Next Gen Medical TOPR West Conformed Copy 03202026.pdf

PAGE 1 OF 59 1. REQUISITION NO.

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

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

TIME

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

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

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

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

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

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

SEE ADDENDUM

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

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

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

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

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

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

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

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

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

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

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

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

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C10G26R0003 12-15-2025

Jessica Portillo 04-03-2026

14:00 EST

36C10G

U.S. Department of Veterans Affairs

OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400

Fredericksburg VA 22408-2697

X

524114

$47 Million

N/A

X

36C10G

OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400

Fredericksburg VA 22408-2697

VAFSC

Financial Services Center

PO BOX 149971

(see Section B.3 invoicing/payment)

Austin TX 78714-8917

1 (877) 489-6135

See CONTINUATION Page

This TOPR is for Community Care Network (CCN) Next Generation

(Next Gen)- Medical West

This procurement effort may result in up to one Task Orders to one awardee.

All initial questions must be in writing and sent to the

Contracting Officer no later than 10:00AM EST on 2/4/2026.

Pre-proposal Conference to be conducted on 1/21/2026.

All Proposals must be submitted by 2:00PM EST on 4/3/2026.

See CONTINUATION Page x X

Jessica Portillo

Contracting Officer

36C10G26R0003 | TOPR 0002 | CCN Next Gen – Medical West

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA:

B.2 TASK ORDER ADMINISTRATION DATA

B.2.1 Task Order Procedures

B. 3 ADDITIONAL CONTRACT INSTRUCTIONS

B.3.1 VA Payment Hierarchy

B 3.2 Waivers of Payment Rates

B.3.3 Computation of “Lesser Of” Payment Rates

B.3.4 Medicare Rates

B.3.5 VA Fee Schedule

B.3.6 Alaska Fee Schedules

B.3.7 Pricing and Coverage Deviations

B.3.8 Cancellation Ceiling

B.4. MEDICAL CLIN STRUCTURE

SECTION C - CONTRACT CLAUSES

C.1 ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

C.2 TASK ORDER INTRODUCTORY LANGUAGE

C.3 TASK ORDER TERMS AND CONDITIONS

C.4 52.217-7 OPTION FOR INCREASED QUANTITY—SEPARATELY PRICED LINE

ITEM (MAR 1989)

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

C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.7 52.222-49 Service Contract Labor Standards-Place of Performance Unknown (May

2014)

C.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.9 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.10 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 CONTRACT ATTACHMENTS

D.2 PWS Attachments

D.3 TOPR Attachments

SECTION E - SOLICITATION PROVISIONS

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

PRODUCTS AND COMMERCIAL SERVICES

E.2 ADDENDUM to FAR 52.212-2 EVALUATION— COMMERICAL ITEMS

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.6 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.7 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA:

All contract administration matters will be handled by the following individuals:

CONTRACTOR: TBD

GOVERNMENT: Jessica Portillo, Contracting Officer

Chief, Procurement Division 6

Telephone Number: TBD

Jessica.Portillo1@va.gov

Strategic Acquisition Center (SAC)

TBD, Contract Specialist

@va.gov

Strategic Acquisition Center (SAC)

Department of Veteran Affairs

TBD, Contracting Officer Representative

@va.gov

Department of Veteran Affairs

CONTRACTOR REMITTANCE ADDRESS:

All payments by the Government to the contractor will be made in accordance with

(IAW):

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

[] 52.232-36, Payment by Third Party

INVOICES: Invoices shall be submitted monthly in arrears, upon VA Approval of the Medical claims or invoices.

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.

INVOICING INSTRUCTIONS:

mailto:Jessica.Portillo1@va.gov mailto:Cristine.Carmody@va.gov mailto:Cristine.Carmody@va.gov

TUNGSTEN (fka OB10) ELECTRONIC INVOICE SUBMISSION FSC e-INVOICE

PROGRAM THRU AUSTIN PORTAL

FSC MANDATORY ELECTRONIC INVOICE SUBMISSION FOR AUSTIN PAYMENTS

Contracting POC: T B D

COR: TBD

Contract/Task Order Number: TBD

Vendor Electronic Invoice Submission Methods:

Fax, email 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 data transmissions below.

VA’s Electronic Invoice Presentment and Payment System – The Financial Services

Center (FSC) in Austin, TX 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. 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 is http://www.x12.org.

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 in Austin, TX for payment processing. If you have questions about the payment status of a properly submitted invoice, the e-invoicing program, or Tungsten, please contact the FSC at the phone number or email address listed below.

