CCN NG Medical Record of Questions Amendment 0009.pdf

36C10G26R0003 0009 Questions and Answers

Question # Vendor Questions VA Answers

I have psychiatric and obesity medicine practice in Naperville IL. I am interested in becoming part of your network. I was unable to find the appropriate form to fill out under your RFP. Could u please send me the forms required to be considered?

Under the current Community Care Network (CCN) contract, Naperville, IL falls under CCN Region 2, which is managed by Optum. In order to join CCN, contact Optum by phone at 1-844-839-6108 or online at https://vacommunitycare.com/provider. Additional information can also be found at https://www.va.gov/COMMUNITYCARE/providers/Community-Care- Network.asp. Future awardees under CCN Next Generation will establish a process for providers interested in joining the network and this process will be posted to the VA Community Care page.

Under the VA Socioeconomic Subcontracting Goals, it is noted that the calculation is based on the percentage of subcontracted dollars for distribution services only. Please define “distribution services.”

See amendment 0008 for further details.

HCD start expectations: The PWS states HCD cannot start sooner than 90 days after award and full HCD must be achieved within 12 months. Does VA intend to direct initial HCD to begin near the 90-day minimum, or may offerors propose a later initial HCD start date (e.g., 150–180 days) provided full HCD is achieved within 12 months?

VA does not direct initial HCD to begin at or near the 90-day minimum. In accordance with Section 2.3 of the Performance Work Statement (PWS) for Task Order Request for Proposals (TOPR) 0001 and 0002, "The Contractor shall not provide HCD at any site sooner than 90 days from contract award but shall achieve full HCD in the CCN Next Generation Medical Network – East [West] no later than 12 months from contract award." This requirement does not dictate when HCD must start, except that it shall not start sooner than 90 days from contract award and that full HCD must be completed no later than 12 months from contract award.

Evaluation impact: If an offeror proposes a later initial HCD start (while meeting the 12-month full HCD requirement), will that be considered acceptable and how (if at all) will it affect technical evaluation / best value tradeoff?

VA will evaluate Offerors’ proposed approaches and schedules in accordance with the applicable evaluation factors set forth in Section E of the TOPRs and the underlying IDIQ, as applicable.

In accordance with Section 2.3 of the Performance Work Statement (PWS) for Task Order Request for Proposals (TOPR) 0001 and 0002, "The Contractor shall not provide HCD at any site sooner than 90 days from contract award but shall achieve full HCD in the CCN Next Generation Medical Network - East [West] no later than 12 months from contract award." This requirement does not dictate when HCD must start, except that it shall not start sooner than 90 days from contract award and that full HCD must be completed no later than 12 months from contract award. VA will evaluate proposals in accordance with Section E of the TOPRs.

Would VA consider modifying the pricing CLIN cap (100% of Medicare fee schedule) to “current contracted rate”? Any additional insight the VA can share on how you envision migrating to more VBC would be helpful.

The ceiling for the pricing CLIN, set at 100% of the Medicare fee schedule, will remain as stated for the purposes of this solicitation and any resultant contract.

For additional information regarding value-based care (VBC), please refer to Section 15.9 of the TOPR PWS.

There are multi aspects of the IDIQ, PWS, and TOPR that contemplate that the VA can make unilateral changes to the contractual obligations during performance, such as:

• IDIQ C.3

• Task Orders, PWS section 1.3

• Service Contract Act (FAR 52.222-43) According to the RFP and TOPR documents, these changes will be negotiated or equitably adjusted on the basis of the contractor’s costs. Can the VA explain whether FAR Part 31 applies to the VA-caused changes? What are the VA’s expectations for how contractors must document, present, and support these costs?

(Program Terms)

FAR 31 is applicable if the conditions listed in FAR 31.000 are present. These are:

(a) the pricing of contracts, subcontracts, and modifications to contracts and subcontracts whenever cost analysis is performed; and (b) the determination, negotiation, or allowance of costs when required by a contract clause. (FAR 31.000)

All changes will be handled in accordance with FAR 52.212-4(c), Changes.

Will the government consider full risk, capitated payment models, such as PMPM pricing or global budgets, as part of the “additional APMs” requirement? For example, industry generally interprets full capitation to include coverage equivalent of Medicare parts A, B, C, and D. (APM Model)

VA encourages offerors to be innovative in their APM proposals for the TOPRs, while recognizing that because of the nature of integrated care across direct care and CCN, some models may not be feasible. Please note the value-based care models will be proposed under the TOPR and not the IDIQ.

Industry Day Participation: The government is hosting an industry day in January, with only two contractor participants eligible to attend in person. To ensure broader engagement and equal access to critical information, will the government provide a conference line or virtual option for additional participants?”

VA posted the pre-proposal Medical and Dental conference recordings in Amendment 0005.

Provider contracting model: Must the contractor execute network agreements with providers/facilities, or can participation occur without executed contracts (paid under VA fee schedule rules)?

The Contractor is required to establish and maintain an adequate provider network consistent with PWS requirements. Network participation is generally established through executed network agreements with providers and facilities.

