36C10X18R0134-001.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:

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. DUNS: DUNS+4:

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. 2/2012)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 67

NONE

36C10X18R0134 05-17-2018

Brian Kadel brian.kadel@va.gov 240.215.1653 05-29-2018

10:00AM

Strategic Acquisition Center - Frederick Department of Veterans Affairs 321 Ballenger Center Drive, Suite 125

Frederick MD 21703

X

524292

$32.5 Million

N/A

See CONTINUATION Page

Workers' Compensation Pharmacy Benefits Management Program

Please see B.3 for Performance Work Statement

All proposal intentions, questions and proposals shall be submitted in accordance with instructions to offerors in Section E.

Proposal Intentions: 10:00AM, 05/21/2018 Questions: 10:00AM, 05/21/2018 Proposals: see block 8 above

**Solicitation previously issued under 36C10XR0003**

See CONTINUATION Page

X X

36C10X18R0134

Table of Contents

SECTION A

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

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN

2011)

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017)

C.3 FAR 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.4 FAR 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ... 21

C.5 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)

C.6 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE

POSTER (DEC 1992)

C.7 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

C.8 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.9 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) ... 23

C.10 MANDATORY WRITTEN DISCLOSURES

C.11 VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

LANGUANGE

C.12 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.13 FAR 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2018)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 ATTACHMENT A: PAST PERFORMANCE QUESTIONAIRRE (PPQ)

D.2 ATTACHMENT B: PRICE MODEL

D.3 ATTACHMENT C: CONTRACT DISCREPANCY REPORT

SECTION E - SOLICITATION PROVISIONS

E.1 FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017) . 42

E.3 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION)

E.4 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

E.5 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

E.6 FAR 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (NOV 2017)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer 0010X Strategic Acquisition Center – Frederick Department of Veterans Affairs 321 Ballenger Center Drive, Suite 125 Frederick, MD 21703

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: N/A

3. INVOICES: See below.

The medical costs associated with the PBM Program will be paid for by Employee Compensation Fund.

This fund is reimbursed annually through a "chargeback" process by the VA. The Contractor's revenue is generated through negotiated pricing arrangements with providers. The Contractor pays the provider directly and then invoices the Department of Labor (DOL)’s Office of Worker’s Compensation Program (OWCP) at a rate that incorporates revenue for the Contractor, but is less than the Federal Employee Compensation Act (FECA) Fee Schedule located via the following link:

https://www.dol.gov/owcp/regs/feeschedule/fee.htm

The Contractor selected shall negotiate its own contract with pharmacies and providers for services that shall generate a discount for generic and brand named drugs, DME, and diagnostic services at a rate that is below the FECA fee schedule and agreed upon at award. The Contractor selected shall be responsible for assisting VA staff with achieving the goal of increasing program penetration, defined as the number of service items paid through the PBM versus the total items paid which is currently at 92 percent. The PBM Program will allow VA employees who are injured on-the-job to receive services at no direct cost to the VA. Participation in the PBM Program is voluntary and does not affect the employee's option of choosing their own provider as stipulated by the FECA. There will be no funds obligated under this contract. The contractor shall provide a monthly copy of all invoices submitted to the DOL’s OWCP for reimbursement to the Contracting Officer, Contract Specialist, and Contracting Officer’s Representative identified in Section B.1 of the contract/award.

4. GOVERNMENT INVOICE ADDRESS: See above.

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

AMENDMENT NO DATE

B.2 SUBCONTRACTING COMMITMENTS--MONITORING AND

COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments.

Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.

B.3 PERFORMANCE WORK STATEMENT

The Department of Veterans Affairs (VA) employs a workforce of approximately 380,000 Federal civilian employees. There were approximately 15,000 VA cases under active case management in FY 17.

These cases generated $21,971 in prescription costs and $37,553,546 in durable medical equipment (DME), Imaging, diagnostic services, and physical therapy costs on the VA Chargeback in FY 2017.

