36C10X19Q0200-002.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 73

36C10X19Q0200 08-14-2019

Jennifer Benisek Jennifer.Benisek@va.gov (202) 794-4118 08-27-2019

01:00 pm/ET

36C10X

Strategic Acquisition Center - Frederick

Department of Veterans Affairs

5202 Presidents Court, Suite 103

Frederick MD 21703

X

813920

$15 Million

X

N/A

X

See Section 5.3 Place of Performance

36C10X

Strategic Acquisition Center - Frederick

Frederick MD 21703

VAFSC

U.S. Department of Veterans Affairs

Financial Services Center

PO BOX 149971

(see Section B.3 invoicing/payment)

Austin TX 78714-8917

1-(877)-489-6135

The Department of Veterans Affairs

Clinical Peer Review Blanket Purchase Agreement (BPA)

Contract Type: Firm-Fixed-Price

Questions Due: 08/19/2019 09:00 AM ET

Quotations Due: See Block 8 Above

See Continuation Pages for Further Details

X X

Corey Mann

Contracting Officer

36C10X19Q0200

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 PRICE SCHEDULE

B.3 PERFORMANCE WORK STATEMENT

B.4 CONFORMED VA INFORMATION AND INFORMATION SYSTEM

SECURITY/PRIVACY REQUIREMENTS

B.5 BPA ORDERING PROCEDURES

SECTION C - CONTRACT CLAUSES

C.1 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (MAY 2019)

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

C.4 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM

REQUIREMENTS (DEC 2009)

C.6 VAAR 852.219-76 SUBCONTRACTING PLANS MONITORING AND COMPLIANCE

(JUL 2018)

C.7 VAAR 852.219-71 VA MENTOR-PROTÉGÉ PROGRAM (DEC 2009)

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

2018)

C.9 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.10 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 INSTRUCTIONS TO OFFERORS

E.2 FAR 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

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

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

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

E.6 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

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

E.7 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.8 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.9 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer: Corey Mann

Strategic Acquisition Center - Frederick (36C10X)

Frederick, MD 21703

2. 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

3. 3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Within 30 days upon delivery and acceptance by the Government

4. 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.

See B.1 Contract Administration Data

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

AMENDMENT NO DATE

TUNGSTEN (fka OB10) ELECTRONIC INVOICE SUBMISSION

FSC e-INVOICE PROGRAM THRU AUSTIN PORTAL

FSC MANDATORY ELECTRONIC INVOICE SUBMISSION FOR AUSTIN PAYMENTS

Purchase Order Number: TBD (please include this on all invoices)

Vendor Electronic Invoice Submission Methods:

Fax, email and scanned documents are not acceptable forms of submission for payment requests.

Electronic form means an automated system transmitting information electronically according to the accepted data transmissions below.

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

(FSC) in Austin, TX uses a third-party contractor, Tungsten, to transition vendors from paper to electronic invoice submission. Please go to this website: http://www.tungsten-network.com/US/en/veterans-affairs/ to begin submitting electronic invoices, free of charge.

• A system that conforms to the X12 electronic data interchange (EDI) formats established by the

Accredited Standards Center (ASC) chartered by the American National Standards Institute

(ANSI). The X12 EDI Web site is http://www.x12.org.

Vendor e-invoice Set-up information:

Please contact Tungsten at the phone number or email address listed below to begin submitting your electronic invoices to the VA Financial Services Center in Austin, TX for payment processing. If you have questions about the payment status of a properly submitted invoice, the e-invoicing program, or Tungsten, please contact the FSC at the phone number or email address listed below.

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

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

• VA TUNGSTEN Number: AAA544240062

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

• FSC e-Invoice email: vafsccshd@va.gov

• http://www.fsc.va.gov/einvoice.asp

COMMUNICATIONS:

• https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-electronic-submission-of-payment-requests

• http://fcw.com/articles/2012/11/27/va-epayments.aspx?s=fcwdaily http://www.tungsten-network.com/US/en/veterans-affairs/ http://www.tungsten-network.com/US/en/veterans-affairs/ http://www.tungsten-network.com/US/en/veterans-affairs/ http://www.x12.org/ mailto:VA.Registration@tungsten-network.com mailto:vafsccshd@va.gov http://www.fsc.va.gov/einvoice.asp https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-%20lectronic-submission-of-payment-requests https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-%20lectronic-submission-of-payment-requests https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-%20lectronic-submission-of-payment-requests http://fcw.com/articles/2012/11/27/va-epayments.aspx?s=fcwdaily

B.2 PRICE SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION

OF SERVICES

Est.

