36C10X21Q0168 (Final).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 78

36C10X21Q0168 07-16-2021

Tanya Sims-Williams@va.gov 240-215-1690 08-09-2021

10:00 AM EDT

36C10X Strategic Acquisition Center - Frederick Department of Veterans Affairs

5202 Presidents Court, Suite 103 Frederick MD 21703

X

541611

$16.5 Million

N/A

X

Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Community Care (OCC)

36C10X

Strategic Acquisition Center - Frederick Department of Veterans Affairs

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

See CONTINUATION Page

Credentials Verification Organization for Non-Community Care Network (CCN) Providers

Please see B.2 for Performance Work Statement and B.3 for Price Schedule.

All quote intentions, questions, and quotes shall be submitted in accordance with instructions to offerors in Section E no later than the following dates/time.

Questions: July 23, 2021, 10:00 AM ET Quote Intentions: July 23, 2021, 10:00 AM ET Quotes: See block 8 above

See CONTINUATION Page

X X

Lind Sylvester

36C10X21Q0168

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PERFORMANCE WORK STATEMENT

B.3 PRICE/COST SCHEDULE

B.4 IT CONTRACT SECURITY

SECTION C - CONTRACT CLAUSES

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

(OCT 2018)

C.2 FAR 52.216-18 ORDERING (AUG 2020)

C.3 FAR 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 FAR 52.216-22 INDEFINITE QUANTITY (OCT 1995)

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

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

C.7 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.8 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.9 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.10 VAAR 852.219-76 SUBCONTRACTING PLANS MONITORING AND

COMPLIANCE (JUL 2018)

C.11 VAAR 852.219-71 VA MENTOR-PROTÉGÉ PROGRAM (DEC 2009)

C.12 FAR 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN

2021) (JUL 2020) (DEVIATION)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 ATTACHMENT A: PAST PERFORMANCE REFERENCES

D.2 ATTACHMENT B: PAST PERFORMANCE QUESTIONNAIRE (PPQ)

D.3 ATTACHMENT C: PRICE SCHEDULE

D.4 ATTACHMENT D: PWS ATTACHMENT A: QUALITY ASSURANCE

SURVEILLANCE PLAN (QASP)

D.5 ATTACHMENT E: PWS ATTACHMENT B: MONTHLY REPORTING TEMPLATE .51

D.6 ATTACHMENT F: PWS ATTACHMENT C: CREDENTIALING APPLICATION

REQUEST EXAMPLE

SECTION E - SOLICITATION PROVISIONS

E.1 INSTRUCTIONS TO OFFERORS

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

E.3 FAR 52.204-24 REPRESENTATION REGARDING CERTAIN

TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT

(OCT 2020)

E.4 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT

2018)

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

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

COMMERCIAL ITEMS (FEB 2021) (JUL 2020) (DEVIATION)

E.7 FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

A. Contract Administration:

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

(1) CONTRACTOR: TBD

(2) GOVERNMENT:

a. The Contracting Officer (CO) for this contract (hereafter “the CO”) is as follows:

Lindi Sylvester, Contracting Officer 36C10X Office of Acquisition Operations Strategic Acquisition Center – Frederick Department of Veterans Affairs

b. The CO is responsible for providing overall scope oversight, maintaining communication between Contractor and VA, ensuring contract compliance, and administering the contract and any modifications. The CO is also responsible for ensuring that task orders issued under the contract (hereafter referred to as “orders”) are within the scope of the contract, issuing and administering all orders, overseeing payment or rejection of invoices, and ensuring that annual performance evaluations are completed either at the contract or order level.

c. The CO is the only person with authority to obligate the Government under the contract or any order, authorize changes to terms or conditions of the contract or any order, or otherwise bind the Government under the contract or any order.

d. The CO reserves the right to designate a Contracting Officer’s Representative (COR) at the contract or order level. The CO will issue a designation letter to the COR and the Contractor to ensure that all parties understand the limited authority of the COR. In no event will the COR have authority to obligate or bind the Government or change the terms and conditions of the contract or any order.

e. An initial order will be placed at time of contract award for the minimum guaranteed quantities listed in subsection B.1.C.(1) below. Subsequent orders, if any, will be placed according to the Government’s need and availability of funding.

f. This contract will use electronic commerce to the maximum extent possible (IAW FAR 4.502(a)). All correspondence regarding contract administration matters between the Government team (Contracting Officer, Contract Specialist and Contracting Officer’s Representative) and the Contractor will be handled via email using the email addresses listed in the contract, inclusive of any modifications. Email will be the primary method for providing copies of contract documents to the Contractor or other parties. This applies to contract modifications, acceptance of supplies/services, invoice items addressed outside of the electronic invoicing system (currently Tungsten), contractor performance assessments addressed outside CPARS, terminations and any other actions covered by the Contract Terms and Conditions or other Clauses.

