S06 36C10X22R0004 0002 Sol Doc.docx

36C10X22R0004 Table of Contents

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 36C10X Corey Mann Strategic Acquisition Center - Frederick Department of Veterans Affairs 5202 Presidents Court, Suite 103 Frederick MD 21703

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

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

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

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

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 at the Task Order Level (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.

0. 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.

0. 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.

0. Tungsten e-Invoice setup information: 1-877-489-6135

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

0. VA TUNGSTEN Number: AAA544240062

0. FSC e-Invoice contact information: 1-877-353-9791

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

0. http://www.fsc.va.gov/einvoice.asp

COMMUNICATIONS:

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

0. http://fcw.com/articles/2012/11/27/va-epayments.aspx?s=fcwdaily 36C10X22R0004

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B.2 PERFORMANCE WORK STATEMENT

Medical Disability Examinations (MDEs) under Section 504 of the Veterans’ Benefits Improvements Act of 1996 (Public Law 104–275; 38 U.S.C. 5101) | International

1 GENERAL

1.1 Introduction

The Department of Veterans Affairs (VA) through the Veterans Benefits Administration (VBA) administers the Compensation & Pension (C&P) Program for benefits to Veterans, Service Members, their dependents, and their survivors. On October 9, 1996, Congress enacted Public Law 104-275 which authorized VA to contract for medical examinations (a critical piece of evidence for determining the extent of permanent impairment) from non-VA medical sources. This effort will establish contract(s) with Prime Contractors to provide disability examination services.

1.2 Objective

VA has a critical requirement for Prime Contractors with deep and relevant institutional/corporate experience and knowledge to provide disability examination services for Claimants through hiring and/or subcontracting with, training, and overseeing a skilled network of licensed Examiners. Additionally, the Prime Contractor(s) shall provide deep and relevant / institutional/corporate experience and knowledge in the development and maintenance of an information technology (IT) network capable of interfacing with various VA systems in order to process incoming examination scheduling requests and to transmit examination results and other data back into the VA’s systems.

1.3 Scope of Work

This contract requires private-sector Medical Disability Examinations (MDEs), Benefits Delivery at Discharge (BDD) and Integrated Disability Evaluation System (IDES) (as defined in 2.7.18) on behalf of VA.

The Contractor shall provide all resources necessary to accomplish the deliverables described in the Performance Work Statement (PWS), except as may otherwise be specified. The Contractor shall locate, subcontract, and train medical professionals in performing MDEs for Claimants living in locations other than the continental United States as further detailed in Section 1.3.1, below. The Contractor shall document examination findings as provided in this PWS.

1.3.1 International Locations

The Contractor shall perform examinations (including Compensation and Pension (C&P), BDD, and IDES within:

36C10X22R0004

Page 1 of Page 1 of American Samoa Australia Bahrain Belgium Belize Canada Columbia Costa Rica Denmark Dominican Republic Ecuador France Germany Greece Guam Honduras The Inuit Islands Ireland Italy Japan Kuwait Luxembourg Mexico New Zealand Netherlands Northern Mariana Islands Panama Philippines Poland Puerto Rico Saudi Arabia South Korea Spain Singapore Thailand United Arab Emirates United Kingdom Uruguay U.S. Virgin Islands

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These locations are subject to change as required by VA. Additional countries may be added when data shows sufficient volume of Exam Scheduling Requests (ESRs) to warrant presence in the location. For any additional countries added the Contractor will be provided a 90 day ramp-up to hire and train additional personnel. Examinations for this contract shall primarily be coordinated via the Pittsburgh, Honolulu, Manila, and San Juan Regional Offices.

1.3.2 Examinations in Identified Countries

For ESRs that are submitted for locations specified in Section 1.3.1 (International Locations), the Contractor shall schedule an appointment that is in-person, Tele C&P, Acceptable Clinical Evidence (ACE) or combination thereof and shall follow the procedures set forth in Section 2 (Specific Requirements / Tasks) (note: ACE and Tele C&P do not require an in-person examination). Medical opinions and examinations completed via ACE or Tele C&P shall only be completed for requests that meet the guidelines outlined in Section 2.7.16 (Tele C&P Examinations) and 2.7.17 (ACE Examinations).

For detailed data regarding anticipated ESR volume for this region, see Attachment B - Workload Volume - International.

