36C77622R0090 0002.docx

36C77622R0090

GENERAL INFORMATION

SET-ASIDE

PCAC-ST. LOUIS

1 Jefferson Barracks Dr., Bldg 56 Saint Louis MO 63125

POINT OF CONTACT*

Contract Specialist Haley T Huff haley.huff@va.gov 314-894-6656

PLACE OF PERFORMANCE

POSTAL CODE

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

DESCRIPTION

Please see SF1449 below the Questions/Answers table for amended solicitation.

E.1 INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS:

SPECIFIC PROPOSAL SUBMISSION INSTRUCTIONS

The offeror shall submit one (1) electronic copy of each proposal volume via email (using encryption protocols). The electronic copies of Volume I, Volume II, Volume III and Volume IV shall be in Portable Document Format (PDF) compatible with Adobe Reader. The electronic copies of Volume V shall consist of electronic files in the following format: Attachment 5 (Price/Cost Schedule).

Please define “encryption protocols” as it relates to both the PDF submissions and the PriceCostSchedule.xls/.xlsx submissions. For example, does the Government expect each file to use Password Encryption? If yes, by what method do we submit the password with the proposal submission?

Removed encryption protocol requirement. Contractor will submit files electronically at their own risk.

E.1 Page Count

The instructions state that “Each page shall be counted except the following: executive summary, cover pages, table of contents, title page, lists of tables/figures/acronyms, glossaries, separator tabs, dividers, blank pages, and Volume IV and V in their entirety. Separator tabs will only be marked with section/subsection identifiers. Any other information placed on the separator tabs will not be reviewed.”

Please confirm that lists of acronyms and glossaries are optional.

Confirmed. Acronyms and glossaries are optional and will not be counted toward page count.

E.1 Page Count

The instructions state that “Each page shall be counted except the following: executive summary, cover pages, table of contents, title page, lists of tables/figures/acronyms, glossaries, separator tabs, dividers, blank pages, and Volume IV and V in their entirety. Separator tabs will only be marked with section/subsection identifiers. Any other information placed on the separator tabs will not be reviewed.”

Please confirm that separator tabs, dividers, and blank pages, which are applicable to hardcopy rather than electronic submissions, are not required for this proposal.

Confirmed. Separator tabs, dividers, and blank pages, which are applicable to hardcopy rather than electronic submissions, are not required for this proposal. However, documents shall be organized in a manner that separates and divides sections for each factor.

E.1 Factor I – Technical Approach/Company Experience (RFP p. 99)

The instructions state for Volume I, Tab 1: Factor I – Technical Approach/Company Experience that "Submission shall include a description of the Contractor’s past experience performing this type of work and a detailed technical approach" and then later state that "The offeror shall also provide up to three (3) projects examples, in narrative form, demonstrating the company’s experience as further detailed in the Evaluation Factors for Award section. Projects should be relevant examples of similar scale (size and scope of the PWS) and complexity of this requirement." These instructions imply that the three (3) project examples are in addition to the description of past experience and detailed technical approach.

Can the Government confirm that the “description of the Contractor’s past experience performing this type of work" is comprised of (equivalent to) the three (3) project descriptions to be provided under Volume I Tab 1? If these are separate elements, please clarify the difference.

Confirmed. Separator tabs, dividers, and blank pages, which are applicable to hardcopy rather than electronic submissions, are not required for this proposal. However, documents shall be organized in a manner that separates and divides sections for each factor.

E.1 Factor I – Technical Approach/Company Experience (RFP p. 99) E.2 Factor I - Technical Factor - Technical Approach/Company Experience (RFP p. 105, 106)

The E.1 instructions state for Volume I, Tab 1: Factor I – Technical Approach/Company Experience that "Submission shall include a description of the Contractor’s past experience performing this type of work and a detailed technical approach" and then later state that "The offeror shall also provide up to three (3) projects examples, in narrative form, demonstrating the company’s experience as further detailed in the Evaluation Factors for Award section. Projects should be relevant examples of similar scale (size and scope of the PWS) and complexity of this requirement."

Then, E.2 states that for Factor I, “The offeror’s technical approach and project examples will address” Understanding of the Task Requirements and Feasibility of Approach.

Will the Government please specify where the past experience and three project examples are to be provided within Tab 1 so that projects can be appropriately evaluated for “understanding of the task requirements” and “feasibility of approach”? For example, does the Government expect a separate section from the technical approach that is dedicated solely to experience, with distinct narratives for each project example, or are the three project examples to be described throughout the 36-page technical approach narrative as they are applicable to the PWS tasks (e.g., included within task-level subsections or callout boxes)?

