DRAFT MDE Reg 1-4 PWS_Short_Term.docx

Medical Disability Examinations (MDEs) under Section 504 of the Veterans’ Benefits Improvements Act of 1996 (Public Law 104–275; 38 U.S.C. 5101) | Regions 1-4 June 2024

Table of Contents

GENERAL

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.

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.

As pertains to the requirements in this Performance Work Statement (PWS), “day(s)” refers to calendar days unless otherwise specified.

Scope of Work This contract requires private-sector Medical Disability Examinations (MDEs) on behalf of VA. The Contractor shall provide all resources necessary to accomplish the deliverables described in the PWS, except as may otherwise be specified. The Contractor shall locate, subcontract, and train medical professionals in performing MDEs for Claimants in one or more of four geographic Regions. Examiners shall perform in person MDEs in the geographic area of the contract, excluding MDEs as outlined in section 2.1.4.1.3. The Contractor shall document examination findings as provided in this PWS.

The geographic area (or VBA Region) to be serviced by this contract includes Region 1 thru Region 4. Following are details for each of the various VBA Regions:

MDE REGIONS 1-4

Region 1 (Northeast) To include Claimants who reside in the jurisdictions of regional offices within the states of Connecticut, Delaware, Illinois, Indiana, Maine, Massachusetts, Michigan, Missouri, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, and Vermont. For detailed data regarding anticipated and historical Examination Scheduling Request (ESR) volume for this region, see Attachment B - Workload Volume.

Disability claims for this region are, primarily, serviced out of the following VA Regional Offices, although other VA Regional Offices may administer the claim or appeal according to VA’s National Work Queue program:

Hartford, CT Chicago, IL Wilmington, DE Boston, MA Indianapolis, IN Togus, ME Detroit, MI Manchester, NH Newark, NJ Buffalo, NY New York, NY Philadelphia, PA Pittsburgh, PA Providence, RI Cleveland, OH White River Junction, VT

St. Louis, MO

Region 2 (Southeast) To include Claimants who reside in the jurisdictions of regional offices within the states of Alabama, Arkansas, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia. For detailed data regarding anticipated and historical ESR volume for this region, see Attachment B - Workload Volume.

Disability claims for this region are, primarily, serviced out of the following VA Regional Offices, although other VA Regional Offices may administer the claim or appeal according to VA’s National Work Queue program:

Washington, DC Montgomery, AL Little Rock, AR St. Petersburg, FL Atlanta, GA Louisville, KY New Orleans, LA Baltimore, MD Jackson, MS Winston-Salem, NC Columbia, SC Nashville, TN Roanoke, VA Huntington, WV

2 of XX

Region 3 (Midwest) To include Claimants who reside in the jurisdictions of regional offices within the states of Colorado, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota, Texas, Wisconsin, and Wyoming. For detailed data regarding anticipated and historical ESR volume for this region, see Attachment B - Workload Volume.

Disability claims for this region are, primarily, serviced out of the following VA Regional Offices, although other VA Regional Offices may administer the claim or appeal according to VA’s National Work Queue program:

Denver, CO Wichita, KS Des Moines, IA St. Paul, MN Lincoln, NE Muskogee, OK Fargo, ND Sioux Falls, SD Waco, TX Houston, TX Milwaukee, WI Cheyenne, WY

Region 4 (Pacific) To include Claimants who reside in the jurisdictions of regional offices within the states of Arizona, California, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Alaska, and Hawaii. For detailed data regarding anticipated and historical ESR volume for this region, see Attachment B - Workload Volume.

Disability claims for this region are, primarily, serviced out of the following VA Regional Offices, although other VA Regional Offices may administer the claim or appeal according to VA’s National Work Queue program:

Oakland, CA Los Angeles, CA Phoenix, AZ Seattle, WA Boise, ID Reno, NV Portland, OR San Diego, CA Honolulu, HI Anchorage, AK Salt Lake City, UT Albuquerque, NM Ft. Harrison, MT

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 and historical ESR volume for region, see Attachment B – Workload Volume, Across all MDE contracts, each ESR, on average, results in two to three unique DBQs, plus additional ancillary diagnostic services and Claimant travel benefits.