Based on an average of this historical data, the annual estimated cost is $70,663,998, and the total estimated cost for a three-year contract is $211,991,994. In Fiscal Year (FY) 2017, VA's Pharmacy Benefit Management (PBM) Program saved approximately $1,750,000 in medical costs on the VA Workers’ Compensation (WC) Chargeback Report. The current participation rate is 90 percent.

2. PURPOSE

The VA is seeking an expert and experienced Contractor, specializing in federal WC, to support the PBM Program or WC. The PBM Program will be a national program for VA employees who are injured on the job, and require prescription medications, durable medical equipment (DME) (walkers, crutches, canes, splints, muscle stimulators, etc.), physical therapy and diagnostic services (Magnetic Resonance Imaging (MRI), Computerized Tomography Scans (CT), Radiology, X-Rays, Electromyogram (EMG), and Nerve Conduction Velocity (NCV) studies. The function of the PBM is to provide a more efficient way for employees who are injured on the job to obtain the services they need, without the need to save receipts or file reimbursement forms.

3. PERIOD OF PERFORMANCE

The estimated contract Period of Performance (PoP) is for a 6-month base period starting on June 29, 2018, through December 29, 2018, with five 6-month option periods (three years total if all options are exercised).

4. ELIGIBILITY

There are two groups of VA employees eligible for coverage under this program.

1. Group 1 is comprised of those who have an existing claim under the FECA. These employees have fully adjudicated WC claims, and have coverage for all prescriptions that meet the OWCP requirements for their accepted injury.

2. Group 2 is comprised of new FECA claimants. These employees are newly injured on the job and have filed FECA claims pending adjudication by OWCP.

VA requires that the PBM Program provide a system for first-fill prescription coverage for employees who sustain a traumatic injury at work. The PBM Program will provide a pharmacy card system to these employees as part of the VA injury packet. Full prescription coverage for the work-related traumatic injury will be provided to all injured employees upon filing a FECA claim for traumatic injury. The VA anticipates 95 percent of these claims will be approved and all prescription costs covered by OWCP.

5. REQUIREMENT OBJECTIVES

The successful Contractor, at a minimum, shall demonstrate the following objectives to operate the PBM Program, to include, but not limited to:

1. Three years' experience in providing PBM services, Experience specializing in federal WC in conjunction with OWCP is required.

2. Can assign a single program manager full-time to support the VA account with at least five years' experience managing a PBM program. Federal PBM WC program experience is desirable.

3. Has national access to pharmacy chains and a majority of other pharmacies with a minimum of 65,000 network pharmacies during the contract term to meet the needs of VA.

4. Can securely transfer electronically all prescription information between participating network pharmacy, PBM, and OWCP. The contractor shall submit bills electronically to OWCP at point of sale.

5. At a minimum, has established a claims processing system that will conform to the National Council for Prescription Drug Programs (NCPDP) standards. The Contractor shall validate NPI number and DEA number to ensure physicians and pharmacies are registered. The Contractor shall be able to report NPI, DEA, and other related information to Government upon request.

6. At a minimum, can bill for prescriptions using the 11-digit National Drug Code (NDC) Number.

7. Can provide a pharmacy program to potentially eligible VA employees. This method is required by OWCP and limited to VA employees.

8. Has the ability to provide a voluntary mail order program option for any VA employee to utilize when requesting this service. The Contractor shall send out information packets to eligible VA employees to inform them of the voluntary mail order option and instructions for requesting this service.

9. Can administer an International Classification of Disease (ICD) 10 code in accordance with and as determined by OWCP.

10. Has the ability to provide a Review and Reporting (RR) Program to include the information necessary to process the bill. The contractor shall obtain access to and use various excluded provider lists (e.g., HHS excluded provider and similar state lists) to deny payment to providers included on those lists. Additionally, Government will provide a list of entities for which payments should not be made. The contractor shall neither pay (nor seek reimbursement for) pharmacy or DME bills for the entities identified by the contractor on these lists, by the Government, or as otherwise suspended or debarred. The contractor shall provide ongoing monitoring to ensure such providers are not part of the network.

