36C79118R0022-0003000.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION

OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR

ACKNOWLEDGMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADM

INISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and d ate specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 3

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO

MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 11-19-2018 Department of Veterans Affairs Commodities & Services Acquisition Svc (003B6E) 555 Corporate Circle Golden CO 80401-5621

To all Offerors/Bidders

36C79118R0022 11-19-2018

X x x 5:00 p.m. MST 11/30/2018 x The purpose of this amendment is to publish the remainder of the questions and answers received.

Additionally, this amendment provides a summary of the changes to the solicitation and a conformed copy of the solicitation. An updated version of Attachment 1 - QASP, Attachment 2- Facility List and Attachment 3- Attestation Statement are all updated and provided herein.

The due date for proposals has been extende d from 11/26/2018 to 11/30/2018 at 5:00 p.m. MST.

CONTINUATION PAGE

Questions and Answers- The following pages provide answers to 37 questions received in response to the solicitation.

1. (Section B.4.2.b) "Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures" Can we get a copy of this handbook and/or outline of actual requirements for background checks?

Answer: This language has been removed from the solicitation.

2. (Section B.4.2.c) "Contract personnel who require access to national security programs must have a valid security clearance." Does this apply to OFFEROR NAME REDACTED? If yes who from OFFEROR NAME REDACTED requires a security clearance?

3. (Section B.4.2.e) "The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employ." - Can we define contractor in terms of OFFEROR NAME REDACTED? If this involves 1,000’s of clinics would be challenging to provide this information.

Answer: The contractor must let the government know within 24 hours via email to the Financial Services Center/Enterprise Helpdesk when an employee no longer has a need to access VA information.

4. (Section B.4.3.b) "VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor’s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met ." Does this refer to EMR? If yes would be very difficult to accomplish. Also VA data may be included in reports and health care operations data run for the clinics. Please advise.

5. (Section B.4.3.i) "The contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed VA’s minimum requirements. VA Configuration Guidelines are available upon request ." Please provide a copy of these guidelines.

Answer: This language has been removed from the solicitation. Contractor needs to follow HIPAA guidelines.

6. (Section B.4.3.j) "Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response. " Does this refer to requests that follow HIPAA requirements? For example patient requests copy of their medical records, etc.

Answer: The contractor must follow HIPAA guidelines that are already in place throughout the industry. This language has been removed from the solicitation.

7. (Section B.4.3.l) "For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA ) on a yearly basis and provide it to the COTR". - Does this apply to OFFEROR NAME REDACTED?

Answer: The contractor must follow HIPAA guidelines that are already in place throughout the industry. This language has been deleted from the solicitation.

8. (Section B.4.3.4.j) "The vendor shall notify VA within 24 hours of the discovery or disclosure of successful exploits of the vulnerability which can compromise the security of the Systems (including the confidentiality or integrity of its data and operations, or the availability of the system). Such issues shall be remediated as quickly as is practical, but in no event longer than 3 business days . " - Does this mean 24 hours within the time of attempted security compromise or actual compromise? 24 hours would be difficult. Can this be expanded to 72 hours?

Answer: No, the VA requires notification within 24 hours. Therefore, as stated in the solicitation: “The vendor shall notify VA within 24 hours of the discovery or disclosure of successful exploits of the vulnerability which can compromise the security of the Systems (including the confidentiality or integrity of its data and operations, or the availability of the system). Such issues shall be remediated as quickly as is practical, but in no event longer than 3 business days.”

9. (Section B.4.3.5.a) "A Privacy Impact Assessment (PIA) must also be provided to the COTR and approved by VA" - When is the PIA due?

Answer: No. A Privacy Impact Assessment will not be required as the contractor system is a HIPAA Covered entity and the data protections fall under the Department of Health and Human Services. This language will be removed from the solicitation.

10. (Section B.4.3.5.b) "Adequate security controls for collecting, processing, transmitting, and storing of Personally Identifiable Information (PII), as determined by the VA Privacy Service, must be in place, tested, and approved by VA prior to hosting, operation, maintenance, or use of the information system, or systems by or on behalf of VA." What mechanism does the VA use for approval? Is this a review of PIA, etc.?

Answer: The contractor must follow HIPAA guidelines that are already in place throughout the industry. This language has been removed from the solicitation.

