web site (http://www.x12.org)

b. Vendor e-invoice Set-Up Information:

Please contact Tungsten at the phone number or email address listed below to begin submitting your electronic invoices to the VA Financial Services Center for payment processing, free of charge. If you have question about the e-invoicing program or Tungsten, please contact the FSC at the phone number or email address listed below.

1. Tungsten e-Invoice Setup Information: 1-877-489-6135

2. Tungsten e-Invoice email: VA.Registration@Tungsten-Network.com

3. FSC e-Invoice Contact Information: 1-877-353-9791

4. FSC e-invoice email: vafsccshd@va.gov

See https://www.fsc.va.gov/einvoice.asp for more information.

http://www.tungsten-network.com/US/en/veterans-affairs/ http://www.tungsten-network.com/US/en/veterans-affairs/ http://www.x12.org/ mailto:VA.Registration@Tungsten-Network.com mailto:vafsccshd@va.gov https://www.fsc.va.gov/einvoice.asp

CONTINUATION PAGE 36C10G24R0038 Page 8 of 152

6. MINIMUM GUARANTEE: The minimum dollar amount the Government agrees to order under the awarded contract under this solicitation is $1,000,000.00. If the Contractor receives total orders for less than the minimum amounts, the Government will pay the difference between the amount ordered and the minimum amount guaranteed. The Government's obligation for the minimum amount only applies to the base period of the awarded contract.

7. EXTENT OF OBLIGATION: The Government is obligated only to the extent of authorized purchases actually made under the resultant contract. A minimum guarantee IAW FAR 16.504(a) of $1,000.000.00 will be placed against this contract upon award of the IDIQ contract via a Task Order (TO). The parties agree the Government will fulfill its obligation to order a minimum quantity by paying the Contractor $1,000,000.00 at the end of the ordering period, unless it orders one unit or a combination of units that exceeds $1,000,000.00 before that time, which would otherwise fulfill the obligation.

8. MAXIMUM CEILING AMOUNT: The maximum ceiling amount is the estimated Actuarial Service’s ceiling of $100,000,000.00.

9. CONTRACTING OFFICER AUTHORITY: The Contracting Officer for the contract shall be the only individual authorized to direct/redirect the efforts under the contract and delivery orders issued or in any way modify the items or terms of this contract.

10. SUCCESSOR CONTRACTING OFFICER: The Contracting Officer who signed this contract and identified is the primary Contracting Officer (CO) for the contract. The Alternate Contracting Officers are designated. These are the only Contracting Officers authorized to take formal action on this contract. The alternate(s) will assume authority when a contract action needs to be taken and the primary Contracting Officer is unavailable. Unless a modification is initiated to change the primary or alternate CO, no other CO has authority to act for or make changes to this contract within his/her authority.

B.2 ACKNOWLEDGMENT OF AMENDMENTS:

The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

CONTINUATION PAGE 36C10G24R0038 Page 9 of 152

B.3 PERFORMANCE WORK STATEMENT

A. GENERAL INFORMATION

A.1. Title of Project: Health Care Actuarial Support Services

A.2. General History:

The Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Chief Strategy Office (CSO), Enrollment and Forecasting (E&F), contracted with a provider of actuarial services and products to develop the VA Enrollee Health Care Projection Model (EHCPM) to project Veteran demand for VA health care. This was based on Congress enacting the Veterans’ Health Care Eligibility Reform Act of 1996, Public Law 104-262.

Eligibility Reform transformed the VA health care system from an episodic, inpatient care provider into a comprehensive health care provider and expanded eligibility for health care to all Veterans. To manage resources, the law required VA to implement a priority-based enrollment system and to annually assess the resources required to provide care to enrolled Veterans.

The EHCPM is an actuarial model for projecting Veteran enrollment and demand for VA health care for 20 years into the future. The projections and supporting analyses are central in the development of the VA medical care budget, strategic, capital, and workforce planning, and policy analysis. VA is dependent on the EHCPM projections to support the development of about 90 percent of the VA medical care budget. The EHCPM is used to provide insight on Veteran demand for VA health care and support VA leadership and stakeholders, including the Office of Management and Budget, Congress, the Government Accountability Office, Congressional Budget Office, and Veteran Service Organizations.

