36C10X18R0133-A00003002.docx

Medical Disability Exams (MDE) Veterans Benefits Administration (VBA) Department of Veterans Affairs (VA) As Authorized by P.L. 104-275 Solicitation Number: 36C10X18R0133 Amendment A00003

For additional information, see the Government responses to other questions within this list of questions regarding “priority processing”.

See Amendment A00003 to the solicitation, which revises the Addendum to FAR 52.212-2, Instructions to Offerors, to permit Offerors to propose a discount percentage for ACE Eligible Exams. Also, see amended Attachment AA, which makes conforming changes to the Pricing Spreadsheet.

6.4

· Column A- Zip Code of coverage location

· Column B- Audiology Provider Total

· Column C- Dental Provider Total

· Column D- Ophthalmologist /Optometrist (Eye) Provider Total

· Column E- Gynecological (GYN) Provider Total

· Column F- Mental Health Provider Total

· Column G- Prisoner of War (POW) Protocol Provider Total

· Column H- Sleep Disorders Provider Total

· Column I- Traumatic Brain Injury (TBI) Provider Total

· Column J- General Provider Total

The rows should reflect the provider total counts by zip code.

In response to inventory that does not meet the expected standard of performance, the Government reserves the right to reduce/offset that Contractor’s percentage of their incoming inventory (examination requests) commensurate with the percentage of inventory pending greater than 20 days. The Government will also may request more frequent status reports identifying all cases pending greater than 20 days. Attachment W has been updated to reflect the required format and necessary information.

Priority processing requests are expected to be approximately 15% of the total exam request volume.

See Amendment A00003 to the RFP, which removes reference to the “Fully Developed Claim” (or FDC) program, which is currently in development by VBA and may be negotiated into the Contract at a later date once the FDC program is ready to roll out by VBA.

The Government estimates that approximately 50% of its inventory includes Fully Developed Claims (FDC). The remaining priority requests make up approximately 15% of the total inventory and may overlap with FDC claims.

In cases of clarifications that take place during triage, the timeliness clock is stopped and restarted at the time Contractor receives the Clarification Response from the VA.

PWS Section 9.37.c.i has been revised by Amendment 00002 to reflect the following:

In cases of clarifications that take place during triage before any appointments have been scheduled the timeliness clock is stopped and restarted at the time Contractor receives the Clarification Response from the VA.

Furthermore, if “No” is answered for any question 2 through 12, the DBQ is considered an error. Our quality review assesses accuracy based upon contractual requirements, and does not assess sufficiency for rating purposes.

· A review at a specific DBQ-type;

· A review on a specific provider; or

· A review on a topic at the request of a third party.

Findings noted from a special focused review will be provided to the Vendor for feedback and corrective action and monitoring, if warranted. Compliance with corrective actions and monitoring will be required. Example of corrective action may include, but are not limited to, re-examination based upon deficiencies found, refresher training requirements, monitoring of a provider’s work to ensure corrected behavior.

The expected standard of performance requires each Vendor to complete 75%-85% of total inventory within 20 calendar days for DBQ/C&P Examinations, other than for Incarcerated Veterans and Agency Priority Reviews.

See Amendment A00003 which updates PWS Section 12.1 as follows:

12.1 Performance evaluation:

Timeliness will be evaluated by measuring the pending inventory on a monthly basis for purposes of section 12.8. Timeliness (based on completed inventory), quality, and Veteran satisfaction survey will be evaluated quarterly for purposes of incentives and disincentives, with a monthly teleconference for feedback and informational purposes.

This requirement where a date of cancelled examination is given the same credit as date completed examination can misrepresent a Vendor’s actual performance. Without a clear definition of “a timely fashion” a Vendor can actually manipulate this requirement to improve their timeliness metric which seems inconsistent with the intent of this requirement. As an example, if a Vendor does not have the necessary provider network coverage and/or staff to handle the volume of assigned exam requests, there are no defined objective and reliable management safeguards defined in this PWS to prevent a Vendor from cancelling exam requests within 20 days from date of receipt from VA. Because this requirement counts cancellations in the calculation of the % of total inventory completed within 20 days (C&P), a high number of cancellations under 20 days actually improves the Expected Standard of Performance for a non-performing Vendor.

The Government defines “a timely fashion”, as meeting the expected standard of performance as defined in the Section 12.0 of the PWS. A Contractor’s request to make cancellations associated with the Contractor’s own inability to complete examination requests within the expect standard of performance will be directed by the Government. The VBMS-EMS system does not allow Vendors to cancel examination requests without Government approval.