11. (Section B.4.3.5.h) "Bio-Medical devices and other equipment or systems containing media (hard drives, optical disks, etc.) with VA sensitive information must not be returned to the vendor at the end of lease, for trade-in, or other purposes. The options are" - Please clarify who is the vendor in this scenario? Does this mean that when returning OFFEROR NAME REDACTED laptops and devices for example to Dell this requirement applies? Or is this saying devices maintained by VA??

Answer: Not applicable. This language has been removed from the solicitation.

12. (Section B.5) Performance Work Statement – Community Care Network (CCN) "It is the VA’s intent to transition dialysis services under the Nationwide Dialysis Services Contract (NDSC) program to the Community Care Network (CCN) contracts providing a wide-array of healthcare services to Veterans. There are four CCN Regions and the contracts will likely not be awarded at the same time. The offerors who are awarded contracts under CCN have a pre-determined amount of time to reach full healthcare delivery. At the point of operational healthcare delivery, the VA may choose not to exercise options on the dialysis contract(s) in the regions where CCN healthcare is operational, may issue a modification to the facility list, Attachment 2, removing facilities, and/or may transition authorizations from the dialysis contracts to the CCN contract(s)." Define point of operational health care delivery. Can this term be applied to regions, states, counties? Describe process on how VA plans to transition dialysis services from OFFEROR NAME REDACTED to CCN?

Answer: CCN contractors have 180 days after contract award to achieve the Start of Health Care Delivery (SHCD). For SHCD, the minimum schedule requirement includes full implementation of one (1) VA Urban Site and one (1) VA Rural Site per awarded CCN Region. SHCD is applicable to each CCN region. The language in the solicitation in the paragraph has been updated. The process for transitioning dialysis services from the Nationwide Dialysis Service Contract (NDSC) to CCN will be based on Veterans medical need and clinical factors.

13. (Section B.5.4)" Contractors shall not perform any services under this contract without prior authorization. " - Contradicts section 5A . Section 5A"Along with the scheduling of an appointment at a specific contracted dialysis facility, the Ordering Officer will provide the contractor with a proper authorization PRIOR to the patient arriving at the scheduled contractor’s facility. In the event that the dialysis facility has not received the authorization in the Provider Portal after coordination has been made, the contractor shall contact the VAMC within 10 business days from the authorization expiration date and inquire as to the status of the authorization. If the authorization has been input into RAS, the contractor shall contact the FSC Customer Service Helpdesk at VAFSCCSHD@va.gov, telephone number 1-877-353-9791 for access issues. The contractor’s inability to access authorizations through the established Provider Portal shall not be a reason to refuse care to the Veteran. If the authorization cannot be obtained via the Provider Portal, alternate methods of obtaining the authorization shall be pursued by the contractor by contacting the authorizing VAMC or COR. Treatment constitutes acceptance of the Veteran and authorization."

Answer: Please see the amended Section B.5.A. for updated language correcting the contradiction. The language stands at B.5.4, “Contractors shall not perform any services under this contract without prior authorization.”

14. (Section B.5.4.E) "Issuance of VA Authorizations: Elements of an authorization for verification include, but are not limited to:

4. Onset Date " I do not see the onset date on current authorizations, where will the onset date appear on the new authorizations?

Physicians have 45 days to submit the 2728 to the network, when there is a new patient on dialysis we may not be able to confirm the first date of dialysis (onset) until that is completed. Verification in these cases cannot be completed in 10 days.

Answer: The onset date is currently populated on the hard copy 7079 authorization issued to contracted facilities and sent via U.S. Mail by the Financial Services Center in Austin TX.

Please see amended section B.5.4.E: “Onset date verification by exception must be 55 business days from the receipt of the authorization.”

15. (Section B.5.4.E) "This verification must be within ten (10) business days of receipt of the authorization and the contractor may request any changes in writing via email during this period through the issuing VAMC and the COR. All questions pertaining to the authorization should be addressed to the Ordering Officer listed on the authorization. If the contractor continues to provide services beyond the ten (10) business day review period, without notifying the issuing VAMC of the authorization issue, payment may be denied. There are three types of authorizations applicable to this contract: new, renewal, and transient. - Physicians have 45 days to submit the 2728 to the network, when there is a new patient on dialysis we may not be able to confirm the first date of dialysis (onset) until that is completed. Verification in these cases cannot be completed in 10 days. Our biggest concern is when we accept a patient, there is delay in the auth and there ends up being a gap between the effective date of auth and actual 1st tmt. How does VA plan to alleviate this issue? Can this period be extended?

Answer: The contractor may not treat a Veteran without an authorization. The contractor may contact the authorizing VAMC to inquire about status of the authorization. The contractor may reach out to the COR or CO for further support as needed. Additionally, the following language exists in the section B.5.4.E, “Note: The VA may modify authorizations to include the allowance to extend previously expired authorizations or to modify an authorization in the event services were provided without a current authorization. The contractor is still responsible for communicating with the VA regarding missing/expired authorizations.” Please see amended Section B.5.4.E.

16. (Section B.5.4.E.1)" If the authorization is not populated into the Provider Portal within 10 business days, the Contractor will contact authorizing VAMC, COR or CO to obtain. " When there is a new clinic an authorization cannot be pulled through the Portal. How will we obtain a copy? The Portal requires an authorization number to access. If not populated up to 10 days this will delay treating. We have 10 days to review the authorization. How will this work if the authorization can take up to 10 days to appear in the Portal and the patient cannot begin treatment until we are issued the authorization?

Answer: Please see amended Section B.5.4.E.1. The contractor has up to 10 days to receive the authorization but if treatment is scheduled prior to the 10th day the contractor and the VAMC will need to collaborate to ensure the contractor has the authorization prior to the Veteran receiving care. The 10 days to review the authorization is from receipt of the authorization. The timelines are not overlapping.

17. (Section B.5.7) " In the event a Change in Ownership (CHOW) affects a facility under contract, the contractor shall notify the CO, COR and applicable VAMC at least 30 calendar days prior to the expected effective date," - Is the Statement of Intent a formalized form or just a written statement? Bill of sale information is confidential and can’t be shared with third parties. Can we add language? Example - "subject to confidentiality provisions pursuant to transaction documents. Contractor will use commercially reasonable efforts to have transaction parties waive confidentiality provisions in order for Contractor to comply with this agreement."

Answer: A formalized form is not required. However, a written statement of intent via email to CO, COR, and applicable VAMC is required. The bill of sale language was removed from the amended solicitation. However, the statement, the contractor shall provide, “Any other applicable documents requested by the CO or COR.” This could include requesting ownership percentages and other related information.

18. (Section B.5.7) " The contractor shall provide:

• Authorizations in RAS valid until legal sale date " - Can we gain clarity as to what this item/process is?

19. QASP #3 standard for reporting breaches – requires email notification with “read receipt”. Does there need to be a dedicated email for these breach reporting that will allow for us to track and monitor?

Answer: Please report breaches to: occdialysis@va.gov. Attachment 1 QASP Table A #3 language has been updated.

20. (Section B.10.F) "Billing for Incomplete Treatments: If a dialysis treatment is started, (i.e., a Veteran is connected to the machine and a dialyzer and blood lines are used), but the treatment is not completed for some unforeseen but valid reason, as determined by the VA, the contractor shall be paid based on the full per treatment price. This should be a rare occurrence and must be fully documented on the billing statement to the VA. This event must also be fully documented by the contractor in the Veteran’s medical record. " Billing system incapable of documenting this on billing statement. Please advise.

Answer: Please see amended Section B.5.10.H which discusses “Billing for Incomplete Treatments”. Note: VA corrected referenced section in the answer because B.10 does not exist.

21. (Section B.5.17) - We see that Contractor Designated Personnel and Responsibilities have been included, but VA Designated Personnel section was previously included, but has now been removed from the current contract solicitation. Please advise.

Answer: The VA Medical Center points of contact information will be provided upon contract award.

22. Attachment 3 Attestation (E) – What are the VA Privacy and Security training requirements? “All” employees is a broad terminology – is there a more refined definition of who needs to complete the training? Can our own Privacy and Security training be substituted as compliant? Is this a one-time training or annual requirement?

Answer: The training is through VHA/FSC. Training will be required annually. Further instructions will be provided upon award. Attachment 3- Attestation Statement “E” has been removed from the solicitation because there is no way for offerors to certify they are compliant with the training in the VA system prior to award. This language may be added and required for Attestations after contract award.

23. Unable to populate VISN on all 2,600 clinics. Do you have VISN by state by County?

Answer: This information is no longer required. Column A – “Network” and Column B – “VISN” is eliminated from Attachment 2 – Facility List.