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 multiple contracts for each 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 for that region. Incumbents with contracts in other regions would be eligible to compete for these regional expansions. 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.

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 ten-year 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. The FY21 to FY25 volumes in Attachment B are estimates only and based on projected law changes that are not currently in effect. 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 Service Members; 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.

Examination Request Allocation For any Region 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 four Contractors support a given Region, each of the four Contractors will receive, as a minimum quantity (see FAR 16.504(a) (2)), 25% of the total examination volume for that Region if they are all meeting the expected Performance Requirements as noted in Section 3.1 (Performance Requirements).

The government reserves the right to update these allocation percentages due to VA initiative, changes in VA work requirements mandated by VA leadership or Congress, unforeseen disasters, or other circumstances.

The government also reserves the right to redistribute the total ESR volume among the Contractors if any Contractor does not meet any of the expected Performance Requirements as noted in Section 3.1 (Performance Requirements).

a. For example, if Contractor A is not meeting any of the expected Performance Requirements, 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 Performance Requirements. 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 Performance Requirements 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 Performance Requirements, if the work received impacts the expected Performance Requirement.

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 Performance Requirements 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 Performance Requirements. 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 Requirements, 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).

Period of Performance The period of performance is a base period of 12 months from the date of award, with a subsequent 12-month option period (option year 1), 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:

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.

Ramp-up Performance The Contractor shall provide a detailed Ramp-up Plan within five 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 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 business 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, within its awarded region, no later than (NLT) 180 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 as indicated below.

· The provider network established to meet the anticipated ESR volume with-in 60 days after contract award

· IT systems, as defined, pass all privacy and security requirements to include UAT testing with-in 150 days after contract award

· ATO must be authorized no later than 180 days after contract award If the Contractor has developed an Examiner network, has developed the required IT systems, and has received an ATO the Contractor shall accept the full workload of ESRs ahead of 180 days. If the Contractor receives the ATO prior to 180 days after contract award the Contractor may be able to accept a partial workload of ESRs prior to 180 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 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 for the region. 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 weekly status updates (meeting and supporting documentation).

Each region covers multiple Regional Office (RO) areas. A partial workload is considered to be a reduced volume of the workload across one or more entire RO area and all DBQ types. A full workload is considered to be all RO areas within a region and all DBQ types. The Ramp-up Plan shall identify which RO areas within the awarded region the Contractor will begin coverage in and when. The Contractor shall not begin accepting ESRs in any RO area until it can accept ESRs for all DBQs. Attachment C - Regional Office Jurisdiction Areas defines the geographic area covered by each VBA RO. The Ramp-up Plan shall provide the readiness review criteria the Contractor will use for determining that an RO area is ready to begin receiving ESRs.

Within five 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 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).

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 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.

17) Authorization Requirements SOP, VA Office of Information Security, April 24, 2024

SPECIFIC REQUIREMENTS / TASKS

MDE Appointment Scheduling Appointment Scheduling The Contractor shall schedule and perform appointments with a Claimant based on a formal ESR sent by the VA. Appointments are the scheduled encounters or actions performed by the clinician to provide complete results for Contentions. Appointments should be scheduled for all appointments associated with each contention, to include diagnostic appointments. 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. The Contractor shall determine the Claimants’ accessibility needs (e.g., mobility, sensory, service animals, assistive devices) prior to scheduling an appointment and ensure the exam location can accommodate their accessibility needs. The contractor shall maintain all efforts to assist with accessibility in accordance with section 2.5 (Telephone Access).

Appointment Rescheduling Rescheduling Request 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” (per Attachment AQ - Cancellation Reasons) 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 associated with any Contention completed and provide the Results Available Package (RAP) Event for the Contention in accordance with Attachment D - VBMS Exam Management Integration Architecture.

Reschedule Not Available If the Claimant is not available to attend a rescheduled appointment within five days following the original appointment date, the Contractor may submit a request for cancellation for the Contentions associated with that appointment selecting the appropriate reason per Attachment AQ - Cancellation Reasons. The Claimant must contact VBA to request a new ESR.

