36C25918R0484-000.docx

FedBizOpps Combined Synopsis/Solicitation Notice

CLASSIFICATION CODE

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RESPONSE DATE

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ARCHIVE

DAYS AFTER THE RESPONSE DATE

RECOVERY ACT FUNDS

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CONTRACTING OFFICE

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(POC Information Automatically Filled from User Profile Unless Entered)

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AGENCY'S URL

URL DESCRIPTION

AGENCY CONTACT'S EMAIL

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EMAIL DESCRIPTION

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ADDITIONAL INFORMATION

GENERAL INFORMATION

PLACE OF PERFORMANCE

* = Required Field FedBizOpps Combined Synopsis/Solicitation Notice Rev. March 2010 R AN-98 Home Health Pricing 80111 36C25918R0484 10-19-2018 N 524291 Department of Veterans Affairs Network Contracting Office 19 Rocky Mountain Acquisition Center 6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 Erica A. Blake erica.blake@va.gov Rocky Mountain Acquisition Center CBO Field Office 3773 Cherry Creek North Drive Suite 495 Denver, CO 80209 United States erica.blake@va.gov erica.blake@va.gov Combined Synopsis/Solicitation for AN-98 Home Health Pricing

1. This is a combined synopsis/solicitation for commercial items and services prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

2. Solicitation number 36C25918R0484 is issued as a request for quote (RFQ).

3. This acquisition is unrestricted. The North American Industry Classification System (NAICS) code is 524291 – Claims Adjusting.

4. FAR Clauses 52.212-1, 52.212-2, 52.212-4 and 52.212-5 apply to this procurement. For the exact text and wording of clauses and provisions please see http://farsite.hill.af.mil. The Government contemplates an award of an unrestricted Firm Fixed Priced (FFP) Lowest Priced Technically Acceptable (LPTA) contract resulting from this solicitation.

5. Description of services: The Contractor shall price PSHC claims that contain CMS Health Insurance Prospective Payment System (HIPPS) codes; complying with applicable CMS guidelines for the HIPPS methodology and have the ability to process between five to eight-thousand eligible HH Hospice outpatient fee claims each month for 152 Veterans Integrated Service Networks (VISN’s) within 21 regions of the United States (U.S.) and its’ U.S. territories. Claims related to services provided in foreign countries and certain services provided in the state of Alaska have been deemed third party contracts between VA Medical Centers, various providers, and 3rd party administrators under the Choice/Community Care Network and are not subject to the requirements of this contract.

The Contractor shall work with the Program Office (PO) and Contracting Officer Representative (COR) to provide HH Hospice and PSCH claims pricing. At no time shall the Contractor direct, change, or engage in the formulation of VA policy. The VA is solely responsible to review the Contractor’s recommendations and to make decisions concerning the formulation of policy.

6. Period of Performance (POP): The POP shall be from the date of award for a 1 (one) 12 (twelve) month base-year period and two (2) twelve (12) month option year periods.

7. See Addendum to 52.212-1 Instructions to Offerors on the attached RFQ document for information on what to submit with your offer.

7. Offers are due October 19, 2018 @ 4:00 PM EST. All questions/inquiries must be submitted to the contract officer via electronic mail (e-mail) not later than October 12, 2018 @ 4:00 PM EST. Inquiries submitted via telephone calls will be re-directed to an e-mail submission.

8. Submit offers or any questions to the attention of Erica A. Blake via email to: erica.blake@va.gov.

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a.

NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE

SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND

APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER

INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF

CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

TBD

36C25918R0484 10-02-2018 Erica A Blake

(303) 712-5816 10-19-2018

4 PM EST

36C259 Department of Veterans Affairs Network Contracting Office 19 Rocky Mountain Acquisition Center 6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 x Y 524291 Department of Veterans Affairs CBO Field Office 3773 Cherry Creek North Drive Suite 495 Denver CO 80209 36C259 Department of Veterans Affairs Network Contracting Office 19 Rocky Mountain Acquisition Center 6162 South Willow Drive, Suite 300 Greenwood Village CO 80111

Electronic Payment Requests Submit Invoice at:

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

AN-98 Home Health Pricing Re-Compete Period of Performance:

Base: 11-01-2018 to 10-31-2019 Option Year 1: 11-01-2019 to 10-31-2020 Option Year 2: 11-01-2020 to 10-31-2021 x x Erica A Blake

PCOE14L3-65147

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:

b. GOVERNMENT: Contracting Officer 36C259 Erica A. Blake / erica.blake@va.gov

Department of Veterans Affairs Network Contracting Office 19 Rocky Mountain Acquisition Center 6162 South Willow Drive, Suite 300 Greenwood Village CO 80111

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

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.