B. Task Order Procedures:

The Contractor shall provide services according to the delivery and performance requirements specified in the Performance Work Statement of the contract. Orders shall specify all applicable tasks, along with the associated deliverables and quantities required.

(1) VA will follow the ordering procedures and requirements in FAR 16.505(a) that are applicable to single award IDIQ contracts, including those set forth at FAR 16.505(a)(2) and 16.505(a)(7).

(2) As the Government identifies a need, the CO will issue an order to the Contractor for the specific tasks and quantities required. The CO is the only person authorized to issue orders. The order may include additional or more specific information and requirements than the contract Performance Work Statement. Any conflicts between the terms of an order and the terms of the contract shall be resolved by giving precedence to the terms of the contract.

(3) Orders will be issued on the SF 1449 via email.

(4) Prices are determined at the contract level and shall remain firm fixed prices throughout the ordering period. Orders shall be placed according to the contract CLINs and prices.

(5) An order is not fully executed until the CO signs the order, after which the fully executed order will be sent via email to the Contractor. The Contractor is not authorized to commence performance at any time prior to issuance of a fully executed order. The Contractor’s failure to begin performance within the timeframe required may result in the termination of the order.

(6) The Contractor shall not perform or provide services that are not expressly identified in the contract and applicable order.

C. Minimum Guaranteed Quantities and Maximum Quantities:

(1) The minimum guaranteed quantities for this contract are stated as number of units and are set forth in the following table. Orders beyond the minimum will be determined by the Government’s need. The Government has no obligation to issue orders for services beyond the minimum guaranteed quantities.

Contract Line Item Description Minimum Quantity

Task 1: Online Database for VA Staff (7.1) Access to database, priced each/per VA user. One time charge for duration of contract for up to 50 licenses

Task 2: Approved credentialing process/ Implementation (7.2.1) One time charge for duration of contract 1

Task 2: Credentials Verification Organization (CVO) Services (7.2.2) New Providers, priced per provider

3,700

Task 2: Re-credentialing Verification (7.2.3) All VCA providers credentialed in Year 1 (every three years), priced per provider

Task 3: Credentialing Committee (7.3) Operation of credentialing review board and administrative support for VA Credentialing Committee, priced monthly

Task 4: Monitoring Providers/NPDB-CQ (7.4) Monitor non-CCN providers, priced per provider, per year 0

Monthly Status Reporting Monthly reporting on all aspects of IDIQ and current orders, priced by each month

(2) The maximum quantities for this contract are stated as number of units and are set forth in the following table. These maximum quantities are for the entire five-year ordering period of the contract. The Government does not guarantee, and is not obligated to order, any quantities beyond the minimums identified in subsection B.1.C(1) above.

Contract Line Item Description Maximum Quantity Task 1: Online Database for VA Staff (7.1) Access to database, priced each/per VA user. One time charge for duration of contract for up to 50 licenses

Task 2: Approved credentialing process/ Implementation (7.2.1) One time charge for duration of contract

Task 2: Credentials Verification Organization (CVO) Services (7.2.2) New Providers, priced per provider

9,465

Task 2: Re-credentialing Verification (7.2.3) All VCA providers credentialed in Year 1 (every three years), priced per provider

8,465

Task 3: Credentialing Committee (7.3) Operation of credentialing review board and administrative support for VA Credentialing Committee, priced monthly

Task 4: Monitoring Providers/NPDB-CQ (7.4) Monitor non-CCN providers, priced per provider, per year 43,130

Monthly Status Reporting Monthly reporting on all aspects of IDIQ and current orders, priced by each month

D. Invoicing:

(1) All payments by the Government to the Contractor will be made in accordance with

52.232-33, Payment by Electronic Funds Transfer – System for Award Management (Oct 2018).

(2) All invoices shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests (Nov 2018). Invoices shall be submitted monthly in arrears, upon Government final inspection/acceptance by the COR. Specific invoicing instructions will be specified in each order.