1.3.3 Examinations in Other Locations

For ESRs that are submitted for locations other than those specified in Section 1.3.1 where ACE or Tele-C&P appointments are not appropriate Contractors may use one of the following options:

1.3.3.1 Single Source Sub-Contracted Examination

Single-Source Sub-contracted Examination (SSSCE): For ESRs that are submitted for locations other than those specified in Section 1.3.1 where ACE or Tele-C&P appointments are not appropriate the Contractor may use a single source sub-contracted Examiner to complete the examination. The single source subcontracted Examiners will not be required to complete the VA C&P examination training. When the SSSCE process is utilized, the Contractor shall send a clarification request for the ESR to be cancelled with the reason specified as “11 – Outside contracted Site jurisdiction”. The Contractor shall then complete an Independent Medical Opinion and/ or all appropriate DBQs to provide a fully complete results available package within 60 days.

1.3.3.2 Alternative Medical Evidence (AME) Examination

Alternative Medical Evidence (AME) Examinations: For ESRs that are submitted for locations other than those specified in Section 1.3.1 where ACE, Tele-C&P appointments are not appropriate the Contractor shall send a clarification request for the ESR to be cancelled with the reason specified as “11 – Outside contracted Site jurisdiction”. The VA will then initiate the AME process which requires the claimant to obtain the necessary DBQs and complete a reimbursement form to VA. VA will send the translated DBQs and reimbursement form to the Contractor as a new ESR. The Contractor shall then complete an Independent Medical Opinion and/or all appropriate DBQs to provide a fully complete results available package and process reimbursement to the Veteran within 60 days.

1.4 Background

The VA, through the VBA administers the C&P Program for benefits to Veterans, Service Members, their dependents, and their survivors. Entitlement determinations for disability compensation and pension claims are made by VBA Rating Veterans Service Representatives (RVSRs) and Decision Review Officers (DROs) working in VA Regional Offices (VAROs) across the country. VA Central Office (VACO) assists the VAROs. An MDE, conducted by both Veterans Health Administration (VHA) and VBA Contractors, is a critical piece of evidence for determining the extent of permanent impairment, and thus the percent of disability that defines the dollar benefit a Claimant is awarded. Because it is so critical, the Disability Benefit Questionnaire (DBQ) must be of high quality, providing essential information to support each diagnosed disability. It is not enough to simply state a diagnosis. The DBQs must provide detailed findings sufficient for RVSRs and DROs to arrive at a determination that is able to withstand the scrutiny of appellate review. Claimants may appeal disability ratings. MDE's must be accurate, thorough, and detailed to answer these challenges. The Contractor shall follow the requirements worksheets to ensure that criteria are met. DBQ requirements are defined in the DBQ Information Exchange Package Documentation (IEPD) (see Attachment A - DBQ IEPD). For the purpose of this PWS, the term “worksheet” represents a DBQ or Compensation and Pension (i.e., Aid & Attendance) worksheet in situations where specific DBQs do not exist. VA reserves the right to substitute worksheets, or any other system VA may deploy in the future.

On October 9, 1996, Congress enacted Public Law 104-275, which authorized VA to contract for medical examinations from non-VA medical sources. The report stated a desire to see the contract medical examination authority expanded and made permanent. A subsequent contract was awarded under the same public law authority. For detailed data regarding anticipated ESR volume for this region, see Attachment B - Workload Volume - International. Across all MDE contracts (US, Pre-Discharge, and International) each request, on average, results in two to three unique appointment types, plus additional ancillary diagnostic services, and Claimant travel benefits.

1.5 Type of Contract Contemplated

This contract is a Firm Fixed-Price, Indefinite Delivery, Indefinite Quantity (IDIQ) contract, under Federal Acquisition Regulation (FAR) 16.202. The Government intends to award a maximum of two contracts for the international region.

The Government reserves the right to “on-ramp” additional Contractors with or without competition based on the Government’s need. On-ramping may be executed throughout the period of performance to ensure adequate coverage of Contractors providing MDEs. Should the Government exercise this right, for competition a new solicitation with identical requirements, terms, and conditions will be issued through the Government Point of Entry and awardees will be added to the MDE IDIQ. Contracts awarded via the “on-ramp” process will share in, but not increase, the previously established ceiling. The “on-ramping” process will not extend the period of performance. The decision to “on-ramp” is at the sole discretion of the Government.

1.6 Contract Minimum and Maximum Dollar Value

In accordance with FAR 16.504(a)(4)(ii), the guaranteed minimum dollar value for the initial period for each contract awarded under this solicitation is $3,500,000.

The Government anticipates it will order the following maximum quantities of examination scheduling requests over the six and a half years life of the contract:

Examination Scheduling Requests – For detailed data regarding historic ESR actual and anticipated volumes over the life of this contract, see Attachment B - Workload Volume - International. The FY21 to FY25 volumes in Attachment B are estimates only and are for planning purposes only. The actual examination scheduling request volume may vary from year to year and depends on many factors including, but not limited to the following examples: Number of Claimants that file for Disability benefits; any unexpected increase or decrease in the number of active Servicemembers; new armed conflicts; new conditions being added to those that are eligible for award of benefits; and/or any significant change in the volume of examinations that can be handled internally by VA through VHA Examiners versus Contracted Examiners.