Electronic Payment Requests

Submit Invoice at:

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

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

B.2 PRICE/COST SCHEDULE

Base Year POP Begin: 11-01-2018 POP End: 10-31-2019

Option Year 1 POP Begin: 11-01-2019 POP End: 10-31-2020

Option Year 2 POP Begin: 11-01-2020 POP End: 10-31-2021

Page 1 of

B.3 PERFORMANCE WORK STATEMENT

Department of Veteran Affairs Veteran’s Health Administration Office of Community Care AN-98 Home Health Pricing

1. Scope: The Department of Veterans (VA), Veteran’s Health Administration (VHA) Office of Community Care (OCC) is looking to establish a contract with a Contractor that can receive and price outpatient electronic web portal Home Health (HH) Hospice and Purchased Skilled Home Care (PSHC) claims pricing from any VHA facility; utilizing, Medicare (CMS) fee schedules. This contract supports the AN-98 regulatory change to 38 CFR 17.56 and affects changes to outpatient healthcare claims for over 10,000 HH Hospice and PSHC providers who do not have existing negotiated contracts with VA.

The contractor shall price VA Purchased Skilled Home Care (PSHC) claims that contain CMS Health Insurance Prospective Payment System (HIPPS) codes and Home Hospice (HH) claims (HCPCS/CPT coded) complying with applicable CMS guidelines for the HIPPS methodology and HH fee schedules plus have the ability to price, initially, between five to ten thousand PSHC and HH claims each month (for the base year, up to an estimated twenty five thousand claims per month for option years) for approximately 152 Veterans Integrated Service Networks (VISN’s) within 21 regions of the United States (U.S.) and its’ U.S. territories. Claims related to services provided in foreign countries and certain services provided in the state of Alaska have been deemed third party contracts between VA Medical Centers, various providers, and 3rd party administrators under the Choice/Community Care Network and are not subject to the requirements of this contract.

The Contractor shall work with the Program Office (PO) and Contracting Officer Representative (COR) to provide HH Hospice and PSCH claims pricing. At no time shall the Contractor direct, change, or engage in the formulation of VA policy. The VA is solely responsible to review the Contractor’s recommendations and to make decisions concerning the formulation of policy.

2. Background: The VA is one of the world’s largest health care delivery organizations in the world and as a part of an integrated strategy to provide Veterans with timely access to quality health care services where all VA healthcare facilities are authorized to pay for health care services acquired from community health care providers. Services are provided to eligible Veterans from community care providers when the VA determines that medically necessary services are not available in an emergency or can be provided on a timely basis.

The VA manages the authorization, claims processing, and reimbursement for HH Hospice services through the Office of Community Care, Claims Adjudication and Reimbursement (CAR) division. The VA amended 38 CFR Section 17.56 that states that the VA cannot supersede pre-negotiated PSHC claim rates; however, all new rates must be pre-negotiated with the VA. This amendment standardized payment processing; utilizing Medicare fee schedules and prospective payment systems (PPS) for the payment of HH Hospice that had been covered by CMS.

3. Period of Performance (POP): The POP shall be from the date of award for a 1 (one) 12 (twelve) month base-year period and two (2) twelve (12) month option year periods.

4. Place of Performance: Work shall take place within a secure Veterans Affairs Network shared drive via CITRIX Access Gateway (CAG) located within 21 regions of the United States (U.S.)

5. Tasks: The Contractor shall:

5.1 Provide services to administer pricing of VA outpatient claims IAW applicable CMS reimbursement pricing methodologies for HH Hospice and PSHC and shall provide:

5.1.1 Configuration of all benefits, codes, and fee schedules

5.1.2 Configuration of all processing/adjudication logic; including pending claims, adjustments and understandable denial code descriptions

5.1.3 Provider data demographics

6. Key General Requirements and Assumptions: The Contractor shall:

6.1 Adhere to VA security and network requirements

6.2 Maintain yearly VA training requirements for Privacy Training and Rules of Behavior

6.3 Indicate ability to maintain continuous VA network connections

6.4 Develop a detailed project plan

6.4.1 The pricing plan shall outline sufficient resource and technologies; including;

6.4.1.1 Web applications

6.4.2.1 Databases

6.4.3.1 Secured IT systems

6.5 Provide pricing reports to include soft copy (RFT, HMTL, etc.)

6.6 Receive electronically VA approved price HH Hospice and PSCH claims utilizing appropriate CMS payment system methodology.