11. Can implement a Drug Review and Reporting (RR) Program and must include at a minimum the following:

a. Detection of fraud and abuse patterns by providers or employees

b. Screening for drug/drug contraindications, drug/age, contraindications, drug/pregnancy contraindications

c. Duplicate prescriptions

d. Therapeutic overlap

e. Early refill

f. Prospective, concurrent, and retrospective RR program specific to, but not restricted to, opioids, letters of medical necessity, and excessive costs.

12. Can implement Formulary Administration and a therapeutics committee with ability to develop and administer one or more ICD-10 code based formularies in accordance with and as determined by

OWCP.

13. Can provide PBM services to support about 380,000 employees of which about 18,000 employees receive prescriptions, durable medical equipment and diagnostic services as a benefit of the WC program.

14. In accordance with FECA law, any requests for DME may require up to two estimates. If DOL should require an estimate, the contractor shall provide the requested estimate to DOL. If DOL approves the contractor’s submitted estimate and if the contractor is voluntarily selected by the claimant, the contractor shall be able to provide efficient, accurate, and timely processing of DME requests to the claimant.

15. Assure accurate and timely report inquiries. The contractor shall ensure that all bill, claimant, provider, pharmacy, drug, and DME-related data used for processing the bill may be shared with the Government.

16. Regular monitoring of rental to ownership conversion for DME, with 100% of the rental costs applied to purchase (Hearing aids are defined as DME for the purposes of the Federal Employees’ Compensation Program.)

17. Can implement reimbursement for duplicate bill payment, monitor providers for billing outside of network, and capture billing outside of network.

18. Can bill for all DME items using definable and/or acceptable coding, and in accordance with OWCP regulations and procedures.

19. Can ensure contracted discount rate below FECA fee schedule is used for generic and brand-named drugs, compounded drugs, and specialty drugs. Diagnostic services and DME items, will achieve a cumulative savings rate below FECA fee schedule.

20. Has access to medical imaging and testing networks, chains or suppliers sufficiently to affect a minimum penetration rate, based on dollars, as mutually agreed to during contract term.

21. Can bill for medical imaging and testing services using Procedure Coding: Billings for medical services subject to the OWCP fee schedule must be identified according to the American Medical Association Physicians' Current Procedural Terminology coding scheme (CPT), the Healthcare Common Procedure Coding System (HCPCS), including the American Dental Association Codes (ADA), or designated OWCP generic codes. The applicable coding rules should be followed as appropriate, including the use of correct CPT and HCPCS modifiers. Use of non-specific or “unlisted” codes to identify procedures clearly described by a CPT code will be denied. OWCP now uses a correct coding initiative program that is based on the CMS model, and separately billed components of services also billed under comprehensive codes will be rejected.

https://www.dol.gov/owcp/regs/feeschedule/fee/feeSept3017/Effective_September_30_2017_Read_ Me_First.htm

22. Provide dedicated and security-cleared customer service representatives for VA job-injured employees to access 24/7 to enroll in the PBM, provide information regarding network pharmacies, claim, drug information, payments, and request authorizations for services via the ACS portal, etc.

23. Will institute performance metrics every 30 days, to measure the effectiveness of the contract.

24. Comply with The Health Insurance Portability and Accountability Act of 1996 (I-IIPAA), Public Law 104-191, and The Privacy Act of 1974 (Pub.L. 93-579, 88 Stat. 1896, enacted December 31, 1974, 5 U.S.C.. § 552a),

25. Able to provide a work flow like the one outlined below:

Pharmacy provider enters prescription into the Point of Sale System

Pharmacy transmits electronic bill to PBM via National Switch

PBM reviews bill, assigns fee schedule for drug charge, and transmits prescription with charge to OWCP via National Switch (NDC) and Department of Labor's (DOL) Bin Number (008787)

OWCP adjudicates claim and returns it through National Switch (NDC) to PBM, authorizing payment for prescription submitted