Tungsten e-Invoice setup information: 1-877-489-6135

Tungsten e-Invoice email: VA.Registration@tungsten-network.com

VA TUNGSTEN Number: AAA544240062

FSC e-Invoice contact information: 1-877-353-9791

FSC e-Invoice email: vafsccshd@va.gov http://www.fsc.va.gov/einvoice.asp

COMMUNICATIONS:

https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-electronic-submission-of-payment-requests http://www.tungsten-network.com/US/en/veterans-affairs/ http://www.x12.org/ mailto:VA.Registration@tungsten-network.com mailto:vafsccshd@va.gov http://www.fsc.va.gov/einvoice.asp https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-electronic-submission-of-payment-requests https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-electronic-submission-of-payment-requests

ACKNOWLEDGMENT OF AMENDMENTS:

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

AMENDMENT NO DATE

B.2 TASK ORDER ADMINISTRATION DATA

B.2.1 TASK ORDER PROCEDURES

Contractors under CCN Next Gen - Medical shall provide services as requirements are identified throughout the ordering period. Each requirement will specify details as they relate to deliverables, performance, and other technical items. The Government anticipates the task orders to have a Period of Performance (PoP) consisting of one (1) three (3) year base period and two (2), 12 month option periods.

In accordance with FAR 17.2, the Government may contemplate the use of options in each task order. Inclusion of options at the task order level will be properly documented and approved in accordance with FAR and agency procedures and will be clearly stated in the TOPR. FAR 52.217-9 will be included in any task orders that include options. TOs may also include FAR 52.217-8, Option to Extend Service.

B. 3 ADDITIONAL CONTRACT INSTRUCTIONS

B.3.1 VA PAYMENT HIERARCHY

For healthcare services provided, when there is a Medicare rate for the authorized services, the VA reimburses the Contractor the rate up to the maximum allowable, locality-adjusted Medicare rate inclusive of the applicable Medicare assigned deductible. The Contractor shall compare the Medicare rate with the provider’s billed charges and pay the provider. After the Contractor pays the provider, the Contractor shall submit an invoice to VA for payment at the lesser of the Medicare rate or the billed charges. When Medicare applies the CMS Mid-level reduction as determined by the rendering providers taxonomy, the Contractor shall apply that reduction. Reference the

“Attachment 2 - CCN Next Gen Medical Contractor Manual _02_24_26_v2” for additional details regarding the CMS Mid-level reduction.

A waiver of the Medicare rate will apply, as outlined in Schedule of Services below, if the Contractor submits and VA approves a request.

When there is not a Medicare rate for the authorized service(s), the VA Fee Schedule dictates the maximum allowable rate. When there is not a Medicare rate for the authorized services but there is a VA Fee Schedule rate for the authorized services, VA requires the Contractor to compare the VA Fee Schedule rate with the provider’s billed charges and pay the provider and submit an invoice to VA for payment at the lesser of the VA Fee Schedule or billed charges.

When there is not a Medicare rate or VA Fee Schedule rate for the authorized service(s), the VA shall reimburse the Contractor at 50% of provider’s billed charges to the general public for similar services.

B 3.2 WAIVERS OF PAYMENT RATES

The VA has a set not to exceed ceiling for rate waivers of 200% above Medicare or the

VA Fee Schedule. Rate waiver submissions exceeding 200% above Medicare of the VA

Fee Schedule will be denied without further review. The Contractor may submit a waiver of payment rates request to VA when payment to its providers aligned to Medicare, the

VA Fee Schedule, or the Alaska Fee Schedule is insufficient to maintain the network in highly rural areas and/or for scarce resources. A highly rural area is defined as a county with fewer than seven individuals residing per square mile. Scarce resources are defined as situations where the Contractor is unable to meet network adequacy standards for specific medical services due to a lack of capable providers in a specific area, as determined through the justification provided by the Contractor in the “Waiver of Payment Rate Request Form” described below.

If a waiver of payment rates is established for a network provider for specific healthcare services, the approved rates will be used to set the maximum price that VA will pay the

Contractor for authorized services. Approved rates shall be applied as a percentage of the Medicare or VA Fee Schedule rate. The Contractor shall evaluate the billed charges versus the awarded maximum waiver rate and price the claim at the lesser of the two; if the provider's billed charges are lower than the awarded maximum waiver rate specified in the contract, the Contractor shall pay the provider claim based on billed charges and the Contractor shall invoice the VA in that amount.

The Contractor shall use the “Waiver of Payment Rates Request Form” provided in

Attachment R, Network Adequacy Rate Waiver Form _02_24_26 v2. A waiver request shall specify the localities for which the waiver is being requested, with consideration given for all localities associated with the Taxpayer Identification Number (TIN) and/or

National Provider Identifier (NPI). The Contractor shall ensure that the Waiver of

Payment Rates Request Form is accurate, complete, and includes all required information related to the justification for the request, to include, but not limited to, the reasoning for submission in terms of network adequacy, the codes to be used with the proposed rate, and whether the Contractor is at risk of not successfully retaining the network provider. Waivers of payment rates will only be applicable to active codes, and

VA will not modify codes or services submitted in a waiver request.

Waiver of payment rates requests are not guaranteed to be approved. VA will consider patient needs, market analyses, provider qualifications, or other factors. If the waiver request is approved and executed by VA, the Contractor shall pay providers in accordance with the approved rate schedule. The approved rate will be effective for claims with a DOS on or after the final signature date of VA and will remain in effect for the duration of the contract unless otherwise specified by VA. If VA denies the request, the Contractor will be informed accordingly.