6.7 Provide CMS subject matter expertise when requested.

6.8 Provide the ability to differentiate between and report HH Hospice and PSCH claims and the ability to differentiate between regulatory and program claims – i.e., AN-98 and Veteran Choice Program claims.

6.09 Provide monthly invoicing capability and the invoices shall:

6.09.1 List contract program management costs

6.09.2 Annotate HH Hospice and PSCH costs

7. Reporting Requirements: The Contractor shall:

7.1 Provide a monthly summary to the COR; identifying inconsistencies and irregularities that impact ongoing deliverables.

7.2 Propose modifications to the reporting requirements to the COR.

7.3 Explain, in writing, to the COR (if for any reason a deliverable cannot be met within the scheduled time frame or adherence to the established schedules cannot be met) the following:

7.3.1 Reasons for the delay

7.3.2 Modified delivery date

7.3.3 Impact on the overall project

7.3.4 A revised project plan with all adjusted dates

7.4 The COR shall brief the incident to the CO, who shall issue a response pursuant to applicable regulations.

8. Level of Effort: The Contractor is encouraged to propose a response consistent with their technical approach for accomplishment of all performance objectives/standards set forth above.

9. Performance Standards:

Each priced deliverable shall be priced independently and billed according to the CLIN structure for each contract year

IAW PWS 10

Review and acceptance by the Government

Deliverables provided IAW the Government approved standard/frequency standard

Each metric has been established to meet mission objectives

IAW PWS 11

Review and acceptance by the Government

Deliverables provided IAW the Government approved standard/frequency standard

10. Priced Deliverables: Each deliverable shall be priced independently and billed as for each contract year.

10.1 Project Management

10.2 Home Health Claims

11. Non-Priced Deliverables: The below performance metrics are associated with these deliverables:

Submit list of employees (names, social security numbers, and home addresses) within 5 business days of contract award

Submit list of employees (names, phone numbers, and home addresses) within 5 business days of contract award

Submit all staff training certificates

Submitted on the 5th business day of each month following contract award

12. Security Requirements: The Contractor shall:

12.1 Not divulge or disclose information received and/or discussed regarding data considered proprietary to other Contractors collaborating on or with this effort.

12.2 Be required to complete yearly mandated VA privacy and security training.

12.3 Limit access to the minimum number of employees necessary to perform tasks that are considered sensitive or proprietary in nature.

12.4 Contact the COR, if the Contractor is uncertain of the sensitivity of any information obtained.

12.5 Indoctrinate all personnel employed by the Contractor and any Sub-Contractor’s involved on their roles and responsibilities for proper handling and nondisclosure of sensitive Government or proprietary information.

12.6 Not engage in any other action, venture or employment wherein sensitive information shall be used for the profit of any party other than those furnishing the information.

12.7 Comply with VA and VHA Security requirements.

12.8 Have or obtain a National Agency Check with Inquiries Clearance (NACI) as required.

13. Information System Hosting, Operation, Maintenance or Use: Outsourcing (Contractor facility, equipment or staff) of systems or network operations, telecommunications services, or other managed services requires certification and accreditation (authorization) (C&A) of the Contractor's systems in accordance with VA Handbook 6500.3, Certification and Accreditation and/or the VA Office of Cyber Security (OCS) Certification PO. Government-owned (facility or equipment) Contractor-operated systems, third (3rd) party or business partner networks require memorandums of understanding and interconnection agreements (MOU-ISA) which detail what data types are shared, who has access, and the appropriate level of security controls for all systems connected to VA networks.

14. Travel: Travel is not required or authorized.

15. Inspections and Acceptance: All reports shall be approved by the COR.

16. Contract Award Meeting: The Contractor shall not commence performance on the tasks described in the PWS until the CO has conducted a kick off meeting or has advised the Contractor that a kick-off meeting has been waived. The Government shall not reimburse the Contractor for any expenses associated with preparing for or executing a kick-off meeting.