PBM notifies pharmacy of OWCP approval through National Switch Pharmacy provides prescription to employee

Independent of VA, PBM pays pharmacy based on previously negotiated fee schedule

6. AGENCY RESPONSIBILITIES

Post Award Kick-Off Meeting

To better understand VA's organizational and cultural environment within five working days from the date of contract award, the VA will host a Post Award Kick-Off Meeting. The intent of the Post Award Kick-Off Meeting is not only to discuss the PWS, tasks and deliverables; accountability and responsibility to include the Quality Assurance Surveillance Plan (QASP) for each task and deliverable; risk identification and mitigation controls, but discuss how the Contractor will accomplish the tasks outlined in this Performance Work Statement, section 5.0 and 7.0. The VA will provide the Contractor with an orientation and briefing, as well as a range of documentation and material that will provide an overview of VA's organizational structure, mission, and goal, the assigned WC program staff, their locations, and their current duties and responsibilities.

This documentation will include:

a. Organization charts, including the current roles and responsibilities for all the organizations within the Department, and

b. Identification of the COR for technical program direction under the scope of work executed by contract.

Upon award of the contract, the agency will be responsible for the following:

a. Notifying DOL OWCP within five days after contract award of the selected Contractor. The Contractor shall not perform Inherently Governmental Functions as prescribed in Federal Acquisition Regulation (FAR) 7.503.

b. Except for the contract/discount price, such pharmacy services must be provided in accordance with OWCP rules for such services. No formularies or other restrictions can be imposed by VA or their contractor. VA bears responsibility to assist in the development of the claim; to assist the employee with the FECA claims process; and fully bears the ultimate responsibility for the entire financial costs of the FECA claim through the FECA chargeback process. The PBM program will be entirely voluntary for VA employees; VA will allow OWCP to review the program materials provided to employees and their claimants, and VA agrees to undertake the responsibility to provide claimants with information relative to the provision of the voluntary PBM program.

The VA COR will monitor contractor’s performance to ensure quality, timeliness, and compliance with the contract terms. The contractor’s performance will be reported on an annual basis to the Contractor Performance Assessment Reporting System (CPARS) by the VA COR and CO. Poor performance may result in issuance of a Contractor Discrepancy Report (CDR). The CO and COR will make use of information from CDRs, as well as any additional knowledge and information available to them with respect to the contractor’s performance, to complete the CPARS.

The COR will review the progress reports and management information reports in comparison with bill pay file reports received from OWCP (bills that OWCP has approved/paid for VA claimants) to ensure all bills the contractor submits to OWCP for VA claimants are in accordance to the discounts and fees negotiated under this contract. Instances of over-payment due to incorrect billing or over-charges by the contractor shall be reported by the VA COR to OWCP and the CO immediately upon finding. Incorrect billing or over-charging will result in the issuance of a CDR to the contractor by the Contracting Officer, requiring a response from the contractor within the time period given in the CDR, and may impact assessment of the contractor’s performance. The contractor agrees to correct and/or reimburse the Government for over-payments in a way determined appropriate by VA and OWCP.

7. PERFORMANCE OBJECTIVES TASK AND DELIVERABLES:

The Contractor shall provide the following tasks and deliverables in support of the Pharmacy Benefit Management Program contract:

Task 1: Post-Award Orientation and Kick-Off Meeting

The contractor shall work with the Government to coordinate and facilitate the kickoff meeting, provide meeting agenda and Work Plan that identifies all tasks, resources utilized (i.e., number, labor category, and description), deliverables to be completed, and the corresponding timetable/delivery dates.

Due: Within 10 business days after the contract award Location: Department of Veterans Affairs Central Office, 810 Vermont, NW, Washington, DC 20420.

Tentative Participants: COR, Contracting Officer (CO)/Contract Specialist (CS), and/or VA's senior executives.

1a. Deliverable: Coordinate and facilitate the meeting, and provide meeting agenda within five business days after the contract has been awarded.