E. Subcontracting Limitations:

The solicitation for this contract is unrestricted and requires an acceptable subcontracting plan from offerors that are not small business concerns (FAR 19.702). Accordingly, the Contractor shall comply with all requirements and limitations of FAR clauses 52.219-8 Utilization of Small Business Concerns, 52.219-9 Small Business Subcontracting Plan, and 52.219-16 Liquidated Damages -- Subcontracting Plan.

Failure to comply with these requirements and the approved subcontracting plan may result negative past performance ratings, discontinued use of the contract (no future orders), or termination of the contract. The CO will follow all post-award responsibilities outlined in FAR 19.705-6, 19.705-7, and 19.706 to ensure Contractor compliance.

F. Acknowledgment of Amendments (solicitation only): The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 PERFORMANCE WORK STATEMENT

Credentials Verification Organization for Non-Community Care Network (CCN) Providers

1.0 GENERAL OVERVIEW

The U.S. Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Office of Community Care (OCC), requires services to credential and monitor non-VA health care providers that furnish hospital care, medical services, or extended care services to Veterans under VA’s Veteran Community Care Program (VCCP). VCCP encompasses different programs including the Community Care Network (CCN) and Veterans Care Agreements (VCA).

A primary goal of VA’s community care program is patient safety for all Veterans served by VA.

To achieve this goal, VA must ensure non-VA health care providers are medically qualified and competent to provide care prior to referring Veterans for community care from such providers.

The credentials verification services and monitoring services identified in this contract and Performance Work Statement (PWS) directly support and facilitate VA’s efforts to assess and/or monitor the medical qualifications and competence of non-VA health care providers who furnish hospital care, medical services, or extended care services to Veterans pursuant to Veterans Care Agreements (VCA) entered into by VA under the authority set forth at 38 U.S.C. § 1703A or other contracts or agreements entered into and administered by VA. These providers are referred to in the contract as “non-CCN providers”.

The desired outcomes of this contract are to: 1) obtain the information needed for Primary Source Verification (PSV) to be completed on all providers submitted to the Credentials verification organization (CVO) which will allow VA to properly assess whether non-CCN providers should be credentialed by VA for purposes of furnishing care to Veterans under VA’s community care program, including whether they are medically qualified, licensed, and competent to provide care to Veterans; 2) establish and operate a credentialing review board that will conduct enhanced reviews of credentialing information, including marginal findings of the credentialing verification process and information asserted and provided in support of provider appeals of VA credentialing determinations, and provide assessments and recommendations to VA’s Credentialing Committee; and 3) monitor non-CCN providers credentialed via the CVO to ensure they maintain appropriate qualifications, licenses, competence, and status throughout the time they are providing care to Veterans under VA’s community care program.

2.0 ORDERING PERIOD

The contract will have a five-year ordering period. The anticipated ordering period is September 1, 2021 – August 31, 2026. Ordering periods for Year 2-5 will be optional.

3.0 PLACE OF PERFORMANCE

The Contractor shall perform all work under this contract at the Contractor’s location.

4.0 CONTRACT TYPE

This is a firm-fixed-price (FFP), single award indefinite-delivery indefinite-quantity (IDIQ) contract. Orders will be placed as the Government need is identified and funding is available.

5.0 GENERAL REQUIREMENTS

1. The Prime Contractor shall always be certified or accredited for its credentials verification services by a nationally recognized certifying or accrediting organization (e.g., the National Committee for Quality Assurance (NCQA) or the Utilization Review Accreditation Commission (URAC) throughout the life of the contract.

2. The Contractor shall follow applicable accreditation standards (NCQA and/or URAC) as the base requirement for PSV processes. Entities without credentialing standards or accreditation requirements (such as home healthcare providers) may require supplemental credentialing standards as defined by VA.

3. The Contractor must always maintain documentation of all accreditation, certification, credentialing, and licensing for its accredited components or programs and providers performing services under this contract. The Contractor must always provide a copy of its accreditation documentation in accordance with the Schedule of Deliverables. The Contractor must always notify VA if its accreditation is put on probation, suspended, or revoked within three (3) business days along with a corrective action plan (CAP).

4. The Government anticipates an initial 30-day implementation phase for set-up, configuring access, and task related to 7.2.1.

Deliverable 5.1 Documentation of accreditation due at time of proposal.