17. Changes to the PWS: Any changes to this PWS shall be authorized and approved only through written correspondence from the CO. A copy of each change shall be kept in a project folder along with any other products of the project. Costs incurred by the Contractor, through the actions of parties other than the CO, shall be borne by the Contractor alone.

18. Security and Privacy - Information and Records: The Contractor shall:

18.1 Return all information and records provided to Contractor by the VA, in whatever medium, as well as all information and documents, including drafts, emails, back-up copies, hand-written notes and copies that contain such information and records gathered or created by Contractor (collectively referred to as “VA information”) in the performance of this Contract, regardless of storage media, are the exclusive property of the VA. The Contractor shall not retain any property interest in these materials and shall not use them for any purpose other than performance of this Contract.

18.2 Provide, upon completion or termination of the contract, all copies of any VA information that it used during work it performed of the contract or certify that it any/all information it obtained has destroyed. Where immediate return or destruction of the information is not practicable, the Contractor shall return and/or destroy the information within thirty (30) business days of completion or termination of the contract. All provisions of this contract concerning the security and protection of VA information that is the subject to this contract shall continue to apply to the VA information for as long as the Contractor retains it, regardless of whether the contract has been completed or terminated.

18.3 Not destroy, prior to termination or completion of this contract, any VA information received from the VA, gathered and/or created in the performance of the contract without prior written approval by the VA.

18.4 Receive, gather, store, backup, maintain, use, disclose and/or dispose of VA information only in accordance with the terms of the contract and any applicable federal, VA, confidentiality, security laws, regulations or policies.

18.5 Not make copies of VA information except as necessary to perform duties required of the contract or to preserve electronic information stored on Contractor electronic storage media for restoration in case any electronic equipment or data used by the Contractor needs to be restored to an operating state.

18.6 Provide access only to VA information to employees, Sub-Contractors, and affiliates to:

18.6.1 The extent necessary to perform the services specified of the contract.

18.6.2 Perform necessary maintenance functions for electronic storage or transmission media necessary for performance of the contract.

18.6.3 Individuals who first satisfy the same conditions, requirements and restrictions that are comparable VA employees shall meet to have access to the same VA information.

18.6.4 Restrictions include the same level of Background Investigations, where applicable.

18.7 Store, transport or transmit VA information only in an encrypted form, using an encryption application that meets the requirements of Federal Information Processing Standards (FIPS) 140-2 or is approved for use by the VA.

18.8 Only use or disclose, except for uses and disclosures of VA information authorized by this contract for performance of the contract in response to an order of a court of competent jurisdiction, or with VA’s prior written authorization. The Contractor shall refer all requests for, demands for production of, or inquiries about, VA information to the VA for response.

18.9 Include the statement, “Contractor shall not release information protected by either 38 USC 5705 or 7332 in response to a court order, and shall immediately refer such court orders to VA for response,” if VA information subject to the contract includes information protected by 38 USC 7332 or 5705.

18.10 Promptly notify the VA, prior to any disclosure pursuant to a court order, of a court order upon its receipt by the Contractor.

18.10.1 Notify the COR by phone and provide the VA a copy of the court order by fax or e-mail within one business day.

18.10.2 If the Contractor cannot notify the VA before being compelled to produce the information under court order, the Contractor shall notify the VA of the disclosure as soon as practical and provide a copy of the court order, a description of the records provided pursuant to the court order, and to whom the Contractor provided the records to under the court order.

18.10.3 The notice shall include the following information to the extent that the Contractor knows it, if it does not show on the face of the court order: the records disclosed pursuant to the order, to whom, where, when, and for what purpose, and any other information that the Contractor reasonably believes is relevant to the disclosure.

18.10.4 If the VA determines that it is appropriate to seek retrieval of information released pursuant to a court order before Contractor notified the VA of the court order, Contractor shall assist the VA in attempting to retrieve VA information involved.

18.11 Inform the VA, by the most expeditious method available to Contractor, of any incident of suspected or actual access to, or disclosure, disposition, alteration or destruction of, VA information not authorized under this contract (“incident”) within one hour of learning of the incident.

18.11.1 An incident includes the transmission, storage or access of VA information by Contractor or Sub-Contractor employees in violation of applicable VA confidentiality and security requirements.