Force Majeure: Appointments Impacts by 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 (Average Days to Complete - ADC and Average Days Pending - ADP) 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.

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

Incoming Events: The Contractor’s system interface shall allow incoming event messages from VBMS pushed from Data Access Services (DAS) in 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.

VBMS EMS to Contractor EMS Integration New and Rework ESRs require the same event packages. The following is a list of defined incoming event packages from VBMS systems to Contractor:

Examination Scheduling Request (ESR) Event Package VA sends ESR Event Packages to Contractors to perform medical disability examinations, medical opinions, and diagnostics, for Claimants.

Veteran Document Manifest Event Package VA sends a Veteran Document Manifest Event Package to Contractors which contains a list of all eFolder documents that will be transmitted upon assignment of a new ESR.

Veteran Document Event Package VA sends a Veteran Document Event Package to Contractors for each eFolder document, which may consist of multiple pages, that is transmitted.

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.

Address Change Modification Event Package If the Claimant’s address changes after an appointment has been scheduled and they remain within 50 miles for a non-specialist appointment (exam or diagnostic) or 100 miles for a specialty appointment (exam or diagnostic), and within the assigned Contractors region, appointment shall continue as previously scheduled. If the Claimant moves outside the 50-to-100-mile radius but stays within the same region, the Contractor shall reschedule the appointment within 50 to 100 miles of the Claimants new address. If the Claimant’s new address is outside of the assigned Contractors region as described, 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 changes their address to outside of the assigned Contractors region after an appointment is scheduled and the Contractor is notified more than one 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” (per Cancellation Reasons).

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 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.

Special Instruction Modification Event Package (Additional Information)

· VA has the capability to send a Special Instruction Modification Event Package (Additional Information) to append additional narrative instructions when instructions were unintentionally left off the initial request.

· This package will not be used if changes to the scope of the ESR are needed.

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

VBMS does not allow the VA user from sending a Contention Cancellation Event Package if an appointment is scheduled within one day.

Appointment Reschedule Request 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 day of the scheduled appointment.

If the appointment is scheduled within one 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 Contractor’s Appointment Scheduled Event Package.

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 via an Appointment Request to Cancel Event Package, provided it is not within one day of the scheduled appointment.

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

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

Rework ESR Event Package Rework is a request for an ESR after a previous ESR produces insufficient results or requires clarification. An insufficient rework ESR includes previously completed Contentions that are missing required information or contain incorrect information on the DBQ. A clarification rework ESR includes previously completed Contentions that require clarification in order to rate.

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:

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

Clarification Request Event Package A Clarification Request Event Package 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. Clarification requests can only take place during triage before any appointments have been scheduled. 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, per Attachment AQ - Cancellation Reasons, if requesting to cancel an ESR.

RESERVED

Appointment Scheduled Event Package The Appointment Scheduled Event Package is used by the Contractor to provide VBMS EMS with appointment schedule data associated to a Contention 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 are required to include Examiner Name, Appointment Location, and EMS point of contact (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 schema for utilizing the exam Name field as per Attachment AP:

· For Acceptable Clinical Evidence (ACE) appointments, the exam 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 (IMO) 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.)]”

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

· For Housebound Audio Diagnostic appointments held for housebound Veterans, the exam name shall be: “Housebound-Audio-Diagnostic”

· For Housebound Audio Diagnostic appointments that are conducted utilizing boothless technology, the exam name shall be: “Housebound-Audio-Boothless Diagnostic”

· For Housebound Audio Diagnostic appointments that are conducted on a Mobile Unit, utilizing boothless technology, the exam name shall be: “Housebound-Mobile-Audio-Boothless Diagnostic)

· For Mobile Unit Appointments:

· For Mobile Unit appointments, the exam name shall be: “Mobile-[insert exam name (e.g. Audio, etc.)]”