QTY UNIT UNIT PRICE AMOUNT

Year One October 1, 2019 – September 30, 2020

5,250 EA NSP NSP

Peer Review for Quality Management - Year 1

Contract Period: Base

POP Begin: 10-01-2019

POP End: 09-30-2020

0001A

1,700 EA $_______________ $_______________

Audit Review (Tier 1)

Contract Period: Base

0001B

Audit Review (Tier 2)

Contract Period: Base

0001C

850 EA $_______________ $_______________

Audit Review (Tier 3)

Contract Period: Base

0001D

400 EA $_______________ $_______________

Facility-Requested Review (Tier 1)

Contract Period: Base

0001E 400 EA $_______________ $_______________

Facility-Requested Review (Tier 2)

Contract Period: Base

0001F 200 EA $_______________ $_______________

Facility-Requested Review (Tier 3)

Contract Period: Base

750 EA NSP NSP

Management Reviews - Year 1

Contract Period: Base

0002A

280 EA $_______________ $_______________

Routine Management Reviews (Tier 1)

Contract Period: Base

0002B

Routine Management Reviews (Tier 2)

Contract Period: Base

0002C

140 EA $_______________ $_______________

Routine Management Reviews (Tier 3)

Contract Period: Base

0002D

18 EA $_______________ $_______________

Medical Advisory Opinion (Tier 1)

Contract Period: Base

0002E

Medical Advisory Opinion (Tier 2)

Contract Period: Base

0002F

9 EA $_______________ $_______________

Medical Advisory Opinion (Tier 3)

Contract Period: Base

0002G 2 EA $_______________ $_______________

Clinical Appeals (Tier 2)

Contract Period: Base

0002H 2 EA $_______________ $_______________

Contract Period: Base

0002I 1 EA $_______________ $_______________

Clinical Appeals (Tier 3)

Contract Period: Base

7 EA NSP NSP

Executive Summary Reports- Year 1

Contract Period: Base

0003A 5 EA $_______________ $_______________

Executive Summary Reports (Step 1)

Contract Period: Base

0003B 1 EA $_______________ $_______________

Executive Summary Reports (Step 2)

Contract Period: Base

0003C 1 EA $_______________ $_______________

Executive Summary Reports (Step 3)

Contract Period: Base

0004 4 EA NSP NSP

End of Call/90 day Reports- Year 1

Contract Period: Base

0005 1 EA NSP NSP

Inter-Rater Reliability (IRR) Studies- Year 1

Contract Period: Base

ITEM

NUMBER

DESCRIPTION

OF SERVICES

Est.

QTY UNIT UNIT PRICE AMOUNT

Year Two October 1, 2020 – September 30, 2021

Peer Review for Quality Management - Year 2

Contract Period: Year 2

POP Begin: 10-01-2020

POP End: 09-30-2021

1001A

Contract Period: Year 2

1001B

Contract Period: Year 2

1001C

Contract Period: Year 2

1001D

Contract Period: Year 2

1001E 400 EA $_______________ $_______________

Contract Period: Year 2

1001F 200 EA $_______________ $_______________

Contract Period: Year 2

Management Reviews - Year 2

Contract Period: Year 2

1002A

Contract Period: Year 2

1002B

Contract Period: Year 2

1002C

Contract Period: Year 2

1002D

Contract Period: Year 2

1002E

Contract Period: Year 2

1002F

Contract Period: Year 2

1002G 2 EA $_______________ $_______________

Contract Period: Year 2

1002H 2 EA $_______________ $_______________

Contract Period: Year 2

1002I 1 EA $_______________ $_______________

Contract Period: Year 2

Executive Summary Reports- Year 2

Contract Period: Year 2

1003A 5 EA $_______________ $_______________

Contract Period: Year 2

1003B 1 EA $_______________ $_______________

Executive Summary Reports (Step 2)

Contract Period: Year 2

1003C 1 EA $_______________ $_______________

Executive Summary Reports (Step 3)

Contract Period: Year 2

1004 4 EA NSP NSP

End of Call/90 day Reports- Year 2

Contract Period: Year 2

1005 1 EA NSP NSP

Inter-Rater Reliability (IRR) Studies- Year 2

Contract Period: Year 2

NUMBER

DESCRIPTION

OF SERVICES

Est.