Section 12.1 of the PWS has been updated as follows:

12.1 Performance evaluation:

Timeliness will be evaluated by measuring the pending inventory on a monthly basis for purposes of section 12.8 Timeliness (based on completed inventory), quality, and Veteran satisfaction survey will be evaluated quarterly for purposes of incentives and disincentives, with a monthly teleconference for feedback and informational purposes.

Pending inventory, which will be measured on a monthly basis is defined as all examination requests in a Vendor’s given inventory that has not been completed. This calculation will exclude examination requests awaiting clarification from the VA. The time clock for this metric begins on the first day of the month and ends on the last day of the respective month.

Completed inventory, which will be measured in a quarterly basis, is defined as all examination requests completed within the quarter. This calculation will exclude all examination requests in a pending status. The time clock for this metric begins on the first day of the quarter and ends on the last day of the respective quarter.

A Contractor should not be penalized repeatedly for an error where communication of the error via the quarterly performance report is not timely. More importantly, timely feedback would help to ensure that our Veterans are receiving a higher level of service through the provision of high quality DBQs. Request VA to reconsider the measurement and communication process for the quality standard in order to reduce costs and improve service.

VBA has no current plans to change their quarterly evaluation process. See Section 12.7 of the PWS. The Government provides the following high-level overview of the quality review process:

· Accuracy will be assessed on a quarterly basis, with formal Quarterly Performance Evaluation Reports provided as described.

· Quarterly quality samples will be divided up across the three months in the quarter.

· Samples will be pulled at the beginning of each month for the prior month’s work.

· Informal findings will be provided based upon the monthly samples throughout the quarter via draft reports and monthly quality calls.

· VBA has and does inform the Vendors as needed of any noted error trends through the monthly calls and would certainly contact a Vendor if need be as a recurring exam deficiency was noted.

Section 12.5 addresses circumstances when a Contractor may qualify for a monetary incentive or disincentive. Insufficient Exams, Inadequate Exams, and Cancellation Rates in Section 12.0 do not apply to penalties and incentives. However, failure to meet the expected standard of performance for Insufficient Exams, Inadequate Exams and Cancellation Rate as indicated in Section 12.0 could be considered failure to perform based on the contract terms.

Section 12.1 of the PWS has been updated as follows:

12.1 Performance evaluation:

Timeliness will be evaluated by measuring the pending inventory on a monthly basis for purposes of section 12.8 Timeliness (based on completed inventory), quality, and Veteran satisfaction survey will be evaluated quarterly for purposes of incentives and disincentives, with a monthly teleconference for feedback and informational purposes.

Pending inventory, which will be measured on a monthly basis is defined as all examination requests in a Vendor’s given inventory that has not been completed. This calculation will exclude examination requests awaiting clarification from the VA. The time clock for this metric begins on the first day of the month and ends on the last day of the respective month.

Completed inventory, which will be measured in a quarterly basis, is defined as all examination requests completed within the quarter. This calculation will exclude all examination requests in a pending status. The time clock for this metric begins on the first day of the quarter and ends on the last day of the respective quarter.

Furthermore, if “No” is answered for any question 2 through 12, the DBQ is considered an error. Our quality review assesses accuracy based upon contractual requirements, and does not assess sufficiency for rating purposes.

The answer to this question can have a significant impact to a Vendor’s cost basis. For example, if there is a daily, equal split of exam requests per Vendor, then Vendors can expect to receive consistent daily volume of exam requests. This allows Vendors to develop a staffing construct which is lower cost as a result of the efficiency gained through daily workload predictability and less variability in the highs and lows of exam requests between days. In contrast, if the Government’s method to ensure equal split is through a daily rotation among awarded Vendors and there are three Vendors in a Region, then this creates a significant level of daily variability as a Vendor may not see any work for two days, then receive a much larger download on the third day of the Vendor’s assigned rotation. The daily rotation example may drive up a Vendors cost basis as additional staff may be required to triage cases on the big download day rather than less staff if smaller volumes are received daily.

The functionality of the VBMS-EMS system allows total examination request volume to be split between the Vendors in real time, on an ongoing basis as received by the Government. CAATS exam requests will use the same routing guidance used for exam requests placed through the VBMS-EMS system.

Will the Government assess all three performance standards or just timeliness or some combination of the three when a decision is made to redistribute exam requests? Additionally, given that the Government will be making these performance assessments every quarter then notifying the Vendor two months after the end of the quarter, it is accurate to assume that exam redistribution will only occur at the end of the quarterly calculation and results notification period? If this is not an accurate assumption, please explain what metrics will be used to redistribute work and at what frequency.