24. Can you please clarify if the intent for the section copied below is to name the solicitations received throughout October regarding this RFP or does this mean to list the attachments received with the final solicitation?

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

Answer: The intent of the quotation immediately above is to ensure offerors track and acknowledge amendments to the solicitation. Offerors are required to fill out the amendment numbers and dates of the amendments in the blank table of the solicitation, or offerors should attach each amendment with their signature to show they have received and acknowledged them.

25. In Attachment 2 – Facility List - FY19, Column A: Please explain the field titled “Network”. Is this meant to reference the ESRD Network in our service area as identified by The National Forum of ESRD Networks (in the case of South Dakota, for example, ESRD Network 11)?

Answer: Updates have been made to Attachment 2. Columns A and B have been removed.

26. In section B3 of the Solicitation on page 7, the document states “No Business Associate Agreement (BAA) is required. In section B4.g. on page 8, it states, “If a VHA contract is terminated for cause, the associated BAA must also be terminated and appropriate actions taken in accordance with VHA Handbook 1600.01, Business Associate Agreements. Absent an agreement to use or disclose protected health information, there is no business associate relationship.” Please explain if this is a contradiction.

Answer: The language for B.4.g has been removed from the solicitation.

27. In Attachment 2 – Facility List – FY19, column U-Current Utilization: What is meant by Current Utilization? Are you looking for VA-specific volumes, overall census or something else? Is the metric intended to be a percentage, such as patients/capacity, or a general number of patients?

Answer: The “Current Authorization” column has been deleted from Attachment #2 – Facility List.

28. From the RFP (Page 20) Section B.5.4: “D. Authorization Process: Ordering Officers will issue written authorizations to the contractor via RAS, or other systems designated by the CO or COR. In accordance with FAR 16.505, Ordering, VA has determined orders will be placed based on Veteran preference, clinical need, contractor’s facility capacity, and price.”

Offeror states: Under FAR 16.505 (B) orders under multiple award contracts contracting officers must provide each awardee a fair opportunity to be considered for each order exceeding $3,500. Patient authorizations are issued (in general) for a year and exceed this threshold. Does the authorization of services under this RFP fall under an exception to the fair opportunity process or will any request for services be open for bid? Please provide clarity regarding those priorities associated with the criteria used in the Authorization Process IAW FAR 16.505 (preference, clinical need, facility, price).

Answer: VA has not determined if an exception to fair opportunity applies. VA intends to issue orders without seeking proposals/offers for individuals orders. Rather, VA intends to consider Veteran preference, clinical need, facility location and price in descending order of importance when placing orders for dialysis services.

29. Section B.3. of the solicitation provides that once copies of VA data are transferred, it is considered the contractors data upon receipt and must be protected under HIPAA rules.” The VA reiterates this further down the section when stating that background checks and training of contractor staff are “not needed as the ownership of the data will transfer to the vendor upon receipt.” However, several other portions of the solicitation refer to “VA information” and impose requirements on security and storage related to the “VA information”. (See Sections B.4.2.e., B.4.3.b., B.4.4., B.4.5., B.4.6.). What is considered “VA information” that falls under the additional requirements? Also, please confirm that information routinely transferred/transmitted to the contractor, including but not limited to patient information and VA billing and payment information, are included under the transferred data exception under Section B.3.

Answer: B.4.3.b., B.4.4., B.4.5., and B.4.6 are deleted and removed from the solicitation.

B.4.2.e. VA Information in this paragraph is referencing the “VA information” retrieved from the FSC Provider Portal. VA needs to ensure that once an employee no longer has a need to access this sensitive information, their access can be removed.

VA reviewed the last portion of this question and could not determine which “exception” was being referenced. When an authorization is loaded in the Provider Portal any and all information in the Provider Portal is included in the umbrella of “information routinely transferred/transmitted to the contractor”. Per Section B.3: “Once copies of VA data are transferred, it is considered the contractors data upon receipt and must be protected under HIPAA Rules.”

30. Section B.5.2. allows for the additional and removal of facilities per the process set out in B.5.6. It appears it is possible to remove facilities should the contractor deem it necessary. Are there any additional restrictions on removal of a facility?

Answer: A 30 calendar day notice is required. This change should be indicated in Attachment #2- Facility listing. The solicitation language has been updated at Section B.5.6.

31. We are still considering whether certain of our facilities will continue to participate in the program. Is it possible to list facilities as open to VA patients currently in them as of the date of the application but not accepting any additional patients, so as to allow for continuity of care while also not obligating a certain facility to admit additional VA patients?