Please see revisions to Factor I in sections E.1 and E.2 clarifying the separation between approach and experience and how each will be evaluated.

E.1 Factor I – Technical Approach/Company Experience (RFP p. 99)

Can other project examples that are relevant be referenced throughout Tab 1 to demonstrate experience and feasibility of approach beyond the three (3) project example narratives?

Only 3 project narratives should be provided in this section.

E.1 Factor I – Technical Approach/Company Experience (RFP p. 99) E.2 Volume III Factor III- Past Performance (RFP p. 100, 101) The instructions state for Volume I, Tab 1: Factor I – Technical Approach/Company Experience that "The offeror shall also provide up to three (3) projects examples, in narrative form, demonstrating the company’s experience as further detailed in the Evaluation Factors for Award section. Projects should be relevant examples of similar scale (size and scope of the PWS) and complexity of this requirement." The instructions for Factor III – Past Performance also state that “Contractors shall submit a narrative detailing up to three (3) total projects (prime contracts, task/delivery orders, or major subcontracts) in performance during the past three (3) years from the date of issuance of this solicitation, which are relevant to the efforts required by the solicitation.”

Can the Government please confirm that the three (3) project examples and narratives provided as part of Volume I, Tab 1 can be the same as those provided under Volume III Past Performance?

Confirmed. The three (3) project examples and narratives provided as part of Volume I, Tab 1 can be the same as those provided under Volume III Past Performance. The past experience should describe what work was performed. The past performance should show how well it was performed (quality).

E.1 Volume, Title, and Page Limitations Table: Volume II (RFP p. 96 of 134) E.1 Factor II- Key Personnel Experience (RFP p. 99 of 134) E.2 Factor II – Key Personnel (RFP p. 106, 107) The Volume, Title, and Page Limitations table on p. 96 states that for Volume II, Factor II – Key Personnel, the Page limitations are “3 project examples” and 2 pages per resume.

The E.1 instructions for Factor II- Key Personnel Experience on p. 99 state that “the offeror shall provide resumes which clearly demonstrate the extent that the personnel meet or exceed the required minimum qualifications, such as education, professional experience, licenses/certifications, accomplishments, and relevant experience to execute the contract requirements.” The E.2 evaluation factor further states that “Evaluation of the proposed key personnel will include educational degrees(s) held and corresponding field of study; description of experience in area of expertise for Proposed Role; the percentage of time available for the proposed role in the contract; description of specific projects related to all tasks outlined in the PWS; responsibilities on specific projects related to tasks outline in the PWS; and description of current project commitments and percent of time committed.”

The instructions and evaluation factor for resumes on p. 99, 106, and 107 request a variety of information and data and make no reference to “3 project examples” nor how that limitation should apply to resumes. Please clarify the “3 project examples” limitation, to include specific instructions as to how it specifically applies to each resume, or alternatively, remove the “3 project examples” limitation so that offerors can describe as many projects as appropriate for each key personnel to demonstrate their relevant experience.

"3 Projects" has been removed from the table. Please disregard the 3 projects within the Key Personnel Factor.

E.1 Factor II- Key Personnel Experience (RFP p. 99 of 134) E.2 Factor II – Key Personnel (RFP p. 106, 107) The E.1 instructions for Factor II- Key Personnel Experience on p. 99 state that “the offeror shall provide resumes which clearly demonstrate the extent that the personnel meet or exceed the required minimum qualifications, such as education, professional experience, licenses/certifications, accomplishments, and relevant experience to execute the contract requirements.” The E.2 evaluation factor further states that “Evaluation of the proposed key personnel will include educational degrees(s) held and corresponding field of study; description of experience in area of expertise for Proposed Role; the percentage of time available for the proposed role in the contract; description of specific projects related to all tasks outlined in the PWS; responsibilities on specific projects related to tasks outline in the PWS; and description of current project commitments and percent of time committed.”

The instructions for Factor II- Key Personnel Experience on p. 99 also state that “an example of a resume template is provided in Attachment 1”.

Please confirm that offerors may include the format outlined in Attachment 1 but can modify the format if needed to ensure compliance with the instructions and evaluation factors for key personnel.

Confirmed. Offerors may include the format outlined in Attachment 1 but can modify the format if needed to ensure compliance with the instructions and evaluation factors for key personnel.

E.1 Volume, Title, and Page Limitations Table: Volume II (RFP p. 96 of 134)

The Volume, Title, and Page Limitations table on p. 96 does not provide a page limitation for Factor VI - Professional Employee Compensation Plan.

Please confirm there is no page limitation for the Professional Employee Compensation Plan.

Confirmed. There is no page limitation for the Professional Employee Compensation Plan.