18.11.2 To the extent known by the Contractor, the Contractor’s notice to the VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information was placed at risk or compromised), and any other information that the Contractor considers relevant.

18.12 Simultaneously report the incident to the appropriate law enforcement entities or jurisdiction. The Contractor, its employees, and its Sub-Contractors and their employees shall cooperate with the VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violations associated with any incident.

18.13 Cooperate with the VA in any civil litigation to recover VA information, to obtain monetary or other compensation from a third (3rd) party for damages arising from any incident, or to obtain injunctive relief against any third (3rd) party arising from, or related to, the incident.

18.13.1 In addition to notifying the COR, the VA shall provide the Contractor with the name, title, telephone number, fax number and email address of the VA official to whom the Contractor shall provide all notices required by this contract.

18.13.2 The VA has the right during normal business hours to inspect the Contractor’s facility, information technology systems and storage and transmission equipment, and software utilized to perform the contract to ensure that the Contractor is providing for the security of VA data and computer systems in accordance with the terms of this contract.

18.14 Receive, gather, store, backup, maintain, use, disclose and/or dispose of VA information only in compliance with all applicable FIPS and Special Publications (SP) issued by the National Institute of Standards and Technology (NIST) concerning VA information that is the subject of this contract. If NIST issues or updates an applicable FIPS or SP after execution of this contract, the parties agree to negotiate in good faith to implement the FIPS or SP in this contract.

18.15 Provide appropriate administrative, technical, and physical safeguards to ensure the confidentiality and security of the Veteran’s data and to prevent unauthorized use or access to it.

18.15.1 Sensitive VA information shall not be transmitted by remote access unless VA approved protection mechanisms are used.

18.15.2 All encryption modules used to protect VA data shall be validated by NIST to meet the current version of FIPS 140 (See http://csrc.nist.gov/cryptval/140-1/1401val.htm for a complete list of validated cryptographic modules).

18.15.3 Only approved encryption solutions using validated modules shall be used when protecting data during transmission.

18.15.4 Additional security controls are required to guard VA sensitive information stored on computers used outside VA facilities.

18.15.7 The Contractor agrees that the data shall not be physically moved or transmitted in any way from the site without first being encrypted and obtaining prior written approval from the VA data owner.

18.15.8 A determination by VA that the Contractor has violated any of the information confidentiality and security provisions of this Contract, including a violation of any applicable FIPS or SP, shall be a basis for VA to terminate the Contract for cause.

18.15.9 If anyone performing this contract, including employees of Sub-Contractor’s, accesses VA computer systems or data in the performance of the contract, the VA shall monitor and record all such access activity.

18.15.10 If VA monitoring reveals any information of suspected or potential criminal law violations; the VA shall refer the matter to the appropriate law enforcement authorities for investigation.

18.16 Inform its employees and other individuals performing any part of this contract that VA shall monitor their actions in accessing or attempting to access VA computer systems and the possible consequences to them for improper access, whether successful or not.

18.17 Ensure that any Sub-Contractor’s or others acting on behalf of or for the Contractor in performing any part of this contract inform their employees, associates or others acting on their behalf that VA shall monitor their access activities. Execution of this contract and any sub-Contractor agreement that constitutes consent to VA monitoring.

18.18 Ensure that all individuals who shall access VA data or systems in performing the contract are appropriately trained in the applicable VA confidentiality and security requirements. The Contractor shall document those who have completed the VA training. The Contractor shall contact the COR regarding access to the required VA training.

18.19 Mitigate, to the extent practicable, any harmful effect on individuals whose VA information was accessed or disclosed in an incident.

18.20 Require Sub-Contractors, agents, affiliates or others to whom Contractor provides access to VA information for the performance of this contract to agree to the same VA information confidentiality and security restrictions and conditions that apply to the Contractor before providing access.

19. Protection of Individual Privacy: The Contractor shall:

19.1 Abide by FAR clauses 52.224-1 and 52.224.2.

19.2 Abide by FAR clauses 52.239-1 for Privacy or Security Safeguards.

19.3 Not publish or disclose in any manner, without the CO’s written consent, the details of any safeguards either designed or developed by the Contractor under this contract or otherwise provided by the Government.

19.3.1 To the extent required to carry out a program of inspection to safeguard against threats and hazards to the security, integrity, and confidentiality of Government data, the Contractor shall afford the Government access to the Contractor’s facilities, installations, technical capabilities, operations, documentation, records, and databases.