QTY UNIT UNIT PRICE AMOUNT

Year Three October 1, 2021 – September 30, 2022

Peer Review for Quality Management - Year 3

Contract Period: Year 3

POP Begin: 10-01-2021

POP End: 09-30-2022

2001A

Contract Period: Year 3

2001B

Contract Period: Year 3

2001C

Contract Period: Year 3

2001D

Contract Period: Year 3

2001E 400 EA $_______________ $_______________

Contract Period: Year 3

2001F 200 EA $_______________ $_______________

Contract Period: Year 3

Management Reviews - Year 1

Contract Period: Year 3

2002A

Contract Period: Year 3

2002B

Contract Period: Year 3

2002C

Contract Period: Year 3

2002D

Contract Period: Year 3

2002E

Contract Period: Year 3

2002F

Contract Period: Year 3

2002G 2 EA $_______________ $_______________

Contract Period: Year 3

2002H 2 EA $_______________ $_______________

Contract Period: Year 3

2002I 1 EA $_______________ $_______________

Contract Period: Year 3

Executive Summary Reports- Year 3

Contract Period: Year 3

2003A 5 EA $_______________ $_______________

Contract Period: Year 3

2003B 1 EA $_______________ $_______________

Contract Period: Year 3

2003C 1 EA $_______________ $_______________

Executive Summary Reports (Step 3)

Contract Period: Year 3

2004 4 EA NSP NSP

End of Call/90 day Reports- Year 3

Contract Period: Year 3

2005 1 EA NSP NSP

Inter-Rater Reliability (IRR) Studies- Year 3

Contract Period: Year 3

NUMBER

DESCRIPTION

OF SERVICES

Est.

QTY UNIT UNIT PRICE AMOUNT

Year Four October 1, 2022 – September 30, 2023

Peer Review for Quality Management - Year 4

Contract Period: Year 4

POP Begin: 10-01-2022

POP End: 09-30-2023

3001A

Contract Period: Year 4

3001B

Contract Period: Year 4

3001C

Contract Period: Year 4

3001D

Contract Period: Year 4

3001E 400 EA $_______________ $_______________

Contract Period: Year 4

3001F 200 EA $_______________ $_______________

Contract Period: Year 4

Management Reviews - Year 4

Contract Period: Year 4

3002A

Contract Period: Year 4

3002B

Contract Period: Year 4

3002C

Contract Period: Year 4

3002D

Contract Period: Year 4

3002E

Contract Period: Year 4

3002F

Contract Period: Year 4

3002G 2 EA $_______________ $_______________

Contract Period: Year 4

3002H 2 EA $_______________ $_______________

Contract Period: Year 4

3002I 1 EA $_______________ $_______________

Contract Period: Year 4

Executive Summary Reports- Year 4

Contract Period: Year 4

3003A 5 EA $_______________ $_______________

Contract Period: Year 4

3003B 1 EA $_______________ $_______________

Contract Period: Year 4

3003C 1 EA $_______________ $_______________

Executive Summary Reports (Step 3)

Contract Period: Year 4

3004 4 EA NSP NSP

End of Call/90 day Reports- Year 4

Contract Period: Year 4

3005 1 EA NSP NSP

Inter-Rater Reliability (IRR) Studies- Year 4

Contract Period: Year 4

NUMBER

DESCRIPTION

OF SERVICES

Est.

QTY UNIT UNIT PRICE AMOUNT

Year Five October 1, 2023 – September 30, 2024

Peer Review for Quality Management - Year 5

Contract Period: Year 5

POP Begin: 10-01-2023

POP End: 09-30-2024

4001A

Contract Period: Year 5

4001B

Contract Period: Year 5

4001C

Contract Period: Year 5

4001D

Contract Period: Year 5

4001E 400 EA $_______________ $_______________

Contract Period: Year 5

4001F 200 EA $_______________ $_______________

Contract Period: Year 5

Management Reviews - Year 5

Contract Period: Year 5

4002A

Contract Period: Year 5

4002B

Contract Period: Year 5

4002C

Contract Period: Year 5

4002D

Contract Period: Year 5

4002E

Contract Period: Year 5

4002F

Contract Period: Year 5

4002G 2 EA $_______________ $_______________

Contract Period: Year 5

4002H 2 EA $_______________ $_______________

Contract Period: Year 5

4002I 1 EA $_______________ $_______________

Contract Period: Year 5

Executive Summary Reports- Year 5

Contract Period: Year 5

4003A 5 EA $_______________ $_______________

Contract Period: Year 5

4003B 1 EA $_______________ $_______________

Contract Period: Year 5

4003C 1 EA $_______________ $_______________

Executive Summary Reports (Step 3)

Contract Period: Year 5

4004 4 EA NSP NSP

End of Call/90 day Reports- Year 5

Contract Period: Year 5

4005 1 EA NSP NSP

Inter-Rater Reliability (IRR) Studies- Year 5

Contract Period: Year 5

B.3 PERFORMANCE WORK STATEMENT

Clinical Peer Review

Blanket Purchase Agreement (BPA)

1. Introduction

1.1 Background

As the largest Federal provider of health care, the Veterans Health Administration’s (VHA) peer review program is a critical element of quality management and demonstrates the agency’s commitment to provide the highest quality care possible for Veterans. Past audits of peer review conducted internally by VHA staff identified opportunities for improving the peer review process within VHA. To facilitate implementation of the requirements of VHA Directive 1190 and to develop a process for improving the rigor and objectivity of peer review, VHA seeks a national Contractor with proven expertise in conducting peer review across all provider disciplines.

