36C10G26R0004 Next Gen Dental Network_Conformed Copy.pdf

PAGE 1 OF 1. REQUISITION NO.

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

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

TIME

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

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS: 524114

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

36C10G26R0004 12-15-2025

Jessica Portillo 4-03-2026

14:00 EST

36C10G

U.S. Department of Veterans Affairs

OPAL | Strategic Acquisition Center

10300 Spotsylvania Ave | STE 400

Fredericksburg VA 22408-2697

X

$47 Million

N/A

36C10G

OPAL | Strategic Acquisition Center

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 solicitation is for Community Care Network (CCN)Next

Generation (Gen) - Dental Network.

This procurement effort is to establish a single-award

Indefinite Delivery/Indefinite Quantity (IDIQ) contract.

Questions must be in writing and sent to the Contracting

Officer no later than 10:00 AM EST on 02/04/2026.

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

All proposals must be submitted by 2:00 PM EST on 4/03/2026.

See CONTINUATION Page

Jessica Portillo

Contracting Officer

36C10G26R0004 Next Gen Dental Network

Table of Contents

SECTION A

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

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.1.1 Contract Administration

B.1.2 CO and COR Responsibilities

B.1.3 IDIQ Period of Performance

B.2 TUNGSTEN ELECTRONIC INVOICE SUBMISSION

B.3 MINIMUM GUARANTEED AMOUNT AND MAXIMUM VALUE

B.4 MODIFICATION ADMINISTRATION INSTRUCTIONS

B.5 ADDITIONAL CONTRACT INSTRUCTIONS

B.5.1 Requirement Development

B.5.2 Multi Agency Language

B.5.3 VA Payment Hierarchy

B.5.4 Waivers of Payment Rates

B.5.5 Computation of “Lesser Of” Payment Rates

B.5.6 Dental VA Fee Schedule

B.5.7 Price Schedule

B.6 DENTAL CLIN STRUCTURE

B.7 PERFORMANCE WORK STATEMENT (PWS)

B.8 INTEGRATED PRODUCT TEAMS

B.9 IT CONTRACT SECURITY

B.10 SUPPLEMENTAL INSTRUCTIONS

B.10.1 Organizational Conflict(s) of Interest (OCI)

B.10.1.1 Pre-award OCI

B.10.1.2 Post-award OCI

B.10.2 Representation of VA Information

B.11 SERVICE CONTRACT LABOR STANDARDS (ADDENDUM)

B.12 CONFIDENTIALITY AND INTEGRITY OF INVESTIGATIONS

SECTION C - CONTRACT CLAUSES

C.1 52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND

CERTIFICATIONS (DEC 2014)

C.2 52.240-93 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2025)

C.3 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

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

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

C.5 52.216-18 ORDERING (AUG 2020)

C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.7 52.216-22 INDEFINITE QUANTITY (NOV 2025)

C.8 52.216-32 TASK-ORDER AND DELIVERY-ORDER OMBUDSMAN (SEP 2019)

ALTERNATE I (SEP 2019)

C.9 52.217-7 OPTION FOR INCREASED QUANTITY-SEPARATELY PRICED LINE

ITEM (MAR 1989)

C.10 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.11 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ..56

C.12 52.222-49 SERVICE CONTRACT LABOR STANDARDS—PLACE OF

PERFORMANCE UNKNOWN (NOV 2025)

C.13 52.227-14 RIGHTS IN DATA—GENERAL (MAY 2014)

C.14 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.15 52.232-23 ASSIGNMENT OF CLAIMS (MAY 2014)

C.16 52.233-3 PROTEST AFTER AWARD (NOV 2025)

C.17 ................................................................................................................. Removed

C.18 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.19 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.20 VAAR 852.204-71 INFORMATION AND INFORMATION SYSTEMS SECURITY

(FEB 2023)

C.21 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

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

C.22 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.23 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.24 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.25 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.26 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 CONTRACT ATTACHMENTS

D.2 RFP ATTACHMENTS

SECTION E – SOLICITATION PROVISIONS AND CLAUSES

E.1 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (NOV 2025)

E.2 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2025)