1b. Deliverable: Within five business days after the kick-off meeting, the Contractor shall submit the Work Plan in both hard-copy and electronic forms to the COR. Format requirements include letter size paper (8 1/2" x 11"), Arial 12 font, created in a program compatible with Microsoft Office 2007 programs.

Task 2: Establishing a Contractor Program Manager

Appoint and electronically notify the COR of the name and contact information of its authorized

Contractor Program Manager (PM) who shall be the primary interface with VA's COR on current PBM contract performance.

2a. Deliverable: Establish a Contractor Program Manager within 5 business days after contract award.

Task 3: Meetings with the VA COR/WC PM

Discuss the progress of the VA PBM with the VA COR, PM and VA management officials no less than quarterly, and as needed, per request by VA COR. These meetings will be scheduled by the COR.

Scheduled meeting may take place in person, during on-site visits or via conference calls.

3a. Deliverable: Establish a meeting schedule within five business days after contract award.

Task 4: Quality Control

Develop and implement internal quality control procedures that produce timely, accurate, complete and relevant data that meets the full requirements of this performance work statement. An evaluation of the PBM system will be conducted will be conducted by the COR, as required to ensure that efficient and effective management processes remain in place and that data is handled in a secure manner and protected to meet all the FECA and Privacy Act requirements as well as VA information security requirements.

Contractor shall ensure that the information is maintained consistent with all Privacy Act requirements, and shall ensure that its information security safeguards are consistent with OWCP policies and practices.

Where applicable, the contractor shall ensure that data is handled in a manner that is compliant with security measures that HIPAA rules require.

4a. Deliverable: The Contractor shall develop and implement internal quality control procedures immediately upon award of contract. The Government will develop a Quality Assurance Surveillance Plan (QASP) after award.

Task 5: Progress Reports

Develop and provide monthly progress reports to the VA COR. The specific format and content of these reports shall be developed by the Contractor and approved by the VA COR. In general, the PBM reports should include summary information that enables VA management to make key decisions about the direction of the WC PBM. The scope, content, and format of these reports will be agreed upon between the VA COR and the Contractor Program Manager.

5a. Deliverable: The Contractor shall submit the management information reports in hard-copy and electronic final form to the COR monthly by the third Wednesday of the month. In the event of a holiday or closure due to an Executive Order, reports shall be due the next business day.

Task 6: Management Information Reports

Develop and provide monthly progress reports to VA COR submitted by the third Wednesday of the month. In the event of a holiday or closure due to an Executive Order, reports shall be due the next business day. The specific format and content of these reports shall be worked out by the VA COR and the Contractor's Program Manager.

In general, the Contractor shall include summary information that enables VA's management to make key decisions about the direction of the PBM Program. The Contractor shall submit a draft progress report template for review and approval by the VA COR. In addition to the monthly progress reports outlined above, the Contractor shall provide management information reports to the VA COR.

6a. Deliverable: Aggregate data and information on VA cases reflecting the number of cases in which PBM services were provided, clearly identifying the type of service (prescription, DME, or imaging).

6b. Deliverable: Periodic information on any cost savings achieved through the Contractor management of the PBM, including actual and cost avoidance savings on medical costs.

6c. Deliverable: Maintain, retain, and make available complete and accurate bill payment and financial reporting history.

6d. Deliverable: Provide timely and accurate reports including the tracking/monitoring of program utilization, cost savings, and performance metrics against program goals.

6e. Deliverable: Provide reports and statistics for quality reviews.

6f. Deliverables: Report cost savings and utilization at district and area level of the VA organization.

6g. Deliverable: Provide assigned staff to support the design, development, implementation, and enhancement of reports. Provide an Information System that includes at a minimum:

a. Cost savings.

b. Report or identification of unusual practices by treating providers.

c. Proposed fee schedule revisions and actual cost savings.

d. Comparative analysis of billed amount to paid amount.

e. Produce hard copy and/or electronic format.

f. Electronic transmission of reports to VA.

g. Prepare non-standard reports if requested.