19.3.2 If new or unanticipated threats or hazards are discovered by either the Government or the Contractor, or if existing safeguards have ceased to function, the discoverer shall immediately bring the situation to the attention of the other party

19.4 Utilize only employees, Sub-Contractors or agents who are physically located within a jurisdiction subject to the laws of the U.S.

19.5 Ensure that it does not use or disclose Personal Health Information (PHI) received from a Covered Entity in any way that shall remove the PHI from such jurisdiction.

19.6 Ensure that its employees, Sub-Contractors and agents do not use or disclose PHI received from Covered Entity in any way that shall remove the PHI from such jurisdiction.

20. Information System Security: The Contractor shall:

20.1 Ensure adequate LAN/Internet, data, information, and system security in accordance with VA standard operating procedures and standard contract language, conditions laws, and regulations.

20.1.1. Firewall and web servers shall meet or exceed the Government minimum requirements for security.

20.1.2 Any security violations or attempted violations shall be reported to the VA project manager and the VHA Headquarters Information Security Officer as soon as possible.

20.2 Follow all applicable VA policies and procedures governing information security, especially those that pertain to certification accreditation.

21. Information System Design and Development: Information systems are designed or developed for or on behalf of VA at non-VA facilities shall comply with all VA policies developed in accordance with the Federal Information Security Management Act (FISMA), HIPAA, NIST, and related VA security and privacy control requirements for Federal Information Systems. This includes standards for the protection of electronic PHI, outlines in 45 C.F.R. Part 164, Subpart C, information and system security categorization level designations in accordance with FIPS 199 and FIPS 200 with implementation of all baseline security controls commensurate with the FIPS 199 System Security Categorization (reference Appendix A of VA Handbook 6500, VA information Security Program). During the development cycle, a privacy impact assessment shall be completed, provided the COR, and approved by the VA Privacy Service in accordance with VA Privacy Impact Assessment Handbook 6500.3.

The security controls shall be designated, developed, approved by the VA, and implemented in accordance with the provisions of the VA Security System development life cycle as outlined in NIST Special Publication 800-37 and VA Handbook 6500.

The Contractor shall be required to design, develop, and operate a System of Records or individuals to accomplish an agency function subject to the Privacy Act of 1974, (as amended), Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Privacy Act may involve the imposition of criminal and civil penalties.

22. Security Training: The Contractor’s employees and Sub-Contractor’s shall (in addition to other VA specific training):

23.1 Complete the VA's on-line Security Awareness Training Course and the Privacy Awareness Training Course annually.

23.2 Provide signed certifications of completion to the CO during each year of the contract.

23. Contractor Responsibility: All Contractor employees who require access to VA computer systems are subject to a Background Investigation and shall receive a favorable adjudication from the VA Security and Investigations Center (SIC) (07C). The level of background security investigation shall be in accordance with VA Directive 0710 dated September 10, 2004 and is available at: http://www.va.gov/pubs/asp/edsdirec.asp (VA Handbook 0710, Appendix A, Table 1-3).

23.1 Obtain appropriate Background Investigation forms shall be provided upon contract award, and shall completed and returned to the VA Security and Investigations Center (07C) within thirty (30) business days for processing. Contractors shall be notified by 07C when the Background Investigation has been completed and adjudicated. These requirements are also applicable to all Sub-Contractor personnel requiring the same access.

23.2 If a Background Investigation is not completed prior to the start date of the contract, the employee shall work on the contract while the security clearance is being processed, but the Contractor shall be responsible for the actions of those individuals they provide to perform work for the VA. If damage arises from work performed by Contractor personnel, under the auspices of the contract, the Contractor shall be responsible for resources necessary to remedy the incident.

23.3 The investigative history for Contractor personnel working under this contract shall be maintained in the databases of either the Office of Personnel Management (OPM) or the Defense Industrial Security Clearance Organization (DISCO). Should the Contractor use a Contractor other than OPM or Defense Security Service (DSS) to conduct investigations, the investigative company shall be certified by OPM/DSS to conduct Contractor investigations.

24. Background Investigations: The position sensitivity impact for this effort has been designated as minimal Risk and the level of Background Investigation is NACI at a cost of $392.00. Price is subject to change in accordance with OPM.