1.2 Scope

The contractor shall provide external expertise and conduct a peer review of selected episodes of care.

The contractor shall use the provided platform (Electronic Health Record) for review of medical records and report templates.

Under this Blanket Purchase Agreement (BPA), the contractor shall conduct the following:

• Peer Review for Quality Management o Audits o Facility Request Reviews

• Management Review o Management Review o Medical Advisory Opinion o Clinical Appeals

• Executive Summaries

• Reports

• Inter-Rater Reliability (IRR) Studies

For each BPA Call Order, the contractor shall provide staff to perform the services requested, comprehensive management, and supervision of contractor resources, and any required deliverables.

1.3 Estimated Reviews Per Year

The Government estimates 6,000 reviews per year, divided between Peer Reviews and Management

Reviews, according to VA's needs. The estimated target number of annual reviews per category is listed below:

• Peer Reviews o Approximately 4250 Audit Reviews o Approximately 1000 Facility-Requested Reviews

• Management Reviews o Approximately 700 Routine Management Reviews o Approximately 45 Medical Advisory Opinions o Approximately 5 Clinical Appeals

1.4 Applicable Documents

In the performance of the tasks associated with this Performance Work Statement, the Contractor shall comply with the following:

• 44 U.S.C. § 3541, “Federal Information Security Management Act (FISMA) of 2002”

• 38 U.S.C. §5705, “Confidentiality of Medical Quality Assurance Records” and its implementing regulations Title 38 Code of Federal Regulations §§ 17.500 through 17l.511.

• 38 U.S.C. §7332, “HIV Infection and Sickle Cell Anemia Medical Records”.

• 38 U.S.C. §5701, “VA Claims Confidentiality Statute”.

• 38 U.S.C. §5705, “Confidentiality of Healthcare Quality Assurance Review Records”.

• Federal Information Security Management Act (FISMA).

• Privacy Act and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

• Public Law 109-461, 5725, Confidentiality of Drug Abuse, Alcoholism and Alcohol Abuse.

• Federal Information Processing Standards (FIPS) Publication 140-2, “Security

Requirements For Cryptographic Modules”

• FIPS Pub 201, “Personal Identity Verification of Federal Employees and Contractors,”

March 2006

• 10 U.S.C. § 2224, "Defense Information Assurance Program"

• Software Engineering Institute, Software Acquisition Capability Maturity Modeling (SA

CMM) Level 2 procedures and processes

• 5 U.S.C. § 552a, as amended, “The Privacy Act of 1974”

• 42 U.S.C. § 2000d “Title VI of the Civil Rights Act of 1964”

• Department of Veterans Affairs (VA) Directive 0710, “Personnel Suitability and Security

Program,” June 04, 2010

• VA Directive 6102, “Internet/Intranet Services,” July 15, 2008

• 36 C.F.R. Part 1194 “Electronic and Information Technology Accessibility Standards,” July

1, 2003

• OMB Circular A-130, “Management of Federal Information Resources,” November 28,

• 32 C.F.R. Part 199, “Civilian Health and Medical Program of the Uniformed Services

(CHAMPUS)/TRICARE”

• An Introductory Resource Guide for Implementing the Health Insurance Portability and

Accountability Act (HIPAA) Security Rule, October 2008

• Sections 504 and 508 of the Rehabilitation Act (29 U.S.C. § 794d), as amended by the

Workforce Investment Act of 1998 (P.L. 105-220), August 7, 1998

• Homeland Security Presidential Directive (12) (HSPD-12), August 27, 2004

• VA Directive 6500, Managing Information Security Risk: VA Information Security

Program, September 20, 2012

• VA Handbook 6500, Risk Management Framework for VA Information Systems– Tier 3:

VA Information Security Program, March 10, 2015

• VA Handbook 6500.1, Electronic Media Sanitization, November 03, 2008

• VA Handbook 6500.2, Management of Data Breaches Involving Sensitive Personal

Information (SPI), July 28, 2016

• VA Handbook 6500.3, Certification and Accreditation of VA Information Systems, February 03, 2014

• VA Handbook, 6500.5, Incorporating Security and Privacy in System Development

Lifecycle, March 22, 2010

• VA Handbook 6500.6, “Contract Security,” March 12, 2010

• VA Technical Reference Model (TRM) (reference at https://www.voa.va.gov/)

• National Institute Standards and Technology (NIST) Special Publications

• VA Directive 6508, Implementation of Privacy Threshold Analysis and Privacy Impact

Assessment, October 15, 2014

• VA Directive 6300, Records and Information Management, February 26, 2009

• VA Handbook, 6300.1, Records Management Procedures, March 24, 2010

• VHA Handbook 1100.17, National Practitioner Data Bank (NPDB) Reports, December 28, 2009.