1.7 Examination Request Allocation

For any contract in which two or more Contractors provide MDEs, 100% of the total ESR volume will be split equally among each of the Contractors throughout the period of performance. For example, if an award is made to two contractors, each of the two Contractors will receive, as a minimum quantity (see FAR 16.504(a) (2)), 50% of the total examination volume if they are all meeting the expected standards of performance as noted in Section 3.1 (Performance Requirements).

The government reserves the right to update these allocation percentages.

VA reserves the right to redistribute the total ESR volume among the Contractors if any Contractor does not meet the expected standards of performance.

a. For example, if Contractor A is not meeting its timeliness expected standard of performance, VBA may redistribute a percentage of ESR for Contractor A’s workload until such time as determined by VBA, Contractor A is once again meeting expected standard of performance. This would include both ESRs that are pending with Contractor A that do not have an appointment scheduled or are not scheduled to be completed within a reasonable timeframe and new ESRs that have not been submitted to a Contractor.

b. The Medical Disability Examination Office (MDEO) will identify and review any ESRs which have already been assigned to a Contractor that are past the expected standard of performance for timeliness and redistribute work at its discretion using the Exam Management System (EMS) in the Veterans Benefits Management System (VBMS). New ESR workload will also be adjusted in VBMS EMS.

c. The percentage of ESR volume as determined by the Government shall be binding on each Contractor, and the Contractor is required to perform the requested number of ESRs in accordance with all terms of this contract. Contractors that are sent ESRs from the Government from another Contractor, due to non-performance, will need to work with the Contracting Officer (CO) to assess and agree to terms related to production and/ or timeliness, if the work received impacts the expected standard of performance.

d. The Contractor shall notify the CO and Contracting Officer’s Representative (COR) of any concern with the allocation of ESR volume, in writing, within 48 hours of becoming aware of the issue.

e. Detailed information regarding Contractor Production, Timeliness, Average Days Pending ADP), Quality, and Customer Satisfaction Survey performance will be continuously available to the Government and summarized for each Contractor in the Quarterly Performance Evaluation Report in Section 3.4 (Quarterly Performance Reports). Contractor capacity to handle the additional volume of work for a particular Region or VA Regional Office will be considered through consultation between the CO, COR, and the Contractors.

f. VBA reserves the right to be reimbursed from a Contractor for reasonable costs associated with the redistribution of work based on a Contractor’s failure to meet the expected standards of performance. The costs will include but are not limited to the additional labor costs that VBA incurs and any price differential due to workload reassignment.

If a Contractor fails over an extended period of time, as determined by VBA, to meet the expected performance standards, the CO reserves the right to not exercise option years and use an alternative method to ensure continuity of operations for ESRs.

Additional IT and Examiner Network build costs associated with ramp-up due to workload distribution may be invoiced (see B.3 Schedule of Prices for definition).

1.8 Period of Performance

The period of performance is a base period of 6 months from the date of award, with six subsequent 12-month option periods. subject to the availability of funds. Exercise of options will be made at the sole discretion of the Government. If VA chooses not to exercise an option, that shall not be deemed a termination of the contract. Following are the periods of performance:

1.9 Place of Performance

Performance shall take place at the Contractor’s place of business, or at the examination provider’s place of business, or an appropriate place authorized by the VA.

1.10 Ramp-up Performance

The Contractor shall provide a detailed Ramp-up Plan within five calendar days of contract award (which covers operations through the Contractor accepting the full workload of ESRs. An initial draft of the Ramp-Up Plan shall be submitted as part of the proposal package).

The Contractor shall provide a detailed Ramp-up Plan within five calendar days of any major contract modification which covers necessary changes to comply with the updated contract requirements.

There may be occasions when there are surges in examination request volumes (a surge is an influx of significantly higher than normal examination request volume due to a VA initiative, change in VA work requirements mandated by VA leadership or Congress, or unforeseen disaster.) The Contractor shall provide a detailed Ramp-up Plan within five calendar days within identification of a surge by the COR which covers necessary changes to accommodate the surge.