E.1 Specific Proposal Instructions, Volume III (RFP p. 93) E.1 Volume, Title, and Page Limitations Table: Volume III (RFP p. 96 of 134) E.1 Factor III- Past Performance (RFP p. 100, 101) E.2 Volume III Factor III- Past Performance (RFP p. 107-109) The Specific Proposal Submission Instructions state that Volume III: Past Performance state is comprised of: Tab 1: Past Performance Questionaries (PPQ); Joint Venture Agreements (if applicable); and Subcontractor Teaming Agreements.

The Volume, Title, and Page Limitations table on p. 96 then state that for Volume III, Factor III - Past Performance that Page limitations are “1 page narrative (References will be complete and provide the questionnaire (PPQ) (solicitation Attachment 3), to the Government. Provide no more than three (3) PPQs. PPQs will not be included in page count limitation.)” However, the E.1 instructions for Volume III Factor 1 include detailed instructions for narratives to be provided for three (3) total projects and that the volume is to be organized into four separate sections: 1) Section 1 - Contract Descriptions; 2) Section 2 – Past Performance Narrative; 3) Section 3 – Subcontracts; and 4) Section 4 - New Corporate Entities. This content cannot possibly fit within the 1 page narrative limitation specified on p. 96.

We respectfully request that the Government increase the page limitation for Volume III Tab 1: Past Performance Questionnaires (PPQ) to at least 10 pages to accommodate the requested information.

Confirmed. There is no page limitation for the Professional Employee Compensation Plan.

E.1 Specific Proposal Instructions, Volume III (RFP p. 93) E.1 Factor III- Past Performance (RFP p. 100, 101) E.2 Volume III Factor III- Past Performance (RFP p. 107-109) The Specific Proposal Submission Instructions for Volume III: Past Performance state to include: Tab 1: Past Performance Questionaries (PPQ); Joint Venture Agreements (if applicable); and Subcontractor Teaming Agreements.

However, the E.1 instructions for Volume III Factor 1 include detailed instructions for narratives to be provided for three (3) total projects organized into four separate sections: 1) Section 1 - Contract Descriptions; 2) Section 2 – Past Performance Narrative; 3) Section 3 – Subcontracts; and 4) Section 4 - New Corporate Entities.

Please confirm that Volume III, Tab 1: Past Performance Questionaries (PPQ) is not comprised of PPQs, but rather the four sections outlined within E.1 Factor III – Past Performance instructions, and that PPQs for the three referenced projects are not to be provided within Tab 1 but completed and submitted separately to the Government by the identified POCs.

Confirmed. that PPQs for the three referenced projects are not to be provided within Tab 1 but completed and submitted separately to the Government by the identified POCs.

E.1 Specific Proposal Instructions, Volume III (RFP p. 93) E.1 Volume, Title, and Page Limitations Table: Volume III (RFP p. 96 of 134) E.1 Factor III- Past Performance (RFP p. 101 and 102) The Specific Proposal Submission Instructions state that Volume III: Past Performance state is comprised of: Tab 1: Past Performance Questionaries (PPQ); Joint Venture Agreements (if applicable); and Subcontractor Teaming Agreements.

However, there are no file names or page limitations listed for the Joint Venture Agreements (if applicable) and Subcontractor Teaming Agreements.

Please confirm that these elements, if applicable, should be provided as appendices within the file entitled “[Contractor Name]PastPerf.pdf” and that they have no page limitation.

Confirmed. These elements, if applicable, should be provided as appendices within the file entitled “[Contractor Name]PastPerf.pdf” and they have no page limitation.

E.2 Factor IV – Service-Disabled Veteran Owned Small Business (SDVOSB)/Veteran Owned Small Business (VOSB) Involvement (RFP p. 110)

The E.2 evaluation factor for Factor IV – Service-Disabled Veteran Owned Small Business (SDVOSB)/Veteran Owned Small Business (VOSB) Involvement state that “Non-Veteran offerors proposing to use SDVOSBs or VOSBs as subcontractors will receive some consideration under this evaluation factor”, but later states as part of the Standard for Evaluation Credit for SDVOSBs/VOSBs section, that “No credit will be given to any prime or subcontractor that is not a VOSB or VOSB.”

Please clarify this discrepancy and confirm that non-Veteran primes proposing SDVOSBs or VOSBs as subcontractors will receive partial credit.

Confirmed. Non-Veteran primes proposing SDVOSBs or VOSBs as subcontractors will receive partial credit. See revision to Standard for Evaluation Credit for SDVOSBs/VOSBs.