25. Contractor Responsibilities: The Contractor shall:

25.1 Bear the expense of obtaining Background Investigations. Please refer to the OPM website for further guidance at http://www.opm.gov/investigations/background-investigations.

25.2 Reimburse the VA within thirty (30) business days, if the investigation is conducted by the Office of Personnel Management (OPM) through the VA.

25.2.1 Background Investigations from investigating agencies other than OPM are permitted if the agencies possess an OPM and Defense Security Service certification.

25.2.2 The Contractor Cage Code number shall be provided to the Security and Investigations Center (07C), which shall confirm the information and advise the CO whether access to the computer systems can be authorized.

25.3 Prescreen all personnel requiring access to the computer systems to ensure they maintain a U.S. citizenship and can read, write, speak and understand the English language.

25.4 Provide a list of personnel names, Social Security Numbers, addresses to the COR utilizing Attachment C.

25.5 Withdraw personnel form working under the contract, who, when notified, have an unfavorable determination by the Government. Failure to comply with the Contractor personnel security requirements shall result in termination of the contract for default.

25.6 Be responsible for the actions of all individuals provided to work for the VA under this contract. If damages arise from work performed by Contractor provided personnel, under the auspices of this contract, the Contractor shall be responsible for all resources necessary to remedy the incident.”

26. Government Responsibilities: The VA Security and Investigations Center (07C) shall provide the necessary forms to the Contractor or its employees after receiving a list of names and addresses.

26.1 Upon receipt, the VA Security and Investigations Center (07C) shall review the completed forms for accuracy and forward the forms to OPM to conduct the Background Investigation.

26.2 The VA facility shall pay for investigations conducted by the OPM in advance. In these instances, the Contractor shall reimburse the VA facility within thirty (30) business days.

26.3 The VA Security and Investigations Center (07C) shall notify the CO and Contractor after adjudicating the results of the Background Investigations received from OPM.

26.4 The CO shall ensure that the Contractor provides evidence that investigations have been completed or are in the process of being requested.

27. VA Internet and Intranet Standards: The Contractor shall adhere to and comply with VA Directive 6102 and VA Handbook 6102, Internet/Intranet Services, including applicable amendments and changes, if the Contractor’s work includes managing, maintaining, establishing and presenting information on VA’s Internet/Intranet Service Sites. This pertains, but is not limited to: creating announcements; collecting information; databases to be accessed, graphics and links to external sites. These documents contain information regarding: VA cookie use policy, privacy statements, Section 508 applicability, posting “Hot Topics”, warning notices and editorial changes.

28.1 Internet/Intranet Services Directive 6102 is posted at:

http://www.va.gov/pubs/directives/Information-Resources-Management-(IRM)/6102d.doc

28.2 Internet/Intranet Services Handbook 6102 is posted at:

http://www.va.gov/pubs/handbooks/Information-Resources-Management-(IRM)/6102h.doc

28.3 Internet/Intranet Services Handbook 6102, Change 1, is posted at: http://www.va.gov/pubs/handbooks/Information-Resources-Management-(IRM)/61021h.doc

28. Invoicing Acceptance: All payments by the Government to the Contractor shall be made in accordance with Far Clause 52.232-34 – Payment by Electronic Funds Transfer – Other Than System for Award Management. All invoices shall be submitted in arrears.

29. Contract Termination: Pursuant to FAR Clause 52.249-2 – Termination for Convenience of the Government (Fixed Price), The Government may terminate performance of work under this contract in whole or, from time to time, in part if the Contracting Officer determines that a termination is in the Government’s interest. The Contracting Officer shall terminate by delivering to the Contractor a Notice of Termination specifying the extent of termination and the effective date. The Contractor shall be paid only for the services rendered up to the point of receiving the termination notice, and then only to the extent that those services meet the requirements of this PWS.

30. Contract Administration: All inquiries and correspondence relative to the administration of the contract shall be addressed to:

CO: Erica A Blake Telephone Number: (303) 712-5816 E-mail: Erica.Blake@va.gov

COR: Barry Brooks Telephone Number: (303) 780-4782 E-mail: Barry.Brooks2@va.gov

31. Inspection and Acceptance: All reports shall be reviewed and approved by the COR. All reports are due 30 calendar days after the contract award date. If a document or part of a document is not translated, COR will contact the vendor to have translated at no cost to the Government or OCC.