Answer: No, the solicitation does not permit facilities to only be available for certain Veterans. It requires an offeror/contractor to list facilities available to provide dialysis services.

32. It is unclear under Section C.2. what under this contract would constitute “Federal contract information”. Under B.3. of the solicitation it is clear that transferred data is not considered information of the government any longer. What data does the VA consider covered under Section C.2.? Additionally, please confirm that information routinely transferred/transmitted to the contractor, including but not limited to patient information and VA billing and payment information, are included under the transferred data exception and not subject to this Section C.2. If incorrect, please provide detailed description.

33. Ownership of Data

a. Section B.3 states that “Once copies of VA data are transferred, it is considered the contractors’ data upon receipt and must be protected under HIPAA rules.” Section B.5.14 states that “Records created by the contractor in the course of treating Veterans under this agreement are the property of the contractor.” However, Section B.4.3 specifically references “VA information” requirements and details specific controls related to use of VA information. Please clarify:

(1) what data held by a contractor remains VA information?

Answer: Once the VA data is extracted from the Provider Portal and is under the contractor’s control, it is theirs upon receipt and is no longer VA data and must be protected by HIPAA guidelines.

(2) the application of VA Handbook 6500 requirements and when and how these requirements are applicable to the data owned by the contractor?

Answer: This language has been removed and the solicitation has been updated.

34. Section B.3, Section B.4.9

a. Provides that “Training and background investigations are not needed as the ownership of the data will transfer to the vendor upon receipt and will fall under the HIPAA Rules associated with the HIPAA covered entity.” Section B.4.9 provides for training requirements for contractor personnel “requiring access to VA information and VA information systems.” What are the applicable training requirements and to whom do they apply?

Answer: VA Privacy and Security training is required when accessing the FSC Provider Portal.

35. B.5 Performance Work Statement: Section 4.E; Section 4.E.2; Section 8.D.2

a. What are the timelines for contractors to comply/address discrepancies? (Example:

authorization not being issued timely, emergency situations, etc.)

Answer: The authorization timeline is 10 business days upon receipt of the authorization. Onset by exception is 55 days. Section B.5.4.E has been updated.

36. Section B.5.5

a. Provides that “In the event that the dialysis facility has not received the authorization in the provider portal after coordination has been made, the contractor shall contact the VAMC within 10 business days from the authorization expiration date.” It appears that the final phrase, “authorization expiration date” is a typographical error. Should “authorization expiration date” be replaced with “date of coordination”

Answer: The VA agrees. The word, “expiration”, will be removed. At this time no other language is being added. Please see revised section B.5.5.

37. B.5.8.D.1

a. How will the authorizations be issued for this change?

b. Who is responsible for initiating the authorizations to cover the temporary transfer?

c. If the period of time is undetermined, will the authorizations cover the estimated time the patients are transferred?

Answer: Regarding Unexpected Transfer of Patients that are VA Initiated, the VAMC is expected to issue authorizations via Provider Portal as appropriate to each unique circumstance. The VAMCs will be responsible for initiating authorizations to cover the temporary transfer. The authorizing VAMC should estimate the duration, and if inaccurate the VA may modify the authorizations accordingly.

Amendment 0003 – Summary of Changes

1. Section B.1.1.b. Contracting Officer is changed FROM: “David Little” TO: “Alyssa Urquhart”

2. Section B.3 Bullets three, four and five are deleted and reserved.

3. Section B.4.2.e. is changed FROM: “The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.”

TO: “The contractor or subcontractor must notify the VA Financial Services Center (877) 353-9791 or vafscenterprisesupport@va.gov immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employment. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.”

4. Section B.4.2.b., 2.c. 2.d. are deleted and reserved.

5. Section B.4.3.b. is deleted and reserved.

6. Section B.4.3.g., 3.h., 3.i., 3.j. are deleted and reserved.

7. Section B.4.3.k. is changed FROM: “Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.”

TO: “Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus to the public. This information may be shared with health care providers for treatment purposes.”