· For Mobile Unit Audio Diagnostic appointments that are conducted, utilizing boothless technology, the exam name shall be: “Mobile-Audio-Boothless Diagnostic”

· • For regular Audio Diagnostic appointments, held on a Mobile Unit, the exam name shall be “Mobile-Audio-Diagnostic”

· For Veterans Claims Clinic Appointments:

· For appointments held during Veteran Claims Clinics, the exam Name shall be: "VCC-[insert exam name (e.g., Audio, etc.)]”

· For Audio Diagnostic appointments held during Veteran Claims Clinics, utilizing boothless technology, the exam name shall be: “VCC-Audio-Boothless Diagnostic”

· For regular Audio Diagnostic appointments, held during Veteran Claims Clinics the exam name shall be “VCC-Audio-Diagnostic”

· For appointments held during Veteran Claims Clinics, on a Mobile Unit, the exam name shall be: “VCC-Mobile--[insert exam name (e.g. Audio, etc.)]”

· For Audio Diagnostic appointments held during Veteran Claims Clinics, on a Mobile Unit, utilizing boothless technology, the exam name shall be: “VCC-Mobile-Audio-Boothless Diagnostic”

· For Audio Diagnostic Appointments:

· For audio diagnostic appointment that are conducted utilizing boothless technology, the exam name shall be “Audio-Boothless Diagnostic”

· For regular audio diagnostic appointments, the exam name shall be “audio Diagnostic” Appointment Reschedule Request Event Package The Appointment Reschedule Request Event Package is used by the Contractor to notify the VA that an appointment is being rescheduled and the 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 updated Appointment Scheduled Event Package using the same Appointment Universally Unique Identifier (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 day or has been cancelled.

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 Package shall be sent by the end of the same business day.

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 Package shall be sent by the end of the same business day. For medical disability examinations, appointments are considered completed when the Veteran shows up for the appointment and has an encounter with a provider. It is not tied to when the completed DBQ has been provided to the Contractor by their examiner.

Contention Cancellation Request Event Package The Contractor shall send a Contention Cancellation Request Event Package to request to cancel a Contention to the VA. Contractors shall include a standard reason for the request per Attachment AQ - Cancellation Reasons. Request to cancel a Contention can only be submitted if all appointments, to include all diagnostics, have been cancelled prior.

Results Upload to eFolder All results (e.g., DBQs, Diagnostics, and other associated documentation) associated with each Contention shall be uploaded by the Contractor to the VBMS eFolder in accordance with (IAW) the DBQ 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.

The generic schema in the DBQ IEPD shall be used for all document uploads that are not DBQs with a prescribed schema. MDEO has requested several other documents to be uploaded to the eFolder. Vendors shall use the list in Attachment AP – Generic Schema Utilization when uploading documents utilizing the generic schema.

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 Average Days to Complete (ADC) performance metric for completed ESRs, unless the last terminal Contention is a Contention Cancellation.

Claimant Examination Notification Letter Appointment Notification The Contractor shall contact the Claimant via telephone, text message, email, or other electronic method to schedule appointments. The Contractor shall send an appointment notification letter as described in Attachment AU - Examination Notification Letter Template. The Contractor shall notify the Claimant via mailed postage-prepaid letter, and/or FedEx, United States Postal Service (USPS) or other commercial package delivery of the appointment date, time, and location. Appointment scheduling notification may be sent via electronically secure method in addition to mailed notification. The Contractor shall ensure the Claimant receives notification at least three days prior to the scheduled appointment. In instances where a Claimant is at a claims clinic or agrees to an appointment within the next three calendar days, the Contractor shall send the notification letter, however it is not required to ensure the Claimant receives the appointment notification letter three days prior to 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 mailed postage-prepaid letter, and/or FedEx, United States Postal Service (USPS) or other commercial package delivery to ensure receipt by the Claimant at least three days prior to the scheduled appointment. Appointment scheduling notification may be sent via electronically secure method in addition to mailed notification. 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, information about cancelling and rescheduling, information regarding how Claimants should submit evidence to VA, information about the Customer Satisfaction Survey, 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.), gender (male/female/other) for exams identified in sections 2.7.8 and 2.7.8.1, License Number, State 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, (certified letter receipt signature, and/or FedEx, UPS, 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 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.