Deliverable 5.2 Annual attestation of accreditation

6.0 REPORTING

The Contractor shall provide monthly reporting from the previous calendar month (excluding the initial 30-day implementation phase) to the COR by the 10th of each month (or next business day, if the 10th falls on a weekend or holiday) along with the corresponding invoice. The Contractor shall use the VA reporting template (see attachment B) for the monthly reporting which includes the following topics:

1. Any outages of the online database under Task 1 during the preceding month, including the length of time of the outage;

2. Itemized list of new providers with the date of request by VA and date of initial contact/attempt to contact by the Contractor;

3. Itemized list and total number of providers for which the Contractor performed credentials verification services under 7.2.2 during the preceding month, and their graded risk assessment results (e.g., A-Fs), with annotation of whether the credentialing services were for initial or re-credentialing;

4. Itemized list of returned providers with documented contact attempts, including dates and modalities for communication;

5. Summary of efforts monitoring all providers for sanctions and disciplinary actions during the preceding month, with an itemized listing of all providers flagged and the specific reason(s) for being flagged; and

6. Credentialing review board status as detailed in Task 3.

Deliverable 6.0 Monthly Status Report

7.0 TASKS

The work performed under this PWS is for the purposes of completing credentialing only, this contract is not for consultation or program management and is not specific to the methods for which VA has agreements with the providers being credentialed. The work performed under this PWS is guided by the VA (see Section 11.0), and orders are specific to the tasks assigned by VA. Services are aligned with the process of obtaining information, completion of PSV, and assessment of the CVO Review Board to allow VA to make a full assessment of a provider’s credentials. If and when ordered by the Government, the Contractor shall perform the following tasks:

7.1 TASK 1: ONLINE DATABASE OF PROVIDER DEMOGRAPHIC, PROFESSIONAL, AND

CREDENTIALS DATA

7.1.1 The Contractor shall maintain a profile-based data collection online database that contains demographic and professional data that is self-reported by providers, as well as data regarding providers’ credentials. The Contractor shall provide VA personnel, and all providers identified by VA, with read- only access to the database. VA personnel will access this database to view provider data and track status of the provider’s credentialing process. This database should serve as a repository to allow providers to directly enter their own information removing the need for VA to directly obtain the demographic information necessary to conduct credentialing.

The contractor shall be responsible for ensuring access and password issues are resolved for all users.

Specifically, VA requires:

a. An online demographic and credentials database compliant with nationally recognized certification and/or accreditation standards (e.g., NCQA, URAC). The database shall have self-reporting capability that allows providers to enter required data and VA to obtain provider information from this database.

b. Database licenses for up to 50 VA personnel.

c. All provider demographic and credentials data within the database must be exportable in PSV and Excel files.

The Contractor shall provide one recorded training session, providing instruction on overall usage of the database, including how to access and export information, and how to use provider credentialing status tracking if available in database. The training should encompass utilization for both staff and providers to ensure all parties have access to understanding use of the database. The training must be available online via the Contractor’s website or an online video-sharing site (such as YouTube) for future VA use.

Deliverable 7.1.1 Up to 50 licenses for VA personnel to access and use online demographic and credentials database.

7.2 TASK 2: CREDENTIALS VERIFICATION ORGANIZATION (CVO) SERVICES

7.2.1 The Contractor shall develop processes and materials necessary to provide VA with credentials verification services that will inform and facilitate VA’s credentialing process for all non-CCN providers. The credentials verification services must consist of contacting providers to obtain information necessary to initiate the credentialing process, collecting and verifying of the information identified in section 7.2.2, below, and providing VA with a risk assessment and analysis of providers’ qualifications based on the application of VA-determined criteria to the Contractor’s review of collected and verified information. The Contractor shall use primary source verification (PSV) as a standard practice, and all documentation supporting the verification and risk assessment shall be submitted to VA. The Contractor shall present, for VA’s approval, the criteria that will be used to verify provider information and conduct a risk assessment of each provider, and the Contractor shall develop a process and materials based on those criteria. All communications the contractor will send to providers must be reviewed and approved by VA for content and specific language appropriate for communication on behalf of VA. The contractor shall formulate communication templates for initial credentialing requests and follow up messages sent to any providers and non-responders, and make any adjustments as required by VA. All communications to providers shall follow those approved templates.

A “Provider” will be defined individuals, facilities, and other entities that fall within the scope of this contract. The following types of providers may be referenced and submitted to CVO for credentialing:

a. Individual Provider – a provider with a Type 1 National Provider Index (NPI) number, who is independently licensed to practice and provide the services outlined by their license.

b. Entity – An organization that hold licensure at the group level, where the individuals under the organization most times do not hold licensure or hold dependent licensure.

c. Facility – a physical location where independent licensed practitioners provide clinical services. These are general a group practice or larger healthcare organization and provide their own internal credentialing.