8. Section B.4.3.l. is deleted and reserved.

9. Section B.4.4. is deleted and reserved.

10. Section B.4.5. is deleted and reserved.

11. Section B.4.6. is deleted and reserved.

12. Section B.4.8. is deleted and reserved.

13. Section B.4.9. is deleted and reserved.

14. Section B.5.1. Last paragraph is changed FROM: “It is the VA’s intent to transition dialysis services under the Nationwide Dialysis Services Contract (NDSC) program to the Community Care Network (CCN) contracts providing a wide-array of healthcare services to Veterans. There are four CCN Regions and the contracts will likely not be awarded at the same time. The offerors who are awarded contracts under CCN have a pre-determined amount of time to reach full healthcare delivery. At the point of operational healthcare delivery, the VA may choose not to exercise options on the dialysis contract(s) in the regions where CCN healthcare is operational, may issue a modification to the facility list, Attachment 2, removing facilities, and/or may transition authorizations from the dialysis contracts to the CCN contract(s)” TO: “It is the VA’s intent to transition dialysis services under the Nationwide Dialysis Services Contract (NDSC) program to the Community Care Network (CCN) contracts providing a wide-array of healthcare services to Veterans. There are four CCN Regions and the contracts will likely not be awarded at the same time. The offerors who are awarded contracts under CCN have a pre-determined amount of time (180 days) to achieve the start of health care delivery (SHCD). For SCHD, the minimum schedule requirement includes full implementation of one (1) VA Urban Site and one (1) VA Rural Site per awarded CCN Region. At the point of SHCD, under each region, the VA may choose not to exercise options on the dialysis contract(s) in the regions where CCN SHCD has been achieved, or the VA may issue a modification to the facility list, Attachment 2, removing facilities, and/or may transition authorizations from the dialysis contracts to the CCN contract(s).”

15. Section B.5.4.A. is changed FROM: “Authorization Form: VA will utilize VA Form 10-7079, Request for Outpatient Medical Services, as the ordering form. All authorizations will be created by the initiating VAMC’s ordering officers through the Referral and Authorization System (RAS). Contractors shall not perform any services under this contract without prior authorization. Contractors are required to retrieve authorizations via the Provider Portal established by the Financial Services Center (FSC). It is the contractor’s responsibility to ensure all appropriate personnel have access to the system, and are properly trained to sign onto this system and retrieve the necessary authorizations. The authorization period start and end period will be stated on each VA Form 10-7079.”

TO: “Authorization Form: VA will utilize VA Form 10-7079, Request for Outpatient Medical Services, as the ordering form. All authorizations will be created by the initiating VAMC’s ordering officers through the Referral and Authorization System (RAS). Contractors shall not perform any services under this contract without prior authorization. Contractors are required to retrieve authorizations via the Provider Portal established by the Financial Services Center (FSC). It is the contractor’s responsibility to ensure all appropriate personnel have access to the system, and are properly trained to sign onto this system and retrieve the necessary authorizations. Authorization effective start and end dates will also be stated on each VA Form 10-7079.”

16. Section B.5.4.D. is changed FROM: “Authorization Process: Ordering Officers will issue written authorizations to the contractor via RAS, or other systems designated by the CO or COR. In accordance with FAR 16.505, Ordering, VA has determined orders will be placed based on Veteran preference, clinical need, contractor’s facility capacity, and price.”

TO: “Authorization Process: Ordering Officers will issue written authorizations to the contractor via RAS, or other systems designated by the CO or COR. In accordance with FAR 16.505, Ordering, VA has determined orders will be placed based on Veteran preference, clinical need, contractor’s facility capacity, and price, in descending order of importance.”

17. Section B.5.4.E. Second paragraph is changed FROM: “This verification must be within ten (10) business days of receipt of the authorization and the contractor may request any changes in writing via email during this period through the issuing VAMC and the COR. All questions pertaining to the authorization should be addressed to the Ordering Officer listed on the authorization. If the contractor continues to provide services beyond the ten (10) business day review period, without notifying the issuing VAMC of the authorization issue, payment may be denied. There are three types of authorizations applicable to this contract: new, renewal, and transient.”

TO: “This verification must be within ten (10) business days of receipt of the authorization and the contractor may request any changes in writing via email during this period through the issuing VAMC and the COR. Onset date verification by exception must be 55 business days from the receipt of the authorization. All questions pertaining to the authorization should be addressed to the Ordering Officer listed on the authorization. If the contractor continues to provide services beyond the ten (10) business day review period, without notifying the issuing VAMC of the authorization issue, payment may be denied. There are three types of authorizations applicable to this contract: new, renewal, and transient.”