For each of the 20 projection years, the EHCPM projects the number of Veterans expected to be enrolled in a geographic area, their total health care needs, and the portion of that care they are expected to receive through VA (either in VA facilities or care purchased by VA in the community) versus from other health care providers. The expenditure projections that support the VA health care budget request are based on the anticipated costs associated with the projected utilization of services (not projected numbers of patients). A key function of the EHCPM is the ability to modify the underlying assumptions in order to produce projection results for multiple scenarios assuming any of the underlying assumptions change over the 20-year projection period.

The EHCPM currently projects utilization for approximately 150 health care service categories, including long term services and supports. Generally, the services VA provides that are comparable to services provided in the private sector are modeled using private sector-based utilization benchmarks. Services that are unique to VA (e.g., blind rehabilitation) or services where VA’s practice pattern differs significantly from the private sector (e.g., prosthetics) are modeled using VA experienced-based utilization benchmarks.

The VHA takes the initiative to evolve its delivery of health care, and these plans are incorporated into projected model assumptions. Usually, a group of subject matter experts will be convened to discuss the initiative or new policy, which leads to changes in projection assumptions. VA must work closely with program offices to incorporate their vision for the future delivery of health care services to the enrolled population into the EHCPM; assess and incorporate the impact of changes in VA’s infrastructure, such as the addition of a new facility or impacts from a natural disaster; and assess the impact of proposed policies (e.g., cost sharing), legislation, and regulations, and external events (e.g., pandemic) on the VA health care system. Additionally, VA serves populations, such as post-9/11 Era Combat Veterans and women veterans, and

CONTINUATION PAGE 36C10G24R0038 Page 10 of 152 provides services, such as mental health, prosthetics, pharmacy, and long-term services and supports, that require specific consideration in the planning and execution of services.

The EHCPM accounts for the impact of the following attributes when projecting Veteran enrollment and use of VA health care services:

(1) Enrollee age, sex, morbidity, and geographic migration patterns;

(2) Enrollee reliance on VA health care versus other health care providers;

(3) Enrollee income, local unemployment rates, and travel distance to VA facilities;

(4) Enrollee transition between enrollment priorities, (e.g., movement into service-connected priorities and transitions due to changes in income);

(5) Unique utilization patterns of various population cohorts, such as females, new enrollees, specific age cohorts, and post- 9/11 Era Combat Veterans;

(6) New policies, regulations, and legislation and changes in the broader environment, such as The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act;

(7) VA health care initiatives, such as the mental health capacity improvement initiative;

(8) A continually evolving VA health care system, e.g., quality and efficiency initiatives;

(9) Future changes in health care practice and technology;

(10) Service location (VA direct or community care); and

(11) Impacts of pandemics or other global disruptions affecting health care delivery.

The EHCPM is a complex health actuarial model that accounts for all known drivers of Veteran demand for VA health care. Projections are developed at a very detailed level by 13 Veterans Health Administration enrollment priorities and sub-priorities, sex, and 15 five-year age bands (under 25, 25-29, 30-35…85-89, and 90 and older).

Geographically, projections are developed for sectors, which consist of one or more counties. In addition, projections are developed separately for enrollees who used VA prior to eligibility reform, for post-9/11 Era Combat Veterans, and for female Veterans.

The EHCPM is developed using VA actual enrollment, utilization, unit cost, and expenditure data, private sector health care utilization data, nationally recognized actuarial data sets, VA/Medicare enrollee level data match, and quantitative market survey data (e.g., VHA’s Survey of Veteran Enrollees). The EHCPM is supported by in-depth analyses of Veteran enrollment rates, enrollee mortality, morbidity, geographic migration, transition among enrollment priorities, reliance on VA versus other health care providers, and assessments of the impacts of drive time, unemployment rates, and income on demand for VA health care.

As an example of the complexity of the EHCPM, over 160 million reliance factors that vary by demographic and geographic detail are used in each of the 20 projection years, and these factors vary by projection year. In addition, stakeholders require that the EHCPM separately quantify the impact of the key drivers of demand for VA health care on enrollment, utilization, and expenditures. Therefore, the factors that drive VA health care demand must be analyzed and input into the EHCPM separately.