VA reserves the right to request that a waiver of payment rate be used for a specific provider or a specific specialty of a provider.

B.3.3 COMPUTATION OF “LESSER OF” PAYMENT RATES

Following the hierarchy described above, the Contractor shall evaluate the provider’s billed charges against the applicable maximum awarded rate (Medicare rate or VA Fee

Schedule rate) and submit invoices to VA for claims paid at the lesser of the two amounts. There are no circumstances where payment for authorized services exceed the provider’s billed charges amount.

If a waiver is approved by the VA CO, the Contractor shall pay providers the lesser of the approved rate or billed charges for services indicated, and VA shall pay the

Contractor the lesser of the approved rate or the provider’s billed charges.

B.3.4 MEDICARE RATES

Medicare rates include geographic adjustments and Medicare Administrative

Contractors (MAC) rates. If a national Medicare rate is not established for a procedure or service, the Contractor shall adhere to the current Medicare Administrative

Contractor (MAC) rates and policies, such as the 'pay by invoice' procedures, and ensure that all claims are processed and paid accurately according to the rates and policies set forth by the applicable MAC. Additionally, the Contractor shall update their payment practices to reflect any changes in MAC rates and policies within 10 business days of the effective date of the change.

The Contractor shall not apply the National Coverage Determination (NCD) and Local

Coverage Determination (LCD) rules for benefits coverage, as VA approved medical services are described within the VA Approved Referral and/or authorization with the exception of Place of Service (POS) requirements. The Contractor shall apply NCD rules associated with POS requirements.

Hospital services shall be reimbursed according to the Medicare Inpatient Prospective

Payment System (IPPS) and Outpatient Prospective Payment System (OPPS). The

Contractor shall apply the IPPS methodology in the following manner:

• IPPS or OPPS Rate is Less than the Billed Amount: When the provider billed amount on a claim is more than would have been paid via IPPS, then the amount paid to the provider must be the IPPS or OPPS amount.

• IPPS or OPPS Rate is Equal to the Billed Amount: When the provider billed amount on a claim is equal to the amount that would have been paid via IPPS or

OPPS, then the amount paid to the provider is the IPPS or OPPS amount.

• IPPS or OPPS Rate is More than the Billed Amount: When the provider billed amount on a claim is less than the amount that would have been paid via IPPS or

OPPS, then the amount paid to the provider is the provider billed amount (e.g., lesser of billed charges versus Medicare).

The Contractor shall ensure that Medicare rates are applied even if Medicare does not pay for the service/procedure, but a rate is available for the code (e.g., non-participating

Medicare providers), and the CMS billing standards and guidelines for Medicare covered services are followed. When applicable, the Contractor shall not apply any type of CMS network reductions when inconsistent with VA covered benefits and payment methodology, as described in “Attachment 2 - CCN Next Gen Medical Network -

Contractor Manual _02_24_26_v2”. When there is not a Medicare rate, the VA Payment

Hierarchy will determine pricing for VA authorized care.

The PPS has exemptions for specific types of services and facilities that are paid through different methodologies Based on CMS-issued payment rules.

Any State who implemented a separate DRG-based payment system or similar payment system to control costs for inpatient care may be exempt from the IPPS and the OPPS, such as All Payer Model Agreement Hospitals. The Contractor shall pay All

Payer Model Agreement Hospitals based on the Hospital Rate Orders and Unit Rates approved and published by the State. Upon receiving updates to the published rates, the Contractor shall update its claims processing platform within 10 business days to reflect the changes. The Contractor shall ensure that the All Payer Model Agreement

Hospital Rates updates are implemented in time to reimburse valid claims based on the effective date of the updated rates. The Contractor shall collaborate with VA to resolve any discrepancies associated with the All Payer Model Agreement Hospital Rates.

Reference “Attachment 2 - CCN Next Gen Medical - Contractor Manual_02_24_26_v2” for additional detail on the IPPS and the OPPS.

B.3.5 VA FEE SCHEDULE

The VA Fee Schedule is used for approved services that are not included on Medicare fee schedules. VA maintains responsibility for the development of the VA Fee Schedule and the methodology used to establish its rates. The VA Fee Schedule is published annually on VA’s Community Care Website. VA will provide interim updates to the VA

Fee Schedule up to once per quarter. Upon receiving the updated VA Fee Schedule, the Contractor shall update its claims processing platform within 10 business days to reflect the changes. The Contractor shall ensure that the VA Fee Schedule updates are implemented in time to reimburse valid claims based on the effective date of the VA Fee

Schedule update. The Contractor shall collaborate with VA to resolve any discrepancies associated with the VA Fee Schedule.

Reference to the “Attachment 2 - CCN Next Gen Medical - Contractor Manual

_02_24_26_v2” for a description of the VA Fee Schedule data.

If there is a Medicare rate, but the authorized service is not covered by Medicare and/or the provider is a non-participating Medicare provider, but the service is covered by a VA

Approved Referral and Medicare applies any type of edits, modifiers, or healthcare provider taxonomy payment adjustments or rate reduction (e.g., modifiers, provider type, ambulatory surgery reductions), the Contractor shall apply the same Medicare reduction to the VA Fee Schedules.