E.3 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

E.4 ADDENDUM to FAR 52.212-2 EVALUATION— COMMERICAL ITEMS

E.5 52.215-1 INSTRUCTIONS TO OFFERORS—COMPETITIVE ACQUISITION

(NOV 2021) ALTERNATE I (NOV 2025)

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.217-5 EVALUATION OF OPTIONS (NOV 2025)

E.8 52.233-2 SERVICE OF PROTEST (NOV 2025)

E.9 52.240-90 SECURITY PROHIBITIONS AND EXCLUSIONS REPRESENTATIONS

AND CERTIFICATIONS (DEVIATION NOV 2025) .......... Error! Bookmark not defined.

E.10 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

E.11 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)

E.12 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.13 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.14 VAAR 852.273-70 LATE PROPOSAL (NOV 2021)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.1.1 Contract Administration

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

1. CONTRACTOR:

2. GOVERNMENT: Jessica Portillo, Contracting Officer (CO) 36C10G

OPAL | Strategic Acquisition Center

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

AMENDMENT NO DATE

CONTRACTOR REMITTANCE ADDRESS:

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

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

[] 52.232-36, Payment by Third Party

INVOICES: Payments shall be made upon inspection and acceptance in arrears upon receipt of a properly prepared invoice.

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.

B.1.2 CO and COR Responsibilities

1. The CCN Next Gen - Dental Network CO is responsible for providing overall scope oversight, maintaining communication between the Contractor and

VA, ensuring contract compliance, administering the base contract and modifications, and ensuring that annual performance evaluations are completed at the base contract level. The CO will also be responsible for ensuring that task orders are within the scope of the IDIQ base contract, administering all task order awards, overseeing payment or rejection of invoices, and ensuring that annual performance evaluations are completed at the IDIQ level and submitted through the Contractor Performance Assessment and Reporting System (CPARS).

2. The CO will designate a Contracting Officer’s Representative (COR) at the

IDIQ contract level and reserves the right to designate a COR at the TO level. The CO will issue a designation letter to the COR and the contractor to ensure that all parties understand the limited authority of the COR. The COR will also be responsible of overseeing payment of invoice or invoice rejection as described in “Attachment 1 – CCN Next Gen Dental Network PWS_03_13_26 v4” and “Attachment 2 – CCN Next Gen Dental Network Contractor Manual_03_06_26 v3” after acceptance of work.

B.1.3 IDIQ Period of Performance

This Request for Proposal (RFP) will result in the award of a Single Award Indefinite-Delivery, Indefinite-Quantity (IDIQ) contract for Community Care Network (CCN) Next Generation (Next Gen) Dental services. This contract is administered in accordance with FAR Subpart 16.5, Indefinite-Delivery Contracts.

Funding will be obligated at the Task Order (TO) level. Award of the base period does not obligate the Government to exercise any subsequent option periods.

The Government may issue orders across any active period of performance, subject to funding availability.

The resulting Single-Award Indefinite-Delivery/Indefinite-Quantity (IDIQ) contract will include one (1) base year with nine (9) one (1) year options, structured as follows:

Base Period: One (1) year (12 months) Option Period I: One (1) year Option Period II: One (1) year Option Period III: One (1) year Option Period IV: One (1) year Option Period V: One (1) year Option Period VI: One (1) year Option Period VII: One (1) year Option Period VIII: One (1) year Option Period IX: One (1) year

B.2 TUNGSTEN ELECTRONIC INVOICE SUBMISSION

FSC e-INVOICE PROGRAM THRU AUSTIN PORTAL

FSC MANDATORY ELECTRONIC INVOICE SUBMISSION FOR AUSTIN PAYMENTS

• Contracting POC: Jessica Portillo

• COR (Contracting Officers Representative): TBD

• Contract/Task Order Number: TBD

• Purchase Order Number: TBD

a. Vendor Electronic Invoice Submission Methods

Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below.

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

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

b. Vendor e-invoice Set-Up Information:

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

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

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

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

4. FSC e-invoice email: vafsccshd@va.gov See https://www.fsc.va.gov/einvoice.asp for more information

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

B.3 MINIMUM GUARANTEED AMOUNT AND MAXIMUM VALUE

(1) The minimum guaranteed amount for this contract is $670,008,794.00, which will be obligated at the time of TO award. The Government has no obligation to award TOs beyond the minimum guaranteed amount.