E.1 Factor IV – Service-Disabled Veteran Owned Small Business (SDVOSB)/Veteran Owned Small Business (VOSB) Involvement (RFP p. 110)

Do large business/non-Veteran offerors who are proposing large business subcontractors need to show the large business subcontractor information as part of items 5 and 6 or are these items only to SDVOSB and VOSB subcontractors?

If not proposing VOSB/SDVOSB subcontractors, please note N/A in section 5 and section 6 need not be submitted. Offeror must still answer questions 1-5 in Volume IV.

E.1 Factor IV – Service-Disabled Veteran Owned Small Business (SDVOSB)/Veteran Owned Small Business (VOSB) Involvement (RFP p. 110)

E.1 instructions for Factor IV – Service-Disabled Veteran Owned Small Business (SDVOSB)/Veteran Owned Small Business (VOSB) Involvement include:

5. Brief description and approximate dollar value and proposed percentage of work performed by proposed subcontract(s).

6. Submit a completed - Self-Performed Work with Proposal (Attachment 4) offerors must “6. Submit a completed - Self-Performed Work with Proposal (Attachment 4) Do large business/non-Veteran offerors who are proposing large business subcontractors need to show the large business subcontractor information as part of items 5 and 6 or are these items only to SDVOSB and VOSB subcontractors?

If not proposing VOSB/SDVOSB subcontractors, please note N/A in section 5 and section 6 need not be submitted. Offeror must still answer questions 1-5 in Volume IV.

E.1 Specific Proposal Instructions, Volume V (RFP p. 94) E.1 Volume, Title, and Page Limitations Table: Volume V (RFP p. 97) E.1 instructions for Volume V, Factor V- Price (RFP p. 102-103) The specific proposal instructions state that Volume V is comprised of: Tab 1: SF 1449 – Cover Letter, Solicitation, acknowledgement of amendments, Offer, and Award (Section A); Tab 2: Representations, Certifications and Other Statements of Offerors; Tab 3: Pricing Schedule; and Tab 4: Subcontracting Plan (Applicable to Large Businesses Only – See Attachment 6 for Subcontracting Plan Template) There is no reference to Tab 4: Subcontracting Plan within the Volume, Title, and Page Limitations Table for “Volume V” and “Volume V Cont.” or within the E.1 instructions for Volume V reference Tab 4: Subcontracting Plan.

Please clarify where Tab 4: Subcontracting Plan (i.e., Attachment 6) is to be included within the Volume V submission files. For example, should it be included within the "[Contractor Name]Other.pdf" submission file?

Please include Attachment 6 within the "[Contractor Name]Other.pdf" submission file.

General

Amendment to a Previous Combined Solicitation

Amendment to a Previous Combined Solicitation

Page 1 of

Amendment to a Previous Combined Solicitation

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

730-22-3-3034-0013 36C77622R0090 07-14-2022 Haley Huff 07-28-2022 17:00

CDT

00776 Department of Veteran Affairs

PCAC-ST. LOUIS

1 Jefferson Barracks Dr., Bldg Saint Louis MO 63125 X 541611 $21.5 Million N/A X See Attached Department of Veteran Affairs Employee Education System (EES) 1 Jefferson Barracks Dr., Bldg Saint Louis MO 63125 00776 Department of Veterans Affairs

PCAC-ST. LOUIS

1 Jefferson Barracks Dr., Bldg St. Louis MO 63125

Department of Veterans Affairs Financial Services Center Invoices To Be Submitted Electronically https://www.fsc.va.gov/einvoice.asp e-Invoice Setup Info Phone 877-489-6135

PHONE: 877-353-9791

FAX: 512-460-5429

See CONTINUATION Page This Solicitation is being prepared and conducted in accordance with FAR Part 15.

The Department of Veterans Affairs (VA) Program Contracting Activity Central (PCAC) is issuing this Request for Proposal (RFP) with the intent of awarding a single award IDIQ contract for Payer Relations and Services Support.

Period of Performance: Base Year Plus Four (4) Option Years Minimum Guarantee: $2,500.00 Minimum Order: $2,500.00 Contract Ceiling: $25,000,000.00 Signed Business Associate Agreement will be required prior to award.

See CONTINUATION Page

730-3620152-3034-805100-2580-SPW0GP1AB

X X X Page 1 of Page 1 of 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 36C776 Department of Veteran Affairs

PCAC-ST. LOUIS

1 Jefferson Barracks Dr., Bldg 56 Saint Louis MO 63125

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.

https://www.fsc.va.gov/einvoice.asp ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

36C77622R0090

Page 1 of Page 1 of Page 1 of Page 1 of

B.2 PERFORMANCE WORK STATEMENT

Title of Project: Payer Relations and Services Support Contract

The Payer Relations and Services (PR&S) department, within the Office of Finance, Revenue Operations, provides detailed analytical support to review reimbursement rates paid or proposed by Third-Party Payers (TPPs) and Pharmacy Benefit Managers (PBMs) to determine whether payments meet federal payment requirements. PR&S is also responsible for the implementation of VA’s rates and charges billed to TPPs and other entities.