The methodology for reimbursing medical services, extended care services, pharmaceuticals, and DME not on Medicare fee schedules is published in the Federal

Register.

Reference “Attachment 2 - CCN Next Gen Medical - Contractor Manual_02_24_26_v2” for additional details on the VA Fee Schedule.

B.3.6 ALASKA FEE SCHEDULES

The Alaska Fee Schedules apply to certain services provided in Alaska, which account for the unique cost of providing care in the geographic area.

Applicable services furnished in Alaska will follow the Alaska Fee Schedule and the

Alaska Professional Fee Schedule, unless there is a VA CO approved rate that sets an alternate rate for such services. The Alaska VA Fee Schedule and the Alaska

Professional Fee Schedule are published annually on VA’s Community Care Website.

VA will provide interim updates to the Alaska Fee Schedules up to once per quarter. VA adjusts the rates on the Alaska Professional Fee Schedule annually in accordance with the published national Medicare Economic Index (MEI). For the years where the annual average is a negative percentage, the fee schedule rates on the Alaska Professional

Fee Schedule will remain the same as the previous year. Upon receiving the updates, the Contractor shall update its claims processing platform within 10 business days to reflect the changes. The Contractor shall ensure that the Alaska Fee Schedules updates are implemented in time to reimburse valid claims based on the effective date of the Alaska Fee Schedules. The Contractor shall collaborate with VA to resolve any discrepancies associated with the Alaska Fee Schedules.

If there is a Medicare rate, but the authorized service is not covered by Medicare and/or the provider is a non-participating Medicare provider, but the services are covered by a

VA Approved Referral and Medicare applies a rate reduction (e.g., modifiers, provider type, ambulatory surgery reductions, etc.), the Contractor shall apply the same

Medicare reduction to the Alaska Fee Schedules.

Detailed information, including an example of the Alaska Fee Schedules, is available at a publicly accessible VA website.

Reference “Attachment 2 - CCN Next Gen Medical - Contractor Manual _02_24_26_v2” for additional information on the Alaska Fee Schedules.

B.3.7 PRICING AND COVERAGE DEVIATIONS

Some healthcare services identified in the VA Medical Benefits Package have distinct coverage and payment policies.

Reference the “Attachment 2 - CCN Next Gen Medical Contractor

Manual_02_24_26_v2” for additional details.

B.3.8 CANCELLATION CEILING

Pricing consists of CLINs in Section B, for a 3 year (multiyear) contract with two (2), (1) one year options that may be exercised at the unilateral discretion of the Government in accordance with

52.217-9, Option to Extend the Term of the Contract. The TO/TOPR has a stated cancellation ceiling for each year of the multi-year contract. Offeror’s may propose variable pricing for the multi-year pricing portion of the schedule below. The Offeror shall submit supporting documentation should they propose a cancellation ceiling that is greater than those percentages included in Table 1 - Cancellation Ceilings. Contract(s) shall be awarded with the first program year (PY) of the resulting contract(s) beginning at the time of award. Award(s) will not be made on less than the first program year requirements. If the Government determines before award that only the first program year requirements are needed, the Government’s evaluation of the price or estimated cost and fee shall consider only the first year. Cancellation of this contract can occur if it is determined that the agency will not have the necessary funds to continue this program. If a cancellation were to occur, contractors would be eligible to receive compensation.

The compensation would cover only those costs authorized up to the percentages outlined for the cancellation ceiling (below) in accordance with FAR clause 52.217-2 Cancellation Under

Multiyear Contracts.

(A) The proposed percentages are the percent of the total cost for each program year to be set aside for the cancellation ceiling and date/period are as follows:

The proposed percentages are the maximum percent of the total cost for each program year to be set aside for the cancellation ceiling and date/period and are as follows:

Table 1 - Cancellation Ceiling

PY Max Percent PY start date

Second Program Year 12% October 1, 2028

Third Program Year 10% October 1, 2029

(B) Percentages above reflect nonrecurring cost estimates to the Contractor based on previous costs provided by Contractors for similar medical services in previous years. It is the contractor’s responsibility to furnish, along with their proposal, documentation supporting any changes in the proposed cancellation ceilings provided above. This documentation should be submitted with their proposal under separate cover and may be negotiated at time of award.

The cancellation ceiling shall not be used as an evaluation factor.

(C) The cancellation ceiling generally includes only nonrecurring costs which means those costs which are generally incurred on a one-time basis and include such costs as (Pull this from the last IGCE).

(D) Recurring costs are those production or service-related costs that vary with the quantity being produced or furnished, such as labor and materials. For many items and services, cancellation costs should be minimal in that start-up (nonrecurring) costs are low or the items have a substantial commercial market to carry the start-up burden. In some cases, a zero dollar cancellation liability is sufficient.