Payment under applicable VA fee schedule rules does not, by itself, constitute network participation.

HCD at each Station will be achieved upon CO acceptance - What is the readiness criteria and evidence (test cases, training completion, data exchanges) that must be presented for CO acceptance at each site for delivery? Is the acceptance criteria the same across all sites across both East and West? (Deployment & Implementation)

Reference TOPR PWS Section 2.3 for deployment and implementation expectations and Section 16 Technology for data flow and interoperability requirements.

Acceptance criteria will be the same across all sites in both East and West.

VA will require that all hardware/software components are installed and operational prior to Health Care Delivery as detailed in the PWS section 16.3.

VA will require the vendor to validate data flow and interoperability across all integrated systems and VA enterprise systems, as outlined in PWS Sections 16 and 16.3.1. This validation will serve as official sign-off confirming compliance with the ICD and EDI Companion Guides.

VA will require the vendor to confirm completion of the readiness checklist and exit criteria before initiation of station level activities. All documentation is to be reviewed and approved by VA stakeholders, ensuring no critical defects as detailed in the PWS section 2.3.

In addition, VA will require the vendor to provide test plans, test results, and validation sign-off as detailed in the PWS section 16.2 and 16.3.

Acceptance criteria will be the same across all sites in both East and West.

We understand as part of this RFP the VA’s intent is to expand the CCN network of providers. We also understand the new RFP structure allows for multiple contractors in any given geographic region. There is very extensive credentialing process and requirements for both the providers and TPAs. Would the VA consider and clarify the following:

• Can a VA credentialed list of providers be established and allow TPAs/contractors to become “VA certified and in a pool of certified contractors” and share the contracted providers terms – this would alleviate each TPA needing to build their own network of the same providers since terms are very specific to VA and alleviate the individual provider maintaining VA credentials for multiple TPAs

• Is it possible that multiple TPA/contractors will be awarded a certain State and then within that state multiple contractors be awarded and they compete for enrollment?

• Has the Department considered limiting TPA/contractors in each State so that each TPA/Contractor will reach an enrollment threshold that will allow them to develop the appropriate infrastructure to provide proper service to its enrolled members?

No. VA cannot credential community providers to allow TPAs/contractors to become “VA certified and in a pool of certified contractors” to share the contracted provider terms. Regarding TPA network sharing, provider contracts, credentialing processes, and contractual terms are proprietary to each contractor and may vary across TPAs. As such, each TPA/contractor is responsible for independently establishing, credentialing, and maintaining its own provider network in accordance with the requirements of this RFP.

No. VA does not intend for multiple TPA/contractors to compete for provider enrollment within the same State.

VA does not plan to limit the number of TPA/contractors within a State for the purpose of ensuring enrollment thresholds. Contractors are expected to develop and maintain the infrastructure necessary to meet performance, access, and service requirements for their awarded geography in accordance with the terms of the contract.

Section E.3.A.h refers to FAR 52.212-1(f)(1), however, section E.2 Proposal Submissions refers to FAR 52.212-1(c)(1). Please confirm which reference is accurate.

The correct FAR reference is FAR 52.212-1(f)(1)

Section E.1 Proposal Submissions refers to FAR 52.212-1(f)(1), however, section E.1.1.g refers to FAR 52.212-1(c)(1). Please confirm which reference is accurate.

The correct FAR reference is FAR 52.212-1(f)(1). Section E.1 is not Proposal Submissions. Section E.2. is Proposal Submissions.

Section D.2 refers to an "ATTACHMENT P – Health Care Appointment Scheduling and Health Care Comprehensive Care Estimated Volumes". Please confirm if this is referring to the attachment labeled "Attachment P Health Care Historical Volumes and Estimated Enrollment and Eligibility.xlsx".

VA confirms that ATTACHMENT P – Health Care Appointment Scheduling and Health Care Comprehensive Care Estimated Volumes, as referenced in Section D.2, refers to the attachment labeled Attachment P Health Care Historical Volumes and Estimated Enrollment and Eligibility.xlsx. The reference to Attachment P under Section D.2 has been updated to refer to it as ATTACHMENT P - Health Care Historical Volumes and Estimated Enrollment and Eligibility, consistent with the file name.

What is the definition/criteria for "unscheduled system maintenance"?

VA defines "Unscheduled system maintenance" as any unscheduled downtime, unexpected interruption to web/online services and contact center functionality;

VA requires the contractor to notify VA points of contact within 1 hour of the contractor becoming aware of an issue as detailed in PWS sections 6.7.2 & 16.3.

VA's criteria for "Unscheduled system maintenance" is categorized by "unscheduled downtime". VA defines these criteria for "unscheduled downtime" as downtime or unexpected interruption that occurs for more than (1) cumulative hour in any given 24-hour period that interrupts web/online services as detailed PWS sections 6.7.2 & 16.3.

Section 13.9 states "Claims will be monitored for suspicious billing activity and rules to perform further evaluation will be applied and adjudication for those claims identified as potentially suspicious.

Further review of these claims will be conducted to ensure claims are not improper or inappropriate." Please clarify if this is the contractors responsibility.