• OMB Memorandum, “Transition to IPv6”, September 28, 2010

• VHA Directive 2007-028, VHA Medical Advisory Opinion Requests by Regional Counsel, September 17, 2007

• Federal Rules of Civil Procedure, Rule 26(b)(4)

• VHA Directive 1190, Peer Review for Quality Management, November 21, 2018

• VHA Directive 1041, Appeal of VHA Clinical Decisions, October 24, 2016

2.0 Task Requirements

2.1 Peer Review for Quality Management Review

A Peer Review for Quality Management is a critical review of care performed by a peer conducted in accordance with all applicable laws, regulations, current VHA policies, and VHA Directive 1190.

Essential elements of Peer Review for Quality Management include:

• Peer evaluation of the care provided by individual clinicians within a selected episode of care.

• Identification of learning opportunities for practice improvement and any related improvement actions recommended by the peer review process.

• Confidential communication back to the clinicians who were peer reviewed regarding the results and any recommended actions to improve their clinical practice. This communication cannot include initiation of any administrative actions (e.g., modification of clinical privileges).

• Identification of system and process issues that may need

Peer Reviews shall be conducted by providers in all identified specialties and subspecialties as described in Attachment A - Specialties, with a panel of sufficient size in each discipline to meet the volume and demand of the VA. The review panel shall include non-physician Providers, such as Physician Assistants

(PA), Advanced Practice Nurses (APRN), and Certified Registered Nurse Anesthetists (CRNA), Psychologists, Pharmacists, Registered Nurses, Licensed Vocational Nurses, Social Workers, and other providers.

Depth at key specialties such as Cardiothoracic Surgery, Interventional Cardiology, Vascular Surgery, Neurosurgery and Mental Health is critical to meeting the needs of VHA.

All specialties must have at least 1 reviewer and must have a depth that is reasonably sufficient to maintain the workload provided for all review categories.

Panel Requirements subject to change based on emerging practices.

Intermittently a specialty may be in higher, immediate demand due to government need.

The contractor shall have a strategy for expanding the panel size to meet emerging practices, such as transplant services.

Contractor will provide a roster of all reviewers (listing name, credential, and any specialties, subspecialties, or dual board certifications), and any specialty vacancies. The contractor shall provide a new list monthly to identify added reviewers and attestation of Health and Human Services Office of

Inspector General List of Excluded Individuals and Entities (LEIE). Documentation of each reviewer’s screen through the LEIE is required upon hire and then monthly.

Medical Records that do not originate at a VA facility may need to be evaluated to effectively review a case.

On a case-by-case basis, there may be administrative reasons to extend a deadline for a review. The government will notify and modify dates if the need arises.

On a case-by-case basis, there may be a need for additional medical director oversight in a written review.

This level of oversight shall be considered part of the quality assurance process.

For every case, the vendor will be given access to the patient record in Community Viewer (or like system). The vendor shall verify credential and specialty of the provider under review for each case before assigning a reviewer. Any incompatible peer matches will be reported as part of the quality assurance surveillance plan.

2.1.1 Audit Reviews

Audit reviews are secondary reviews of a sample of episodes of care that have undergone internal Peer

Review for Quality Management.

See Attachment E for Audit Review template.

The Contractor shall include all required information as seen in Attachment E1.

2.1.2 Facility-Requested Reviews

A facility-requested review (FRR) is an external peer review of an episode of care where the facility desires external expertise (e.g., when there are no qualified local peers or if there is a conflict of interest to complete locally).

See Attachment E for Facility-Requested Review template.

The Contractor shall include all required information as seen in Attachment E2.

2.1.3 Management Review

Management Reviews are not confidential and privileged under 38 U.S.C. §5705 and it’s implementing regulations and are not considered Quality Management activities These reviews may require a comprehensive review of care and/or a focused review of a specific clinical discipline.

See Attachment F for Management Review template.

The Contractor shall include all required information as seen in Attachment F1.

Outside of routine management reviews, there are two specialized groups of management reviews:

2.1.4 Medical Advisory Opinion

Clinical reviews to provide medical advisory opinions related to standard of care determinations. A medical advisory opinion is an essential component of the VA General Counsel’s decision to settle or deny a claim. VA regulations, at Title 38 Code of Federal Regulations (CFR) § 14.602(b), provide that

Regional Counsel staff are guided by the views of the Under Secretary for Health as to the standard of medical care and treatment, the nature and extent of the injuries, the degree of temporary or permanent disability, the prognosis, the necessity for future treatment or physical rehabilitation, and any other pertinent medical aspects of a claim. Medical advisory opinions are generally protected from discovery in litigation and are exempt from disclosure under the Freedom of Information Act (FOIA) exemption 5

(Title 5 United States Code (U.S.C.) § 552(b)(5)), by the attorney work-product doctrine codified in Rule

26(b)(3), Federal Rules of Civil Procedure. They are not, however, considered confidential and privileged quality assurance records under 38 U.S.C. § 5705. No disclosure should be made of such opinions without the approval of the Regional Counsel or General Counsel. The opinions are qualitatively different from a peer review. Medical issues not identified by General Counsel, but which the reviewer believes are relevant to the episode of care under review should be identified by the reviewer, even if the medical issue was not specifically identified by the General Counsel attorney.

