36C24919R0119-001.docx

36C24919R0119 – Attachment 1

NEUROSURGERY ON-CALL SERVICES COVERAGE

PERFORMANCE WORK STATEMENT

I. GENERAL

A. The Contractor shall furnish board eligible and/or board certified Neurosurgery Attendings to provide the following as noted below.

1. On-Call Coverage for General Neurosurgery Services - The Contractor will provide on-call telephone consultation coverage 365 days per year, 24/7. This on-call includes evaluation of Veteran patients presenting with Neurosurgery conditions. If required, the Contractor shall transfer the Veteran patient to a local hospital of the Contractor’s choice; however, it must be within 20 miles of the Robley Rex VAMC. The Contractor must be able to properly manage acute Neurosurgery patients and must have admitting privileges at the specified local hospital. Except in cases of emergency, requirements for on-call coverage will be scheduled 90 days in advance. Coverage will include consultation with the Robley Rex VAMC’s physicians regarding the appropriate medical care of Veterans presenting with Neurosurgery conditions. A telephone response is required within 15 minutes for an Emergent call for services and a telephone response is expected within 30 minutes of an urgent call. Charges for hospital care completed at a local hospital will be reimbursed by the Robley Rex VAMC, Non-VA Care Office, Louisville, KY. Charges for hospital care and any issues regarding patient care are NOT covered under this contract and are handled through the Robley Rex VAMC Non-VA Care Office.

a. Consultation services requested from the Robley Rex Veterans Affairs Medical Center are expected to be made by telephone consultation to the Robley Rex VAMC in a timely manner, as agreed upon with the consulting physician. Consultations shall be documented appropriately by the responding on-call physician, and a copy of the consultation documentation shall be furnished to the Robley Rex VAMC within 24 hours of completion of the consultation.

b. The Contractor will provide a schedule to the VA Surgical Service Administrative Office which contains 90 days of on-call rotation. This will be provided at least three (3) working days before the start of each month. The on-call schedule will be faxed to (502) 287-6802 or e-mailed to the Administrative Officer for Surgical Service/Contracting Officer’s Representative (COR). The schedule will provide the names of the Neurosurgery Attending physicians assigned to provide both acute care and general Neurosurgery coverage, as well as contact information, such as pager or cell phone numbers. The schedule will be updated and forwarded to the Surgical Service Administrative Office whenever changes are made.

II. QUALITY & QUALIFICATION REQUIREMENTS

A. The Contractor must ensure that all Contractor employees or sub-contractors providing services under this contract are fully trained and completely competent to perform the required services. The Contractor is required to maintain records that document competency/performance level of Contractor employees and sub-contractors providing services under this contract in accordance with The Joint Commission (TJC) and/or other regulatory body requirements. The Contractor shall provide current copies of these records upon request as needed.

B. If the providers are not employees of the Contractor, they must be regarded as sub-contractors. When this is the case, the Contractor will be responsible for all care rendered by any sub-contractor(s) and must ensure the sub-contractors meet all aspects of this contract.

III. ADMINISTRATIVE TASKS/TIME AND CLINICAL TASK/TIME

The Contractor may be required to attend meetings via teleconference with the Robley Rex VAMC medical and administrative staff to discuss patient care and contract issues.

IV. REQUIREMENTS AND HOW THEY WILL BE BILLED

A. Payments made to the Contractor by the Department of Veterans Affairs (VA) under this contract shall be for the total cost of services provided. The Contractor hereby agrees, that in no event shall the Contractor or his agents bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against the beneficiary, the beneficiary’s family, private insurer, Medicare, or any other entity acting on the beneficiary’s behalf. Payment for patient care is NOT covered under this contract and is paid through the Robley Rex Non-VA Care Office. Payment for this contract is for 24/7/365 on-call coverage ONLY.