Section 13.9 does not exist in TOPR East. Yes, confirming this is the Contractor's responsibility, referring to Section 14.11 of the PWS for further information.

What weight will be levied for offerors that consistently demonstrate a large amount of internal veteran involvement?

(Factors to be Evaluated; Page 106)

Veterans Involvement/Subcontracting Plan(s) will be evaluated in accordance with Section E of the RFP and TOPRs.

Does the Government prefer the Offeror respond to as many PWS elements for which they are qualified, or is there a preference for focused responses on specific areas of expertise?

Offerors do not have to demonstrate corporate experience in all task areas defined in Section 1.2 of the IDIQ PWS. Offerors who demonstrate adequate corporate experience, as described in Section E of the IDIQ RFP, for relevant services in one or more of the task areas described in Section 1.2 of the IDIQ PWS will be evaluated and considered for IDIQ contract award.

The Government will evaluate and award task order / TOPR proposals in accordance with Section E of the TOPR.

Evaluation Weighting: Are the individual Performance Work Statement (PWS) functional areas weighted differently in the technical evaluation (e.g., medical network development versus customer service), or are they evaluated equally?

Please refer to E.2 ADDENDUM TO FAR 52.212-2 EVALUATION— COMMERICAL ITEMS of the TOPR RFP for detailed information regarding the evaluation weighting of the individual Performance Work Statement (PWS) functional areas.

This section outlines how subfactors will be evaluated and how their assessments will contribute to the final adjectival rating of the overall technical evaluation.

1. Under CLIN X008, what specific services does the VA anticipate will be included under Alternate payment model and reimbursed as administrative services?

2. Does the government expect that an integrated care and coverage solution will be reimbursed for both medical services CLIN X001 and the administrative services listed under CLIN X008?

3. For Administrative Services listed in CLIN X008, would the government expect to pay the contractor at actual cost or commercial off the shelf rates?

(Admin Services)

1) CLIN X008 is for VA’s payment to the Contractor for the administrative services required to deliver the healthcare services under the contract. Costs associated with operating or administrating alternative payment models, as well as all other administrative services costs, are to be invoiced through CLIN X008.

2) CLIN X008 is for the administrative services required to deliver healthcare services. CLIN X001, however, includes the cost of medical services at locality-adjusted Medicare rates only. The Contractor does not propose pricing for CLIN X001.

3) VA will pay the contractor at the awarded rates. The Contractor should propose the costs required to administer and deliver the healthcare services required under the contract; VA does not have an expectation as to how the Contractor developed their proposed price, as it is likely driven by their existing rate structures and how the business is organized and operated.

Under the alternate payment model, for IDIQ and CCN TPA TOPR (VBC 15.9), does the government intend to pay the Contractor at actual cost or commercial off-the-shelf rates? (APM Model)

VA has not defined payment structures for additional alternate payment models (APM), rather has requested APMs and implementation for consideration and approval. Please reference PWS section 15.9 for further information about the requested APMs and implementation

Under the Alternate Payment Model (APM) in CCN TPA TOPR (VBC 15.9) or the IDIQ, will the government’s model require patients to receive care both within VHA facilities and through the APM delivery system (i.e., integrated or shared care)? (APM Model)

VA has not defined payment structures for additional alternate payment models (APM), rather has requested APMs and implementation for consideration and approval. Please reference PWS section 15.9 for further information about the requested APMs and implementation

Under the Alternate Payment Model (APM), if care is required within the VHA, would the government allow an end-of-year financial reconciliation to ensure VHA is reimbursed for care it delivers or that the APM model is appropriately discounted? (APM Model)

Offerors should propose such end-of-year financial reconciliation in their APM proposal deliverable and VA will consider it as part of the broader APM initiative review.

Under the APM model in CCN TPA TOPR (VBC 15.9) or the IDIQ, will all existing TPA pharmacy requirements remain applicable, including utilization of VA formulary for pharmacy services?

VA’s existing pharmacy requirements as stated in the PWS Section 9 are applicable to any APMs proposed.

Will the government accept a fully integrated health plan offer— providing both coverage and care delivery—as an IDIQ prime vendor to support healthcare services for VA beneficiaries?

Offerors must propose solutions that fully satisfy the requirements and scope as defined in the IDIQ solicitation and associated Task Order Request(s). The Government will evaluate proposals based on the stated requirements, evaluation criteria, and CLIN structure.

Will the government accept an IDIQ solution that fully satisfies all 17 general task areas and also includes healthcare delivery as an additional capability? For example, if a multistate health plan is capable of fulfilling all identified task areas and additionally offers an integrated healthcare delivery system for veterans. (Contract)

Offerors must propose solutions that fully satisfy the requirements and scope as defined in the IDIQ solicitation and associated Task Order Request(s). The Government will evaluate proposals based on the stated requirements, evaluation criteria, and CLIN structure.

The Government will not evaluate, or award based on capabilities that fall outside the defined scope of the IDIQ or Task Order unless the solicitation specifically provides for optional or additional capabilities. Offerors should ensure their proposals align strictly with the solicitation requirements and avoid including enhancements that could be construed as out-of-scope or as creating ambiguity in evaluation.