(2) The maximum aggregate value of all awards and task orders under this IDIQ is $30,000,000,000.00.

(3) The Government will fund any minimum guarantees at time of award. VA will not reimburse bid and proposal costs in the event a contract is not awarded.

B.4 MODIFICATION ADMINISTRATION INSTRUCTIONS

1. Submission Deadlines: The Contractor shall submit all modification proposals, including but not limited to technical, cost, and management proposals, by the deadlines specified in the contract schedule or as otherwise directed by the

Contracting Officer.

2. Notification of Submission: The Contractor shall provide written notification to the

Contracting Officer confirming the submission of proposals no later than one (1) business day following the submission.

3. Extension Requests: The Contractor may request an extension of the proposal submission deadline. Such requests shall be submitted in writing to the

Contracting Officer no less than 3 business days prior to the original submission deadline. The Contracting Officer may, at their discretion, grant or deny the request for an extension.

4. Mitigating Circumstances: In the event of unforeseen circumstances beyond the control of the Contractor, which prevent timely submission, the Contractor shall notify the Contracting Officer immediately and provide documentation supporting the delay. The Contracting Officer will assess the situation and may provide an extension, at their discretion.

5. Records of Submission: The Contractor is required to maintain accurate records of all proposal submissions, including dates and times, and provide such records to the Contracting Officer upon request.

6. Consequences of Late Submission: Failure to submit proposals by the specified deadlines, without an approved extension from the Contracting Officer, may result in the following:

a) Performance Evaluation: Late submissions may negatively impact the

Contractor’s performance evaluation and future contract opportunities with the

VA.

b) Termination for Cause: Repeated failure to submit proposals timely may result in termination of the contract for cause in accordance with the contract's termination provisions.

7. The CO reserves the right to issue a Notice to Proceed (NTP) to approve administrative updates to contract attachments. These updates are limited to administrative changes that do not change the scope, cost, or terms and conditions of the contract. Upon the determination of the required administrative update, the CO will issue a written NTP to the Contractor via email. This NTP will authorize the Contractor to implement the identified updates immediately. All outstanding NTP will be definitized through a quarterly administrative modification. In the event that the implementation of the administrative update will result in additional costs, the Contractor is required to notify the CO within two (2) business days of receipt of the NTP and submit the following before proceeding with the update:

a) A detailed explanation of the reasons why the Contractor believes additional costs will be incurred

b) An estimate of the anticipated additional costs

c) Any relevant supporting documentation to substantiate the additional costs.

At the discretion of the CO, a CO Technical Direction (COTD) may be issued to authorize the Contractor to proceed, in part or full, with the implementation of administrative updates. The COTD will provide, at a minimum, details of the approved administrative update, a mutually agreed upon not to exceed (NTE) amount and the timeline to definitize the update via bilateral modification of the contract.

B.5 ADDITIONAL CONTRACT INSTRUCTIONS

B.5.1 Requirement Development

The Government reserves the right to seek comments on conceptional approaches from when a potential modification may have complex requirements that require continued development. At the discretion of the CO, the Contractor may be invited to collaborate with the Government to increase understanding of the requirements, provide suggestions for refining requirements, and discuss risk reduction measures.

B.5.2 Multi Agency Language

This contract is intended exclusively for use by the Department of Veterans Affairs. The services provided under this contract are specific to the needs and requirements of VHA and are not authorized for use as a mandatory source by other agencies without prior written approval from the IDIQ CO.

The Contractor agrees that this contract is exclusive to the Department of Veterans Affairs, and all orders placed under this contract shall be processed through the designated COs. Any unauthorized use or orders by other agencies will not be binding under the terms of this contract.

All task orders issued under this IDIQ contract must be issued by the designated CO of the Department of Veterans Affairs. No other federal agency or entity shall have the authority to place orders under this contract unless explicitly authorized in writing by the designated IDIQ CO.