The EHCPM projects utilization for approximately 150 health care service categories, including long-term care services. The definitions of the service categories and number of services modeled will evolve over time. Depending on the health care service category, the EHCPM projects utilization based on Current Procedural Terminology (CPTs), Healthcare Common Procedure Coding System (HCPCs), visits, bed days, and a VA-specific metric, clinic stops. Where appropriate, the Relative Value Units associated with the projected health care utilization are also reported. Relative Value Units (RVUs) are also fundamental in the development of unit costs.

CONTINUATION PAGE 36C10G24R0038 Page 11 of 152

The EHCPM reflects over 20 years of extensive study of Veteran demand for VA health care. As a result, the EHCPM has evolved into a complex health care actuarial model in order to account for all known drivers of Veteran enrollment and utilization of VA health care and the cost associated with that care.

The annual EHCPM update process begins in June and is completed by the following April as outlined in Attachment C.

Key attributes and functionality of the EHCPM include:

1. Extensive demographic and geographic detail projection detail. Since Veteran demand is known to vary significantly by demographics and geography, the EHCPM models for Veteran demand at a very detailed demographic and geographic level (see Table 1).

2. Scope and detail of health care services projected by the EHCPM. EHCPM projects utilization and cost for approximately 150 health care service categories.

This number has grown in recent years to provide more detail on the types of care purchased in the community and to support workforce planning.

3. Ability to separately quantify the impact of all key drivers of enrollment, utilization, and cost of VA health care, including demographics, reliance, economic factors, health care trends, new or proposed policies. This is required by stakeholders to provide transparency when reviewing the projected demand (see Attachment B – Sample Budget Impact).

4. Ability to differentiate health care provided in VA facilities and care purchased in the community. Based on operational and policy guidance, the total enrollee demand for VA health care projected by the EHCPM is reported separately for care expected to be provided in VA facilities and expected to be purchased in the community. To support this functionality, many of the inputs and factors in the EHCPM vary by the location of care, including unit costs, health care trends, and reliance.

The below identifies the key areas of the EHCPM:

B1: Overview of the Enrollee Health Care Projection Model B2: Model Tutorial – Enrollment Projections B3: Model Tutorial – Private Sector Based Projections B4: Model Tutorial – VA Experience-Based Projections B5: EHCPM Model Updates B6: Overview of Modeling for Community Care Services B7: Overview of Hybrid Modeling Approach

C1: Enrollment Projection Methodology C2: Creation of the Master Enrollment File C3: Veteran Population Proxy Development C4: Enrollment Rates C5: County Consolidation Methodology C6: Priority and Morbidity Class Transition C7: Geographic Migration C8: Mortality Rates C9: Patient Projection Analysis C10: Enrollment and VetPop Proxy County Allocations

CONTINUATION PAGE 36C10G24R0038 Page 12 of 152

The below identifies the key areas of the EHCPM (Continued):

D1: Private Sector-Based Service Benchmarks D2: Covered Benefits Package and Adjustments D3: Copay Levels and Adjustments D4: Geographic Area Adjustments D5: Age and Sex Adjustments D6: Inpatient Efficiency Analysis D7: Inpatient Hospital Under- and Over-Coding Analysis E1: Modeling Methodology for VA Experience-Based Service Projections E2: Special Modeling Adjustments for VA Experience-Based Service Projections E3: Blind Rehabilitation Service Program Projections

G1: Overview of Reliance and Morbidity Modeling G2: Morbidity Risk Weight Development G3: Enrollee Morbidity Analyses – Ages 65 and Over G4: Enrollee Morbidity Analyses – Under Age 65 G5: Enrollee Reliance Analyses – Ages 65 and Over G6: Enrollee Reliance Analyses – Under Age 65 G7: Morbidity Birth Year Cohorts G8: Morbidity and Reliance Drift Adjustments G9: Enrollment Duration Utilization Adjustment G10: Condition-Based Morbidity Adjustments G11: Enrollee Reliance Generational Shift