See Attachment G for Medical Advisory Opinions template.

The Contractor shall include all required information as seen in Attachment G1.

2.1.5 Clinical Appeals

Clinical reviews provide recommendations regarding appropriate and/or reasonable and necessary clinical service was provided and/or denied by VHA. These Clinical appeals may include caregiver support reviews. These reviews are not considered confidential and privileged quality assurance records under 38

U.S.C. § 5705.

See Attachment F for Clinical Appeals template.

The Contractor shall include all required information as seen in Attachment F2.

2.1.6 Executive Summaries

Executive summaries may be requested for both protected and non-protected reviews. These summaries will be for synthesis of multiple cases.

A reviewer in the specialty in question shall prepare the summary. The contractor shall provide analysis and summation of trends, commonalities, and/or discordant findings. These summaries shall be at least 2 pages (not including any cover page) and enough to adequately summarize the complexities of the evaluation

The Contractor shall include all required information as seen in Attachment I.

2.1.7 Reports

A no more than 2-page summary of work performed under the task order at the end of that call or every

90 days, whichever is shorter.

The Contractor shall include all required information as seen in Attachment J.

2.1.8 Inter-Rater Reliability (IRR) Studies

Peer reviewers for the Contractor shall undergo a process of inter-rater reliability testing, based on accepted industry standards and a strategy approved by the Contracting Officer’s Representative (COR).

This strategy must include what is considered passing, what is failing, remediation and reassessment protocols, and when removal from the panel is warranted.

Findings shall be made available to the COR.

The Contractor shall include all required information as seen in Attachment K.

2.1.9 Kick-Off Meeting

The contractor shall not commence performance on the tasks in this Performance Work Statement (PWS) until the Contracting Officer has conducted a kick-off meeting or the Contracting Officer has advised the contractor that a kick-off meeting is waived. The kick-off meeting will be held via teleconference and will last approximately one hour.

2.1.10 Weekly Meetings

The contractor shall meet with the program office once per week during the ramp up phase, or as often as needed to accomplish the ramp up. The COR will assess the effectiveness of the contractor and may decrease the frequency of teleconference meetings

2.1.11 Monthly Meetings

The contractor shall meet with the program office one per month to discuss Users and technical aspects as needed (e.g., errors in reports, one-off discussion points, panel depth concerns, individual on- boarding updates and concerns).

3.0 Deliverables

Deliverables are due to VHA Monday through Friday, No Later Than (NLT) 3:00PM, Eastern Time (ET).

Any deliverable submitted after 3:00PM, ET shall be considered as received the following business day.

See Deliverable Schedule for each type.

All reviews shall be submitted in PDF format.

Section Deliverable Format Due Date/Time

PWS, 2.1 Reviewer Roster

Excel First Business Day of the month

PWS, 2.1.1 Audit Reviews PDF 15 Business days after state date

PWS, 2.1.2 Facility-Requested Reviews PDF 10 Business days after start date

PWS, 2.1.3 Management Reviews PDF 10 Business days after start date

PWS, 2.1.4 Medical Advisory Opinions PDF 10 Business days after start date

PWS 2.1.5 Clinical Appeals PDF 10 Business days after start

PWS, 2.1.6 Executive Summaries PDF 3 Business Days after last review’s completion

PWS, 2.1.7 Reports PDF End of Task Order

PWS, 2.1.8 InterRating Reliability Plan PDF During Kick Off

PWS 2.1.9 Kick-off Meeting teleconference Within 20 business days of award

PWS 2.1.10 Weekly Meetings teleconference Once per week

PWS, 2.1.11 Monthly Meetings teleconference Scheduled for 3rd Tuesday of the month at 1 p.m.

Eastern Time, or as agreed upon by Vendor, Program

Manager, and COR

B.4, 2.f Resigned Reviewers or Staff

Notification of resigned reviewers

Email Immediately as needed

B.4, 5.e Information System Hosting, Operation Maintenance, or Use self-assessment

PDF Annually

B.4, 9.a.1 Contractor Rules of Behavior signed acknowledgment

PDF At Onboarding

B.4, 19.9 VA Form 0752 – NDA PDF At Onboarding

Attachment B Reviewer Conflict of Interest

Attestation

PDF At Onboarding

4.0 Personnel Requirements/Responsibilities

• The Medical Director and the original reviewer/specialist shall be available on a case-by-case basis for a teleconference call with Veterans Integrated Service Network (VISN), medical center, and RM office staff for case discussion. The original reviewer/specialist shall be present on the teleconference call.