Task 7: Contractor Case Files Maintenance

7a Deliverable: Upon completion of the contract, all computer and paper files and records will be turned over to VA or destroyed at the direction of the VA COR.

Task 8: Help Desk

The Contractor shall provide dedicated and security-cleared customer service representatives for VA job-injured employees to access 24/7 to enroll in the PBM, provide information regarding network pharmacies, claim denials, claim, drug information, payments, and request authorizations for services via the Affiliated Computer Services (ACS), or other related portal.

8. INFORMATION SECURITY

The Contractor and its personnel shall be subject to the same Federal laws, regulations, standards, and VA policies as VA personnel regarding information and information system security. These include, but are not limited to, Federal Information Security Management Act (FISMA), Appendix III of the Office of Management and Budget Circular A-130, and guidance and standards available from the Department of Commerce's National Institute of Standards & Technology (NIST). This also includes the use of common security configurations available from NIST's web site at http://checklists.nist.gov. To ensure that appropriate security controls are in place.

All information and material concerning Federal Workers’ Compensation claims or data that the Contractor may acquire as a result of providing PBM services to VA, whether such claims or data are electronic, verbal or written, are covered by the Privacy Act System of Records (DOL/GOVT-1) and remain the property of DOL. The contractor must comply with all DOL rules and procedures regarding the protection of records in the DOL/GOVT-1 Privacy Act System of Records as published in the Federal Register. All information and material received from VA regarding claims or data shall be stored and maintained in the Contractor’s secured system, separate from any other agency or company information.

The contractor shall not disclose, sell, market or utilize any information and material concerning Federal Workers’ Compensation they acquire as a result of providing PBM services to the VA for any other purposes that are not explicitly included in this contract.

For any data not governed by the preceding two paragraphs, the contractor must also follow the procedures set forth in Section C.1 “VA Information and Information System Security/Privacy Requirements for IT Contracts”.

9. APPLICABLE DOCUMENTATION, DEFINITIONS

All Contractor personnel shall follow and adhere to all the policies and procedures established by OWCP DOL Office of WC Programs for the Federal WC Program and Office of Occupational Safety and Health for the Federal OSH Program, contained in their regulations, in FECA, OSHA and in the Privacy Act. All technical terms used in this contract are as defined by DOL in its regulations or in the FECA and OSHA legislation. http://www.dol.gov/owcp/dfec/procedure-manual.htm

10. DELIVERABLE SCHEDULE

Task Item Description Quantity Delivery Date

Task

Deliverable a:

Coordination and Facilitation of Kick- Off Meeting and Meeting Agenda

One Kick-Off Meeting and Meeting Agenda.

Meeting agenda due within five business days after contract award. Kick-Off Meeting to be held within 10 business days after contract award.

Task

Deliverable b:

Work Plan

One Work Plan in both hard-copy and electronic forms.

Work plan is due within five business days after the kick-off meeting.

Task

Deliverable a:

Establish a Contractor Program Manager

One Contractor Program Manager Point of Contact

Identification of Contractor Program Manager is due within five business days after contract award.

Task

Deliverable a:

Establish a Meeting Schedule

One Meeting Schedule. Meeting schedule is due within five business days after contract award.

Task

Deliverable a:

Quality Control Procedures

Quality Control Procedures Contractor shall develop and implement quality control procedures immediately upon contract award.

Task

Deliverable a:

Progress Reports

Twelve Reports Due monthly to the COR by the third Wednesday of the month; next business day in event of holiday or closure.

Task

Deliverable a:

Aggregate Data and Information on VA cases

As Requested Due upon COR request.

Task

Deliverable b:

Periodic Information on Cost Savings

As Requested Due upon COR request.

Task

Deliverable c: Bill Payment and Reporting History

As Requested Due upon COR request.

Task

Deliverable d:

Tracking/Monitoring of Program Utilization, Cost Savings, and Performance Metrics Against Program Goals

As Requested Due upon COR request.