The Ramp-up Plan shall at a minimum cover plans for:

a) Making capital expenditures, including facilities and equipment;

b) Ensuring a qualified workforce is in place (e.g., business operations, quality staff, IT support);

c) Conducting background investigations and obtaining security clearances as applicable;

d) Providing appropriate training updates in the training plan;

e) Meeting the IT requirements of the PWS, including the Contractor and Veterans Portals;

f) Obtaining an Authority to Operate (ATO);

g) Establishing a provider network;

h) Details around any partial workload ESR rollout;

i) Preparing to accept all ESRs across the entire region.

j) Walk through of operational process The Ramp-up Plan shall include a work break-down structure (WBS) including identification of activities, start and end dates, milestones, and dependencies. It shall also include a risk assessment identifying risks and mitigations associated with the ramp-up activities.

For New Contractors The VA requires contractors to be able to accept the full workload of ESRs NLT 180 calendar days after award. This requires the Contractor to have an established network of examiners capable of completing the full workload of ESRs, have the required IT systems in place, and have achieved an ATO. Before going live, new contractors shall demonstrate the full end-to-end operational/system process as a demonstration for the Government.

If the Contractor has developed an examiner network sufficient for the international scope, and has developed the required IT systems in place, and an ATO is received, the Contractor shall accept the full workload of ESRs ahead of 180 calendar days. If the ATO is received prior to 180 calendar days after contract award the Contractor may be able to accept a partial workload of ESRs prior to 180 calendar days after contract award in accordance with the Ramp-up Plan. No ESRs will be sent to a contractor until their IT systems are in place with a current ATO.

Initial IT and Examiner Network build costs associated with ramp-up may be invoiced (see B.3 Schedule of Prices for definition).

For All Contractors:

If a Provider Network and ATO is already established at time of award, work will begin within 14 calendar days after contract award with a full workload. If a Provider Network and ATO are not already established at time of award, the Ramp-up Plan may include starting performance with a partial workload ahead of accepting the full workload. The ramp-up strategy shall provide network adequacy criteria that include the number of examination appointments available, number of providers, and provider specialties available to evaluate all the MDE condition types to ensure the network will adequately deliver the appropriate level of services to meet the operational demand of the DBQ requirements. The Ramp-up Plan shall contain a high-level phased implementation schedule that supports the ramp up phase and has aligned milestones. The Contractor shall provide a weekly status update (meeting and supporting documentation).

A partial workload is considered to be a reduced volume of the workload in each foreign location for all DBQ types. A full workload is considered to be for all foreign locations and all DBQ types. The Ramp-up Plan shall identify which foreign location the Contractor will begin coverage in and when. The Contractor shall not begin accepting ESRs in any foreign location until it can accept ESRs for all DBQs. The Ramp-up Plan shall provide the readiness review criteria the Contractor will use for determining that a location is ready to begin receiving ESRs.

Within five calendar days after award the Contractor shall deliver to the COR onboarding documents for key personnel. Onboarding documents for other employees may also be submitted at that time. Additional onboarding documents shall be provided on an ad-hoc basis throughout the life of the contract as appropriate. It is critical that all onboarding documents be mistake-free. If mistakes are found the Contractor shall correct the mistakes within 24 hours of notification. All documents must be submitted electronically.

During the ramp-up period (initial, or during the life of the contract, when bringing on support to new or different countries) the Contractor shall provide weekly reports regarding the progress of the ramp-up. The reports shall include at a minimum:

a) Data regarding establishment of the provider network (e.g., number of Examiners needed; number of Examiners contracted)

b) Updates regarding implementation across the region (e.g., markets go-live since the last report; markets go-live overall)

c) Updates regarding establishment of supporting systems, including ATO of IT systems

d) Issues, risks, and mitigations specific to the ramp-up

e) Location of facilities and ownership (e.g., brick and mortar, subcontracting provider)

f) Status of preparation activities identified in Ramp-up Plan IT and Examiner Network build costs associated with ramp-up to comply with updated requirements in a contract mod may be invoiced (see B.3 Schedule of Prices for definition).

1.11 Applicable Documents

In the performance of the tasks associated with this PWS, the Contractor shall comply with the following documents:

1) VA Health Care Fact Sheet 16-2 (June 2010), Beneficiary Travel Benefit. https://www.va.gov/health-care/get-reimbursed-for-travel-pay and https://www.youtube.com/watch?v=7lNUiyQT4gM&list=PL3AQ_JVoBEyzJnt68Eq_mPBdyZfkvq0Wu;

2) Privacy Act, 5 United States Code (U.S.C.) §552a;

3) VA Directive 6500 (particularly the sections referenced in Section 10 (Security) of this PWS), which is available at: https://www.va.gov/vapubs/Search_action.cfm?FormNo=6500

4) Veterans Health Administration (VHA) Directive 0710 (and the Implementation Handbook 0710.01), which are available at: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8110 and https://www.va.gov/SECURITYINVESTIGATIONSCENTER/Directives_and_Regulatory_Guidance.asp;