B.5.3 VA Payment Hierarchy

For dental services provided, where there is a Dental VA Fee Schedule (DVAFS) rate, for the authorized services, the VA reimburses the Contractor for the rate up to the maximum allowable rate as indicated in the DVAFS, which includes geographic adjustments based on the Geozip and the applicable American Dental Association

(ADA) Current Dental Terminology (CDT) code(s). The Contractor shall compare the

DVAFS 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 reimbursement at the lesser of the DVAFS rate or the provider’s billed charges.

A waiver of the DVAFS rate will apply, as outlined in Section 5.7 - Price Schedule below, if the Contractor submits and VA approves a request.

When there is no rate for the authorized service(s) in the DVAFS, VA shall reimburse the Contractor 50% of the provider’s billed charges to the general public for similar services.

B.5.4 Waivers of Payment Rates

The VA has set a “not to exceed” (NTE) 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 DVAFS 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 dental 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 Rates Request Form” described below.

If a waiver of payment rates is established for a network provider for specific dental services, the approved rates will be used to set the maximum price that the VA will pay the Contractor for authorized specific dental services. Approved rates shall be applied as a percentage of DVAFS. The Contractor shall evaluate the billed charges versus the awarded maximum waiver rate; 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 VA in that amount.

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

Attachment Q, Network Adequacy Rate Waiver Form- Dental Network_02_24_26 v3.pdf. A waiver of payment rates 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 CDT 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 CDT codes, and VA will not reimburse non-active CDT codes nor modify active CDT codes submitted in a waiver request.

Waiver of payment rates requests are not guaranteed to be approved. VA will consider patient needs, market analyses, dental provider qualifications, or other factors. If the waiver request is approved and executed by the VA CO, the Contractor shall pay providers in accordance with the VA approved waiver rate schedule or the provider billed charges, whichever is less. The VA approved waiver rate will be effective for claims with a Date of Service (DOS) on or after VA’s final signature date and will remain in effect for the duration of the contract unless otherwise specified by VA. If VA denies the request, and 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.5.5 Computation of “Lesser Of” Payment Rates

Following the hierarchy described above in Section B.4.1, the Contractor must evaluate the provider’s billed charges against the DVAFS rate and submit invoices to VA for claims paid at the lesser of the two amounts. There are no circumstances where VA payment for authorized services will exceed the provider’s billed charges.

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

B.5.6 Dental VA Fee Schedule

DVAFS rates incorporate geographic adjustments through geozip codes specific to the applicable region. If a DVAFS rate is not established for a procedure or service, the

Contractor shall utilize the "By Report" (BR) methodology as outlined in the DVAFS.

The Contractor must ensure that all applicable DVAFS rates are integrated into its claims processing platform(s). Dental services will be reimbursed based on the DVAFS, with pricing determined as the lesser of billed charges and the DVAFS rates.

VA-approved dental services are explicitly outlined within the VA-Approved Referral and/or authorization.

The DVAFS will be provided to the Contractor upon award and updated semi-annually based on the period of performance at no cost, although VA may request additional updates throughout the performance period. Upon receiving the updated DVAFS data, the Contractor shall update its claims processing platform within 10 business days to reflect the changes. The Contractor shall ensure that the DVAFS updates are implemented in time to reimburse valid claims with a date of service on or after the effective date of the DVAFS update. Claims with a date of service on or after the

Contractor’s revised DVAFS implementation date shall be priced according to the new

DVAFS rates. The Contractor shall collaborate with VA to resolve any discrepancies associated with the DVAFS.

The DVAFS includes codes that are not payable. Non-payable is indicated by “N” in the

Coverage Flag column in the DVAFS and $0.00 in the Fee Column. Implementation of the no-pay code is based on the effective date of the fee schedule compared to the date of service.

Reference Part 2 of the Dental Manual for additional details on the DVAFS.

B.5.7 Price Schedule

The following Price Schedule sets forth the amount VA pays for the services purchased through this contract, specifying the rates and units applicable to each Contract Line-

Item Number (CLIN).