What is the anticipated award dates for the IDIQ and the TPA? What is the anticipated start date for delivery for the IDIQ and the TPA? (Contract)

Currently, the anticipated start date has not yet been determined. The IDIQ will be awarded with a three-year base period. Refer to 2.3 in the East and West TOPR PWS for further information regarding healthcare delivery.

Enrollment Approach: Under APM models, what process and/or mechanism will the government use to prevent adverse selection that could give an unfair advantage to Feefor-Service (FFS) TPAs, while ensuring fair competition among all contractors?

Participation is based on the Veteran not the TPA and the historical volume of episodes. Veteran Choice is maintained.

Are there any restrictions on bidding for other general task areas if a contractor is not awarded for that specific area?

No. The Government confirms that there are no restrictions preventing an Offeror from bidding on or competing for other Task Orders under this contract that is not awarded.

We understand it is the Government's intent to promote maximum competition and is not limiting prospective offerors to those who have experience as large carriers with a regional/national footprint.

With that understanding, can an offeror cite experience in multiple state Medicaid programs to meet the requirements for experience "covering multiple states" even though each of those contracts are with each individual state? Question and answer #7 / Page 3.

Medical IDIQ Record of Questions Amendment 0001 12.23.25

Refer to Amendment 0004 for further clarity regarding Factor 1: Corporate Experience.

"Contractors must provide written notification to the CO and COR no later than 4 hours when an employee working on a VA information system or with access to VA information is reassigned or leaves the Contractor's employment under the relevant contract." Question: Does this notification apply to clinical and non clinical associates working on the plan interacting with providers and members doing utilization managment and case management?

Yes

"If a Veteran dies while receiving care from the nursing home provider, the Contractor shall ensure its nursing home providers notify the VA facility authorizing the care and attend to the Veteran's personal effects. Contractor shall create an itemized list of the Veteran's personal property and/or send the personal property to the VA within 24 hours, as required."

Question: Is this process implemented and in action today?

The process is not implemented and in action today. VA currently requires notification but does not require notice within 24-hours.

Page 105 Medical East Contract Manual shows that denials would go to VA for final determination. Question: Would all denials need to go to VA before determination?

The contractor is responsible for making a recommended determination to the VA based on the medical necessity review of the request, irrespective of approval or denial. The VA currently will make the final determination after receiving the recommended determination by the contractor.

Vision benefits covered under DME section 4.8 for eyeglass and contact lenses. Does the VA currently offer an allowance based coverage or full coverage of these items?

Vision benefits for eyeglasses and contact lenses under DME Section 4.8 are provided in accordance with VA policy and Veteran eligibility criteria, not as a commercial-style allowance. Coverage may include full coverage of authorized items when clinically indicated and approved by VA, subject to applicable limitations, medical necessity determinations, and formulary or policy requirements.

The Government does not utilize a fixed dollar allowance model for eyeglasses or contact lenses. Contractors should process and support these benefits consistent with VA authorizations, referrals, and governing policies, as applicable.

Would the VA be able to define how 90% directory accuracy is calculated for urgent care?

Refer to Attachment Ca for calculations.

There are a number of items that list "reserved" in the description for Payment Integrity / Program Integrity, when will we be provided detail on those pieces?

To the extent practicable, the Medical Manual Table of Contents mirrors this PWS to easily identify when there is Medical Manual content for a PWS section. If there is no Medical Manual content for a corresponding PWS section, then the section is marked “RESERVED” in the Medical Manual.

The documentation mentions a daily eligibility file. After the initial load, it sounds like the files will be transactional only files. Please provide confirmation this is true.

Refer to TOPR PWS, Attachment 1, for information related to the eligibility files

Is this RFP inclusive of CHAMPVA - The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) - for the spouses, dependents, and survivors of Veterans who meet certain service-connected disability requirements?

No. This RFP is not inclusive of CHAMPVA beneficiaries. The CCN Next Generation Medical solicitation applies to the community care services for eligible Veterans only. CHAMPVA is a separate statutory health benefits program administered under different authorities and is not included within the scope of this solicitation.

For Vision & Contact Lenses, please confirm the current medical benefits cover 'specialty' contact lenses/fittings. Can the VA please define what constitutes 'specialty' contact lenses? Is there criteria the member must meet to have this covered under the medical benefits ?

Yes, Contact lenses are provided to eligible Veterans who meet the clinical prescribing criteria (subject to evaluation by or the recommendation, prescription and approval of a VA eye care provider). Refer to PWS Section 4.8.5 Specialty Contact Lenses.

How will the Veterans Community Care Eligibility Codes (VCE) be passed on the eligibility file? Will this information be needed to service the Veterans? Will the contractor be expected to maintain this value (which would need defining) within their eligibility system?