7.2.1.1 The Contractor shall develop a credentialing application form to gather all required information from providers. When applicable, application forms will follow accreditation standards and industry practice for information gathering and content. For providers outside of accreditation standards, VA approval of the content within the application form is required.

Additionally, to follow VHA regulations, application forms may require information above industry standards dependent upon the specialty and category of services offered. If such additions are required, the VA will inform the CVO and all application forms must be in compliance. Please see Attachment C for Home Health Credentialing Application as an example. All application forms must be available in both digital and hard copy form.

7.2.1.2 The Contractor shall develop a process for receiving provider information for the purpose of contacting providers to initiate the credentialing process. The process must have two entry points with at least one being electronic. For each order placed the VA will provide the Contractor with a providers list(s) for which the credentialing process must be initiated.

VA will provide the following basic elements to initiate the credentialing process with the contractor.

a. Provider NPI

b. Provider Name

c. Provider Address (If available, but no less than the city and state where the provider practices)

d. Provider Phone number

e. If available, Provider Email Address

f. If available, Provider Fax Number

As part of the process, the contractor will develop a matrix for communication cadence. The communication matrix will define that no more than five (5) total contacts, via any modality (e.g.

phone, fax, email, etc.) will be conducted in attempt to obtain provider information or to encourage providers to complete the application for credentialing. Upon five (5) documented contact attempts, the contractor shall return the provider to VA. The return of a provider is defined as the contractor providing the name and scenario necessitating the return to VA and all work for that verification package will be stopped until VA can review and provide further guidance and next steps for action for that provider. The contractor shall return a provider to the VA no later than twenty (20) days after receipt of the provider file for that provider to be considered for payment under subCLIN x003AB. In most cases, these providers will be added in a later provider request/submission to complete the credentialing process, but this is not guaranteed. VA may request the return of a provider at any time; those providers will be considered to have had five contact attempts, regardless of the actual number of attempts.

7.2.1.3 The Contractor shall develop a standardized assessment to use for all providers in documenting the results of the credentials verification and risk assessment of the provider, for VA approval. The assessment must include, at a minimum:

• Overall risk assessment of the provider, expressed in terms of a scaled grading system (e.g., A-F or 1-5).

• Outcome/categorization of selected verification elements, with score for each (list to be approved by VA, could include all elements) and free text comments as needed

• Method, source, verification date, and name and/or initials of primary source verification (PSV) staff

7.2.1.4 The Contractor shall develop and provide a Frequently Asked Questions (FAQ) sheet for use by providers and must address commonly asked questions on the contractors credentialing process, including the credentials verification processes implemented by the Contractor, how providers submit an application, and the process for providers to appeal VA’s credentialing determinations.

7.2.2 The Contractor shall use the processes and materials developed under section 7.2.1 to provide credentials verification services for non-CCN providers requested by VA to be credentialed. The Contractor is not responsible for, nor authorized under this contract, to solicit, investigate, or otherwise obtain additional providers names or information beyond those providers requested/submitted by VA to be credentialed. Upon VA request to initiate credentials verification services for a specific provider, the Contractor shall provide all required credentials verification services for that provider, including:

a. Utilize the process developed under section 7.2.1.2 and the application form developed under section 7.2.1.1 to initiate the credentialing process, contact the provider, and obtain all required information.

b. Obtain documentation of and verify the following credentials information (as applicable to the type of provider), using primary source verification (PSV) as a standard practice:

1. License to practice

2. Drug Enforcement Administration (DEA) and Controlled Dangerous Substances (CDS) certificates

3. Education and training

4. Board certification

5. Work History

6. Malpractice history (NPDB)/ Professional liability claims

7. License sanctions (NPDB)

8. Medicare/Medicaid sanctions (NPDB)

9. Current malpractice coverage to be of a certain minimum value

10. Current attestation and disclosure questions

11. OIG sanction check

12. SAM and LEIE sanction check

13. Medicare participating/enrolled/ opt-out check

c. Document the results of the credentials verification and conduct and document the risk assessment described in section 7.2.1.3 in accordance with the requirements and process under that section. The Contractor shall complete and submit an assessment that includes the overall graded risk assessment (7.2.1.3) for the provider, along with a summary of the results from the primary and other sources for the credentials verification, to VA.