B. The Administrative Officer for Surgical Service will serve as the administrative COR for purposes of processing invoices for telephone consultations performed for the VAMC facility, which is covered under this contract. The Business Office staff, Non-VA Care Section, will serve as the administrative COR for purposes of processing invoices for payment of clinic visits and surgery cases performed outside of the VAMC via the Business Office, Non-VA Care Program. These services are NOT covered under this contract.

C. Invoice requirements and supporting documentation: Supporting documentation and invoice must be submitted no later than the 20th workday of the month. Subsequent changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a “proper” invoice in accordance with FAR 52.212-4 (g), all invoices must include:

1. Name and Address of Contractor

2. Invoice Date and Invoice Number

3. Contract Number and Purchase/Task Order Number

4. Date of Service

5. Contractor’s physician(s) (Name of Contractor’s Employee)

6. Hourly Rate

7. Quantity of hours worked

8. Total price D. Vendor Electronic Invoice Submission Methods

Invoices will be electronically submitted to the Tungsten website at http://www.tungsten-network.com/US/en/veterans-affairs/Tungsten direct vendor support number is 877-489-6135 for VA contracts. The VA-FSC pays all associated transaction fees for VA orders. During Implementation (technical set-up) Tungsten will confirm your Tax Payer ID Number with the VA-FSC. This process can take up to 5 business days to complete to ensure your invoice is automatically routed to your Certifying Official for approval and payment. In order to successfully submit an invoice to VA-FSC please review “How to Create an Invoice” within the how to guides. All invoices submitted through Tungsten to the VA-FSC should mirror your current submission of Invoice, with the following items required. Clarification of additional requirements should be confirmed with your Certifying Official (your CO or buyer). The VA-FSC requires specific information in compliance with the Prompt Pay Act and Business Requirements. For additional information, please contact:

Tungsten Support Phone: 1-877-489-6135 Website: http://www.tungsten-network.com/uk/en/

V. TIMELY RESPONSE AND DOCUMENTATION

A. Timeliness is an essential component of this contract and the Contractor must adhere to established timeframes for the provision of service for work. Contractor shall be available 365/24/7 via telephone for consultation services when requested 100%. Response is required within 15 minutes for an Emergent call for services, and within 30 minutes of an Urgent call for services. Failure to provide the documentation required by this agreement or to provide documentation to support the charges being assessed will be seen as incomplete services and will result in delayed processing of invoices.

B. Written documentation associated with each consultation must be available to the VA within 24 hours of the consultation. Documentation of treatment shall be completed on the day the service is rendered. When requested, such written documentation must be provided to the VA within two (2) hours.

C. National Holidays: The 10 holidays observed by the Federal Government are:

New Year’s Day Martin Luther King’s Birthday Presidents Day Memorial Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day

Any other day specifically declared by the President of the United States to be a national holiday.

On-call coverage is required for all holidays.

VI. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT(QI)

A. Quality Management/Quality Assurance Surveillance: Contractor physician(s) shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, and Peer Reviews. Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

B. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

C. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

D. Performance Standards:

1. Measure: Call Schedule Provided Timely Performance Requirement: On-Call Coverage shall be scheduled 90 days in advance and submitted to the COR.

Standard: 100% of on-call coverage is scheduled 90 days in advance and submitted to the COR.

Acceptable Quality Level: 95% of on-call coverage shall be scheduled 90 days in advance and submitted to the COR.

Surveillance Method: Direct Observation

2. Measure: Telephone Response Performance Requirement: Telephone response occurs within 15 minutes for emergent call and within 30 minutes of an urgent call.

Standard: All 100% telephone responses occur within 15 minutes for emergent call and within 30 minutes of urgent call.

Acceptable Quality Level: 95% of telephone responses occur within 15 minutes for emergent call and within 30 minutes of urgent call.

Surveillance Method: Direct Observation

3. Measure: Consultation Documentation Performance Requirement: Consultation documentation provided to Robley Rex within 24 hours of consultation.

Standard: All 100% consultation documentation provided to Robley Rex within 24 hours of consultation.