18. Section B.5.4.E.1. is changed FROM: “New Authorization: A new authorization is created to begin a Veteran’s treatment. The period of validity will be stated in the authorization. The contractor shall obtain a new authorization before changing the Veteran’s treatment modality or servicing facility. Failure to obtain proper authorization prior to changing Veteran’s treatment modality or servicing facility may result in denial of claims for the period and services not authorized. If the authorization is not populated into the Provider Portal within 10 business days, the Contractor will contact authorizing VAMC, COR or CO to obtain.”

TO: “New Authorization: A new authorization is created to begin a Veteran’s treatment. The period of validity will be stated in the authorization. The contractor shall obtain a new authorization before changing the Veteran’s treatment modality or servicing facility. Failure to obtain proper authorization prior to changing Veteran’s treatment modality or servicing facility may result in denial of claims for the period and services not authorized. If the authorization is not populated into the Provider Portal within 10 business days, the Contractor will contact authorizing VAMC, COR or CO to obtain. In the event the Veteran is scheduled for dialysis prior to the 10th business day, the contractor shall follow up with the authorizing VAMC staff, or the Enterprise Help Desk at 877-353-9791, or vafsccshd@mail.va.gov for assistance.”

19. Section B.5.5.A. is changed FROM: “Veteran Acceptance: When the contractor has confirmed the Veteran is accepted to the facility, the VA and contractor’s dialysis facility and its designated representatives e.g., social workers) will collaborate and coordinate on a date to transfer the Veteran to the care of the contractor without disruption of the Veteran’s required dialysis treatment. Along with the scheduling of an appointment at a specific contracted dialysis facility, the Ordering Officer will provide the contractor with a proper authorization PRIOR to the patient arriving at the scheduled contractor’s facility. In the event that the dialysis facility has not received the authorization in the Provider Portal after coordination has been made, the contractor shall contact the VAMC within 10 business days from the authorization expiration date and inquire as to the status of the authorization. If the authorization has been input into RAS, the contractor shall contact the FSC Customer Service Helpdesk at VAFSCCSHD@va.gov, telephone number 1-877-353-9791 for access issues. The contractor’s inability to access authorizations through the established Provider Portal shall not be a reason to refuse care to the Veteran. If the authorization cannot be obtained via the Provider Portal, alternate methods of obtaining the authorization shall be pursued by the contractor by contacting the authorizing VAMC or COR. Treatment constitutes acceptance of the Veteran and authorization.”

TO: “Veteran Acceptance: When the contractor has confirmed the Veteran is accepted to the facility, the VA and contractor’s dialysis facility and its designated representatives e.g., social workers) will collaborate and coordinate on a date to transfer the Veteran to the care of the contractor without disruption of the Veteran’s required dialysis treatment. Along with the scheduling of an appointment at a specific contracted dialysis facility, the Ordering Officer will provide the contractor with a proper authorization PRIOR to the patient arriving at the scheduled contractor’s facility. In the event that the dialysis facility has not received the authorization in the Provider Portal after coordination has been made, the contractor shall contact the VAMC within 10 business days from the authorization date and inquire as to the status of the authorization. If the authorization has been input into RAS, the contractor shall contact the FSC Customer Service Helpdesk at VAFSCCSHD@va.gov, telephone number 1-877-353-9791 for access issues.”

20. Section B.5.6. “Facilities Removal” section is changed FROM:

“Facilities Removal:

1. Identification of the facility

1. Brief description of the reason for removal”

TO: “Facilities Removal:

A. Provide VAMC, CO and COR 30 calendar days prior notice of intent.

B. Identification of the facility via Attachment #2 – Facility Listing C. Brief description of the reason for removal”

21. Section B.5.7. First paragraph is changed to FROM: “In the event a Change in Ownership (CHOW) affects a facility under contract, the contractor shall notify the CO, COR and applicable VAMC at least 30 calendar days prior to the expected effective date.”

TO: “In the event a Change in Ownership (CHOW) affects a facility under contract, the contractor shall notify the CO, COR and applicable VAMC at least 30 calendar days prior to the expected effective date. Of note, current RAS authorizations will remain valid until specific date of sale.”