In accordance with Attachment 1 – CCN Next Gen – Medical East TOPR PWS Section 5 and Attachment 1 – CCN Next Gen – Medical West TOPR PWS Section 5 : “The Contractor shall have the capability to receive enrollment and eligibility information from VA in a daily eligibility file through EDI Gateway/Data Access Services (DAS), which will serve as the primary method of data exchange until VA develops and implements real-time data-sharing capabilities. VA may also use secure messaging to transmit enrollment and eligibility information. The file will contain Veterans Community Care Eligibility (VCE) Code changes for eligible individuals. Additional explanatory information on VCE codes can be found in the Medical Manual Section 5.6, “Veteran Community Care Eligibility Codes.”

The Contractor shall not provide HCD at any site sooner than 90 days from contract award but shall achieve full HCD in the CCN Next Generation Medical Network - East no later than 12 months from contract award. Section 20 Definitions, defines HCD as Healthcare delivery of ALL medical services at any site(s). Is this language implying a staged approach to go-live?(2.3 Deployment and Implementation, page 7)(East/West PWS)

It is incumbent upon the offeror to determine its approach to enabling and achieving full health care delivery (HCD) throughout the region in accordance with Section 2.3 of the TOPR PWS.

For EVV-required services, will the network provider be forced to submit billing via the Contractor’s chosen EVV solution, or will claims be submitted through a clearing house/ other methods?

Determination of the solution used by network providers for submitting EVV data will be between the Contractor and provider.

In section 18.1 of the TOPR documents if a veteran doesn’t choose a network provider, who will be responsible to assign the referral?

Will it be the contractor as referenced, or will the VA social workers or care coordinators be responsible for initial care coordination?

The VA contacts the Veteran for scheduling preferences to determine the provider prior to assigning the referral.

How will the contractor transmit all RFS form Requests and statuses to the VA Via EDI?

Contractors will submit and receive information through EDI gateways.

Currently VA GEC Care Coordinator is supposed to use the case mix tool to determine levels of Care for Home Care as per the memo titled “Update to 2017 Operational Memorandum ‘Case Mix Tool for Personal Care Services’ (VIEWS 5487746)”. With the new RFS process in place is that expected to change? Will the contractor approve or deny hours of care using said methodology?

The Government confirms that it will provide the Contractor with access to relevant data necessary to support final determinations (approvals, denials, or modifications) and related documentation, to the extent such data exists and is maintained by VA. VA will retain authority to approve or deny all RFS.

Will the code S5150 no longer be in use? In section … of the Contractor Manual S5150 is not an EVV required code.

Additionally, does the VA anticipate using T1019 and S5125 for Custodial and Personal Care Services?

The Government does not anticipate requiring the use of code S5150 for EVV purposes. Offerors should not include S5150 as an EVV-required code unless otherwise directed in future guidance or updates to the Contractor Manual.

With respect to T1019 and S5125, these codes may be used for Custodial and Personal Care Services as specified in the applicable PWS, Contractor Manual, or Task Order instructions. The Government will provide any additional clarification regarding code usage, including EVV requirements and reporting expectations, through the Contractor Manual or subsequent guidance.

Since VA retains final approval authority over risk mitigation strategies, how will unresolved risks that are outside of the Contractor’s direct control be reflected in performance assessments and surveillance activities? Risk Management

VA Risk Management requires that unresolved risks be reported quarterly in the "Project Risk Register" deliverable and presented during the PMR under "Risk Status." The impact of unresolved risks on performance assessments and surveillance activities will depend on the risk assessment, documented responses, and discussions held during the PMR. Additionally, other risk responses (e.g., acceptance) may be considered at that time, with final approval authority resting with the VA.

Is there a penalty if we do not meet that 10 day timeframe? What is the risk associated with missing this turn around time? VA Fee Schedule

The 10-day implementation period for the VA Fee Schedule is a contractual requirement. The potential risks from an operational perspective are not paying providers timely or paying them an incorrect amount, resulting in rework at the Contractor’s expense and provider abrasion.

Does VA require provider directory submissions specifically in EDI 274 format? If so, is this expected as a full extract, incremental updates, or both? Medical Network Provider Data for VA’s Provider Directory

Yes, VA requires provider data submissions in EDI 274 format. Please refer to Attachment 1 CCN Next Gen PWS, Section 3.7.

Can the Contractor work exclusively with Indian Health Clinics for Native American Healing Services, or is it permissible to contract with other providers as well? If contracting outside of IHCs is allowed, what are the basic criteria for an individual's eligibility to provide these services? CCN Complementary and Integrative Health Care Services

The Contractor is not limited to working exclusively with Indian Health Clinics (IHCs) for Native American Healing Services. The Contractor may contract with other qualified providers, provided such providers meet applicable VA credentialing, licensure (where required), and network participation requirements, and are authorized to furnish the services under the applicable Task Order and VA policy.

Could you provide information on the billing codes and rates that apply to Native American Healing services Complementary and Integrative Health Care Services

In accordance with Section 11.2 Claims Processing and Adjudication, the Contractor shall ensure network providers use the most appropriate Current Procedural Terminology (CPT) and/or Healthcare Common Procedure Coding System (HCPCS) code that accurately describes the procedure. The Contractor shall provide guidance to its network providers that when billing a service or procedure, they shall select the CPT or HCPCS codes that accurately identify the service or procedure performed. If no such code exists, the Contractor shall instruct network providers to report the service or procedure using the appropriate unlisted procedure or National Occupational Classification code.