5) VA Directive 6300, Records and Information Management (VA Handbook 6300.1 Records Management Procedure, and all applicable VA Records Control Schedules);

6) VA Information and Information System Security/Privacy Requirements for Information Technology (IT) Contracts (available at: http://www.ois.oit.va.gov/docs/Appendix_C.pdf)

7) VA Directive 0730, Section 6 (Physical Security);

8) VA Memorandum: IT Oversight & Compliance Information Physical Security Assessments, October 24, 2007;

9) Health Insurance Portability and Accountability Act (HIPAA); 45 Code of Federal Regulations (CFR) Part 160, 162, and 164; Health Insurance Reform: Security Standards; Final Rule dated February 20, 2003;

10) An Introductory Resource Guide for Implementing the HIPAA Security Rule, March 2005;

11) 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;

12) Title IV - Health Information Technology for Economic and Clinical Health (HITECH) Act, January 16, 2009;

13) Contracts for Data Processing or Maintenance (38 U.S.C. § 5725), February 1, 2010;

14) Occupational Safety and Health Administration (OSHA) Standards 29 CFR Appendix D 1910.95, Occupational Noise Exposure, January 3, 1984; and

15) License Portability Act (Public Law 116-315 – HR7105 Section 2002), January 5, 2021;

16) HR7105 Veterans Health Care and Benefits Improvement Act of 2020 (Public Law 116-315, aka the DELIVER Act), January 5, 2021, and

2 SPECIFIC REQUIREMENTS / TASKS

2.1 MDE Appointment Scheduling

2.1.1 Appointment Scheduling

The Contractor shall schedule and perform appointments with a Claimant based on a formal ESR by the VA. Appointments are the scheduled encounters or actions performed by the clinician to provide complete results for Contentions. Contentions are the claimed conditions the Claimant has asked VA to adjudicate. There may be multiple DBQs for each Contention, and multiple Contentions for each ESR.

2.1.2 Appointment Rescheduling

2.1.2.1 Rescheduling Request

The Contractor shall limit requests for rescheduling of any appointment(s) to one. Claimants will have only one opportunity to request any or all appointment(s) to be rescheduled, unless otherwise requested and approved by VACO. If the Claimant fails to show for the rescheduled appointment(s), the Contractor shall send an appointment cancellation package with the reason of “No show”, then would subsequently send a request to cancel a Contention event with the reason of “No Show” to EMS. If any appointments have been previously held for the Contention(s), the Contractor shall not request cancellation of the Contention(s) and shall upload the results of any appointment completed and provide those results including the Results Available Package (RAP) for the Contention in accordance with Attachment D - VBMS Exam Management Integration Architecture.

2.1.2.2 Reschedule Not Available

If the Claimant is not available to attend a rescheduled appointment within five calendar days following the original appointment date, the Contractor may submit a request for cancellation for the Contentions associated with that appointment. The Claimant must contact VBA to request a new ESR.

2.1.3 Force Majeure: Appointments

Impacts by Global, National, Federal and/or State Declared Emergencies, Force Majeure, or Acts of God shall not be cancelled by Contractors unless specifically requested by the Claimant, CO, or COR. If the Contractors operations are affected, the Contractor shall notify the COR as soon as possible. The Contractor shall provide daily updates of all impacted appointments and ESRs. Timeliness and production calculations will be adjusted on a case-by-case basis based on each unique situation. Reporting on above incidents shall start as soon as possible in conjunction with the COR.

2.1.4 Examination Management System Process

Contractors shall follow the procedures outlined. The Contractor shall accept all ESRs immediately after receipt and automatically send an Acknowledgement Event Package (AEP) to begin the ESR timeliness calculation described below and at Section 3.1 (Performance Requirements). System processes supporting MDEs are:

· Incoming Events: The Contractor’s system interface shall allow incoming event messages from VBMS to be pushed from the Data Access Services (DAS) real-time. Contractors will not pull from the DAS data store, but accept messaging sent directly from DAS.

· Outgoing Events: The Contractor’s system shall provide for real-time events to be sent to DAS, as activities are accomplished (e.g., Appointments Cancelled, Appointments Scheduled, Clarification Requested). No batch or bulk uploading of events shall be used in order to keep events moving real-time, as activities are accomplished.

2.1.4.1.1 Examination Scheduling Request (ESR) Event Package

A Contractor sends ESR Event Packages to Contractors to perform medical disability examinations, medical opinions, and diagnostics, for Claimants.

2.1.4.1.2 Clarification Response Event Package

A user response to a Clarification Request Event Package utilizing a Clarification Response Event Package. Clarification requests can only take place during triage before any appointments have been scheduled. ESRs with clarification requests without responses pending greater than 10 calendar days shall be identified in the monthly status report (Attachment E – Monthly Status Report).

2.1.4.1.3 Address Change Modification Event Package

If the Claimant’s address changes after an appointment has been scheduled and they are within 50 miles for a non-specialist appointment (exam or diagnostic) or 100 miles for a specialty appointment (exam or diagnostic), and within a covered country, appointment shall continue as previously scheduled. If the Claimant moves outside the 50 to 100 mile radius but remains within a covered country, the Contractor shall reschedule the appointment within 50 to 100 miles of the Claimants new address. If the Claimant’s new address is stateside, the ESR shall be cancelled by the VA and VA will have to resubmit the ESR based on the Claimant’s new address.

If the Claimant moves to a location other than those specified in Section 1.3.1 then the process in Section 1.3.3.1 (Single Source Sub Contracted Examination) or 1.3.3.2 (Alternative Medical Evidence (AME) Examination) shall be followed.

If the Claimant changes their address to stateside after an appointment is scheduled and the Contractor is notified more than one calendar day prior to the scheduled appointment, the Contractor shall cancel the appointment, request to cancel the Contention, and categorize the cancellation reason as “Claimant relocated.”

Cancellation of future appointment(s) shall be treated as partial or complete no show based on notification timeline. Partial no shows are defined as a Claimant requesting an appointment reschedule or cancellation within one calendar day of the scheduled appointment. Complete no shows are defined as a Claimant failing to appear to an appointment when proper appointment guidelines have been adhered to. Contractors shall invoice partial and complete no-shows.

2.1.4.1.4 Contention Cancellation Event Package

VA has the capability to send Contention Cancellations for Contentions that no longer require Contractor action.

VBMS bars the VA user from sending a Contention Cancellation Event Package if an appointment is scheduled within one calendar day.

See Attachment D - VBMS Exam Management Integration Architecture for the definition of Contention Cancellations.

2.1.4.1.5 Reschedule Appointment Event Package

If the Claimant reaches out to the VA to request to reschedule an appointment, the VA will complete this action via an Appointment Reschedule Request Event Package, provided it is not within one calendar day of the scheduled appointment.

If the appointment is scheduled within one calendar day of the Claimant’s appointment reschedule request, the VA is unable to request the rescheduled appointment.

This event only documents the reason for the need to reschedule the appointment. It does not change the scheduled appointment from the Appointment Scheduled Event Package.

2.1.4.1.6 Appointment Request to Cancel Event Package

If the Claimant reaches out to the VA to request an appointment cancellation, the VA will complete this action cancel the appointment via an Appointment Request to Cancel Event Package, provided it is not within the cancellation request is submitted before one calendar day of the scheduled appointment.

If the appointment is scheduled within one calendar day of the Claimant’s appointment cancellation request, the VA is unable to request the cancelled appointment.

2.1.4.1.7 ESR Cancellation Event Package

VA has the capability to cancel an entire ESR, if there are no appointments currently or previously scheduled.

2.1.4.1.8 Rework ESR Event Package

A request for an ESR after a previous ESR produces unclear or inconsistent results. A rework ESR includes previously completed Contentions that require either clarification or are insufficient to rate.

2.1.4.2 Contractor EMS to VBMS EMS Integration

New and Rework ESRs require the same event packages.

The following is a list of defined event packages from Contractor to VBMS systems:

2.1.4.2.1 Acknowledgement Event Package

The Contractor’s system shall accept all New and Rework ESRs immediately after receipt and automatically send an Acknowledgement Event Package.

2.1.4.2.2 Clarification Request Event Package

A Clarification Request is sent from Contractors to the VA to get answers to questions, request cancellation of the ESRs for specific issues (e.g., jurisdiction), or to correct ESR data. The Clarification Request Event Package will pause the timeliness calculations until a Clarification Response Event Package is received from VA.

Contractors shall include a standard reason for the Clarification Request as noted in Attachment F - VBMS Exam Management Business Object Model (BOM).

Contractors shall also include a standard reason if requesting to cancel an ESR from the options as noted below:

a. Cancelled at Claimant’s request

b. Cancelled at request of Site/VA

c. Claimant relocated

d. Claimant unavailable

e. Unable to contact Claimants

f. Examination restricted by contract

g. Claimants deployed

h. Medical record not received

i. Duplicate request

j. Claimants is deceased

k. Outside contracted Site jurisdiction

l. Unauthorized recording

m. No Show

n. Denied access to veteran/facility

2.1.4.2.3 Appointment Scheduled Event Package

The Appointment Scheduled Event Package is used by the Contractor to provide VBMS EMS with appointment schedule data associated to Contention Universally Unique Identifiers (UUID(s)) on an ESR. The Appointment Scheduled Event Package shall be sent immediately after it is scheduled in the Contractor’s system. All appointments (e.g., examinations, diagnostics, and other ancillary) that need to be held require an Appointment Scheduled Event Package.

Contractors shall include Examiner Name, Appointment Location, and EMS POC Phone Number in the Appointment Scheduled Event Package.

This Appointment Scheduled Event Package includes a field entitled "exam Name". This field is to be utilized to delineate the modality of the appointment that is scheduled. Contractors shall use the following schema for utilizing the exam Name field:

· For Acceptable Clinical Evidence (ACE) appointments, the examination Name shall be:” ACE- [insert exam name (e.g., Audio, etc.)]

· For Tele-C&P appointments, the exam Name shall be: "Telehealth-[insert exam name (e.g., Audio, etc.)]

· For Independent Medical Opinion appointments, the exam Name shall be: "IMO-[insert exam name (e.g., Audio, etc.)]

· For Housebound appointments

· For in-person appointments held for housebound Veterans, the exam name shall be: “Housebound-[insert exam name (e.g. Audio, etc.)]”

· If the Housebound appointment is completed via ACE, the exam name shall be: “Housebound-ACE-[insert exam name (e.g. Audio, etc.)]”

· If the Housebound appointment is completed via Tele C&P, the exam name shall be: “Housebound-Telehealth-[insert exam name (e.g. Audio, etc.)]”

· If the Housebound appointment is completed via IMO, the exam name shall be: “Housebound-IMO-[insert exam name (e.g. Audio, etc.)]”

2.1.4.2.4 Appointment Rescheduled Event Package

The Contractor shall use the Appointment Rescheduled Event Package to notify the VA that an appointment is being reschedule and associated reason for the needed reschedule. The event shall be sent immediately upon identification that an appointment needs to be rescheduled.

This event only documents the reason for the need to reschedule the appointment. It does not change the scheduled appointment from the Appointment Scheduled Event Package.

Either an update Appointment Scheduled Event Package using the same Appointment UUID, or a new Appointment Scheduled Event Package using a new Appointment UUID shall be used depending on whether the previous appointment is still pending more than one calendar day or has been cancelled.

2.1.4.2.5 Appointment Cancellation Event Package

The Appointment Cancellation Event Package is used by the Contractor to cancel appointments (to include diagnostic appointments) associated with Contentions on an ESR. Upon cancellation of each appointment, an appointment cancellation event shall be sent. The Contractor owns the appointment process and therefore can send an Appointment Cancellation Event at any time to record the reason for appointment cancellation.

2.1.4.2.6 Appointment Completed Event Package

The Appointment Completed Event Package is used by the Contractor to identify that an appointment has been completed for each and every appointment to include diagnostics associated with Contentions on an ESR. Upon completion of each appointment, an appointment completed event shall be sent.

2.1.4.2.7 Contention Cancellation Request Event Package

The Contractor shall send a Contention Cancellation Request Event Package to request to cancel a Contention to the VA. The reason associated with the request should be included from the standard list below. Request to cancel a Contention can only be submitted if all appointments, to include all diagnostics, have been cancelled prior.

a. Cancelled at Claimant’s request

b. Cancelled at request of Site/VA

c. Claimant relocated

d. Claimant unavailable

e. Unable to contact Claimant

f. Examination restricted by contract

g. Claimant deployed

h. Medical record not received

i. Duplicate request

j. Claimant is deceased

k. Outside contracted Site jurisdiction

l. Unauthorized recording

m. No Show

2.1.4.2.8 Results Upload to eFolder

All results (e.g., DBQs, Diagnostics, Letters, and other associated documentation) associated with each Contention shall be uploaded by the Contractor to the VBMS eFolder IAW the DBQ Information Exchange Package Documentation (IEPD). Full results for each Contention shall be uploaded as they are completed by the Contractor, unless there are interactions between Contentions or otherwise directed by the MDEO. Upload of the completed Separation Health Assessment (SHA) DBQ should be performed if any additional pending examinations would not adversely impact the overall content of the SHA.

2.1.4.2.9 Results Available Package (RAP) Event Package

Results Available Package Event Packages for each completed Contention shall be sent by the Contractor to certify all required actions have been completed for that Contention and that the results have been uploaded to the VBMS eFolder. The RAPs will include reference to the Doc ID(s) and associated Contention UUID. The first instance of the last RAP associated with an ESR represents the end of the timeliness Performance Metric for completed ESRs.