22. Section B.5.7. Third Paragraph is changed FROM:

“The contractor shall provide:

· Statement of Intent with at least 30 calendar days’ notice

· Authorizations in RAS valid until legal sale date

· Bill of sale documents with ownership percentages

· Selling or purchasing a facility (facilities)

· Date facility (facilities) will no longer be available

· Any other applicable documents requested by the CO or COR”

TO: “The contractor shall provide:

· Statement of Intent with at least 30 calendar days’ notice

· Selling or purchasing a facility (facilities) – Attachment #2 – Facility Listing

· Date facility (facilities) will no longer be available

· Any other applicable documents requested by the CO or COR”

23. Section B.5.10.E.c. The Contracting Officer is changed FROM: “David. F. Little at David.Little@va.gov” TO: “Alyssa S. Urquhart at Alyssa.Urquhart@va.gov”

24. Section B.5.10.E. The last paragraph is changed FROM: “Denied claims must be resubmitted within 90 calendar days of denial notice date.”

TO: “Denied and rejected claims must be resubmitted within 90 calendar days of denial notice date.”

25. Section B.5.10.H. is changed FROM: “Billing for Incomplete Treatments: If a dialysis treatment is started, (i.e., a Veteran is connected to the machine and a dialyzer and blood lines are used), but the treatment is not completed for some unforeseen but valid reason, as determined by the VA, the contractor shall be paid based on the full per treatment price. This should be a rare occurrence and must be fully documented on the billing statement to the VA. This event must also be fully documented by the contractor in the Veteran’s medical record.”

TO: “Billing for Incomplete Treatments: If a dialysis treatment is started, (i.e., a Veteran is connected to the machine and a dialyzer and blood lines are used), but the treatment is not completed for some unforeseen but valid reason, as determined by the VA, the contractor shall be paid based on the full per treatment price. This should be a rare occurrence and fully documented at VA request. This event must also be fully documented by the contractor in the Veteran’s medical record.”

26. Section C.2 is deleted and reserved.

27. Section C.14 Administrative change to correct spelling of the word “Occurrence”

28. Section E.6 The Contracting Officer is changed FROM: “David. F. Little at David.Little@va.gov” TO: “Alyssa S. Urquhart at Alyssa.Urquhart@va.gov”

29. Attachment 1- QASP. Change to Table A, #3 Security/Breaches/Privacy, Confidentiality and HIPAA, “performance requirement” and “standard” language columns were updated. The email address of where to report breaches to was added (OCCdialysis@VA.gov). The timeframe to report breaches was changed from 2 days to 24 hours. A new version of Attachment 1 is provided with this amendment.

30. Attachment 1- QASP. Administrative changes to renumber paragraphs as there were previously two paragraphs with number “5.” Page numbers were removed. A new version of Attachment 1 is provided with this amendment.

31. Attachment 2- Facility List Column A – “Network”, Column B – “VISN”, Column U – “Current Utilization” were deleted. A new version of Attachment 2 is provided with this amendment.

32. Attachment 2- Facility List- Instructions Tab was updated FROM: “Column P- CMS Certification Column is formatted to save as "text", please ensure this is entered as text and not another number format.

TO: “Column N- CMS Certification Column is formatted to save as "text", please ensure this is entered as text and not another number format.” A new version of Attachment 2 is provided with this amendment.

33. Attachment 2- Facility List- Instructions Tab was updated FROM: “Column S- Modality Treatments Offered- Please list any and all Modalities offered (For example- Center HD, Home HD, Center PD, Home PD, Home Training)”. A new version of Attachment 2 is provided with this amendment.

TO: “Column P- Modality Treatments Offered- Please list any and all Modalities offered (For example- Center HD, Home HD, Center PD, Home PD, Home Training)”. A new version of Attachment 2 is provided with this amendment.

34. Attachment 2- Facility List- Instructions Tab was updated to add the following explanation: “Column I - L Point of Contact (Business Hours), Email Address, Point of Contact (After Hours), After Hours Phone #”. A new version of Attachment 2 is provided with this amendment.

35. Attachment 3 – “(E) Employees of the contractor are in compliance with VA privacy and security training requirements” was deleted and is reserved at this time. The language may be added after contract award with a new attestation statement. Prior to contract award offerors are not able to certify they are in compliance with VA privacy and security training requirements. A new version of Attachment 3 is provided with this amendment.

See attached document: 36C79118R0022 RFP - 11192018 CONFORMED.

See attached document: Attachment 1 - QASP NDSC-Program-V3.

See attached document: Attachment 2 - Facility List - FY19.

See attached document: Attachment 3 - Attestation Statement v2.