• The contractor may need to make the reviewer available to confer with VA Regional Counsel for further clarification of information contained in a Medical Advisory Opinion review. For example, if there is ambiguity in the reviewer’s opinion or an opinion is provided by the claimant, it may become necessary for the VA Regional Counsel to consult with the reviewer.

• These calls shall be billed in 15-minute increments.

4.1 Peer Reviewer Qualifications

The contractor shall verify eligibility of reviewers via current URAC credentialing standards. Reviewer

Curriculum Vitae must be made available to COR upon Request. Should the VHA Directive for Peer

Review for Quality Management be updated during contract performance, the contractor shall conduct reviews according to the revised standards for levels of care.

Peer Reviewers shall:

• Not be employees or contractors of VA providing direct care to Veterans; (limited exceptions may be considered on a case-by-case basis).

• Possess the relevant clinical expertise necessary to make accurate evaluations about the decisions being reviewed;

• Be able to make a fair and credible assessment of the actions taken by a clinician relative to the episode of care under review.

• Possess knowledge of current evidence-based standards of care relevant to the case under review.

• Complete training regarding the peer review process, responsibilities of the peer reviewer, and the associated legal and ethical requirements. Guidance will be provided by VACO RM.

• Have no direct involvement with the care in question;

• Have no conflicts of interest or other factors that might influence the ability to conduct objective, impartial, accurate and informed review;

• Not be excluded from receiving payment from any Federal healthcare program confirmed through screening through the Health and Human Services Office of Inspector General List of Excluded

Individuals and Entities.

4.1.1 Physician Reviewers

• Shall be board certified in the specialty they are reviewing according to the American Board of

Specialties or equivalent (e.g., American Board of Physician Specialties)

• Shall be in active practice at least 20-hours per month. Short-term exceptions to this requirement will be considered on a case-by-case basis by the COR.

4.1.2 Non-Physician Reviewers

• Must be licensed and

• In active practice at least 20 hours per month. Short-term exceptions to this requirement will be considered on a case-by-case basis by the COR.

4.2 Medical Director Responsibilities

The Medical Director shall:

• Be a Physician.

• Represent knowledge and ability to perform oversight in the following Disciplines: Medicine, Surgery, Mental Health, Nursing, Primary Care/ED

• Have access to consult with personnel with a requested medical specialty on an ad hoc basis.

• Review the cases for clinical sufficiency and serve as a resource for clinical guidance.

• Review the credentialing files and provide any other medical guidance for clinical oversight.

• Participate in reconciliation calls and other conference calls at the request of VA.

5.0 General Requirements

5.1 Type of Contract

This Performance Work Statement (PWS) is for a Blanket Purchase Agreement (BPA). BPA Call Orders shall be issued on a firm-fixed price basis.

5.2 Period of Performance

The period of performance of this BPA is five years. Each BPA Call Order shall specify the period of performance to govern that Task Order.

5.3 Place of Performance

Tasks under this PWS shall be performed at contractor facilities.

The contractor personnel that require logical access or physical access must obtain VA issued PIV Badges to support this requirement. PIV badges shall be obtained in accordance with Homeland Security

Personnel Directive (HSPD) requirements.

5.4 Travel

The Government does not anticipate travel. Program-related meetings or conferences will be conducted by conference call throughout the period of performance. The Government will not pay for travel.

5.5 Performance Requirements

The contractor’s performance will be evaluated based on the Quality Assurance Surveillance Plan

(Attachment C).

Replacement Cases – If a case is unable to be complete the Government can cancel and replace a case.

All cases receive secondary consideration from the facilities in which they derive. If that facility requests additional consideration due to perceived inaccuracies, a reconsideration at the cost of the vendor is required. See Attachment D – workflow.

5.6 Government Furnished Property/Information

Government-Furnished Property is not applicable to this acquisition.

The Government will provide the contractor with necessary procedural guides, business rules, reference materials, and program documentation to meet task objectives.

5.7 Protected Health Information (PHI) / Personally Identifiable Information (PII)

The contractor shall abide by all government requirements for dissemination of Protected Health

Information (PHI) and Personally Identifiable Information (PII). Approved mechanisms are available from the Contracting Officer or COR.