Are Native American Healing services exclusively available to Native American Veterans? If this benefit is limited to them, will the VA provide the Contractor with an eligibility file at the county or ZIP code level upon initial award?CCN Complementary and Integrative Health Care Services

Eligibility for Complementary and Integrative Health Care Services, including Native American Healing, is determined by VA clinical authorization and applicable policy, not solely by Veteran ethnicity or tribal affiliation.

The VA does not intend to provide an eligibility file at the county or ZIP code level identifying Veterans eligible for Native American Healing services. Authorization for these services will be communicated through standard VA referral and authorization processes at the individual Veteran level.

Native American Healing was added to the CIHS list. What do these services entail? What are the certifications if any?

“Native American Healing” as included within the CIHS list refers to traditional healing practices rooted in Native American cultural and spiritual traditions.

These services may include, but are not limited to, traditional ceremonies, spiritual counseling, healing rituals, and other culturally specific practices intended to support holistic health and well-being.

There is no single national certification standard for Native American Healing services. Provider eligibility will be determined based on applicable VA policy, credentialing requirements (as appropriate), recognition within the relevant tribal community or tradition, and compliance with federal, state, and tribal regulations. Additional guidance regarding provider qualifications and documentation requirements will be provided at the Task Order level or through subsequent VA policy direction.

What are the fee structures for CIHS providers who are not licensed? Does the VA have specific definitions for non-licensed CIHS providers?

The Government does not establish a separate or uniform fee structure based solely on licensure status for CIHS providers. Fee structures for CIHS services, including those furnished by providers who are not licensed, will be defined in the applicable fee schedules, PWS provisions, Contractor Manual, or Task Order requirements. Reimbursement may vary based on the specific CIHS modality, provider qualifications, geographic considerations, and VA policy.

Are there exclusions that disqualify a provider from joining the network for the expanded services (Indian healing services, biofeedback providers, tai chi, yoga providers)?

The Contractor must ensure that all providers in the network meet the credentialing and accreditation standards in the PWS. The Contractor shall ensure that network providers who do not have national accrediting organization standards for their specialty provide the minimum documentation indicated in Section 3.6, Credentialing, of Attachment 1 – CCN Next Gen PWS. The Contractor shall describe their approach to ensure these providers provide the minimum documentation in its Credentialing Plan. For unlicensed, unskilled providers, the Contractor shall conduct and document a background check in lieu of licensure (e.g., home health aide). Please refer to Attachment 1 CCN Next Gen PWS, Section 3.6.

Will the Yoga and Tai Chi providers need to be credentialed?CCN Complementary and Integrative Health Care Services

The Contractor shall ensure that network providers who do not have national accrediting organization standards for their specialty provide the minimum documentation indicated in Section 3.6, Credentialing, of Attachment 1 – CCN Next Gen PWS. The Contractor shall describe their approach to ensure these providers provide the minimum documentation in its Credentialing Plan. For unlicensed, unskilled providers, the Contractor shall conduct and document a background check in lieu of licensure (e.g., home health aide). Please refer to Attachment 1 CCN Next Gen PWS, Section 3.6.

If credentialing is required for Yoga and Tai Chi providers, what credentialing criteria will need to be used?

The Contractor shall ensure that network providers who do not have national accrediting organization standards for their specialty provide the minimum documentation indicated in Section 3.6, Credentialing, of Attachment 1 – CCN Next Gen PWS. The Contractor shall describe their approach to ensure these providers provide the minimum documentation in its Credentialing Plan. For unlicensed, unskilled providers, the Contractor shall conduct and document a background check in lieu of licensure (e.g., home health aide). Please refer to Attachment 1 CCN Next Gen PWS, Section 3.6

Will Yoga and Tai Chi providers have to be approved by a credentialing board similar to other standard health providers?

The Contractor shall ensure that network providers who do not have national accrediting organization standards for their specialty provide the minimum documentation indicated in Section 3.6, Credentialing, of Attachment 1 – CCN Next Gen PWS. The Contractor shall describe their approach to ensure these providers provide the minimum documentation in its Credentialing Plan. For unlicensed, unskilled providers, the Contractor shall conduct and document a background check in lieu of licensure (e.g., home health aide). Please refer to Attachment 1 CCN Next Gen PWS, Section 3.6.

What licensure is needed to qualify NIHS (Native Indian Healing Services) providers, if any?CCN Complementary and Integrative Health Care Services

The Contractor shall ensure that network providers who do not have national accrediting organization standards for their specialty provide the minimum documentation indicated in Section 3.6, Credentialing, of Attachment 1 – CCN Next Gen PWS. The Contractor shall describe their approach to ensure these providers provide the minimum documentation in its Credentialing Plan. For unlicensed, unskilled providers, the Contractor shall conduct and document a background check in lieu of licensure (e.g., home health aide). Please refer to Attachment 1 CCN Next Gen PWS, Section 3.6.