B.4. MEDICAL CLIN STRUCTURE

CLIN X001, Healthcare Services:

CLIN X001, Healthcare Services, VA will pay the Contractor for all authorized medical services provided under this contract. The Contractor shall reimburse network providers at the lessor of the billed charges or the maximum allowable rate specified by Medicare.

The lesser of the billed charges means that if the amount billed by the network provider is lower than the maximum allowable Medicare rate, the Contractor shall reimburse the provider based on the billed amount rather than the Medicare rate.

Sub CLIN X001AA, Standard Medicare Rate Healthcare Services:

Sub CLIN X001AA, Standard Medicare Rate Healthcare Services: VA will pay the Contractor for authorized medical services at the locality adjusted Medicare Rates.

Sub CLIN X001AB, PPS Exempt Healthcare Services:

Sub CLIN X001AB, PPS Exempt Healthcare Services, VA will pay the Contractor for authorized medical services that are excluded from IPPS and OPPS based on CMS issued payment rules. This includes services delivered at All Payer Model Agreement Hospitals that are included in rate orders and unit rates approved by the State, unless there is a VA CO approved rate that sets an alternate rate for such services.

CLIN X002, Waivers of Payment Rates:

CLIN X002, Waiver of Payment Rates, VA will pay the Contractor for authorized services in highly rural areas and/or regions with scarce medical resources by allowing payment at a percentage above the locality-adjusted Medicare rate, the VA Fee Schedule rate, or the Alaska Fee Schedule rate. Upon VA approval and execution of a waiver request, the Contractor shall reimburse providers at the lesser of the approved rate or the billed charges for the specified services. The lesser of the billed charges means that if the provider's billed amount is lower than the rate approved through the waiver request, the Contractor will reimburse the provider based on the billed amount rather than the higher approved waiver rate.

CLIN X003, Seasonal Vaccinations and Adult Immunizations:

CLIN X003, Seasonal Vaccinations, VA will pay the Contractor for administrating the influenza (trivalent, quadrivalent and high dosage), COVID-19 vaccines, and VA approved adult immunizations at retail pharmacies. Pricing for this CLIN is determined by the Medicare rates and methodology for each vaccination. CLIN X003 includes the administration.. See attachment P.a for VA approved adult immunizations.

CLIN X004, Fee Schedules:

CLIN X004, VA Fee Schedule, covers all authorized non-Medicare medical services. VA will pay the Contractor the Fee Schedule rates when a given medical procedure is not payable under Medicare rules or is payable under Medicare rules but does not have established pricing at the local level.

Sub CLIN X004AA, VA Fee Schedule:

Sub CLIN X004AA, VA Fee Schedule, VA will pay the Contractor the VA Fee Schedule rate when a given medical procedure is not payable under Medicare rules or is payable under Medicare rules but does not have established pricing at the local level and there is an established VA Fee Schedule rate.

Sub CLIN X004AB, Alaska Fee Schedule:

Sub CLIN X004AB, Alaska Fee Schedule, covers all authorized non-Medicare medical services in the state of Alaska. VA will pay the Alaska Fee Schedule rate for services furnished in Alaksa using the Alaska Fee Schedule and the Alaska Professional Fee Schedule, unless there is a VA CO approved rate that sets an alternate rate for such services.

CLIN X005, Non-Medicare, Non-VA, Non-Alaska Fee Schedule Healthcare Services:

CLIN X005, Non-Medicare, Non-VA, Non-Alaska Fee Schedule Healthcare Services, VA will pay the Contractor for authorized healthcare services when a given medical service or procedure is not payable under Medicare rules, or is payable under Medicare rules but does not have established pricing at the local level, and is not included in the VA Fee Schedule. When there is not a Medicare rate or VA Fee Schedule rate for the authorized service(s), the VA shall reimburse the Contractor at 50% of the provider’s billed charges.

CLIN X006

, Urgent and Emergent Medication:

CLIN X006, Urgent and Emergent Medication, VA will pay the Contractor for urgent and emergent medications dispensed by pharmacies in the Contractor's network without direct charges to the Veteran. VA will reimburse the Contractor for Brand Name (Sub CLIN X006AA) and Generic (Sub CLIN X006AB) medication based on a percentage of Average Wholesale Price (AWP). The Contractor shall invoice the Dispensing fee (Sub CLIN X006AC) at the awarded price for each dispensing activity.

Sub CLIN X006AA Brand Name Medication

Sub CLIN X006AB Generic Medication

Sub CLIN X006AC Dispensing Fee

CLIN X007, Disaster Response ONLY – Urgent and Emergent Medication:

OPTIONAL CLIN X007, Disaster Response ONLY – Urgent and Emergent Medication, VA will pay the Contractor for urgent and emergent medications dispensed by pharmacies in the Contractor's network without direct charges to the Veteran during a specified and approved “Disaster Response” scenario. CLIN X007 will only be exercised in the case of a disaster that prevents VA’s mail order pharmacy from delivering medications to Veterans. Prescription fills may be for 30-days under this CLIN. VA will reimburse the Contractor for Brand Name (Sub CLIN X007AA) and Generic (Sub CLIN X007AB) medication at based on a percent of AWP. The Contractor shall invoice the Dispensing fee (Sub CLIN X007AC) at the awarded price for each dispensing activity.