Documentation list to be saved in a location accessible to VA. VA will have unlimited rights, within the meaning of FAR 52.227-14 (May 2014), in all data and documents delivered to VA under Task 2, and VA will retain ownership of all such documents after the contract ends.

The Contractor shall follow the process for the return of a provider identified in section 7.2.1.2 and can invoice for returned providers in accordance with the price schedule.

7.2.3 The Contractor shall provide the services identified in section 7.2.2 for non-CCN providers that VA decides to re-credential, which generally will occur three years after being initially credentialed. All requirements pertaining to credentialing shall also apply to re-credentialing except where expressly stated in that the requirement does not apply to re-credentialing. VA will initiate this process in the same manner established under section 7.2.2.

Deliverable 7.2.1 Approved credentialing process/Implementation, one-time deliverable), including:

Deliverable 7.2.1.1 Credentialing plan summarizing credentialing processes and procedures Deliverable 7.2.1.2 Provider application forms based on type of provider Deliverable 7.2.1.3 Provider information receipt process Deliverable 7.2.1.4 Approved credentials verification process and standardized assessment Deliverable 7.2.1.5 Frequently Asked Questions (FAQ) sheet

Deliverable 7.2.2 Completed credential verification package for each provider, including risk assessment Deliverable 7.2.3 Completed re-credential verification package for each provider, including new risk assessment

7.3 TASK 3: OPERATION OF CREDENTIALING REVIEW BOARD

7.3.1. The Contractor shall establish and operate a peer-level credentialing review board that will conduct enhanced reviews of credentialing information, including marginal findings resulting from the credentials verification process conducted under Task 2, information indicating providers have potentially committed egregious acts, and information asserted and provided in support of provider appeals of VA credentialing determinations, and provide assessments and recommendations to VA.

As outlined in section 7.2 Task 2, VA will use the credentials verification files and risk assessments provided by the Contractor to determine if non-CCN providers are suitable and qualified to be credentialed for purposes of furnishing hospital care, medical services, or extended care services to Veterans under VA’s community care program. VA’s credentialing process will entail automatic acceptance or rejection of certain providers that meet or fail to meet certain criteria. Providers that are not automatically accepted or rejected will be reviewed by VA personnel.

Upon request from VA or initiation of a provider directly to the contractor (regarding appeals), the Contractor’s credentialing review board shall also evaluate provider appeals of VA credentialing determinations, including reviewing the relevant credentials verification files and assessments, as well as the appeal and any supporting information. For each of the foregoing types of evaluations, the Contractor’s credentialing review board shall be responsible for conducting an enhanced review of each such provider and for providing a written assessment and recommendation to VA for consideration by VA’s Appeals Committee. VA’s Appeals

Committee will independently determine whether to credential the provider and whether or not to grant or deny an appeal.

7.3.2. Should there be any database errors that lead to a delay in credentialing or an incomplete review by the CVO Committee (i.e. requesting board certification when not needed), report of the concern should take place within 3 days and include a projected action plan and timeframe for resolution.

7.3.2. The Contractor shall provide a status report of the Credentialing Committee activities and reviews to the COR in the monthly status report. The report shall include an aggregate of the total number of files reviewed by the Committee, average time to complete the review from start work file submission to CVO Credentialing Committee review and submission of recommendation, and total approved and rejected. The Contractor shall establish an electronic process to disseminate documents and collect individual summaries of provider file reviews.

Documents will be disseminated to OCC POC; summaries of provider files will be collected from

OCC.

Deliverable 7.3.1a Establish and operate credentialing review board Deliverable 7.3.1b Enhanced review and written assessment and recommendation to VA’s Credentialing Committee for each provider under review, including any appeals.

Deliverable 7.3.2a Database errors, Action Plan and Timeframe Deliverable 7.3.2b Monthly Credentialing Committee Report Deliverable 7.3.2c The Contractor shall establish an electronic process to submit credentialing recommendations and assessments to the VHA with applicable justifications and documentation.

7.4 TASK 4: MONITORING PROVIDERS

7.4.1 The contractor must establish a process to enroll all eligible providers in Continuous Monitoring under The National Practitioner Database (NPDB-CQ). NPDB-CQ enrollment must occur prior to the credentialing review board recommendation. Additionally, NPDB-CQ enrollment will occur under OCC’s administrative account, and the contractor will be established as a delegate of the VHA. All NPDB-CQ renewals are required to be submitted prior to expiration. Any incident where a NPDB-CQ failed to be renewed must be reported to the COR within three (3) business days.