Scope of Work: The Contractor shall provide subject matter expertise sufficient to support PR&S in areas to include Electronic Health Record Modernization (EHRM) implementation, development of rates and charges, changing payer reimbursement models, rate verifications, expanding analytical needs, and program/project support.

Specifically, the contractor shall support PR&S with the following:

· Overall PR&S program support to include project management, Standard Operating Procedure (SOP) and Guidebook development, special project support, business and strategic analysis of PR&S operations, development of executive presentations, and facilitation of executive briefings

· Planning, development, calculation and implementation of VA Rates and Charges for inpatient admissions, skilled nursing admissions, outpatient services, professional services, supplies, and drugs; encompassing all medical services for over 1500 VA hospitals/clinics in over 700 geographic areas

· Provision of national rates and charges to the specific geographic adjusted charge for stations in production with the VA’s new Electronic Health Record (EHR).

· Administration of TPP Rate Verification activities

· Key Performance Indicator (KPI) monitoring and risk mitigation under Electronic Health Record Modernization (ERHM) Charge Services (CS) and Charge Description Master (CDM) governance

· Net Collection Ratio (NCR) analysis, review, and recommendations

· Provide assessments of current state to industry best practices

· Development and stand up of a robust revenue integrity program that aligns revenue and workload components across Consolidated Patient Account Centers (CPACs), Veterans Integrated Services Networks (VISNs), and Veterans Affairs Medicals Centers (VAMCs).

· Support PR&S and regional Payer Relations Managers (PRMs) with activities relating to value-base care (VBC) arrangements

· Analysis of annual charge master updates that assesses the impact of variances in charge amounts, unit dosage changes, and VA utilization changes from the prior year

· Training, mentoring and education support of PR&S staff and PRMs

· Ad Hoc analyses, studies, or assessments

· TPP agreement review and recommendations

· Financial impact analysis related to rate verification with commercial payers

2. Background: Title 38 USC Section 1729 and Title 38 CFR Part 17.101 and Part 17.106 is the authority that permits VA to seek reimbursement from TPPs and PBMs for the cost of non-service-connected medical care furnished to eligible Veterans who have commercial insurance coverage. Under this authority TPPs are required to pay VA billed charges, or the amount they can demonstrate to the satisfaction of the Secretary of VA that they pay non-government providers in the same geographic area as a VA Medical Center (VAMC). The money collected from TPPs and PBMs is revenue anticipated in the President’s budget and helps to offset VA imposed cost sharing for world class medical care provided to our nations Veterans.

PR&S established a process to verify whether or not a TPP or PBM is reimbursing VA per the authority noted above and has worked with a number of TPPs to develop regional and national payer agreements and rates. The goal of this process is to ensure TPP compliance with this authority and to identify and maximize revenue and operational opportunities.

VA is committed to delivering world-class service to Veterans and their families. To adequately fund world-class health care services, VA needs to collect funds from private health insurers and, where permitted by law, public health insurance.

VA implemented the reasonable charges methodology to set charges for medical care services and updates them on an annual basis. This methodology sets VA charges at the 80th percentile of nationwide charges. This methodology has been employed since 1999. VA requires Contractor support to assist in the development of rates and charges for a variety of services, in addition to providing support in evaluating opportunities to improve revenue.

3. Performance Period: The period of performance shall be one year from the date of award for a base period. The contract will also include four (4) 12-month option years.

There are eleven (11) Federal holidays set by law (U.S.C. Title 5 Section 6103):

Under current definitions, five are set by date:

If any of the above falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if it falls on a Sunday, then Monday shall be observed as a holiday.

The other six are set by a day of the week and month:

Work at the government site shall not take place on Federal holidays or weekends unless directed by the Contracting Officer (CO).

4. Place of Performance: The Contractor shall support this effort at the Contractor facilities within the continental United States. Under no circumstances can any of the services be provided by contractor employees outside of the United States.

5. Type of Contract: The Government will award a Firm Fixed Price, Indefinite Delivery, Indefinite Quantity (IDIQ) contract for this requirement.

6. APPLICABLE DOCUMENTS:

Documents referenced or germane to this PWS are listed below. The Contractor shall be guided by the information contained in the documents in performance of this PWS. The documents are:

a. 38 Code of Federal Regulations (CFR), 17.101, 17.100, 17.102 and 17.106

b. Title 38 USC Section 1729

c. Center of Medicare and Medicaid Services (CMS) guidelines

d. Center of Medicare and Medicaid Services (CMS) Databases

e. Data reports to mirror those described in 38 CFR 17.101

f. The Health Insurance Portability and Accountability Act of 1996 (HIPAA – all existing and revised statutes)

g. Federal Information Security Management Act (FISMA)

h. VHA Policy

In addition, all work and products executed and provided to VHA Office of Finance/Revenue Operations PR&S shall be formatted and/or structured to be compatible (e.g., data structures/input/output must execute without error and reports/documents shall be formatted to comply with established guidance) with the following established protocols:

· Structured Query Language (SQL)

· My SOL, Workbench, Oracle Discoverer and Oracle Business

· VHA Intelligence tools (Power+, mPower, Power BI (Oracle Business Intelligence); Payer Compliance Tool; Tableau or Spotfire

· Project Management Institutes Body of Knowledge (PMBOK)

· MS Office

B1. GENERAL REQUIREMENTS:

General Requirements:

a. All written deliverables will be phrased in layperson language. Statistical and other technical terminology will not be used without providing a glossary of terms.

b. All CMS mandated regulations relating to billing, rates, and charges shall be incorporated into the rate development task identified in tasks 3 through 5.

c. All VA Reasonable Charge methodology as identified in 38 CFR 17.101 (including data sources and calculations) shall be followed.

The Contractor team shall have knowledge of Current Procedural Terminology (CPT)/Diagnostic Related Group (DRG)/Healthcare Common Procedure Coding System (HCPCS) codes. In addition, possess knowledge of technical concepts and training in preparing analytic reports and economic analysis using VA data which is Billed and Charge data by month, to do trend analysis and projections on estimated revenue impact on charge updates. Also, the contractor shall have the medical health care expertise in making sound judgement calls on the data that is being used to develop charges. This is a critical necessity to have as a contractor due to the sensitivity of the work. The contractor shall possess and demonstrate the following knowledge:

a) 3rd Party Coding and Billing – updating codes, modifiers and charges based on CMS regulations and effective dates.

b) A CMS Bundling rules –understanding some codes are not billable.

c) A Bundling regulations for admin codes.

d) A Status indicator knowledge – understanding what codes are used for Inpatient, Outpatient and SNF billing.

e) A VA IT Host files preparation – working with staff and IT patch developer staff to provide proper charge assignments.

f) VA Reasonable Charges Regulations in 38 CFR 17.101 (pages of calculations) for each area of billing.

g) CMS Regulations relating to billing, rates, and charges.

h) Developing charges at the 80th Percentile of nationwide charges.

i) Itemized vs per diem inpatient billing.

j) Extensive knowledge of Medicare Severity Diagnostic Related Groups (MS-DRGs) – which began in 2008 with Complications and Comorbidities (CC) and Major Complications and Comorbidities (MCC’s).

k) Developing Room & Board (R&B), Ancillary, Intensive Care Unit (ICU) services – most data received nationwide is based on itemized billing.

l) Working knowledge of APC Groupings – Medicare APC pricing has to be adjusted to conform to VA’s rates at the 80th percentile.

m) Working with outlier claims and the correlation for developing charges – some charges should not be used because they skew the outcome of the charge development and are out of the norm.

n) Use of medical and non-medical CPI-U, Medicare geographic practice cost expense and all urban consumers.

o) Working knowledge of developing Geographical Area Adjustment Factors (GAAF’s) to develop charges for different areas of the country. Understand COLA (Cost of Living Allowances), wage indexes and non-wage indexes which all play a part in COLA/GAAF’s. Labor/non-labor components.

p) A Working knowledge of Med Par files, Market Scan and Fair-Health databases.

q) Working knowledge of creating DME, Medical and Lab Fee Schedules.

r) Working knowledge of the development of Professional conversion factors.

s) How payers in the private sector apply discounts on reimbursement of billed charges.

t) Working knowledge and experience with creating an economic analysis - very critical to projection of future revenue generation.

u) And hands-on experience making the tables 508 compliant using Adobe XI PRO or applicable VA required software for web-posting

v) The contractor shall possess an understanding of conversion of drug dosages from Milliliters to Milligrams to properly set charge rates for drugs.

w) To analyze large claim database extracts (up to 100,000,000 rows or lines of data) of sensitive information in accordance with FISMA from both the VA and external TPP systems and provide a relevant data analysis of both the VA claims data and TPP claims data to determine if reimbursement rates paid or proposed by TPPs or PBM meet federal payment requirements.

x) To complete market and data analysis related to emerging TPP alternative payment methodologies in order to provide the financial impact of emerging payment methodologies in the insurance industry.

y) To be able to complete an annual analysis of VA Annual Charge Master updates that analyzes impact of variances in charge amounts, unit dosage changes, and VA Utilization changes from the previous year.

It is an integral requirement of this contract that the contractor shall provide staff experienced in healthcare consulting including a comprehensive knowledge and understanding of common reimbursement methodologies and payment practices for Medicare and other third-party payers. Key personnel demonstrating an understanding of the federal regulatory process as well as the VA charge methodology detailed in 38 CFR 17.101 is required.

A member of the Contractor team shall be a member of the American College of Healthcare Executives (ACHE), American Association of Healthcare Administration Management (AAHAM), Healthcare Financial Management Association (HFMA), the American Health Information Management Association (AHIMA) or similar healthcare administration industry organization.

Key Personnel: The Contractor shall provide staff experienced in healthcare consulting, including development of charges using a variety of methods for both Medicare and commercial insurance billing. This includes a comprehensive knowledge and understanding of common payment practices for Medicare and other third-party payers. The Contractor shall be able to develop rates and charges based on the published VA methodology and perform an economic analysis on the expected changes in the rates and charges. The Contractor shall be able to demonstrate extensive experience in the following categories: actuarial experience, healthcare billing experience, and exhibit comprehensive knowledge and understanding of common payment practices for Medicare and other third-party payers. The Contractor shall demonstrate an understanding of the federal regulatory process as well as the VA charge methodology detailed in 38 CFR 17.101. The Contractor shall be experienced in evaluating payment rates and methodologies made by TPPs and have a comprehensive knowledge and understand of common reimbursement methodologies and payment practices. In meeting the requirements of this contract, the individuals listed below are considered essential to successful performance and are “Key Personnel” who must possess, at a minimum, the following experience and background:

Partner/Principal – Must possess a Bachelor’s degree and Actuary Certification

Must possess a minimum of ten (10) years actuarial experience in the health insurance industry particularly with respect to facility and professional rate development, charge description master maintenance and evaluation of rates in relationship to Medicare Fee Schedules and payer agreements. The Contractor shall have at least one principal/partner with current professional actuarial certification and be a member of an actuarial society in good-standing (e.g., Fellow of the Society of Actuaries (FSA), Associate of the Society of Actuaries (ASA), Member of the American Academy of Actuaries (MAAA)). Previous experience and working knowledge of Centers for Medicare and Medicaid Services (CMS) regulations and development of actuarial models based on Medicare Provider Analysis and Review file (MedPAR), MarketScan, Essential Resource-Based Relative Value Scale (RBRVS), FAIR Health databases, Medicare Ambulatory Payment Classification (APC), Medicare Geographic Practice Cost Index for both practice and work expense, Medicare Durable Medical Equipment (DME), Medicare Lab Fee Schedule and Medicare Conversion Factors. Additionally, experience working with Consumer Price Index – All Urban Consumers (CPI)-U in applied situations for statistical modeling.

Project Manager – Must possess a Bachelor’s degree and Project Management Professional (PMP) Certification

Must have a minimum of seven (7) years’ experience as a Project Manager and Health Care Reimbursement subject matter expert.

Senior Staff – Must possess a Bachelor’s degree and Actuary Certification

Must possess a minimum of Five (5) years actuarial experience in the health insurance industry particularly with respect to facility and professional rate development, charge description master maintenance and evaluation of rates in relationship to Medicare Fee Schedules and payer agreements. The Contractor shall have at least one senior staff member with current professional actuarial certification and be a member of an actuarial society in good-standing (e.g., Fellow of the Society of Actuaries (FSA), Associate of the Society of Actuaries (ASA), Member of the American Academy of Actuaries (MAAA)). Must have previous experience and working knowledge of CMS regulations and development of actuarial models based on MedPAR, MarketScan, Essential RBRVS, FAIR Health databases, Medicare APC, Medicare Geographic Practice Cost Index for both practice and work expense, Medicare DME, Medicare Lab Fee Schedule and Medicare Conversion Factors. Additionally, experience working with CPI-U in applied situations for statistical modeling.

Substitution of Key Personnel. All Contractor requests for approval of substitutions hereunder shall be submitted in writing to the COR and the Contracting Officer at least (30) calendar days in advance of the effective date, whenever possible, and shall provide a detailed explanation of the circumstances necessitating the proposed substitution, a complete resume for the proposed substitute, and any other information requested by the Contracting Officer necessary to vet the proposed substitution. Substitute key personnel shall not commence work until all necessary security requirements have been fulfilled and resumes provided and personnel accepted by the Contracting Officer. The COR and the Contracting Officer will evaluate such requests and promptly notify the Contractor of approval or disapproval in writing. All substitutions must demonstrate via resume the minimum requirements listed in this section.