Sub CLIN X007AA Brand Name Medication

Sub CLIN X007AB Generic Medication

Sub CLIN X007AC Dispensing Fee

CLIN X008, Administrative Services:

CLIN X008, Administrative Services, VA will pay the Contractor for the administrative services required to manage and deliver the services purchased under this contract.

These costs are separate from the costs of providing medical services and implementation. Administrative services and activities include, but are not limited to, the following items:

• Claims Appeals

• Claims Processing

• Clinical Quality and Patient Safety Monitoring

• Alternative Payment Models

• Utilization Management

• Contractor Administrative Costs

• Contact Center

• Contractor Profits

• Credentialing

• Customer Service

• Data Analytics and Reporting

• Fee Schedule Updates

• Invoicing and Billing

• Medical Documentation Procedures

• Network Development and Management

• Program Integrity

• Project Management

• Referrals Management

• Training

This CLIN is paid following achievement of full healthcare delivery (HCD) based on the monthly Enrolled Veteran population in the Task Order's geographic jurisdiction/region.

Sub CLIN X008AA Administrative Services for Healthcare Services:

Sub CLIN X008AA, Administrative Services for Healthcare Services, VA will pay the Contractor for administrative services required to manage and deliver the healthcare services purchased under this contract.

Sub CLIN X008AB, Administrative Services for Pharmacy Benefits Management (PBM):

Sub CLIN X008AB, Administrative Services for Pharmacy Benefits Management (PBM), will pay the Contractor for administrative services required to manage and deliver the pharmacy services purchased under this contract.

CLIN X009, Organ Acquisition Cost:

CLIN X009, Organ Acquisition Cost, VA will pay the Contractor an equitable payment for reasonable organ acquisition services/costs required to support quality transplant programs in agreement with certified transplant centers (CTC). Medicare Standard Acquisition Charges (SACs) shall be used for reimbursement of the reasonable and necessary costs associated with solid organ acquisition.

The Contractor shall include provisions in agreement with CTCs that allows reimbursement for organ acquisition according to the most current Medicare Cost Report Data, under the D-4 Worksheet.

CLIN X010, Incentives/Disincentives:

VA will pay for incentives and disincentives related to performance metrics, quality of service, and other criteria as specified by the PWS; incentives encourage exceeding baseline performance requirements and disincentives address underperformance.

Sub CLIN X010AA, Adverse Credit Reporting Incentives:

Sub CLIN X010AA, Adverse Credit Reporting Incentives, VA will pay the Contractor for net incentive fees earned (less any disincentive fees assessed) for PO2.7 during the period of performance in accordance with “Performance Requirement Summary_Medical West_02_24_26 v3”.

Sub CLIN X010AB, Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive:

Sub CLIN X010AB, Value Based Care Lower Extremity Joint Replacement (LEJR) Performance Incentive, VA will pay the Contractor for net incentive fees earned (less any disincentive fees assessed) for PO5.1 during the period of performance in accordance with “Performance Requirement Summary_Medical West_02_24_26 v3”.

CLIN X011, Implementation:

CLIN X011, Implementation, VA will make a lump sum payment to the Contractor upon satisfactory completion of all start-up/implementation milestones identified in the contractor’s implementation plan and accepted by the CO. “Satisfactory completion” would mean the Contractor has completed all start-up/implementation milestones identified in the Contractor’s implementation plan and those milestones have been accepted by the CO. It also requires that the Contractor not invoice for implementation until full HCD is achieved across the region, with invoicing aligned to the firm fixed price performance-based milestones and covering the lump-sum transition/ implementation/ administrative services prior to full HCD (with implementation services excluded from CLIN X008, Administrative Services).

CLIN X012, Transition Out:

CLIN X012, Transition Out, VA will pay the Contractor for transition out and residual service tasks, including retroactive processing of referrals and claims adjudication, providing claims, transition open referrals, providing an inventory of assets, facilitating knowledge transfer, removal of government furnished information, and customer service transition. This CLIN will be paid as a fixed price upon VA initiation of the transition out period. Transition out services shall be excluded from CLIN X008, Administrative Services.

OPTIONAL CLIN X013, Task Implementation:

OPTIONAL Sub CLIN X013AA, Implementation of Appointment Scheduling and Comprehensive Care Coordination at the VA Facility:

OPTIONAL Sub CLIN X013AA, Implementation of Appointment Scheduling and Comprehensive Care Coordination at the VA Facility, VA will pay the Contractor for completion of the implementation of appointment scheduling and care coordination at a VA facility. VA will pay the awarded price for each VA Facility that orders appointment scheduling and comprehensive care coordination.

Implementation services shall be excluded from CLIN X008, Administrative Services and CLIN X011, Implementation. The Contractor is only eligible to invoice for one implementation payment per VA Facility during the Period of Performance of the contract.