Payments for authorized dental services will adhere to the Dental VA Fee Schedule

(DVAFS), ensuring consistency and transparency in pricing, unless otherwise stated in the contract or approved through a waiver of payment rate. The Contractor shall price network providers’ claims for authorized dental services to the written terms and conditions outlined in the CCN Next Generation Dental contract. The DVAFS encompasses the costs for dental services based on the associated American Dental

Association (ADA) Current Dental Terminology (CDT) code(s) and associated fees.

Administrative and other costs are captured separately within the CLIN structure.

Unless otherwise specified, payment rates will not exceed the applicable DVAFS amount for the period in which the service was provided, as defined in the Price

Schedule and the Dental Manual, without any changes based on subsequent adjustments or information. The rates within the DVAFS will be effective for claims with a DOS on or after the final signature/approval date of DVAFS updates.

B.6 DENTAL CLIN STRUCTURE

CLIN X001, Dental Services:

Dental Services, VA will pay the Contractor for all authorized dental services provided under the contract. Pricing for this CLIN is determined based on the DVAFS. The

Contractor shall reimburse network providers at the lesser of the billed charges or the maximum allowable rate specified in the DVAFS. The lesser of the billed charges means that if the amount billed by the network provider is lower than the maximum allowable rate specified in the DVAFS, the Contractor will reimburse the provider based on the billed amount rather than the DVAFS rate. The Contractor shall ensure that the amount invoiced to VA is a direct pass-through and exactly matches the amount paid to the network providers and does not include any discrepancies or additional charges beyond the actual payment to the network provider.

CLIN X002, Waivers of Payment Rates:

Waiver of Payment Rates, VA compensates the Contractor for authorized services in rural/highly rural areas and/or regions with scarce dental resources by allowing payment at a percentage above the DVAFS, not to exceed 200%. 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, Non-DVAFS Dental Services:

Non-DVAFS Dental Services, VA will pay the Contractor for authorized services when a given dental service or procedure is not included in the DVAFS. VA will reimburse the dental claims based on a rate of 50% of billed charges.

CLIN X004, Administrative Services:

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 dental 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

• 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 Dental eligible Veteran population.

CLIN X005, Implementation

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. The Contractor shall invoice in accordance with the firm-fixed price performance-based milestone (PWS Section 2.3).

The Contractor shall not invoice for implementation before full HCD is achieved across the region. CLIN X005 reflects the total lump sum costs of transition, implementation, and administrative services prior to full HCD. Implementation services shall be excluded from CLIN X004, Administrative Services.

OPTIONAL CLIN X006, Dental Appointment Scheduling

Dental Appointment Scheduling, VA will pay the Contractor upon completion of appointment scheduling activities for Veterans who have been assigned by the VA

Facility Community Care staff as needing scheduling support, including implementation of the scheduling process, initial Veteran contact, scheduling, Veteran notification, Veteran support, quality assurance, VA coordination, reporting, and support to Veteran self-scheduling.

This CLIN is paid based on a fixed price per VA-Approved Referral for appointment scheduling. VA will not reimburse for referrals returned within the two (2) day review period or referrals that are duplicates.

OPTIONAL subCLIN X006AA, Implementation for Dental Appointment

Scheduling at the VA Facility:

Implementation for Dental Appointment Scheduling at the VA Facility, VA will pay the Contractor for completion of the implementation of appointment scheduling at a VA facility. VA will pay the awarded price for each VA Facility that orders

Appointment Scheduling. The Contractor is only eligible to invoice for one implementation payment per VA Facility during the period of performance of the contract.

OPTIONAL subCLIN X006AB, Implementation for Dental Appointment

Scheduling at the Contractor's Site:

Implementation for Dental Appointment Scheduling at the Contractor's Site, VA will pay the Contractor for completion of the implementation of appointment scheduling. VA will pay the awarded price for Appointment Scheduling at the

Contractor's site. The Contractor is only eligible to invoice for one implementation payment during the period of performance of the contract.

OPTIONAL subCLIN X006AC, Dental Appointment Scheduling

Administration:

Dental Appointment Scheduling Administration VA will pay the Contractor for appointment scheduling at the awarded monthly price for the number of unique

Approved Referrals ordered. 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 Agile methodologies associated with software solutions, as needed.

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

Optional subCLIN X007AA 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 subCLIN X007AB 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 subCLIN X007AC 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 subCLIN X007AD 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 subCLIN X007AE 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.

CLIN X008, Transition Out:

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 of 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 X004, Administrative Services.

B.7 PERFORMANCE WORK STATEMENT (PWS)

See “Attachment 1 – CCN Next Gen Dental Network PWS_03_13_26 v4”

B.8 INTEGRATED PRODUCT TEAMS

In order to address evolving technologies or new healthcare services, the Government may develop requirement and program changes that may result in IDIQ contract modifications, task order modifications and/or Medical TO Contractor Manual updates through the use of Integrated Product Teams (IPTs) staffed by Government and Contractor personnel. The Government will not establish IPTs for all modifications or changes. The Government will not establish IPTs for all contract changes. The IPT process required in this section will begin on the date the CO notifies the Contractor in writing of the Government’s intent to establish an IPT. Within 14 days after receiving such written notification, the Contractor shall identify the appropriate personnel (as agreed by the CO and the Contractor) to serve on the IPT to develop and/or improve the technical, business, and implementation approach to any proposed CCN program or contract change.

The Contractor shall participate in all required IPT meetings, as determined by the Government designated team lead, regardless of the mode of meeting (in person or via teleconference, video-teleconference, or another electronic conference mode). The frequency and scheduling of such meetings will vary depending on the topic. The Contractor shall participate with the Government team and provide assistance in the entire process from VA concept development through establishment of the final requirement by VA. The IPT process required in this section may include assisting in the development of the Government’s budgetary cost estimates, identifying requirements, developing associated rough order of magnitude cost estimates, and preparing the final specification/statement of work.

The Government will have sole discretion to decide to implement an IPT’s recommendation based on designed outcomes and budgetary cost estimates.

Unless otherwise determined, on a case-by-case basis, by the Government, the IPT process shall occur as follows:

1. Establish IPT membership

a. Establish full-team and component teams (e.g. technical, cost, etc.)

b. Establish Government-only and Contractor-only teams that allow for issues to be raised on a non-attribution basis.

2. IPT Kick-off Meeting

a. Review of IPT Objectives and resource demands required to support the technical and time needs of the IPT

b. Identify Key Milestones

c. Establish an IPT Schedule, to include a meeting cadence, dates, and times for the full team, component teams, Government-only team(s), and Contractor-only team(s)

d. Discuss method(s) of communication and exchange of information and documentation

3. Contract Change Review Board (CCRB) review

4. Revise/update as necessary based on feedback from CCRB

B.9 IT CONTRACT SECURITY

GENERAL

The Community Care Network Next Gen (CCN NG) contract will require direct access to

VA information or VA systems to meet the requirements of the CCN contract. The CCN

Contractor will need to send to and receive data from VA internal systems. VA and its partners must exchange data using a standardized format such as HL7, EDI, and consider FHIR as it becomes standardized in the industry. The HL7 FHIR standard allows health apps (like HSRM) to leverage data from any EHR in a standard format.

The Contractors shall educate providers to have a FHIR interface as a solution to return information back to VA. VA also encourages implementation of Trusted Exchange

Framework and Common Agreement (TEFCA) or SMART on FHIR.

VA will legally disclose a copy of the required sensitive Government Furnished

Information to the CCN Contractor under the authority of the Privacy Act System of

Records “Non-VA Care (Fee) Records-VA”, 23VA10B3 Routine Use 10 ( 80 FR 146, July 30, 2015), Privacy Act System of Records “Patient Medical Records-VA”, 24VA10P2 Routine Use 43 (79 FR 157, August 14, 2014), 38 U.S.C. 5701, HIPAA

Privacy Rule provision 45 CFR § 164.506(c) and The Veterans Choice Program

Improvement Act, Public Law 115 26 and 38 U.S.C. 7332(b)(2)(H). The data will be sent via Federal Information Processing Standards (FIPS) 140-2 (or successor) validated encryption transmission. The CCN Contractor will then receive, retain and then be responsible for safeguarding and proper use of that data copy. When the CCN

Contractor submits back to VA the agreed upon information, VA will then assume responsibility for that copy. Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

VA INFORMATION CUSTODIAL LANGUAGE. This entire section applies to all acquisitions requiring any Information Security and Privacy language.

a. The Government shall receive unlimited rights to data/intellectual property first produced and delivered in the performance of this contract or order (hereinafter “contract”) unless expressly stated otherwise in this contract. This includes all rights to source code and all documentation created in support thereof. The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General. The primary clause used to define computer software license (not data/intellectual property first produced under this contractor or order) is FAR 52.227-19, Commercial Computer Software License.

b. Information made available to the contractor by VA for the performance or administration of this contract will be used only for the purposes specified in the service agreement, SOW, PWS, PD, and/or contract. The contractor shall not use VA information in any other manner without prior written approval from a VA Contracting Officer (CO). The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General.

c. VA information will not be co-mingled with any other data on the contractor’s information systems or media storage systems. The contractor shall ensure compliance with Federal and VA requirements related to data protection, data encryption, physical data segregation, logical data segregation, classification requirements and media sanitization.

d. VA reserves the right to conduct scheduled or unscheduled audits, assessments, or investigations of contractor Information Technology (IT) resources to ensure information security is compliant with Federal and VA requirements. The contractor shall provide all necessary access to records (including electronic and documentary materials related to the contracts and subcontracts) and support (including access to contractor and subcontractor staff associated with the contract) to VA, VA's Office Inspector General (OIG), and/or Government Accountability Office (GAO) staff during periodic control assessments, audits, or investigations.

e. The contractor may only use VA information within the terms of the contract and applicable Federal law, regulations, and VA policies. If new Federal information security laws, regulations or VA policies become applicable after execution of the contract, the parties agree to negotiate contract modification and adjustment necessary to implement the new laws, regulations, and/or policies.

f. The contractor shall not make copies of VA information except as specifically authorized and necessary to perform the terms of the contract. If copies are made for restoration purposes, after the restoration is complete, the copies shall be destroyed in accordance with VA Directive 6500, VA Cybersecurity Program and VA Information Security Knowledge Service.

g. If a Veterans Health Administration (VHA) contract is terminated for default or cause with a business associate, the related local Business Associate Agreement (BAA) shall also be terminated and actions taken in accordance with VHA Directive 1605.05, Business Associate Agreements. If there is an executed national BAA associated with the contract, VA will determine what actions are appropriate and notify the contactor.

h. The contractor shall store and transmit VA sensitive information in an encrypted form, using VA-approved encryption tools which are, at a minimum, Federal Information Processing Standards (FIPS) 140-2, Security Requirements for Cryptographic Modules (or its successor) validated and in conformance with VA Information Security Knowledge Service requirements. The contractor shall transmit VA sensitive information using VA approved Transport Layer Security (TLS) configured with FIPS based cipher suites in conformance with National Institute of Standards and Technology (NIST) 800-52, Guidelines for the Selection, Configuration and Use of Transport Layer Security (TLS) Implementations.

i. The contractor’s firewall and web services security controls, as applicable, shall meet or exceed VA’s minimum requirements.

j. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor may use and disclose VA information only in two situations: (i) in response to a qualifying order of a court of competent jurisdiction after notification to VA CO (ii) with written approval from the VA CO. The contractor shall refer all requests for, demands for production of or inquiries about, VA information and information systems to the VA CO for response.

k. Notwithstanding the provision above, the contractor shall not release VA records protected by Title 38 U.S.C. § 5705, Confidentiality of medical qualityassurance records and/or Title 38 U.S.C. § 7332, Confidentiality of certain medical records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse or infection with Human Immunodeficiency Virus (HIV). If the contractor is in receipt of a court order or other requests for the abovementioned information, the contractor shall immediately refer such court order or other requests to the VA CO for response.

l. Information made available to the contractor by VA for the performance or administration of this contract or information developed by the contractor in performance or administration of the contract will be protected and secured in accordance with VA Directive 6500 and Identity and Access Management (IAM) Security processes specified in the VA Information Security Knowledge Service.

m. Any data destruction done on behalf of VA by a contractor shall be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management, VA Handbook 6300.1, Records Management Procedures, and applicable VA Records Control Schedules.