2.2 Claimant Examination Notification Letter

2.2.1 Appointment Scheduling Notification

The Contractor shall contact the Claimant via telephone, text message, email, or other electronic method to schedule appointments. The Contractor shall notify the Claimant via electronically secure method, mailed postage-prepaid letter, and/or FedEx, mail, or other commercial package delivery of the appointment date, time, and location. The Contractor shall ensure the Claimant receives notification at least three calendar days prior to the scheduled appointment. For appointments scheduled when the Contractor was unable to verbally confirm the appointment with the Claimant, the appointment information must be sent via electronically secure method, mailed postage-prepaid letter, and/or FedEx, mail, or other commercial package delivery to ensure receipt by the Claimant receives confirmation at least three calendar days prior to the scheduled appointment. Contractors may, in their initial contact with the Claimant or at the time of scheduling the appointment, discover the Claimant has relocated. See Section 2.1.4.1.3 (Address Change Modification Event Package).

The appointment notification letter shall include the following information: the date and time of the appointment, the location of the appointment to include directions, information about mileage reimbursement (only for Claimants residing in US Territories), information about cancelling and rescheduling, information regarding how Claimants should submit evidence to VA, information about the Customer Satisfaction Survey, information about reimbursement if using the AME process, and information about the training and credentials of the Examiner. Information to be included is as follows: Provider Name, Specialty/Field, Provider Type (MD, PA, etc.), License Number, Country of Licensure, Board Certifications, Education (where degree conferred and year), years of medical experience, years of VBA compensation related experience, and all compensation and pension related training received.

The Contractor shall post to the Contractor’s website proof of confirmation, (an email read receipt, certified letter receipt signature, cellular text message, verbal confirmation, and/or FedEx, mail, or other commercial package delivery service confirmation) that the Claimant received the appointment notification. The Contractor shall also provide the Claimant with a follow-up notice of the appointment(s) 24 to 48 hours before the scheduled appointment via telephone, text message, email, or other electronic methods. The Contractor shall document all attempts to reach the Claimant. If the Contractor is unable to reach the Claimant via telephone, text message, email, or other electronic method within three calendar days, the Contractor shall schedule the appointment within a reasonable time, taking into account the Claimant’s interest and the DBQ delivery requirements noted above. The Contractor shall upload a copy of the appointment notification letters into the VBMS eFolder using the “generic schema” entitled “Letter”, to the Contractor’s Contractor Portal (accessible by MDEO), and the Contractor’s Veteran Portal (accessible by the Veteran/Claimant). The required file format for posting the notice to the Contractor’s site is PDF and the posting must be § 508 compliant.

2.2.2 Appointment Cancelation Notification

Upon request by the Government, the Contractor shall provide documentation regarding the appointment notice including the contact information and the actual document if applicable (e.g., email, letter) used for any appointment cancelled for failure of an individual to report for appointment.

2.2.3 Claimant Notification: Examiner Training and Credentials The Contractor shall develop a process for disseminating information on the training and credentials of Subcontracted Examiners to all Claimants attending a contract appointment or receiving a medical opinion or ACE appointment in accordance with Section 2.2.1 (Appointment Scheduling Notification). This information shall be documented in the appointment notification letter sent to the Claimant prior to their appointment. For appointments not requiring an appointment notification letter, the Contractor shall send a notification to the Claimant informing them that VA has requested a medical opinion or ACE appointment for their claimed condition. In the event that the Examiner changes after the original letter goes out, the Contractor shall send an updated letter to the Claimant with the required information for the new Examiner.

2.3 Contractor Portal

The Contractor shall provide a Contractor Portal through which VA may obtain a real-time status of their appointments. VA requires that this be a component of the Contractor’s secure management information system and accessible by VA. This is not a separately priced deliverable but shall be a feature of the Contractor’s secure management information system. The system shall be available no later than 60 calendar days after the contract award for Contractors that already have an ATO approved and no later than 180 days after the contract award date or contract modification date for Contractors awaiting ATO approval. Content available to VA include: Status of Claimant Appointments (Planned, Scheduled, Completed), Provider Facility Locations (Address/Contact Information), Travel Reimbursement Status (check number, payment amount, date paid, date check cashed), Contractor Contact Information, Frequently Asked Questions (FAQs – e.g., how to cancel appointments, how to reschedule appointments, how to address billing questions, etc.), Claimant Notification letters, and documentation of attempts to schedule appointments for claimants. The VA must be able to access this information in real time.

Should a new VA mandated portal be created the Contractor may be required to comply with the new requirements through a modification of the contract and any associated cost will be negotiated at that time.

2.4 Veteran Portal

The Contractor shall…