32. Quality Assurance: The Contractor shall develop and maintain an effective quality control program in accordance with their approved Management Oversight Plan (MOP) to ensure services are performed in accordance with the PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s Quality Control Program (QCP) is the means to assure that the work complies with the requirement of the contract. As a minimum, the Contractor shall develop QCP that address the areas identified in the Quality Assurance Surveillance Plan (QASP).

33. Performance Assessment: The Government shall evaluate the Contractor’s performance under this contract in accordance with the QASP in a separate document. This plan is primarily focused on what the Government shall do to ensure that the Contractor has performed in accordance with the performance standards. The QASP what shall be monitored, how monitoring shall take place, who shall conduct the monitoring, and how monitoring efforts and results shall be documented.

Quality Assurance Surveillance Plan Department of Veteran Affairs Veteran’s Health Administration Office of Community Care AN-98 Home Health Hospice Pricing

Contract No: TBD

Contract Description: The Department of Veterans (VA), Veteran’s Health Administration (VHA) Office of Community Care (OCC) is looking to establish a contract with a Contractor that can receive and price outpatient electronic web portal Home Health (HH) Hospice and Purchased Skilled Home Care (PSHC) claims pricing from any VHA facility; utilizing, Medicare (CMS) fee schedules within five seconds. This contract supports the AN-98 regulatory change to 38 CFR 17.56 and affects changes to outpatient healthcare claims for over 10,000 HH Hospice and PSHC providers who do not have existing negotiated contracts with VA.

The Contractor shall price PSHC claims that contain CMS Health Insurance Prospective Payment System (HIPPS) codes; complying with applicable CMS guidelines for the HIPPS methodology and have the ability to process between five to eight-thousand eligible HH Hospice outpatient fee claims each month for 152 Veterans Integrated Service Networks (VISN’s) within 21 regions of the United States (U.S.) and its’ U.S. territories. Claims related to services provided in foreign countries and certain services provided in the state of Alaska have been deemed third party contracts between VA Medical Centers, various providers, and 3rd party administrators under the Choice/Community Care Network and are not subject to the requirements of this contract.

Contractor’s name: TBD

1. PURPOSE: Each Contractor is required to submit this document within 30 calendar days after the contract award date that outlines how the Contractor plans to provide continued uninterrupted quality of service. This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract and explains the following:

a. What shall be monitored?

b. How monitoring shall take place?

c. Who shall conduct the monitoring?

d. How monitoring efforts and results shall be documented?

e. Incentives/disincentives.

This QASP does not detail how the Contractor accomplishes the work. Rather, the QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government shall review and revise it on a regular basis. However, the Government shall coordinate changes with the Contractor. Copies of the original QASP and revisions shall be provided to the Contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES: The following personnel shall oversee and coordinate surveillance activities.

a. Contracting Officer (CO): The Contracting Officer (CO) shall ensure performance of all necessary actions for effective Contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States (U.S) in the Contractual relationship. The CO shall also assure that the Contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

Assigned CO: Erica A Blake Telephone Number: (303) 712-5816 E-mail: Erica.Blake@va.gov

b. Contracting Officer’s Representative (COR): The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the Contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any Contractual commitments or to authorize any Contractual changes on the Government’s behalf.

Assigned COR: Barry Brooks Telephone Number: (303) 780-4782 E-mail: Barry.Brooks2@va.gov

c. Other Key Government Personnel: Upon award, Government shall enter name, if applicable and shall include Performance Monitors, Clinical Quality experts, etc. who act on behalf of the COR to monitor performance.

3. CONTRACTOR REPRESENTATIVES: The following employees of the Contractor serve as the Contractor’s PM for this contract.

a. Program Manager (PM): Barry Brooks

4. PERFORMANCE STANDARDS: Performance standards define desired services. The Government performs surveillance to determine if the Contractor exceeds, meets or does not meet these standards.

The Performance Requirements Summary Matrix below includes performance standards. The Government shall use these standards to determine Contractor performance and shall compare Contractor performance to the Acceptable Quality Level (AQL) in table 11a and 11b.

Performance Standards:

Submit list of employees (names, social security numbers, and home addresses) within 5 business days of contract award Electronically in Microsoft 2010 or higher

Submit list of employees (names, phone numbers, and home addresses) within 5 business days of contract award Electronically in Microsoft 2010 or higher

Submit all staff training certificates Electronically in Microsoft 2010 or higher