Section 12.1 of the PWS has been updated as follows:

12.1 Performance evaluation:

a. Timeliness will be evaluated by measuring the pending inventory on a monthly basis for purposes of section 12.8

b. Timeliness (based on completed inventory), quality, and Veteran satisfaction survey will be evaluated quarterly for purposes of incentives and disincentives, with a monthly teleconference for feedback and informational purposes.

Section 12.8.a.iii has been updated to address how the Government will handle impacts to timeliness based on the redistribution of work.

Section 12.8.a states that VA reserves the right to redistribute the total examination request volume among the Vendors if any Vendor does not meet the expected standards of performance.

The Government will make performance assessments on timeliness on a monthly basis as indicated in Section 12.1. Vendors will receive performance feedback on a monthly and quarterly basis.

In addition, if the VA does not qualify the redistributed work as a “surge” justifying a timeliness waiver, then the performing Contractor(s) is now faced with the additional risk of a financial disincentive. Finally, the performing Contractor(s) may need to make additional resource investments and hire staff to support the work the non-performing Contractor unable to support, only to have that additional work re-allocated back to the non-performing Contractor when they are once again meeting expected standards of performance which can be weeks or months and completely unknown to the performing Contractor(s). The longer it takes for the non-performing Contractor to recover, the more time performing Contractor(s) have to leverage the additional work volume to recoup their additional investments. If the non-performing contactor recovers quickly, then the performing Contractor(s) may have to divest their investments and lay off staff, which again ultimately seems to serve as a disincentive to the performing Contractor(s).

Based on this explanation, will the Government reconsider this methodology? If so, some considerations are: 1) to allow the performing Contractor(s) to maintain the reallocated work until they experience performance problems and not when the non-performing Contractor is able to recover, 2) grant the performing Contractor(s), absorbing the potentially problematic work, to receive an automatic waiver and qualify for the performance incentives for the performance assessment period in which the reallocation of work was made.

The Government intends to mitigate negative or adverse impact to the performing Contractor as a result of the redistribution of work. Section 12.8.a.iii has been updated to address how the Government will handle impacts to timeliness based on the redistribution of work.

This process does not allow a Contractor to be informed of their Veteran satisfaction performance on a timely basis and make any adjustments on an ongoing basis and therefore creates a much higher risk for penalties and contributes to higher prices. It is understood per PWS Section 12.1 that there is a monthly teleconference for feedback and informational purposes though the evaluation, and contractual rating, is performed quarterly.

A Contractor should not be penalized repeatedly for an error where communication of the error via the quarterly performance report is not timely. More importantly, timely feedback would help to ensure that our Veterans are receiving a higher level of service. Request VA to reconsider the communication process for the Veteran satisfaction standard in order to reduce costs and improve service.

See PWS Section 12.1 which indicates that Vendors will receive monthly feedback regarding all performance elements.

Please provide a comprehensive list of the banned devices to ensure compliance.

See Attachment K (TRM Prohibited Decision Type Report as of 06-15-2018), which is added to the RFP as of Amendment A00003. Attachment K provides the current list of unauthorized software. Should any updates be made to the list, whether during the solicitation period or after contract award, an updated list will be provided to all interested parties.

And if this assumption is not correct, request reconsideration as requiring a NACI for network providers will have a significant negative impact on the ability to recruit providers for MDEs and increase prices due to Contractor costs for the provider’s time and the NACI itself. The time for the Government to process a very high volume of background investigations does not permit Contractors to be responsive during contract start-up, expansion of the network on an on-going basis, surge situations, and unique situations such as a adding a specialist in a remote area. In addition, VA does not absolutely require a NACI for all providers working at VHA or for all contracts for providers. Alternate additional requirements for credentialing can be used to address specific item(s) of concern in lieu of a NACI.

Network providers that do not have access to VA systems do not require NACI background checks.

VBMS Exam Management Integration Architecture as it is not included with the RFP and clarify the Attachment naming.

The Exam Management Integration Architecture document is included as part of the Exam Management IEPD. It is the primary document in the Documentation Folder of the IEPD zip file. The Exam Management IEPD is included in this solicitation as Attachment T of this RFP. By way of Amendment A00003, references in the PWS have been updated to reflect the correct source documents.

· Attachment C: Section 9.22

· Attachment H: Section 10.19.b.i

· Attachment I: Section 10.18.b.ii

· Attachment Q: Section 9.13

· Attachment R: Section 9.13