n. The contractor shall provide its plan for destruction of all VA data in its possession according to VA Directive 6500 and NIST 800-88, Guidelines for Media Sanitization prior to termination or completion of this contract. If directed by the COR/CO, the contractor shall return all Federal Records to VA for disposition.

o. Any media, such as paper, magnetic tape, magnetic disks, solid state devices or optical discs that is used to store, process, or access VA information that cannot be destroyed shall be returned to VA.The contractor shall hold the appropriate material until otherwise directed by the Contracting Officer’s Representative (COR) or CO. Items shall be returned securely via VA-approved methods. VA sensitive information must be transmitted utilizing VA-approved encryption tools which are validated under FIPS 140-2 (or its successor) and NIST 800-52. If mailed, the contractor shall send via a trackable method (USPS, UPS, FedEx, etc.) and immediately provide the COR/CO with the tracking information. Self-certification by the contractor that the data destruction requirements above have been met shall be sent to the COR/CO within 30 business days of termination of the contract.

p. All electronic storage media (hard drives, optical disks, CDs, back-up tapes, etc.) used to store, process or access VA information will not be returned to the contractor at the end of lease, loan, or trade-in. Exceptions to this paragraph will only be granted with the written approval of the VA CO.

3. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS. This section applies when any person requires access to information made available to the contractor by VA for the performance or administration of this contract or information developed by the contractor in performance or administration of the contract.

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees and subcontractors only to the extent necessary to perform the services specified in the solicitation or contract. This includes indirect entities, both affiliate of contractor/subcontractor and agent of contractor/subcontractor.

b. Contractors and subcontractors shall sign the VA Information Security Rule of Behavior (ROB) before access is provided to VA information and information systems (see Section 4, Training, below). The ROB contains the minimum user compliance requirements and does not supersede any policies of VA facilities or other agency components which provide higher levels of protection to VA’s information or information systems. Users who require privileged access shall complete the VA elevated privilege access request processes before privileged access is granted.

c. All contractors and subcontractors working with VA information are subject to the same security investigative and clearance requirements as those of VA appointees or employees who have access to the same types of information.

The level and process of background security investigations for contractors shall be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office of Human Resources and Administration/Operations, Security and Preparedness (HRA/OSP) is responsible for these policies and procedures. Contract personnel who require access to classified information or information systems shall have an appropriate security clearance. Verification of a Security Clearance shall be processed through the Special Security Officer located in HRA/OSP.

Contractors shall conform to all requirements stated in the National Industrial Security Program Operating Manual (NISPOM).

d. All contractors and subcontractors shall comply with conditions specified in VAAR 852.204-71(d); Contractor operations required to be in United States.

All contractors and subcontractors working with VA information must be permanently located within a jurisdiction subject to the law of the United States or its Territories to the maximum extent feasible. If services are proposed to be performed abroad the contractor must state where all non-U.S. services are provided. The contractor shall deliver to VA a detailed plan specifically addressing communications, personnel control, data protection and potential legal issues. The plan shall be approved by the COR/CO in writing prior to access being granted.

e. The contractor shall notify the COR/CO in writing immediately (no later than 24 hours) after personnel separation or occurrence of other causes. Causes may include the following:

(1) Contractor/subcontractor personnel no longer has a need for access to VA information or VA information systems.

(2) Contractor/subcontractor personnel are terminated, suspended, or otherwise has their work on a VA project discontinued for any reason.

(3) Contractor believes their own personnel or subcontractor personnel may pose a threat to their company’s working environment or to any companyowned property. This includes contractor-owned assets, buildings, confidential data, customers, employees, networks, systems, trade secrets and/or VA data.

(4) Any previously undisclosed changes to contractor/subcontractor background history are brought to light, including but not limited to changes to background investigation or employee record.

(5) Contractor/subcontractor personnel have their authorization to work in the United States revoked.

(6) Agreement by which contractor provides products and services to VA has either been fulfilled or terminated, such that VA can cut off electronic and/or physical access for contractor personnel.

f. In such cases of contract fulfillment, termination, or other causes; the contractor shall take the necessary measures to immediately revoke access to VA network, property, information, and information systems (logical and physical) by…