H1: VA Inpatient Workload Data H2: VA Inpatient Encounter Workload Data H3: VA Ambulatory Workload Data H4: VA Prosthetics Workload Data H5: VA Pharmacy Workload Data H6: VA Dental Workload Data H7: FY 2021 Baseline Database Construction

I1: VA Base Year Unit Cost Development I2: VA Inpatient Base Year Unit Cost Development I3: VA Ambulatory Base Year Unit Cost Development I4: VA Pharmacy Base Year Unit Cost Development I5: VA Unit Cost Age Band & Sex Adjustments

J1: Actual-to-Expected Utilization Adjustment J2: Unit Cost Reconciliation Methodology

K1: Post-9/11 Era Combat Veteran Enrollee Assumptions K2: Mental Health Policy Assumptions K3: Regional and Facility Reviews and Adjustments K4: Trend Rate Assumptions K5: Enrollment Policy Assumptions K6: Women's Health Assumptions K7: Impact of Economic Forecasts K8: Inpatient Efficiency Assumptions K9: Outpatient Efficiency Assumptions K10: Pharmacy Efficiency Assumptions K11: Pipeline Drug Impact Policy Assumptions K12: Homeless Program Adjustments

CONTINUATION PAGE 36C10G24R0038 Page 13 of 152

The below identifies the key areas of the EHCPM (Continued):

K13: Long-Term Services and Supports Policy Assumptions K14: Civilian Wage Policy Assumptions K15: Patient Aligned Care Team (PACT) Policy Assumptions K16: Telehealth Policy Assumptions K17: Community Care Adjustments K18: Hepatitis C Drug Impact Policy Assumptions K19: Dialysis and Related Services Reliance Assumptions K20: Pharmacy Tiered Copayment Assumptions K21: COVID-19 Pandemic Modeling K22: Post-9/11 Era Combat Veteran Enrollee Assumptions K23: PACT Act

L1: Projections to Support Planning and Special Analyses L2: EHCPM Global Relative Value Units L3: Health Systems Planning Category Projections L4: Ambulatory Health Systems Planning Category Development L5: Parent Facility Allocation Methodology

M1: EHCPM Data Sources

N1: CHAMPVA Cost Projection N2: PCAFC Projection Model N3: Newborn Care Projections N4: Fertility Services Projections N5: Other Than Honorable Projections N6: MHRRTP 3D Model N7: RCS Projection Model

The VA health care system and the broader environment are continually changing, and the enrollment, utilization, and expenditure projections must reflect the impact of these changes.

This requires that the VHA Chief Strategy Office (CSO) and its actuarial consultants work closely with VA program offices, field staff, and researchers to incorporate their vision for the future delivery of health care services (e.g., Patient Aligned Care Teams), the impact of health care initiatives (e.g., mental health), the impact of changes in VA’s infrastructure, and assess and incorporate the impact of proposed policies (e.g., cost sharing), legislation and regulations (e.g., the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 and the PACT Act of 2022), and external events (e.g., economic recession and pandemic) on the VA health care system.

A key challenge in modeling for the Veteran enrollee population is that enrollees have many other options for health care coverage (private insurance, TRICARE, Medicare, Medicaid, etc.). As a result, most enrollees only receive a portion of the total health care they need through the VA health care system. For example, enrollees only choose to receive approximately one third of all of the inpatient care they need from VA.

As a result, VA’s internal data sources cannot be exclusively used to project total health care needs of the enrolled Veteran population. In order to project demand for needed services, VA must understand enrollees’ total health care needs because many internal and external factors can change enrollees’ reliance on VA health care. For services VA provides that are comparable to the private sector, the EHCPM currently utilizes the incumbent’s health care benchmarks as a basis to project enrollees’ total health care demand.

CONTINUATION PAGE 36C10G24R0038 Page 14 of 152

B. SCOPE OF WORK

B.1. General

The contractor shall perform all services. The contractor shall provide all qualified personnel, equipment, supplies, facilities, transportation, travel, tools, materials, supervision, and other items and non-personal services necessary to successfully perform the services as defined in this Performance Work Statement (PWS) except for those items specified as Government Furnished Property (GFP), Information (GFI), and Government Furnished Services (GFS). Contractor shall also ensure requirements in PWS are accomplished In Accordance With (IAW) the applicable documents list in Section D - Contract Documents, Exhibits, Or Attachments.