New and renewed NPDB-CQ should be included on the monthly report and clearly identify the type of enrollment (i.e. new, renewal). All new NPDB-CQ enrollment prior to the boards review of the credentialing file.

VA will be responsible for notifying providers (non-CCN) of negative findings, such as sanctions, found during monitoring.

Deliverable 7.4.1 Monitoring Statement and Process

8.0 PERFORMANCE STANDARDS; ACCEPTABLE QUALITY LEVELS; AND

PERFORMANCE MONITORING BY VA

The performance standards and acceptable quality levels (AQL) set forth in Attachment A:

Quality Assurance Surveillance Plan (QASP) are incorporated by reference into this PWS. The Contractor shall always comply with all performance standards and AQLs set forth in the QASP.

VA will monitor contractor performance in accordance with the performance standards set forth in Attachment A: Quality Assurance Surveillance Plan (QASP).

9.0 DELIVERABLES

The following table outlines the deliverables required under each task. Each order will outline the specific task(s) required; deliverables will only be assigned and completed according to the orders awarded. Any due dates that fall on a weekend or holiday will be moved to the following business day.

VA will have unlimited rights, within the meaning of FAR 52.227-14 (May 2014), in all data and documents delivered to VA under all tasks within this Performance Work Statement, and VA will retain ownership of all such documents after the contract ends.

TASK/DELIVERABLE DESCRIPTION DUE DATE

5.1 Documentation of accreditation Due at time of contract

award

5.2 Annual attestation of accreditation

6.0 Monthly Status Report 10th of the month

7.1.1

Up to 50 licenses for VA personnel to access and use online demographic and credentials database

30 calendar days after order effective date

7.2.1

Approved credentialing process (NSP, one-time deliverable), including:

• Credentialing plan summarizing credentialing processes and procedures (7.2.1.1)

• Provider application form (7.2.1.2)

• Provider information receipt process

(7.2.1.3)

• Approved credentialing process and standardized assessment (7.2.1.4)

• FAQ sheet (7.2.1.5)

7.2.2

Completed credential verification package for each provider, including risk assessment

37 calendar days after receipt of request for provider verification

7.2.3 Completed re-credential verification package for each provider, including new risk assessment

30 calendar days after receipt of request for provider verification

7.3.1a

Establish and operate credentialing review board

5 business days after receipt of VA request for credentialing review board review of one or more cases under 7.3.1

7.3.1b

Enhanced review and written assessment and recommendation to VA’s Credentialing Committee for each provider under review

3 business days after assignment to the review board

7.3.2a

Database errors (that delay credentialing or an incomplete review by the CVO Committee); action plan; projected timeframe for resolution

NLT 3 business days from incident

7.3.2b Monthly Credentialing Committee Report 15th of the month

7.3.2c

The Contractor shall establish an electronic process to submit credentialing recommendations and assessments to the VHA with applicable justifications and documentation.

7.4.1 Monitoring Statement and Process Flow

Enrollments from the prior month are to be reported on the monthly report.

10.0 INHERENTLY GOVERNMENTAL FUNCTIONS

This contract and its associated orders will not be used to acquire services for inherently governmental functions as defined by FAR 7.503. In providing the credentialing services identified in this contract and associated orders, the Contractor will not perform work reserved for performance by Federal employees, and the Government will manage the Contractor consistent with its responsibility to perform all inherently governmental functions and maintain control of its mission and operations in accordance with requirements of OFPP Policy Letter 11- 01.

For those services that include functions “closely associated” with inherently governmental functions as prescribed in the Policy Letter, VA will (1) limit or guide the Contractor’s exercise of discretion and retain control of government operations by both—(i) establishing in the Contract or individual orders specified ranges of acceptable decisions and/or conduct; and (ii) establishing in advance a process for subjecting the Contractor’s discretionary decisions and conduct to meaningful oversight and, whenever necessary, final approval by an agency official;