When a VA-Approved Referral is corrected or amended, does VA issue a new referral number or update the existing referral, and how should claims be matched in each scenario? Referrals

When VA makes a correction to a referral, it will depend on the scope of the change to determine if the existing referral number can be utilized or if a new referral number is needed. The corrected referral with the associated referral number is communicated and should be utilized when submitting claims.

How should services that partially exceed referral date ranges but are clinically part of the authorized episode of care be adjudicated?Referrals

When care is needed that falls outside of the validity periods of the authorization, community providers will submit a request for service (RFS) to the contractor for review that is routed to the VA. VA will review the request and communicate approval or denial.

What notification systems in the VA should receive any critical findings? Is there a DAS connection for this or should this be done via a phone call?Critical Findings

VA requires that critical findings be communicated promptly to protect patient safety. The contractor shall ensure that critical findings are communicated verbally via phone as soon as identified, followed by written documentation through Medical Documentation. Written documentation must confirm verbal communication occurred. Communication must have occurred within (2) days or sooner as outlined in PWS Section, 10.5 “Critical Findings”.

Which date governs eligibility validation for claims adjudication:

date of service, date of claim receipt, or the most recent eligibility file available?

Claims should be processed using the most recent eligibility data that covers the date of service. In cases where the individual is deceased, or other special circumstances, a look back at historical eligibility data may be needed.

When claims are denied due to VA-controlled data issues (eligibility, referral corrections, retroactive updates), are these considered VA dependency issues or Contractor performance failures?

Claims denied due to VA-controlled data issues—such as eligibility discrepancies, referral corrections, or retroactive updates—are considered VA dependency issues, not Contractor performance failures.

When does the 30-day reimbursement submission clock begin:

after provider payment, after final adjudication, or after resolution of VA-driven data issues? Reimbursement Submission to VA

Contractor submits claim invoices to VA for reimbursement within thirty (30) days of the Contractor’s complete adjudication and payment of the claim submitted by the network provider. Refer to PWS section 12 Reimbursement Submission to

VA.

Will VA grant timeliness or submission exceptions when reimbursement delays are caused by VA system, data, or policy dependencies? Reimbursement Submission to VA

VA will grant exemptions to the claim submission timeline requirement on a case-by-case basis. Exemption requests will be granted based on the justification provided. Requests with justification clearly demonstrating circumstances outside of the Contractor’s control are likely to be granted.

What constitutes “real-time, read-only access” for VA users, and are there defined expectations for performance, availability, and reporting access? Technology

VA requires all contractors to provide VA with real-time, read-only access to the Contractor’s system(s). This requirement access includes real-time, ready only access to the Contractor Contact Center, claims processing, Contractor self-service portal, and any additional systems that are developed or used under this contract as outlined in PWS Section 16.1, "Communication and Access to Contractor Systems"

VA's expectation for contractor performance, availability, and reporting; is to have the ability to run a query data, run reports, access systems via Application Programming Interface (API) and access care coordination data as required under the contract as outlined in PWS Section 16.1, "Communication and Access to Contractor Systems"

PWS states "Each eLearning course will be provided by VA to the Contractor for inclusion on their learning platform in an industry-standard format, including SCORM 1.2/2004, xAPI (Tin Can), or cmi5, to ensure compatibility with current and future learning management systems". Will the contractor house all eLearning on an LMS owned by the contractor that feeds into the Community Care Education and Training site or will the contractor monitor, track, and upload training to the Community Care Education and Training site. VA Provided Training

The training will be housed on VHA ILEAD’s TRAIN site where completions are recorded. VHA TRAIN is an external learning management system to provide valuable, Veteran-focused, accredited, continuing medical education at no cost to community health care providers.

Several performance objectives require Contractor-developed calculation methodologies that must be approved at kickoff. Will VA provide baseline expectations, templates, or exemplars to promote consistency across Contractors? Performance Surveillance and Assessment

Contractors are responsible for developing calculation methodologies in accordance with the requirements of the Performance Work Statement and applicable Task Orders. The Government will review and approve these methodologies at the kickoff meeting. Offerors may refer to the Attachment C PRS and Attachment Ca QASP for sample calculations. Offerors should propose approaches that meet the stated requirements and evaluation criteria.

VA may unilaterally implement minor updates to the Performance Requirement Summary. How will VA determine whether a change materially impacts Contractor cost, scope, or performance risk?

PRS Updates

In accordance with Attachment 1 TOPR PWS East and Attachment 1 TOPR PWS West; Page 9: The VA determines material impact by evaluating whether the proposed change alters cost, scope, or performance related elements of the PRS;

if it does, it is treated as a major update add language and will be executed as a bilateral agreement between VA and the Contractor.

The Medical Network Adequacy Plan must be submitted with the proposal. Should offerors assume access to VA-identified preferred providers at proposal submission, or should this be treated as a post-award coordination activity? Medical Network Adequacy Plan

Offerors should not assume that they already have access to the VA-identified preferred providers when they submit their proposal. The Medical Network Adequacy Plan is a required deliverable that must be included with the proposal and should describe the contractor’s approach for obtaining and integrating those preferred providers into the network. The actual coordination, credentialing and enrollment of the VA-identified providers is a post-award activity that will be finalized during contract implementation.