The contractor’s actuarial managers shall be accredited by the Society of Actuaries (SOA), including Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA), and shall have SAS and SQL expertise, project management and quality control expertise, and health care actuarial subject matter expertise.

The Government shall neither supervise contractor employees nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor employee. If the contractor believes that any actions constitute, or are perceived to constitute personal services, it shall be the contractor’s responsibility to notify the Contracting Officer (CO) immediately.

B.2. Scope VA requires a wide range of health care actuarial expertise and experience in areas such as morbidity-risk scoring, population and health status assessments, dual or triple eligible populations, health care trends (inflation, intensity, and utilization) in the commercial marketplace and Medicare, impact of health policy on the utilization and cost of health care, and actuarial modeling capabilities dynamic enough to project utilization for strategic planning at the medical facility-level and at a more global level for budget formulation. Requirements are attributed to certain Activities in the PWS and will require extensive discussions with VA and its stakeholders. Only within the COR’s authority or the CO shall, direct the contractor to perform any services called out in the PWS via Task Order. The PWS covers actuarial modeling and support services in support of seven major Activities. The majority of the requirement revolves around the EHCPM.

VA requires actuarial modeling creation/development, consulting, analysis, and support to use the EHCPM and other actuarial models to assess the impact of an evolving VA health care system and the broader environment, proposed policies, regulations, and legislation; support the VA medical care budget process, and support VA leadership and stakeholders.

B.2.1 Actuarial modeling and analytical services to assess the impact of an evolving VA health care system and broader environment on Veteran enrollment and demand for VA health care.

B.2.2 Maintaining, enhancing, validating, and annually updating the EHCPM with new data from the most recently completed fiscal year and other newly available data, updating supporting analyses, integrating new or updated assumptions and enhanced methodology. Assessing the predictive power of

CONTINUATION PAGE 36C10G24R0038 Page 15 of 152 the EHCPM and respond to requests, for comparisons and projections of actual enrollment, patients, utilization, and expenditures.

B.2.2.1 Maintaining and updating the EHCPM at the level of detail and functionality as defined in this PWS. VA will provide the necessary data, documentation of the methodology and assumptions, and the SAS or SQL code that constitutes the current EHCPM at the Task Order level. Contractor shall use the current EHCPM as the starting point for updating and producing the new/revised EHCPM.

B.2.2.2 The Contractor shall develop a working knowledge through previous EHCPM reports and deliverables to support analyses and requests that span multiple EHCPM projection scenarios. In particular, the Contractor shall seamlessly support comparisons of the methodology, analyses, and projections between the current and future EHCPM.

B.2.3 Enhancing the EHCPM to support strategic, capital, workforce planning, policy analyses and other needs that arise requiring special reporting of the EHCPM projections.

B.2.4 Providing trainings and briefings related to the EHCPM and additional actuarial models’ methodology, assumptions, and projections and assisting stakeholders and oversight entities in understanding the models and the key drivers of Veteran demand for VA health care.

B.2.5 Providing transparency tools, exhibits, and reporting to increase the transparency of the EHCPM and additional actuarial models’ methodology, assumptions, and projections to assist stakeholders and oversight entities in understanding the models and the key drivers of Veteran demand for VA health care.

B.2.6 Developing additional actuarial models, including:

B.2.6.1 Maintain, enhance, and update the Civilian Health and Medical Program of the Department of Veterans’ Affairs (CHAMPVA) Projection Model.

B.2.6.2 Maintain, enhance, and update enrollment and cost projections associated with Veteran utilization of caregivers in the Program of Comprehensive Assistance for Family Caregivers (PCAFC).

Model requests to understand program eligibility and policy changes.

B.2.6.3 Maintain, enhance, and update expenditure projections to support the provision of newborn services.

B.2.6.4 Maintain, enhance, and update expenditure projections to support the provision of fertility services.

B.2.6.5 Maintain, enhance, and update expenditure projections to support the provision of Other Than Honorable (OTH) projections.

B.2.6.6 Maintain, enhance, and update Mental Health Residential Rehab Treatment Program Diagnosis and Demographic-Based Demand (MH RRTP 3D) Model.