OPTIONAL Sub CLIN X013AB, Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site:

OPTIONAL Sub CLIN X013AB, Implementation for Appointment Scheduling and Comprehensive Care Coordination at the Contractor's Site, VA will pay the Contractor for completion of the implementation of appointment scheduling and care coordination at the Contractor’s site. VA will pay the awarded price for appointment scheduling and comprehensive care coordination at the Contractor's site. Implementation services shall be excluded from CLIN X008, Administrative Services and CLIN X011, Implementation. The Contractor is only eligible to invoice for one implementation payment during the period of performance of the contract.

OPTIONAL CLIN X014, Healthcare Appointment Scheduling and Comprehensive Care Coordination:

OPTIONAL Sub CLIN X014, Appointment Scheduling and Comprehensive Care Coordination, VA will pay the Contractor for appointment scheduling and care coordination at the awarded monthly price for the number of unique VA Approved Referrals for the tier ordered. If the Contractor receives unique referrals over the annual tiered volumes, the Contractor shall return those referrals to VA.

When the quantity of unique VA Approved Referrals exceeds a tier, the subsequent tier may be ordered.

The tiers are as follows:

CLIN X014

Number of Unique VA Approved Referrals by Period of Performance

Sub CLIN X014AA (Tier 1) 0 – 200,000

Sub CLIN X014AB (Tier 2) 200,001 – 300,000

Sub CLIN X014AC (Tier 3) 300,001 – 400,000

Sub CLIN X014AD (Tier 4) 400,001 – 500,000

Sub CLIN X014AE (Tier 5) 500,001 +

OPTIONAL CLIN X015, Care Coordination Follow-Up:

OPTIONAL CLIN X015, Care Coordination Follow-Up, VA will pay the Contractor for care coordination follow-up services at the awarded monthly price for the number of unique VA Approved Referrals, including implementing the care coordination follow-up process. Payments are limited to one payment per Veteran per month.

OPTIONAL CLIN X016, Software, Process, and Proof of Concept Development:

OPTIONAL CLIN X016, Software, Process, and Proof of Concept Development, VA will pay the Contractor for software design, customization, development, configuration, interface development, programming changes, and modifications to include system update services and process and proof of concepts changes in accordance with current software development methodologies associated with software solutions, as needed.

This CLIN is paid based on a fixed price for each instance of a software development, process, or proof of concept task aligned to the following task sizes:

OPTIONAL Sub CLIN X016AA Extra-Small (XS):

OPTIONAL SUBCLIN X016AA Extra-Small (XS), Small modifications to existing functionality. Architecturally insignificant, only involves one team, similar to work done in the past by team, no new technologies involved. An extra small task consists of 1 Sprint, over a 1–4-week period.

OPTIONAL Sub CLIN X016AB Small (S):

OPTIONAL SUBCLIN X016AB Small (S), Small modifications to existing functionality. Architecturally insignificant, few dependencies but only involves one team, similar to work done in the past by team, no new technologies involved. A small task consists of 2 Sprints, over a 1–2-month period.

Optional Sub CLIN X016AC Medium (M):

OPTIONAL SUBCLIN X016AC Medium (M), More significant modifications to existing functionality. Minor architectural changes, few dependencies across 1-2 teams, precedents exist for the work but teams are inexperienced in doing it, may involve new technologies. A medium task consists of 4 Sprints, over a 3–6-month period.

OPTIONAL Sub CLIN X016AD Large (L):

OPTIONAL SUBCLIN X016AD Large (L), No existing functionality to leverage.

Major architectural changes required, multiple dependencies across multiple teams, no precedents for the work, no experience on the teams, involves new technologies. A large task consists of 7 Sprints, over a 7–18-month period.

OPTIONAL Sub CLIN X016AE Extra Large (XL):

OPTIONAL SUBCLIN X016AE Extra Large (XL), No existing functionality to leverage. Major architectural changes required, multiple dependencies across multiple teams, no precedents for the work, no experience on the teams, involves new technologies. An extra-large task consists of 10 Sprints, over an 18+ month period.

SECTION C - CONTRACT CLAUSES

C.1 ADDENDUM TO FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the

Contracting Officer will make their full text available.

The following clauses are incorporated into 52.212-4 as an addendum to this contract:

C.2 TASK ORDER INTRODUCTORY LANGUAGE

The terms and conditions of the IDIQ, including any contract modifications, apply to all task orders issued under the contract as a result of this TOPR. When a lower price has been established, or when the delivery terms, FOB terms, or ordering requirements have been modified by the task order, those modified terms will apply to all services made pursuant to it and take precedence over the contract. Any unique terms and conditions of an order issued under the contract that are not a part of the applicable

IDIQ will govern. In the event of an inconsistency between the terms and conditions of a task order and the IDIQ, other than those identified above, the terms of the IDIQ will take precedence.

C.3 TASK ORDER TERMS AND CONDITIONS

The order resultant from this solicitation will be subject to the terms and conditions referenced in the CCN - Next Gen Medical IDIQ.