(2) assign a sufficient number of qualified government employees, with expertise to administer or perform the work, to give special management attention to the Contractor’s activities, in particular, to ensure that they do not expand to include inherently governmental functions, are not performed in ways not contemplated by the Contract so as to become inherently governmental, do not undermine the integrity of the government’s decision making process, and do not interfere with Federal employees’ performance of the closely-associated inherently governmental functions; (3) ensure that the level of oversight and management that would be needed to retain government control of Contractor performance and preclude the transfer of inherently governmental responsibilities to the Contractor will not result in unauthorized personal services as provided by FAR 37.104; (4) ensure that a reasonable identification of contractors and Contractor work products is made whenever there is a risk that Congress, the public, or other persons outside of the government might confuse contractor personnel or work products with government officials or work products, respectively; and (5) take appropriate steps to avoid or mitigate conflicts of interest, such as by conducting pre-award conflict of interest reviews, to ensure contract performance is in accordance with objective standards and contract specifications, and developing a conflict of interest mitigation plan, if needed, that identifies the conflict and specific actions that will be taken to lessen the potential for conflict of interest or reduce the risk involved with a potential conflict of interest.

In providing credentialing services and a credentialing review board, the Contractor is advised that Contractor personnel shall be responsible for gathering and researching provider data and making recommendations to VA OCC and the VA Credentialing Committee on each provider reviewed. All information shall be submitted to VA for VA review and final determinations. The Contractor shall not make any final determinations or decisions regarding whether providers will be credentialed by VA for purposes of furnishing hospital care, medical services, or extended care services under VA’s community care program.

11.0 GOVERNMENT FURNISHED EQUIPMENT, INFORMATION, AND FACILITIES

The Government will provide all information required for the Contractor to provide reports and data, along with certain provider information necessary to contact providers to initiate credentialing. Business Associate Agreement (BAA) will not be required as protected health Information (PHI) will not be shared from VA to the Contractor. All data the Contractor receives from the providers shall be protected by and the responsibility of the Contractor.

There will be no Government furnished equipment or facilities, nor access to internal VA systems.

12.0 SECURITY

This contract or any orders will not require direct access to VA information or VA systems to meet the requirements of the contract. VA will legally disclose a copy of the required sensitive Government Furnished Information to the Contractor under the authority of the Privacy Act System of Records “Non-VA Care (Fee) Records-VA”, 23VA10B3 Routine Use 10 ( 80 FR 146, July 30, 2015), Privacy Act System of Records “Patient Medical Records-VA”, 24VA10P2 Routine Use 43 (79 FR 157, August 14, 2014), 38 U.S.C. 5701, HIPAA Privacy Rule provision 45 CFR § 164.506(c) and The Veterans Choice Program Improvement Act, Public Law 115-26 and 38 U.S.C. 7332(b)(2)(H). The data will be sent via FIPS 140-2 encrypted transmission. The contractor will then receive, retain and then own that data copy. When the Contractor submits back to VA the agreed upon information, VA will then own that copy.

The Contractor, duly owning the received data, will then be solely responsible for ensuring the privacy and security protection of the information in accordance with all applicable federal, state and local laws and provisions afforded sensitive and personally identifiable healthcare information.

The Contractor must be capable of sending and receiving this sensitive data to and from VA using NIST FIPS 140-2 validated encryption. The contractor must fully cooperate and assist in a government-sponsored security controls assessment; including those initiated by the Office of Inspector General. The government may conduct a security control assessment on shorter notice (to include unannounced assessments) as determined by VA in the event of a security incident or at any other time.

13.0 DATA RIGHTS

Government Furnished Information modified, updated, revised or changed in any manner by the Contractor during performance of the contract is technical data as that term is used in FAR 52.227-14, Rights in Data—General (May 2014) and VA shall receive unlimited rights to all such data.

During the period of performance of the contract, VA shall have unlimited access to both Government Furnished Information and any and all technical data produced by the Contractor.

At the conclusion of the contract, Contractor shall return to VA in a format acceptable to VA all data, including but not limited to the Government Furnished Information and technical data, entered into and processed by the Contractor in performance of this Contract in order that such data can be used, stored, and/or maintained by the Government. The parties agree that the technical data generated, stored, and processed by the Contactor pursuant to this Contract may contain Sensitive Information. The CO will be the sole authorized official to release verbally or in writing, any VA Government Furnished Information, technical data or any other written or printed materials pertaining to the VA maintained and provided by Contractor pursuant to the requirements of the contract.

B.3 PRICE/COST SCHEDULE

The PRICE SCHEDULE for this solicitation is provided as Attachment E. Any contract resulting from this solicitation will include a final PRICE SCHEDULE with the CLIN number, description, and unit price in this section. Quantities and extended price per CLIN will not be listed in the

IDIQ PRICE SCHEDULE.

B.4 IT CONTRACT SECURITY

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

1. GENERAL

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. 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 the 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…