B.2.6.7 Maintain, enhance, and update Readjustment Counseling Service (RCS) Projection Model.

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B.2.6.8 Develop, maintain, enhance, and update additional actuarial models as needed.

Overall Desired Outcomes/Objectives Accurately assess the impact of an evolving VA health care system and broader environment on Veteran enrollment and demand for VA health care to produce projections central in the development of the VA medical care budget, strategic, capital, and workforce planning, and policy analysis.

B.3. Government Furnished Equipment, Items, and Services

The Government may furnish to the Contractor GFE, GFI, and/or GFS as indicated in the following paragraphs.

B.3.1 Government Furnished Equipment

(Not Applicable to this Acquisition)

B.3.2 Government Furnished Items The Government will furnish VA data for updating and producing the models.

All procedural guides, reference materials, and VA program documentation for the project and other Government applications will also be provided on an as-needed basis. The Contractor shall request other Government documentation deemed pertinent to the work accomplishment directly from the COR. Badges may be provided.

B.3.3 Government Furnished Services (Not Applicable to this Acquisition)

B.4. Period of Performance

The period of performance shall be a twelve month base period and four, twelve month option periods.

Base Period TBD

Option Period 1 TBD

Option Period 2 TBD

Option Period 3 TBD

Option Period 4 TBD

B.5. Type of Contract

The Government will award a single contract Indefinite Delivery Indefinite Quantity (IDIQ) Task Orders with both fixed price and labor hour CLINs with not to exceed amounts and other direct cost Travel CLIN. The Service Contract Labor Standards (SCLS), formerly the Service Contract Act (SCA), apply to this contract and it includes SCLS applicable labor categories and fixed price services.

B.6. Place of Performance

All work completed under this PWS shall take place at the contractor’s facility. Work may also occur at VA space or VA conference locations, on an infrequent basis.

Travel expenditures shall be considered reimbursable under 52.212-4 ALT 1, Other Direct Costs (ODC) and FAR 31.205-46. The Government will limit travel and any

CONTINUATION PAGE 36C10G24R0038 Page 17 of 152 travel must be approved before commencement by the COR and CO. Any travel will be identified in Task Orders.

B.7. Recognized Holidays The contractor shall not be required to perform services on this contract on the following Federal holidays.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day Washington’s Birthday Veterans Day Memorial Day Thanksgiving Day Juneteenth Christmas Day Independence Day

B.8 Hours of Operation

The contractor is responsible for conducting normal business between the hours of 8:00AM and 5:00PM Eastern Time Monday through Friday except federal holidays. If performance is required at a Government facility when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings; contractor shall seek clarification from the CO to perform via another method or cancel all together.

B.9 Business Day For purposes of communication with the Program Office, an administrative business day is 8:00AM ET to 5:00PM ET. These are the days between and including Monday to Friday and do not include public holidays and weekends.

B.10. Definitions The following definitions are used throughout the PWS and are to be construed as the statement of the meaning of a word, word group, a sign, or symbol; a statement expressing the essential nature of something; a product of defining; the action or the power of describing, explaining, or making definite.

For additional contractual definitions, see the Federal Acquisition Regulation (FAR) Subpart 2.101 – Definitions. This FAR part defines words and terms that are frequently used in the FAR; Provides cross-references to other definitions in the FAR of the same word or term; and provides for the incorporation of these definitions in solicitations and contracts by reference.

These definitions have been derived by several sources, including but not limited to the FAR, The Department of Veteran’s Affairs Acquisition Regulations (VAAR), Law Insider Dictionary, and Black’s Law Dictionary. Select modeling definitions are included from the 2023 EHCPM Documentation and Analysis Report Glossary.

Please refer to Attachment E for further modeling-specific definitions.

Accurate: Free from error or defect; consistent with a standard, rule, or model.

Actuarial Model: A simplified representation of relationships among real world variables, entities, or events using statistical, financial, economic, mathematical, or scientific concepts and equations. A model consists of three components: an information input component, which delivers assumptions, parameters, and data to the model; a processing component, which transforms inputs into estimates; and an output component, which translates the estimates into useful business information.