Task

Deliverable e:

Quality Review Reports and Statistics

As Requested Due upon COR request.

Task

Deliverable f: Cost Savings and Utilization (District and Area Level of VA Organization)

As Requested Due upon COR request.

Task

Deliverable g:

Information System and Staff to Support Design, Development, Implementation, and Enhancement of Reports

One Ongoing.

Task

Deliverable a:

Turnover, or Destruction of Files

One Due upon COR request.

11. KEY PERSONNEL

The Contractor shall assign sufficient experienced personnel who are qualified in the conduct of similar skills and who have a proven background and level of experience for the work required. Key project personnel include only those persons who will be assigned to this project and who will be the actual personnel responsible for management and performance in the event the proposal results in award. The contractor shall provide a full-time Program/Project manager to provide support the VA account; this PM must have at least five years' experience managing a PBM program. The Contractor shall designate a minimum of one other individual as key personnel, such as a clinical director, a head of reporting team, or VP which the Contractor deems essential to contract performance.

12. SUBSTITUTION OF KEY PERSONNEL

All Contractor requests for approval of substitutions hereunder shall be submitted in writing to the COR, and the CO at least 15 calendar days in advance of the effective date, whenever possible, and shall provide a detailed explanation of the circumstances necessitating the proposed substitution, a complete resume for the proposed substitute, and any other information requested by the CO necessary to approve or disapprove the proposed substitution. The résumés shall include the employee's education (including names of school and degree/certificate), specific experiences that are directly related to the requirements of this procurement, periods of employment, title and job descriptions, and level of responsibility. New personnel shall not commence work until all necessary security requirements have been fulfilled and resumes provided and accepted. The COR, and the CO will evaluate such requests and promptly notify the Contractor of approval or disapproval in writing. Any substituted personnel shall have the equivalent or better education, experience, and credentials than the personnel they may replace, subject to VA review and approval.

13. CONTRACTOR PERSONNEL

The Contractor shall be responsible for managing and overseeing the activities of all Contractor personnel, as well as sub-Contractor (if any) efforts used in performance of this effort. The Contractor's management responsibilities shall include all activities necessary to ensure the accomplishment of timely and effective support, performed in accordance with the requirements contained in the statement of work.

The CO, in consultation with the COR, will approve any request to substitute personnel to be used in conducting the review. Any proposed substitution shall be of personnel at comparable backgrounds as the person being replaced.

The CO may notify the Contractor and request immediate removal of any personnel assigned to the task order by the Contractor that are deemed to have a conflict of interest with the government or if the performance is deemed to be unsatisfactory. The reason for removal shall be documented and replacement personnel shall be identified within three business days of the notification. Employment and staffing difficulties shall not be justification for failure to meet established schedules.

SECTION C - CONTRACT CLAUSES

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

ITEMS (JAN 2017)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment.—

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

(2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR part 1315.

(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause.

(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.

(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—

(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—

(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);

(B) Affected contract number and delivery order number, if applicable;

(C) Affected line item or subline item, if applicable; and

(D) Contractor point of contact.

(ii) Provide a copy of the remittance and supporting documentation to the Contracting Officer.

(6) Interest.

(i) All amounts that become payable by the Contractor to the Government under this contract shall bear simple interest from the date due until paid unless paid within 30 days of becoming due. The interest rate shall be the interest rate established by the Secretary of the Treasury as provided in 41 U.S.C. 7109, which is applicable to the period in which the amount becomes due, as provided in (i)(6)(v) of this clause, and then at the rate applicable for each six-month period as fixed by the Secretary until the amount is paid.

(ii) The Government may issue a demand for payment to the Contractor upon finding a debt is due under the contract.

(iii) Final decisions. The Contracting Officer will issue a final decision as required by 33.211 if—

(A) The Contracting Officer and the Contractor are unable to reach agreement on the existence or amount of a debt within 30 days;

(B) The Contractor fails to liquidate a debt previously demanded by the Contracting Officer within the timeline specified in the demand for payment unless the amounts were not repaid because the Contractor has requested an installment payment agreement; or

(C) The Contractor requests a deferment of collection on a debt previously demanded by the Contracting Officer (see 32.607-2).