B2. SPECIFIC MANDATORY TASKS AND ASSOCIATED DELIVERABLES

Description of tasks and Associated Deliverables: The Contractor shall provide the specific deliverables described below. See the schedule of deliverables for the specific dates.

Task 1: Project Management. The Contractor shall establish an initial kick-off conference call/virtual meeting with the PR&S project team. The Contractor shall provide a detailed project management plan and briefing for the PR&S project team, which presents the Contractor’s plan for completing the task order. The Contractor’s plan shall be responsive to this PWS and describe, in further detail, the approach to be used for each aspect of the task order as defined in the technical proposal. At a minimum, the project management plan shall include the risk, quality, and technical management approach, detailed schedule, cost requirements and proposed personnel. The Contractor shall keep the project management plan up to date throughout the period of performance. The Contractor shall establish a recurring conference call/virtual meeting with PR&S project team monthly and provide meeting minutes documenting attendance, discussions, decisions, actions, and next steps within 5 calendar days following the meeting.

Deliverable 1:

· 1a: Initial Kick-off meeting established within 7 calendar days of contract award.

· 1b: Project Management Plan within 30 calendar days of contract award.

· 1c: Monthly Project Status meeting established within 30 calendar days of contract award.

· 1d. Meeting minutes provided within 5 calendar days following the meeting.

· 1e. Monthly status report providing work in-progress or completed, as well as any issues or risks that need to be communicated to the COR. The report will be delivered on the fourth Wednesday of each month.

Task 2. Program Support. The Contractor shall meet with the PR&S project team in person at the PR&S Offices in the Mid-Atlantic Consolidated Patient Account Center (MACPAC) building located at 128 Bingham Road, Asheville NC 28801 within 30 calendar days of contract award. The Contractor shall provide a staff member skilled in project management and meeting facilitation as well as a senior healthcare consultant. This meeting will plan out the program support needs for the period of performance to include:

· Standard Operating Procedure (SOP) development or updates

· Guidebook development and/or updates

· Key Performance Indicator monitoring

· Business and strategic analysis

· Other program support needs determined during the initial meeting.

Monthly program support meetings will be scheduled, facilitated, and recorded by the Contractor.

Deliverable 2:

· 2a - Contractor shall provide a detailed project plan to meet the objectives identified in the Program Support meeting within 15 calendar days following the meeting.

· 2b – Monthly meeting minutes and project plan updates shall be provided within 5 calendar days following the monthly meeting.

Task 3. Inpatient Update. The Contractor shall submit the draft and final inpatient economic analysis to VA PR&S project team to include existing and new MS-DRGs (for inpatient and Skilled Nursing Facility (SNF) updates) based on the CMS regulations published each fiscal year. The Contractor will identify any new MS DRG codes and provide to the PR&S team within 15 days of the codes being published by the Standard Development Organization (SDO). The Contractor will assist VA on how to set up the EHR billing system for the new codes, as necessary. The Contractor shall facilitate a virtual meeting to review the findings and address any rate outliers. The Contractor shall submit draft Host Files and Federal Register tables to the PR&S project team for review. The Contractor shall provide updated final Host File and Federal Register tables related to the inpatient charge update upon PR&S project team approval of draft documents. The Contractor shall review methodologies used previously in accordance with 38 CFR 17.101 and ensure that regulations are followed while developing the Inpatient and SNF tables and charges. The rate updates must include updated tables based on CMS regulations published each fiscal year. The tables must be in the format used by VA for Federal Register publication and the Host file tables must be developed based on VA format (Excel spreadsheet) and reviewed by Office of Information Technology staff prior to acceptance. The contractor will provide the annual DRG and SNF EHR Data Collection Workbook (DCW) with geographically adjusted per diem prices for all medical centers currently implemented with the Cerner Millennium system or those that have been identified by VA as being in the testing phases of a future implementation. VA will provide a current list of facilities for the period of performance that have implemented the new EHR or are in the testing phase on a monthly basis by the 1st Tuesday of each month. The Contractor shall provide a final project binder describing the methodology used for the MS-DRG rate update, a copy of the host files and federal register tables, as well as detailed reports showing the variance in rates per MS-DRG year over year. The Contractor shall participate as needed on rate development conference calls and respond to questions directed to them within two business days of the receipt of the question.

The Contractor shall:

3a. Provide a draft economic analysis in Excel spreadsheet format by the first week in July, annually. The economic analysis must include a detailed estimate of increase in revenue based on VA’s prior year…