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Base Year: The fiscal year (FY) of actual data upon which projections are based. For example, FY 2023 is October 2022 through September 2023 and forms the basis for the BY23 EHCPM. This model is used to support the 2026/2027 VA budget submission.

Complete: Full; entire; Including every item or element of the thing spoken of, without omissions or deficiencies; as, a “complete” copy, record, schedule, or transcript.

Comprehensive: Complete; including all or nearly all elements or aspects of something.

Current: Whatever is at present in course of passage, present in its progress, the service rendered, and the compensation therefore measured by the time of the occurrence of the event. Passing in time or belonging to the time actually passing, now passing, present in its course, as the current month.

EHCPM Global Relative Value Units (RVU): The EHCPM Global RVUs build on the Centers for Medicare and Medicaid Services (CMS) Resource-Based Relative Value Scale (RBRVS) to cover services and resources that are not assigned CMS RBRVS RVUs. The EHCPM Global RVUs are equal to the CMS RBRVS RVUs for services paid under the CMS RBRVS. The EHCPM Global RVUs produce RVUs consistent with the CMS RBRVS RVUs for other medical services where CMS does not assign RVUs.

Final: Last; conclusive.

Final Submission: Exists when nothing remains to be done to render submission complete.

Plan: A delineation; a design, a draft, a draft or form or representation; the representation of anything drawn on a plane, as a map or chart; a scheme; a sketch;

also, a method of action, procedure, or arrangement.

Quantitative: The purpose is to explain, predict, and/or control phenomena through focused collection of numerical data. Test hypotheses, deductive. Administration of tests and questionnaires (close ended). Conclusions and generalizations formulated at end of study, stated with predetermined degree of certainty. Inferences and/or generalizations are the researcher’s responsibility. Never 100% certain of findings.

Qualitative: The purpose is to explain and gain insight and understanding of phenomena through intensive collection of narrative data, generate hypothesis to be test inductive. Raw data are in words. Essentially ongoing, involves using the observations/comments to come to a conclusion. Conclusions are tentative (conclusions can change), reviewed on an ongoing basis, conclusions are generalizations. The validity of the inferences/generalizations are the reader’s responsibility.

Report: An official or formal statement of facts or proceedings. An account given of a particular matter, especially in the form of an official document, after thorough investigation or consideration by an appointed person or body.

Sufficient: Adequate, enough, as much as may be necessary, equal, or fit for end proposed, and that which may be necessary to accomplish an object.

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Update: To change (something) by including the most recent information; to make (something) more modern; to give (someone) the most recent information about something.

B.11. Acronyms The following acronyms are used throughout the PWS and are to be construed as the statement of the meaning of a word(s) abbreviated but holding the same meaning.

This list is not all inclusive, but represents the main acronyms used throughout.

APO Acquisition Performance Objectives

AQL Acceptable Quality Level(s)

ART Assisted Reproductive Technologies

ATO Authority to Operate

BAA Business Associate Agreement(s)

C&A Certification and Accreditation

CAP Corrective Action Plan(s)

CHAMPVA Civilian Health and Medical Program of the Department of Veterans’

Affairs

CFR Code of Federal Regulations

CIO Chief Information Officer

CLIN Contract Line Items Number(s)

CMS Centers for Medicare and Medicaid Services

CO Contracting Officer

COR Contracting Officer’s Representative

CPARS Contractor Performance Assessment Reporting System

CSCA Contractor Security Control Assessment

DSS Defense Security Service

CSO Chief Strategy Office

EHCPM Enrollee Health Care Projection Model

FAR Federal Acquisition Regulation

FedRAMP Federal Risk and Authorization Management Program

FISMA Federal Information Security Management Act

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FFP Firm Fixed Price

FP Fixed Price

GEC Geriatrics and Extended Care

GFE Government Furnished Equipment

HSC Health Care Service Category

HSPC Health Systems Planning Category

IAW In Accordance With

ISA Interconnection Agreements

ISO Information Security Officer

LH Labor Hour

MH RRTP Mental Health Residential Rehab Treatment Program Diagnosis and

Demographic-Based Demand

MISSION Maintaining Internal Systems and Strengthening Integrated Outside

Networks

MOU Memorandum of Understanding

MS Microsoft

NARA National Archives and Records Administration

NISP National Industrial Security Program

NTE Not To Exceed

OMHSP Office of Mental Health and Suicide Prevention

OTH Other Than Honorable

PACT Patient Aligned Care Team

PACT Act The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act or the “Honoring our PACT Act of 2022”