For continuity of care for Veterans and ease of transition for providers, will the VA provide the Contractor (upon initial award) with a comprehensive claim file of all CCN claims for the region (including at least provider name, tax ID, number of claims and service locations) over the last 12 months? In addition, will the VA provide the Contractor (upon initial award) a full list of Custodial Nursing Homes and Adult Day providers who had active referrals in the last 12 months? Single Case Agreement and Continuity of Care

For historical claims data, please refer to Attachment P, Health Care Historical Volumes and Estimated Enrollment and Eligibility. Providing continuity of care will require access to information for the Veteran. The HealthShare Referral Manager (HSRM) provides a secure system of managing all community care referrals. In addition, our Joint Health Information Exchange will be used to share health information (similar to how other HIEs function.)

What credentialing is expected for SCA providers? Single Case Agreement and Continuity of Care

The Contractor shall ensure that the SCA providers follow standards as outlined in PWS Section 3.6, “Credentialing.”

What is the expected expedited credentialing timeline? Single Case Agreement and Continuity of Care

The Contractor shall ensure that the SCA providers follow standards as outlined in PWS Section 3.6, “Credentialing.” The expedited process should be indicated in the Contractor’s Credentialing Plan. According to the PWS Section 3.3.2, the Contractor shall work with VA to establish an SCA within 72 hours of request.

Is the 72-hour timeframe for establishing a single case agreement based on business days/hours? Single Case Agreements

The referenced timeframe is measured in hours not business hours. In instances where business hours are expected, it will be explicitly stated in the PWS.

Is the 90-day timeframe for credentialing based on when a provider submits documents, not when we chase down paperwork? Single Case Agreements

The 90-day timeframe begins upon the network provider’s acknowledgement of the request for credentialing. The Contractor shall ensure credentialing of its network providers is completed within 90 days. This 90-day credentialing period begins upon a network provider’s acknowledgement of the request for credentialing and ends when VA is notified of successful completion of credentialing.

Can the VA share any Veteran's care agreement rates for dialysis? The Government will not provide Veteran care agreement rates for dialysis.

What is the make-up of the dialysis network nationally through Veterans care agreements? Dialysis

Dialysis care is not managed under Veterans Care Agreements.

This only references Solid Organ Transplant. Is it implied that this also includes Stem Cell and CAR T-Cell Transplant Services? Organ Donation and Transplants

Yes, this includes Stem Cell and CAR-T cell transplant services. From the definition table on page 218 of the PWS, transplantation includes medical or surgical procedure in which a solid organ or stem cells are removed from a donor's body and implanted in the body of a recipient. Types of organ transplantation include solid organ (kidney, liver, lung, heart, pancreas, small bowel or combination thereof in dual organ transplants) and stem cell transplants.

Where is accreditation unavailable due to state, specialty, or provider-type limitations, how quickly will VA adjudicate accreditation waiver requests to support network build timelines?Accreditation

VA will adjudicate accreditation waiver requests in a timely manner in alignment with the completion of the business rules for accreditation waiver requests.

Please see Attachment 2 CCN Next Gen Medical Network Contractor Manual, Table 5, for reference.

Waiver approvals are discretionary and not guaranteed. Will VA prioritize or expedite waiver reviews during the initial implementation period to reduce early non-compliance risk?Medical Network Waiver Requests

Yes, VA will prioritize the review of waiver requests that include adequate justification and a clearly defined remediation plan, as outlined in section 3.3.1 of the Medical East TOPR PWS and Medical West TOPR PWS.

Year 1 includes implementation. Why is pricing required for other CLINs (healthcare and admin) during the Year 1 implementation period? Please confirm the implementation duration and the start of healthcare delivery. Attachment 3 Price Schedule (East/West)

The PWS states, “The Contractor shall not provide HCD at any site sooner than 90 days from contract award but shall achieve full HCD in the CCN Next Generation Medical Network - East no later than 12 months from contract award.”

As a Contractor achieves HCD at a site, then HCD costs after that should be captured in the appropriate CLINs and not in the Implementation CLIN.

To support accurate and consistent pricing assumptions, the solicitation and Attachment P do not appear to provide sufficient detail regarding historical or estimated operational volumes that materially drive staffing, system capacity, utilization management, and care coordination costs.

Does the Government intend to provide any historical or estimated volume data (at a regional or aggregate level) for the CCN Next Generation Medical program, including but not limited to:

• Total annual referrals issued, and of those referrals, the number resulting in scheduled appointments;

If such historical or estimated data will not be provided, does the Government agree that offerors may rely on reasonable, experience-based assumptions for these volume drivers when developing pricing and staffing models, including assumptions related to utilization management workload, care coordination staffing, claims processing effort, and system throughput?

In any areas where detailed volume information is not provided, offerors are expected to use their own established estimating methodologies—such as historical experience, parametric estimation techniques, benchmarking, and SME input—to develop…