6. Contract Administration

6.1 Ceiling

The estimated ceiling of this BPA over 5 years is $20,000,000

B.4 CONFORMED VA INFORMATION AND INFORMATION SYSTEM

SECURITY/PRIVACY REQUIREMENTS

1. GENERAL

a. 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.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and

VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information, unless granted authorized exemptions. The level and process of background security investigations for contractors must be in accordance with VA Directive and

Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and

Preparedness is responsible for these policies and procedures.

c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The

Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security

Service (DSS). Verification of a Security Clearance must be processed through the Special Security

Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

e. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

3. VA INFORMATION CUSTODIAL LANGUAGE

a. Information made available to the Contractor or Subcontractor by VA for the performance or administration of this contract or information developed by the Contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of VA. This clause expressly limits the

Contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d)

(1).

b. VA information should not be co-mingled, if possible, with any other data on the

Contractors/Subcontractor’s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the Contractor must ensure that VA information is returned to VA or destroyed in accordance with VA’s sanitization requirements. VA reserves the right to conduct onsite inspections of Contractor and Subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with

VA directive requirements.

c. Prior to termination or completion of this contract, Contractor/subcontractor must not destroy information received from VA, or gathered/created by the Contractor in the course of performing this contract without prior written approval by VA. Any data destruction done on behalf of VA by a

Contractor/subcontractor must be done in accordance with National Archives and Records Administration

(NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its

Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA

Handbook 6500.1, Electronic Media Sanitization. Self-certification by the Contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract.

d. The Contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or

Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies in this contract.

e. The Contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on

Contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the Contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.

f. If VA determines that the Contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the

Contractor or third party or terminate the contract for default or terminate for cause under Federal

Acquisition Regulation (FAR) part 12.

g. If a VHA contract is terminated for cause, the associated Business Associate Agreement (BAA) must also be terminated and appropriate actions taken in accordance with VHA Handbook 1600.01, Business

Associate Agreements. Absent an agreement to use or disclose protected health information, there is no business associate relationship.

h. The Contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated.

i. The Contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed VA minimum requirements. VA Configuration Guidelines are available upon request.

j. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the Contractor/subcontractor may use and disclose VA information only in two other situations:

(i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA prior written approval. The Contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response.

k. Notwithstanding the provision above, the Contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. §5705, confidentiality of medical quality assurance records and/or Title 38

U.S.C. §7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the

Contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that Contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.

l. For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or a Memorandum of Understanding-Interconnection Service

Agreement (MOU-ISA) for system interconnection, the Contractor/subcontractor must complete a

Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COR.

4. INFORMATION SYSTEM DESIGN AND DEVELOPMENT

a. Information systems that are designed or developed for or on behalf of VA at non-VA facilities shall comply with all VA directives developed in accordance with FISMA, HIPAA, NIST, and related VA security and privacy control requirements for Federal information systems. This includes standards for the protection of electronic PHI, outlined in 45 C.F.R. Part 164, Subpart C, information and system security categorization level designations in accordance with FIPS 199 and FIPS 200 with implementation of all baseline security controls commensurate with the FIPS 199 system security categorization (reference

Appendix D of VA Handbook 6500, VA Information Security Program). During the development cycle a

Privacy Impact Assessment (PIA) must be completed, provided to the COR, and approved by the VA

Privacy Service in accordance with Directive 6508, VA Privacy Impact Assessment.

b. The Contractor/subcontractor shall certify to the COR that applications are fully functional and operate correctly as intended on systems using the VA Federal Desktop Core Configuration (FDCC), and the common security configuration guidelines provided by NIST or VA. This includes Internet Explorer 7 configured to operate on Windows XP and Vista (in Protected Mode on Vista) and future versions, as required.

c. The standard installation, operation, maintenance, updating, and patching of software shall not alter the configuration settings from the VA approved and FDCC configuration. Information technology staff must also use the Windows Installer Service for installation to the default “program files” directory and silently install and uninstall.

d. Applications designed for normal end users shall run in the standard user context without elevated system administration privileges.

e. The security controls must be designed, developed, approved by VA, and implemented in accordance with the provisions of VA security system development life cycle as outlined in NIST Special

Publication 800-37, Guide for Applying the Risk Management Framework to Federal Information

Systems, VA Handbook 6500, Information Security Program and VA Handbook 6500.5, Incorporating

Security and Privacy in System Development Lifecycle.

e.1 The Contractor/subcontractor is required to design, develop, or operate a System of Records

Notice (SOR) on individuals to accomplish an agency function subject to the Privacy Act of

1974, (as amended), Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Privacy Act may involve the imposition of criminal and civil penalties.

e.2 The Contractor/subcontractor agrees to:

• Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies:

o The Systems of Records (SOR); and o The design, development, or operation work that the Contractor/subcontractor is to perform;

• Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a SOR on individuals that is subject to the Privacy Act; and

• Include this Privacy Act clause, including this subparagraph (3), in all subcontracts awarded under this contract which requires the design, development, or operation of such a SOR

f. In the event of violations of the Act, a civil action…