(iv) If a demand for payment was previously issued for the debt, the demand for payment included in the final decision shall identify the same due date as the original demand for payment.

(v) Amounts shall be due at the earliest of the following dates:

(A) The date fixed under this contract.

(B) The date of the first written demand for payment, including any demand for payment resulting from a default termination.

(vi) The interest charge shall be computed for the actual number of calendar days involved beginning on the due date and ending on—

(A) The date on which the designated office receives payment from the Contractor;

(B) The date of issuance of a Government check to the Contractor from which an amount otherwise payable has been withheld as a credit against the contract debt; or

(C) The date on which an amount withheld and applied to the contract debt would otherwise have become payable to the Contractor.

(vii) The interest charge made under this clause may be reduced under the procedures prescribed in 32.608-2 of the Federal Acquisition Regulation in effect on the date of this contract.

(j) Risk of loss. Unless the contract specifically provides otherwise, risk of loss or damage to the supplies provided under this contract shall remain with the Contractor until, and shall pass to the Government upon:

(1) Delivery of the supplies to a carrier, if transportation is f.o.b. origin; or

(2) Delivery of the supplies to the Government at the destination specified in the contract, if transportation is f.o.b. destination.

(k) Taxes. The contract price includes all applicable Federal, State, and local taxes and duties.

(l) Termination for the Government's convenience. The Government reserves the right to terminate this contract, or any part hereof, for its sole convenience. In the event of such termination, the Contractor shall immediately stop all work hereunder and shall immediately cause any and all of its suppliers and subcontractors to cease work. Subject to the terms of this contract, the Contractor shall be paid a percentage of the contract price reflecting the percentage of the work performed prior to the notice of termination, plus reasonable charges the Contractor can demonstrate to the satisfaction of the Government using its standard record keeping system, have resulted from the termination. The Contractor shall not be required to comply with the cost accounting standards or contract cost principles for this purpose. This paragraph does not give the Government any right to audit the Contractor's records. The Contractor shall not be paid for any work performed or costs incurred which reasonably could have been avoided.

(m) Termination for cause. The Government may terminate this contract, or any part hereof, for cause in the event of any default by the Contractor, or if the Contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the Contractor for any amount for supplies or services not accepted, and the Contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience.

(n) Title. Unless specified elsewhere in this contract, title to items furnished under this contract shall pass to the Government upon acceptance, regardless of when or where the Government takes physical possession.

(o) Warranty. The Contractor warrants and implies that the items delivered hereunder are merchantable and fit for use for the particular purpose described in this contract.

(p) Limitation of liability. Except as otherwise provided by an express warranty, the Contractor will not be liable to the Government for consequential damages resulting from any defect or deficiencies in accepted items.

(q) Other compliances. The Contractor shall comply with all applicable Federal, State and local laws, executive orders, rules and regulations applicable to its performance under this contract.

(r) Compliance with laws unique to Government contracts. The Contractor agrees to comply with 31 U.S.C. 1352 relating to limitations on the use of appropriated funds to influence certain Federal contracts;

18 U.S.C. 431 relating to officials not to benefit; 40 U.S.C. chapter 37, Contract Work Hours and Safety Standards; 41 U.S.C. chapter 87, Kickbacks; 41 U.S.C. 4712 and 10 U.S.C. 2409 relating to whistleblower protections; 49 U.S.C. 40118, Fly American; and 41 U.S.C. chapter 21 relating to procurement integrity.

(s) Order of precedence. Any inconsistencies in this solicitation or contract shall be resolved by giving precedence in the following order:

(1) The schedule of supplies/services.

(2) The Assignments, Disputes, Payments, Invoice, Other Compliances, Compliance with Laws Unique to Government Contracts, and Unauthorized Obligations paragraphs of this clause;

(3) The clause at 52.212-5.

(4) Addenda to…