C.4 52.217-7 OPTION FOR INCREASED QUANTITY—SEPARATELY PRICED LINE

ITEM (MAR 1989)

The Government may require the delivery of the numbered line item, identified in the

Schedule as an option item, in the quantity and at the price stated in the Schedule. The

Contracting Officer may exercise the option by written notice to the Contractor within

(INC-QUANT-SEP-PRICE-OPTION). Delivery of added items shall continue at the same rate that like items are called for under the contract, unless the parties otherwise agree.

(End of Clause)

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

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor by the end of the contract.

(End of Clause)

C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the

Contractor within 30 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 calendar days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed five (5) years.

C.7 52.222-49 SERVICE CONTRACT LABOR STANDARDS-PLACE OF

PERFORMANCE UNKNOWN (MAY 2014)

(a) This contract is subject to the Service Contract Labor Standards statute, and the place of performance was unknown when the solicitation was issued. In addition to places or areas identified in wage determinations, if any, attached to the solicitation, wage determinations have also been requested for the following: None. The Contracting Officer will request wage determinations for additional places or areas of performance if asked to do so in writing by the proposal submission date.

(b) Offerors who intend to perform in a place or area of performance for which a wage determination has not been attached or requested may nevertheless submit bids or proposals. However, a wage determination shall be requested and incorporated in the resultant contract retroactive to the date of contract award, and there shall be no adjustment in the contract price.

(End of clause)

C.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

(a) Definitions. As used in this clause—

(1) Contract financing payment has the meaning given in FAR 32.001;

(2) Designated agency office means the office designated by the purchase order, agreement, or contract to first receive and review invoices. This office can be contractually designated as the receiving entity. This office may be different from the office issuing the payment;

(3) Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods and formats identified in paragraph (c) of this clause. Facsimile, email, and scanned documents are not acceptable electronic forms for submission of payment requests;

(4) Invoice payment has the meaning given in FAR 32.001; and

(5) Payment request means any request for contract financing payment or invoice payment submitted by the contractor under this contract.

(b) Electronic payment requests. Except as provided in paragraph (e) of this clause, the contractor shall submit payment requests in electronic form. Purchases paid with a Government-wide commercial purchase card are considered to be an electronic transaction for purposes of this rule, and therefore no additional electronic invoice submission is required.

(c) Data transmission. A contractor must ensure that the data transmission method and format are through one of the following:

(1) VA’s Electronic Invoice Presentment and Payment System at the current website address provided in the contract.

(2) Any system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) and chartered by the American National Standards Institute (ANSI).

(d) Invoice requirements. Invoices shall comply with FAR 32.905.

(e) Exceptions. If, based on one of the circumstances in this paragraph (e), the Contracting Officer directs that payment requests be made by mail, the Contractor shall submit payment requests by mail through the United States Postal Service to the designated agency office. Submission of payment requests by mail may be required for—

(1) Awards made to foreign vendors for work performed outside the United States;

(2) Classified contracts or purchases when electronic submission and processing of payment requests could compromise the safeguarding of classified or privacy information;

(3) Contracts awarded by contracting officers in the conduct of emergency operations, such as responses to national emergencies;

(4) Solicitations or contracts in which the designated agency office is a VA entity other than the VA Financial Services Center in Austin, Texas; or

(5) Solicitations or contracts in which the VA designated agency office does not have electronic invoicing capability as described above.

C.9 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

https://www.acquisition.gov/browse/index/far https://www.va.gov/oal/library/vaar/

FAR Number Title Date

52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER

RIGHTS

NOV 2023

52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE OCT 2018

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE

MAINTENANCE

AUG 2020

52.227-14 RIGHTS IN DATA—GENERAL MAY 2014

52.228-5 INSURANCE—WORK ON A GOVERNMENT

INSTALLATION

JAN 1997

852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE DEC 2022

852.203-70 COMMERCIAL ADVERTISING MAY 2018

852.222-71 COMPLIANCE WITH EXECUTIVE ORDER 13899

(DEVIATION)

APR 2025

C.10 MANDATORY WRITTEN DISCLOSURES

Mandatory written disclosures required by FAR clause 52.203-13 to the Department of

Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at https://www.vaoig.gov/hotline/online-forms and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the

Hotline at 1-800-488-8244 for further instructions.

(End of Addendum ) http://www.acquisition.gov/browse/index/far http://www.va.gov/oal/library/vaar/ https://www.vaoig.gov/hotline/online-forms

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR

ATTACHMENTS

D.1 CONTRACT ATTACHMENTS

See attached document: ATTACHMENT 1 – CCN Next Gen – Medical West TOPR

PWS 03_05_26 v3

See attached document: ATTACHMENT 2 – CCN Next Gen – Medical Contractor

Manual _02_24_26_v2

See attached document: ATTACHMENT 3 – CCN Next Gen - Medical West TOPR

Price Schedule v3

D.2 PWS ATTACHMENTS

See attached document: ATTACHMENT A - Community Care Network Stakeholders

List

See attached document: ATTACHMENT B - Project Risk Register

See attached document: ATTACHMENT C - Performance Requirement

Summary_Medical…