PCAFC Program of Comprehensive Assistance for Family Caregivers

PDF Portable Document Format

PIA Privacy Impact Assessment

PII Personally Identifiable Information

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POA&M Plan of Action and Milestones

PWS Performance Work Statement

QAP Quality Assurance Plan

QASP Quality Assurance Surveillance Plan

QM Quality Measures

RVU Relative Value Units

RBRVS Resource-Based Relative Value Scale

SAC Strategic Acquisition Center

SSP System Security Plan

VA Department of Veterans Affairs

VAAR Department of Veterans Affairs Acquisition Regulation

VHA Veterans Health Administration

C. SPECIFIC ACTIVITIES, MANDATORY TASKS, and ASSOCIATED DELIVERABLES

C.1. General Requirements

The contractor shall provide actuarial modeling and analytical services to assess the impact of an evolving VA health care system and broader environment on Veteran enrollment and demand for VA health care.

The contractor shall be required to create/develop models, maintain, enhance, validate, and annually update all models with new data from the most recently completed fiscal year and other newly available data, update supporting analyses, integrate new or updated assumptions and enhanced methodology. The contractor shall assess the predictive power of the models and respond to requests, at Task Order level, for comparisons of actual enrollment, patients, utilization, and expenditures to project enrollment, patients, utilization, and expenditures (See Attachment C for an average model update timeline and Attachments F1 and F2 for the deliverables).

All activities, tasks, and deliverables specified in this section shall be required to be performed and/or delivered in the contract by the Contractor. The Contract Line Item Number(s) (CLIN) shall identify the required Activity. Task Orders(s) shall have sufficient information to determine the Activity, tasks, and deliverables required to be performed. Any task not indicated shall not be required to be provided by the contractor. CLINs will be designated with either activity, task, and/or associated deliverables. The activities are the overarching requirements which correlate to tasks and deliverables.

If for any reason the delivery date for a deliverable cannot be met, the contractor shall submit a written explanation to the Contracting officer’s representative (COR) within three business days before the deliverable date. This notice to the COR shall include the original deliverable due date, cite the reasons for the delay, describe the impact

CONTINUATION PAGE 36C10G24R0038 Page 22 of 152 on the overall program, and include a firm commitment of when the work shall be completed. This is intended to be required as part of any deliverable requirement. The COR will then review the facts and discuss with the CO. The COR or CO shall respond to the contractor acknowledging receipt and communicating any additional concerns within two business days in accordance with applicable regulations.

VA will provide the necessary data, documentation of the methodology and assumptions, and the SAS or SQL files that constitutes the current EHCPM to the Contractor. The Contractor shall use the current EHCPM as the starting point for producing the new EHCPM.

C.2. Method and Distribution of Deliverables

All information, data, reports, etc., used or produced for this contract shall be in an electronic format fully compatible with the current release level of SAS, SQL, Microsoft Office software, and / or other agreed upon format such as Power BI. The projection models developed for this contract shall be provided in an executable or non-executable format (SAS or SQL files / programs). Complete written documentation of the methodologies, analyses, and results including factor tables used for calculating impacts of various factors throughout the models are required for satisfactory performance of this contract. This includes all intermediate or interim analyses and findings that have a significant impact on the final results or reveal additional insight into delivering health care to Veterans. The final Model Documentation and Analysis Report (See Attachment E) shall be provided in electronic format (MS Word and Adobe PDF formats).

C.3 Activity 1: Program Management Program management is critical to effective program execution in the areas of risk management, quality assurance, and changing mission priorities. Good planning builds effective partnerships, establishes open communications, sets clear expectations, defines roles and responsibilities, and sets the framework for mission success. Contract management is a multi-disciplined process which encompasses technical, business, and procurement perspectives.

VA requires project management planning activities and materials, regular weekly meetings to ensure contract performance and define objectives, documentation of quality assurance processes, and documentation…