Acceptable Quality Level: 95% consultation documentation provided to Robley Rex within 24 hours of consultation.

Surveillance Method: Direct Observation

4. Measure: Privacy, Confidentiality, and HIPAA Performance Requirement: Contractor is aware of all laws, regulations, policies, and procedures relating to Privacy, Confidentiality, and HIPAA and complies with all standards. Zero breaches of privacy or confidentiality.

Standard: All 100% contractor’s physicians comply with all laws, regulations, policies and procedures relating to Privacy, confidentiality and HIPAA.

Acceptable Quality Level: 100% contractor’s physicians comply with all laws, regulations, policies and procedures relating to Privacy, confidentiality and HIPAA.

Surveillance Method: Direct Observation

VI. Contractor Security Requirements (Handbook 6500.6)

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 should not be co-mingled, if possible, with any other data on the contractors/subcontractor's information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA's information is returned to the VA or destroyed in accordance with VA's sanitization requirements. VA reserves the right to conduct on site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.

c. Prior to termination or completion of this contract, contractor/ subcontractor must not destroy information received from VA, or gathered/ created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract.

d. The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies in this contract.

e. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.

f. If VA determines that the contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the contractor or third party or terminate the contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12.

g. If a VHA contract is terminated for cause, the associated BAA must also be terminated and appropriate actions taken in accordance with VHA Handbook 1600.01, Business Associate Agreements. Absent an agreement to use or disclose protected health information, there is no business associate relationship.

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

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

j. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA's prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response.

k. Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.

l. For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COR.

4. INFORMATION SYSTEM DESIGN AND DEVELOPMENT

Not Applicable.

5. INFORMATION SYSTEM HOSTING, OPERATION, MAINTENANCE, OR USE

Not Applicable.

6. SECURITY INCIDENT INVESTIGATION

a. The term "security incident" means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/ subcontractor shall immediately notify the COR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/ subcontractor has access.

b. To the extent known by the contractor/subcontractor, the contractor/ subcontractor's notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.

c. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.

d. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.

7. LIQUIDATED DAMAGES FOR DATA BREACH

a. Consistent with the requirements of 38 U.S.C. 5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract. However, it is the policy of VA to forgo collection of liquidated damages in the event the Contractor provides payment of actual damages in an amount determined to be adequate by the agency.

b. The contractor/subcontractor shall provide notice to VA of a "security incident" as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.

c. Each risk analysis shall address all relevant information concerning the data breach, including the following:

(1) Nature of the event (loss, theft, unauthorized access);

(2) Description of the event, including:

a. date of occurrence;

b. data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code;

(3) Number of individuals affected or potentially affected;

(4) Names of individuals or groups affected or potentially affected;

(5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text;

(6) Amount of time the data has been out of VA control;

(7) The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons);

(8) Known misuses of data containing sensitive personal information, if any;

(9) Assessment of the potential harm to the affected individuals;

(10) Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and

(11) Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised.

d. Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per person per day to cover the cost of providing credit protection services to affected individuals consisting of the following:

(1) Notification;

(2) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports;

(3) Data breach analysis;

(4) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution;

(5) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and

(6) Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.

8. SECURITY CONTROLS COMPLIANCE TESTING

a. On a periodic basis, VA, including the Office of Inspector General, reserves the right to evaluate any or all of the security controls and privacy practices implemented by the contractor under the clauses contained within the contract. With 10 working-day's notice, at the request of the government, the contractor must fully cooperate and assist in a government-sponsored security controls assessment at each location wherein VA information is processed or stored, or information systems are developed, operated, maintained, or used on behalf of VA, 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.

9. TRAINING

a. All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems:

(1) Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems;

(2) Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training;

(3) Successfully complete the appropriate VA privacy training and annually complete required privacy training; and

(4) Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document - e.g., any role-based information security training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.]

b. The contractor shall provide to the contracting officer and/or the COR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required.

c. Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete.