Amendment RFP 36C10X25R0021 0002.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER3. 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 CODECODE

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 ADMINISTRATIVE 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 date 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 30 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)

1 39

0002 08-27-2025

36C10X

Strategic Acquisition Center - Frederick Department of Veterans Affairs

5202 Presidents Court, Suite 103 Frederick MD 21703

36C10X

Strategic Acquisition Center - Frederick Department of Veterans Affairs

5202 Presidents Court, Suite 103 Frederick MD 21703

To all Offerors/Bidders

36C10X25R0021

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 09-09-2025 12:00 EDT

X 1

The purpose of this amendment is to provide final questions and answers.

No additional questions will be accepted at this time.

Jacky Jean-Jacques Contracting Officer

CONTINUATION PAGE

I. Questions and Answers summary:

1. Answers to the following questions received during the solicitation phase.

2. Revised Section B.2 PRIC/COST SCHEDULE.

3. Attachment D.6, which now encompasses the Financial Capability Description.

4. Revised Section B.3, PWS 1.9.2. Task 7 Associated with Auditing VA Paid Claim Data.

5. Revised Section B3, PWS 2.4 Conference Calls.

6. Revised Section B3, PWS 2.5.1 Case File Disposition

7. Revised Section E VOLUME I – TECHNICAL AND FUNCTIONAL CAPABILITY to include Resume submission instructions.

8. Revised Section B.3, PWS 2.8.1 Key Personnel, Program Director (only).

9. Revised Section B.3, PWS 3.2.7 Ad Hoc Report.

10. Revised Section B.3, PWS 3.7 Task 7 – Auditing Paid Claims

11. Revised Attachment D.1 Subcontracting Plan is amended to update the column labeled

“Planned Dollars” to “% of contractor’s recovered funds.

12. Section 2.6 Validation – contingency fee is deleted.

13. Addition of VOLUME II – FINANICAL CAPABILITY FACTOR

14. Revised VOLUME IV -SOCIO ECONOMIC CONSIDERATIONS

Section Reference

Question Answer

Block 8 of

SF1449

(Page 1)

Based on the release of the Final RFP on July 29, with Questions being due on August 5, and recognizing a time period being required for the VA to respond to the Questions, would VA consider an extension of at least 10 to 14 days from the current Proposal due date of August 27, following VA returning responses to the questions and any associated amendment(s)?

Yes Sept 9, 2025

Section B.2, Price/Cost Schedule, (Page 5)

In note 1, VA states: “The contractor shall bear the burden of costs of performing the tasks associated with the RA and will be compensated only on a percentage of the actual funds recovered.

Due to numerous variables, the Government does not guarantee any specific amount of overpayment recovery and does not guarantee a specific sum of dollars to the contractor”. In addition, under Section E – Solicitation Provisions, Volume IV - Price (Page 74), VA states: “Offerors shall provide a fixed percentage for the base and option periods, and that percentage must be valid for the entirety of each period. UNIT Price will be submitted in the form of percentage.”

The basis for the contractor being compensated would be the quoted percentage (UNIT PRICE) of recovered overpayment dollars. Given the that the amount of overpayment recovery is not guaranteed, the column in the B.2 table, labelled as “AMOUNT”, is not applicable (not known) and would be based upon the actual recovered overpayment dollars.

Can the VA delete the column labelled “AMOUNT” from the B.2 table?

Section B.2 PRICE/COST SHCEDULE will be updated to reflect the removal of the amount column. The Contractor should include their SLA fee within the line-item unit price as well.

Section B.2, Price/Cost

In note 1, VA states: “UNIT PRICE% represents quoted percentage of recovered overpayment dollars due the contractor as payment for audit and identification of overpayments. Actual payment

Amended solicitation

Schedule, (Page 5) amount depends upon actual amounts recovered by the VA Debt Management Center. The Government’s obligation to make payments to the contractor under this contract is contingent upon both the contractor’s correct identification of valid overpayments and the Government’s subsequent recovery of overpayments, or portion of overpayments. The contractor shall bear the burden of costs of performing the tasks associated with the RA and will be compensated only on a percentage of the actual funds recovered.”

The contractor is to be compensated only based upon a percentage of the actual funds recovered, and the contractor bears the burden of costs associated with performing the tasks associated with the recovery audit services. The B.2 table structure does not conform to commercial practice. Under commercial practice, a contingency fee (UNIT PRICE) is not broken into subparts for tasks which are not directly reimbursed. Given this is a FAR Part 12 solicitation, it should be structured in accordance with commercial practice. Commercial practice for recovery audit contracts and Government practice (including the previous procurement for this requirement) for recovery audit contracts is for the contractor to bid one percentage fee that is applied to recoveries (which will be compensation for all CLINs/SLINs). Contract required tasks, tasks associated with auditing, or other administrative tasks should not be separately priced but listed as requirements in the Performance Work Statement.

Can the VA revise the B.2 table structure to be consistent with commercial and Government practice for no-cost (contingency fee) recovery audit contracts?

A sample suggested format for the B.2 Price/Cost Schedule is included below for VA consideration (sized to fit the question sheet), for Base Period and the Option Period One:

BASE PERIOD: Anticipated Period of Performance (Month, Day, Year – Month, Day, Year)

ITEM # DESCRIPTION OF

SERVICES

QUANTITY UNIT UNIT PRICE%[1]

0001 Recovery Audits Services

1 EA ________

OPTION PERIOD ONE: Anticipated Period of Performance (Month, Day, Year – Month, Day, Year)

ITEM # DESCRIPTION OF

SERVICES

QUANTITY UNIT UNIT PRICE%

1001 Recovery Audits Services

1 EA ________

Section B.2, Price/Cost Schedule

3.7 Task 7

Auditing Claims, CLINS

0008-

0008AF,

(Page 6)

In section B.2 Price/Cost Schedule, the pricing table auditing tasks (3.7 Task 7 AUDITING CLAIMS) are marked as optional in the base period and the following option periods.

Can VA clarify which of the auditing tasks (Task 7a-7g) are not optional or otherwise provide the reason for maintaining all auditing tasks (Task 7a-g) for the various VA programs as optional, given that the completion of these auditing tasks are the mechanism by which the contractor will receive compensation (upon recovery of funds)?

To preserve VA’s flexibility to expand and mature scope of community care recovery audits, all possible program domains are identified. Program domains can have unique claims processing requirements. The only currently known mandatory task will be part of task 7a-7d, specifically claims processed by VA and not by Community Care Network TPAs.

Section

B.3, PWS

1.3 Period

of Performan ce, (Page 16)

The Period of Performance is defined as one base period and four

(4) option years.

Based on the time it takes to collect on identified overpayments. would the VA consider adding an optional administrative support period of up to one year to complete the collection process, as well as appeals process, from the audits that are completed in the final year of the contract?

Clause 52.217-8 is included for six months.

Section

B.3, PWS

1.6 Financial Capability, (Page 16)

In Section 1.6, VA States: “At the time of award, the contractor must be able to support their contract personnel and resources.

The contractor shall have the financial capacity (e.g., working capital, and other resources) to achieve contract requirements.” In addition, under the Draft PWS provided with the RFI that released for this procurement in December 2024 (Notice ID: VA-RFI-2024- 001, Released 12/18/2024), stated (Page 8 of 22): “This contract will require an ATO which could take up to a year to obtain. The

Vendors are required to complete the revised Attachment D.6, which now encompasses the Financial Capability Description.

contractor must be able to support their contract personnel and resources during this period. The contractor shall have the financial capacity (e.g., working capital, and other resources) to achieve contract requirements.”

Under previous Government procurements for recovery audit services (including the previous procurement for this requirement), an Offer Statement of Financial Capability and D.6 Offeror Attestation of Responsibility is normally included and evaluated with a non-price factor for Financial Capability. For this, a contractor is normally requested to demonstrate (Offeror Statement of Financial Capability) the ability to sustain operations under a performance-based (contingency fee model) contract for up to one year (such as the one year period which may be required to obtain an ATO) without receiving a payment. The RFP does not require offerors to submit information regarding financial capability, and the evaluation criteria do not reference financial capability.

Can the VA clarify/revise the RFP instructions for completion and inclusion of an Offeror Statement of Financial Capability, as well as how the Financial Capability factor will be considered as part of the RFP evaluation?

Section

B.3, PWS

1.9.2. Task

Associated with Auditing VA Paid Claim Data, (Page 18)

The VA states: “Total estimated value of all claims in each category (FY24 sample)”. In the task table, the VA subsequently lists claim values for Task 7a-7g, which totals to an approximate range of $850,000 to $1,450,000 for the total value of claims in all categories.

For a procurement for Recovery Audit (RA) Services, it is essential and a best practice for the offeror(s) to be provided with information regarding paid claim data including total volume (numbers) and total value (dollars) by fiscal year and by claim type (e.g. Inpatient, Outpatient, Professional, etc). This information is essential for the offeror in terms of the technical solution and pricing offer for the proposal response. It may be that VA has only provided a subset of the claim information for FY24, based on the reference in the table in referring to the “FY24 sample”.

The VA has amended the solicitation to reflect this change.

Can VA provide additional paid claim data detail with total volume and total value by fiscal year for task 7a-7g, at least for prior fiscal years, such as for FY22, FY23, FY24?

Task VA Program Authority Total Estimated Value (FY24)

Task 7a VACC Preauthorized Claims 38 U.S.C. 1703

Inpatient: 9K-6M ($139M-11B);

Outpatient: 77K-5.5M ($110M-6B);

Professional: 760K-31M ($1.3M- 10B)Skilled Nursing Facility: 800K ($1.4M)

Task 7b VACC Emergency Care for Non- Service Connected Veterans 38 U.S.C. 1725

Inpatient: 3000 ($41M); Outpatient:

37,000 ($32M); Professional:

114,000 ($21M)

Task 7c VACC Emergency Care for Service Connected Veterans 38 U.S.C. 1728

Inpatient: 5700 ($110M); Outpatient:

46,000 ($59M); Professional:

112,000 ($57M)

Task 7d VACC Emergency Care for Acute Suicidal Crisis 38 U.S.C. 1720J

Inpatient: 560 ($7M); Outpatient:

800 ($700K); Professional: 10,000 ($4M)

Task 7e

Civilian Health and Medical Program of the Department of Veteran Affairs

(CHAMPVA) 38 U.S.C. 1781

Task 7f Spina Bifida

38 CFR 17.900-

17.905

Inpatient: 180K ($379M);

Outpatient: 3M ($492M);

Professional: 5.5M ($570M); Skilled Nursing: 10K ($26M)

Task 7g National Dialysis Contract (NDC) 38 U.S.C. 8153 215,000 claims ($800M) Section B3, PWS 2.4

Conferenc e Calls, (Page 20)

“The Contractor must use VA credentials and the VA telecommunications system for all calls with VA”. Due to the nature of this work being completed outside of VA’s internal system, requiring a contractor to use VA credentials and VA telecommunications is -inefficient for both the VA and the contractor.

Will VA consider removing this requirement?

Yes, the VA has amended the solicitation to reflect this change.

Section B3, PWS 2.5.1

Case File

“..at VA’s request no later than fifteen (15) business days after contract termination, the contractor shall return all case files.”

Based on the return method of case files, and the anticipated

Yes, In accordance with Appendix C, at VA’s request, no later than sixty (60) business days after contract termination, the contractor shall

Disposition , (Page 21) volume, we would recommend 60 days. This is a best practice consistent with CMS practices, for example.

Would VA consider changing this requirement to 60 days?

return all case files. The contractor shall not destroy any supporting documentation relating to the overpayment identification or recovery process unless otherwise directed.

Section B3, PWS 2.6

Validation, (Page 21)

“Examples of inaccuracy include false positives and overturned disputes. For the purpose of applying incentives and penalties, accuracy ratings will be rounded to the nearest whole percentage”.

Will accuracy be measured through a statistically valid sample? Will VA define what is considered a false positive?

VA reviews findings from RAC vendors before bills of collection are issued. Accuracy will be determined based on the results of these VA reviews. A false positive is a claim that the RAC vendor identified as overpaid, that upon VA review prior to issuing the bill of collection, VA determines is not overpaid based on information that was available to the RAC vendor.

Section

B.3, PWS

2.8.1 Key

Personnel, (Page 23)

Section 2.8.1: Requires resumes to be submitted for Key Personnel. Section E does not contain instructions for resumes.

Does the Government intend for the resumes to be attachments to Volume I Technical Capability with a 2-Page limit for each resume?

VOLUME I – TECHNICAL AND FUNCTIONAL

CAPABILITY

Resume Review:

o Submit resumes for all key personnel, limited to three pages each, covering relevant experience from the last 3-4 years.

o Ensure resumes highlight significant achievements and competencies relevant to the PWS requirements.

Section

B.3, PWS

2.8.1 Key

Personnel, (Page 23)

Certified coding specialists and clinical staff (nurses or physicians) are listed as key personnel under PWS section 2.8.1. While these roles are essential for successful recovery audits, they are not typically considered key personnel, requiring a resume for review and approval process from VA. Essential staff refer to personnel that are crucial for the performance of a contract and must be maintained during the contract performance, while key personnel staff are a subset of contract staff that are specifically responsible for overall contract performance.

Will VA consider removing the key personnel requirement for

According to the FAR, key personnel are individuals identified by the contractor as essential to the work being performed under the contract. The designation of certified coding specialists and clinical staff (nurses or physicians) as key personnel is essential to ensure the highest standards of expertise and oversight in the performance of recovery audits. This classification ensures that these critical roles undergo a thorough review process, including the submission of resumes certified coding specialists and clinical staff (nurses and physicians) and consider defining these roles as essential?

for VA’s evaluation and approval.

Section

B.3, PWS

2.8.1 Key

Personnel, (Page 23)

The Program Director and Information Technology Security Analysts are key personnel roles and are vital to the success of a recovery audit project. Adding valid requirements around these roles ensure successful contract management. In general, education requirements are standard for key personnel positions, such as for key personnel similar to this at CMS.

Program Director Education: The PD shall possess a bachelor's degree in Accounting, Business, Marketing, Public Administration or other Healthcare relevant field.

Program Director Experience: The PD shall have at a minimum 5 years of professional work experience in the healthcare industry supporting either Federal Government agencies or Commercial Healthcare market as a project manager, project leader, operations manager, technical project manager, or product manager.

ITSA Education: shall possess an associate degree in information systems, Computer Science, or other related technology field. Relevant work experience in related field of work will be considered in lieu of associate degree.

ITSA Experience: The ITSA must be knowledgeable of the regulations and requirements related to obtaining and retaining an ATO and able to provide continuous Assessment and Authorization (A&A) support. The ITSA must demonstrate involvement, experience and knowledge of federal government security requirements shall have 5 years combined work experience with at least 3 of those years being in the healthcare industry supporting either Federal Government agencies or Commercial Healthcare market as the SSO, Information technology specialist, Security engineer, Information security analyst, or Information systems technician

Will VA consider adding the following education qualifications

The VA has amended the solicitation to include Program Director Experience only.

to the Program Director and ITSA key personnel roles?

Section

B.3, PWS

2.10 Provider Outreach, (Page 23)

“The contractor will be required to obtain access to VA systems and locate needed documentation to audit claims. In the event the medical documentation in the VA systems is not sufficient to make a determination, the contractor is allowed to contact providers to request additional medical documentation when such documentation is necessary to complete auditing, unless otherwise instructed by VA.” This is not a common or best practice as the provider is the best source to obtain the medical records required for the specific claim under review, as this is the most current and accurate documentation supporting the billed claim(s) in question.

Would VA consider removing this requirement to ensure an efficient and effective audit process by requesting all medical records directly from the Provider?

No change at this time.

Section

B.3, PWS,

3.2 – Task 2 – Reporting (Page 26, 27)

Under Section 3.24 Monthly Reports (Page 27), Monthly Reports include: “Number and dollar amount of underpayments identified, if any, and identified root causes”.

While the VA RA requirements indicate that the contractor will receive payment for overpayments, there does not appear to be a provision for the contractor to receive payment for underpayments.

Incentivizing the RA contractor for both overpayments and underpayments is a best practice in industry and Government. For example, CMS incentivizes RAC’s for both overpayments and underpayments under its recovery audit program.

Incentivizing the RA contractor for underpayments benefits providers and demonstrates the focus of the program for correcting improper payments and is crucial in helping VA ensure providers receive the correct payment for services rendered for the VA (in supporting Veterans) and for the providers improve their claims processing and reduce future errors.

Has the VA considered including payment for identified underpayments by the VA RA contractor?

Underpayments are out of scope at this time.

Section

B.3, PWS

3.2.7 Ad

Hoc

“The contractor shall provide Ad Hoc Reports one (1) business day after the request. Many times, ad hoc reports require additional research and programming that may involve various team members.

The VA has amended the solicitation to reflect this change.

Report, (Page 28) Would VA consider changing this requirement to 5 business days?

Section

B.3, PWS

2.3.8 Final

Report, (Page 29)

“The Final Report shall be due by COB 60 calendar days after the end of the contract”. Currently the RFP states that VA will cease providing contingency fee payment, as a result of recoupments and offsets, to the contractor six months after the contract expires (section 5.5). To have accurate final results, we recommend the final report be due in line with the expiration of the defined collection period. Should VA consider adding an administrative period at the end of the contract, we recommend VA consider the final report draft be due 6 weeks prior to the end of the defined collection period and the Final Report due two weeks prior to the end of the defined collection period.

Would VA consider adjusting the final report to the suggested structure?

VA will not amend the final report due date at this time. The current requirement for the Final Report to be due by COB 60 calendar days after the end of the contract is designed to ensure timely closure of the contract and facilitate prompt administrative processing and review.

Section

B.3, PWS

3.7 Task 7

– Auditing Paid Claims, (Page 33)

Under Section 3.7, VA states: “Contractor must identify potential overpayments within 15 business days after receiving claim files and audit claims within 15 days of receiving medical records. Contractor must complete both of these within their 90 day exclusivity period. If not completed within these timeframes, the claim will be removed from Contractor’s inventory, will no longer be available for overpayment recovery fees to Contractor, and may be sent to other RA contractors afterwards. Medical records received by Contractor will be sent to VA within 15 calendar days of receipt. Contractor will not request medical records from providers that VA already possesses.”

Given the typical timeframes for data ingestion, data validation, and claim selection for a medical record request, the 90-day exclusivity is suggested to apply from the receipt of “clean” paid claim data and to include selecting those claims for requesting a medical record and identifying those selected claims (ie. claim numbers) for further review, at which point the unselected records may

The auditing tasks for this contract/task order include a backlog of claims (generally dating back to FY24 until the contractor’s audit begins), as well as claims paid more recently.

The contractor’s audit plan shall include provisions to review claims starting from the most recently completed fiscal year and continuing until up to FY29, as well as to concurrently work down the backlog starting with the oldest claims. In the first option year, if exercised, the contractor will audit claims paid during the base year of the contract and FY24, and so forth. While initially the contractor shall receive a large volume of older claims needing RAC review, the goal is to move towards a continuous audit model as VA’s long-term process.

The auditing related to this contract/task order includes claims paid between FY24-FY29. The contractor’s audit plan shall include provisions be released for review by the next contractor. Given the established time frames for providers to send requested medical records (typically up to 90 days), the contractor is suggested to have 30 days from receipt of a medical record to audit the claim and identify a finding (or no finding). For example, CMS allows 30 days to audit a claim after a medical record is received.

Will VA consider revising the timeframes for claim selection and claim audit as suggested (90 days to ingest, review, and select claims for audit; and 30 days to review the medical record once received)?

for each program authority and their individual eligibilities and payment methodologies. The contractor will be responsible for obtaining and reviewing medical records and creating a first level dispute process.

As noted above, the fiscal year ranges identified below refer to payment dates.

VA’s claims data may be sent to other RA contractors prior to being sent to Contractor.

Contractor will not receive claims that prior RA contractors identified overpayments on, unless VA chooses to send to Contractor. Contractor must identify potential overpayments within 15 business days after receiving claim files and audit claims within 15 days of receiving medical records. The contractor must identify potential overpayments within 15 business days after receiving claim files and audit claims within 30 days of receiving medical records.

Contractor must complete both of these within their 90-day exclusivity period. If not completed within these timeframes, the claim will be removed from Contractor’s inventory, will no longer be available for overpayment recovery fees to Contractor, and may be sent to other RA contractors afterwards. Medical records received by Contractor will be sent to VA within 15 calendar days of receipt. Contractor will not request medical records from providers that VA already possesses.

During the entire period the Contractor is unable to perform RA services, even if due to Contractor or VA technology or process requirements or issues, Contractor will not receive claim files. VA will skip Contractor and send to other RA contractors who are able to perform RA services at the time the claim is in the RAC evaluation process.

VA can modify the contractor order at-will that claim files are sent to based on performance, thereby affecting the order of claim review exclusivity periods.

Audit plan may vary for each VA Program and VA payer.

VA OF Program Lead or COR must approve audit plan by VA Program and VA Payer.

Section

B.3, PWS

3.7 Task 7

– Auditing Paid Claims, (Page 33)

In Section E.2 Evaluation Approach (Page 75), VA states: “Award will be made in consecutive order of the most-to-least highly rated contractor.” In Section E.2 Evaluation Approach, A. Basis For Award (Page 75), VA states: “Award will be made on a best value basis”. In Section E.6 52.216-1 Type of Contract (APR 1984) (Page 83), VA states: “If more than one contract is awarded, the highest-rated contractor will be given an exclusive 90-day period to review and select claims. Then the remaining data set will drop to the next highest-rated contractor(s) for a similar period to repeat and close the cycle.”

Under Section 3.7 (Page 33), VA states: “VA can modify the contractor order at-will that claim files are sent to based on performance, thereby affecting the order of claim review exclusivity periods.”

Given that the specific evaluation criteria (Page 75) and the Type of Contract (Page 83) define how the contract will be awarded and how the order of contactor claim file review will be established, can the VA provide additional process detail and criteria for determining to modify the contractor order, based on performance?

Performance issues that could result in modifications to the contractor order relate back to the requirements in the PWS.

Examples include late delivery of reports, delays in medical record reviews and poor accuracy.

For example, if the contractor-owned auditing system experiences an inability to functionally or technically process ingested data to support the audit result, then the contract could be modified to reflect a change in the impacted review exclusivity period.

Section

B.3, PWS

3.7 Auditing Paid Claims, (Page 33)

“Medical records received by the contractor will be sent to VA within 15 calendars of receipt. Contractors will not request medical records from providers that VA already possesses”. As a best practice, medical records are provided at the end of the contract with the completed case file. Also, medical records are obtained from the provider around the specific claim under review.

Identifying and requesting medical records through VA prior to requesting medical records from a provider will elongate the audit timeline.

No change at this time.

Will VA consider removing or revising these requirements, given that submitting medical records as they are received to VA without the completed audit case file is not vital to the audit process as requesting medical records from both the VA and the Provider elongates the audit timeframe expected by

VA?

Section

B.3, PWS

3.7.1 Task

7a- Audit of

VACC

Reauthoriz ed Claims, (Page 34)

“Prior to finalizing audit results for Task 7a claims, the contractor will ask the TPA or provider if they can make available evidence of an agreement to be paid rates other than Medicare rates for the services provided.” All provider agreements should be provided to the contractor prior to initiating any audit as this will reduce the burden on providers since audit selections are based on payment methodologies.

Will VA consider proactively providing these agreements to the contractor prior to audit claim selection process?

Due to the volume of agreements, the only practical manner to make provider agreements available is for contractor to access VA’s systems. VA is amenable to providing contractor with appropriate system access.

Section

B.3, PWS

3.7.1 Task

7a- Audit of

VACC

Reauthoriz ed Claims, (Page 34)

“VA reimburses hospital, medical and extended care services up to the maximum allowable rate which for most services is the Medicare rate published by Centers for Medicare and Medicaid Services (CMS). When a Medicare rate does not exist, VA pays the lessor of the VA Fee Schedule (VAFS) or billed charges. The Fee Schedule will be provided to the contractor There are two notable exceptions: dental, whose reimbursement rate is propriety and Alaska providers, who are subject to increases based on the Medicare Economic Index”.

Since these claim types are not listed as exclusions, and the reimbursement rate is vital for a successful audit, will VA proactively provide the reimbursement rates for the claims to be properly audited?

Yes, VA will provide these rates.

Section

B.3, PWS

3.7.2 TASK

7B – Audit Of Vacc

“The contractor shall audit the payment and administrative eligibility of claims, including coordination of benefits, and shall assume that clinical eligibility determinations were correct.”

Can VA expand on the expectations of coordination of benefits

Other primary insurance should be included in the payment integrity audit as one cause for overpayment.

Emergency Care For Non- Service Connected Veterans Claims, (Page 34) for this task? Does VA anticipate the contractor to review VA’s system to identify any known primary insurance, prior to completing a payment integrity audit?

Section

B.3, PWS

3.7.2 TASK

7B – Audit Of Vacc Emergency Care For Non- Service Connected Veterans Claims, And B3, PWS 3.7.2

Task 7c,- Audit Of Vacc Emergency Care For Service Connected Veterans Claims, (Page 34- 35)

In both Tasks 7B and 7A, it states the following: “The contractor shall audit the payment and administrative eligibility of claims…”

Can VA clarify or provide a definition of meant by audit the payment and “administrative eligibility” and how VA anticipates the contractor to complete this task during the recovery audit process?

U.S.C. 1725 (Task 7b) requires that VA be the payer of last resort. The audit for this task should include the review of coordination of benefits, as repaying a new DRG is inappropriate if VA should not have paid at all.

SAC 18-01

– SAC

Service Level Agreement Fee and

Reference is made to SAC 18-01 on page 64 of the RFP document, SAC Service Level Agreement Fee and Submission of Quarterly Sales Reports. The Presolicitation Notice (June 27, 2024) states (on Page 4) that: “OF intends to award up to 3 no cost (contractor is paid out of recovered funds only) contract(s), to provide healthcare claims recovery auditing services.” The no cost

The current SLA which applies to this contract action is {3.0%}. This SLA Fee shall be imbedded in the awarded contract/agreement price(s) and offers submitted in response to this solicitation shall include this SLA Fee in the price of every line

Submissio n of Quarterly Sales Reports;

{Open Market, General Services Agency Federal Supply Schedule

(GSA

FSS), Non Federal Supply Schedule Medical Supply Prime Vendor

(MSPV),

NX

Equipment} (January, 2019), (Page 64) contract is unique in its nature with compensation to the contractor being based upon a fixed percentage of the actual recovered overpayment dollars.

Section C, Clause 18-01 is only applicable to procurements funded by the VA Supply Fund, which is for “for the operation and maintenance of a supply system for the Department (including procurement of supplies, equipment, and personal services and the repair and reclamation of used, spent, or excess personal property).” 38 U.S.C. § 8121(a). The solicitation contemplates a non-personal services contract and is not related to the VA’s supply system. Also, the procurement does not obligate appropriated funds, whether in the Supply Fund or otherwise. Instead, the procurement is a no-cost contract funded entirely by recovered funds. The SAC Service Level Agreement, based upon the Supply Fund would appear to be not applicable.

Based on this, will the VA please revise the RFP to remove this requirement clause for the SAC Service Level Agreement?

item offered.

Section D, D.6 Offeror Attestation of Responsibi lity, (Page 67)

Section D lists D.6 Offeror Attestation of Responsibility, and the attachment D.6 is provided with the solicitation as a separate document.

However, there are no RFP instructions nor RFP evaluation under Section E - Solicitation Provisions for the completion or inclusion of D.6 Offeror Attestation of Responsibility. Under previous Government procurements for recovery audit services (including the previous procurement for this requirement), the Offeror Attestation of Responsibility is normally included and evaluated

Refer to the revised Attachment D.6. Check the appropriate boxes and provide the information needed as listed within the document.

Additional Notes: Please see revised RFQ highlighted sections on pages 62, and 68.

with a non-price factor for Financial Capability.

Can the VA clarify the RFP instructions for completion and inclusion of D.6 Offeror Attestation of Responsibility, as well as how this will be considered as part of the RFP evaluation?

Section E.1, Table 9, (Page 69)

Table 9: The table in instruction 9 that contains the volume names, file naming conventions, and Page limitations does not require the offeror's name for Vol III Socioeconomic Considerations.

Does the Government intend for the Offerors to name the file in accordance with the others as [Offeror Name] Soc.doc/pdf?

Yes.

Section E.1, Table 9, (Page 69)

Table 9: The table in instruction 9 that contains the volume names, file naming conventions, and page limitations requires the Offeror to name Vol IV Price as [Offeror Name] - Complete B.2 PRICE/COST SCHEDULE. The forward slash is not allowed in file names.

Does the Government concur that the following naming convention can be substituted: [Offeror Name] Complete B.2 Price Cost Schedule.xls/xlsx?

Yes, Complete B.2 Price Cost Schedule within the solicitation

Section E, Volume II – Past Performan ce and Relevance of Experience , (Page 71)

VA states: “New Corporate Entities. New corporate entities may submit data on prior contracts involving its officers and employees.

However, in addition to the other requirements in this section, the Offeror shall discuss in detail the role performed by such persons in the prior contracts cited. Information should be included in the files described in the sections above.”

Under Section E.2 Evaluation Approach, 2 Past Performance and Relevance of Experience (Page 76), VA states: “Recent experience (within the past three years) will be assessed more positively”.

Can VA clarify under the RFP evaluation (Page 76) similarly that past performance which includes a PPQ will be assessed more positively?

Providing PPQs as part of past performance should not inherently count against you.

Rather, it allows the evaluators to assess your performance history comprehensively. If your PPQs indicate strong, relevant experience, it will benefit your evaluation. If there are concerns or negative aspects, those might be noted as part of the overall assessment.

Therefore, contractors are encouraged to include complete and accurate past performance data to reflect their capabilities accurately.

Section E, VA states: “The contracts may be held by any member of the The VA clarifies that the relevant past

Volume II – Past Performan ce and Relevance of Experience , (Page 72) proposed vendor structure. The contracts must be relevant, defined as services which, when considered as a whole, are similar in size, scope and complexity when compared to the anticipated requirements of this procurement. Data concerning the prime contractor shall be provided first, followed by each proposed major subcontractor, teaming partner, or mentor/protégé, in alphabetical order.”

The RFP allows that all three past performance contracts (and PPQs) submitted in Volume II can be contracts held by subcontractors.

Given the prime contractor’s overall responsibility for contract performance and vendor/ subcontractor management, will the VA clarify that relevant past performance (and PPQ) of a prime contractor will be assessed more positively than relevant past performance of a subcontractor?

performance and Past Performance Questionnaires (PPQs) of a prime contractor will generally be assessed more positively than those of a subcontractor.

This is because the prime contractor holds overall responsibility for contract performance and vendor/subcontractor management, demonstrating a proven history of managing large and complex projects effectively.

Section E, Volume III

– Socio Economic Considerati ons, (Page 73)

The VA States: “2) Non-Veteran Owned Offerors must state in their proposals the names of the SDVOSBs and VOSBs with whom they intend to subcontract and provide a brief description of the proposed subcontracts and the approximate dollar values of the proposed subcontracts.”

The VA also states: “6) The VA will assign evaluation credit for an Offeror (prime Contractor) that is a SDVOSB or VOSB. Non-Veteran owned firms that subcontract 7% or more of the contract value to a SDVOSB or 10% or more of the contract value to VOSB will also receive evaluation credit. The factor will be evaluated by the SSA/CO.”

The amount of overpayment recovery and the approximate dollar value of the contract is not known, given the contingency-fee structure of the contract, and would be based upon a fixed percentage of the actual recovered overpayment dollars.

In lieu or approximate dollar values of the proposed subcontracts, will the VA consider awarding an evaluation credit for a non-veteran owned offeror which includes a commitment in their proposal to subcontract 7% or more to an SDVOB or to

The credit will be based on a percentage of the compensated amount awarded to the contractor for recovered funds. All proposals will be evaluated in accordance with the evaluation criteria.

subcontract 10% or more to a VSOB after collection based on a percentage of the actual funds recovered?

Section E, Solicitation Provisions, Volume IV

– Price, (Page 74), Section E – Solicitation Provisions, B.,

4. Price – Price, (Page 77)

Section E, Solicitation Provisions, Volume IV - Price (Page 74), VA States: “Offerors shall provide a fixed percentage for the base and option periods, and that percentage must be valid for the entirety of each period. UNIT Price will be submitted in the form of percentage.” In addition, under Section E – Solicitation Provisions, B., 4. Price - Price (Page 77), VA States: “Offerors shall submit a completed B.2 Price/Cost Schedule. Offerors must propose pricing for each line item according to the quantities listed in the Price/Cost Schedule.”

The RFP instructions (Page 74) indicate a single fixed percentage be provided for the base and option periods that is valid for the entirety of each period. The RFP evaluation (Page 77) indicate offers propose pricing for each line item according to the quantities listed.

Can VA clarify in the RFP evaluation (Page 77) that the completed B.2 Price/Cost Schedule include a single fixed percentage for the base and option periods that is valid for the entirety of each period, to be consistent with the RFP instructions (Page 74)?

Duplicate question already answered above on page 2.

Section E;

E.2 Evaluation Approach, (page 75)

The VA states: “Award will be made on a best value basis, identifying the proposals that are determined to be in the best interest of the Government. The best value determination will be made subsequent to an assessment of the following factors in order of importance: Technical and Functional Capability Fit to Requirement, Past Performance and Relevance of Experience, Socio-economic Considerations, and Price. All non-price factors, when combined are equal to Price factor alone.”

While the RFP indicates award will be made based on best value, it is unclear as to how this will occur based on technical (combined) and price being equally weighted. For example, do you intend to use the lowest priced technically acceptable process or the tradeoff process? Can you please clarify the best value continuum contemplated for this contract based on FAR 15.101?

Can you also elaborate on how you will evaluate price in the

Award will be made on a best value basis, identifying the proposals that are determined to be in the best interest of the Government. The best value determination will be made subsequent to an assessment of the following factors in order of importance: Technical and Functional Capability Fit to Requirement, Past Performance and Relevance of Experience, Socio-economic Considerations, and Price. All non-price factors, when combined are equal to Price factor alone.

The Government will evaluate price to determine whether it is considered fair and reasonable. The Government will evaluate context of where offerors rate technically? price reasonableness using price analysis techniques as prescribed in FAR 15.404-1(b).

Section E - Solicitation Provisions, Volume III

– Socio Economic Considerati ons (Page

73) and Section E - Solicitation Provisions,

3. Socio Economic Considerati ons (Page

77) Section E - Solicitation Provisions,

4. Price - Subcontrac ting Plan (page 78), Attachment D.1 Subcontrac ting Plan

Section B.2 indicates that “The Government’s obligation to make payments to the contractor under this contract is contingent upon both the contractor’s correct identification of valid overpayments and the Government’s subsequent recovery of overpayments, or portion of overpayments.”

The compensation to the contractor is based upon a fixed percentage of the actual recovered overpayment dollars, and as such this would be a no cost contract, which is unique in its nature. The Attachment D.1 Subcontracting Plan tables contain a column labelled “% of Total Subcontracting” and “Planned Dollars”.

Given that the “Planned Dollars” is not known, given the contingency-fee structure of the contract, and would be based upon a fixed percentage of the actual recovered overpayment dollars.

Can the VA modify the Attachment D.1 Subcontracting Plan remove the column labelled as “Planned Dollars” or otherwise modify the Subcontracting Plan tables to indicate to “% of contractor’s recovered funds)?

The Attachment D.1 Subcontracting Plan is amended to update the column labeled “Planned Dollars” to “% of contractor’s recovered funds”

Section E - Solicitation Provisions, Volume III

– Socio Economic Considerati ons (Page

The VA States: “2) Non-Veteran Owned Offerors must state in their proposals the names of the SDVOSBs and VOSBs with whom they intend to subcontract and provide a brief description of the proposed subcontracts and the approximate dollar values of the proposed subcontracts.”

The VA also states: “6) The VA will assign evaluation credit for an Offeror (prime Contractor) that is a SDVOSB or VOSB. Non-Veteran owned firms that subcontract 7% or

73) and Section E - Solicitation Provisions,

3. Socio Economic Considerati ons (Page

77) Section E - Solicitation Provisions,

4. Price - Subcontrac ting Plan (page 78) more of the contract value to a SDVOSB or 10% or more of the contract value to VOSB will also receive evaluation credit. The factor will be evaluated by the SSA/CO.”

The VA has identified the socioeconomic consideration for 7% or more subcontract value to an SDVOSB or 10% or more of contract value to VOSB, as the only subcontracting goals for socioeconomic categories.

As such, can the VA confirm that a Subcontracting Plan with a goal of 7% or more subcontract value to an SDVOSB or 10% or more of contract value to VOSB as the only allocation goals for socioeconomic categories that are required in order for the Subcontracting Plan to be considered “Acceptable” in the evaluation?

Section Reference

Question Answer

B.2 Price/Cost Schedule (Pg. 5-14)

Regarding CLINs xx8 (3.7 Task 7 Audit Claims), what does the Government request the vendor to supply from a cost perspective in each CLIN from Base Period through Option Year 4?

Regarding CLINs xx8 (3.7 Task 7 Audit Claims), the Government has revised the B.2 table structure to be consistent with commercial and Government practice for no-cost (contingency fee) recovery audit contracts.

B.2 Price/Cost Schedule (Pg. 5-14)

Some CLINs, i.e., xx3AG, are only used at the end of the contract.

Is it correct to assume that this CLIN would not be priced from the Base Period through Option Year 3?

Regarding the question about some CLINs, i.e., xx3AG, which are only used at the end of the contract: The Government has revised the B.2 table structure to be consistent with commercial and Government practice for no-cost (contingency fee) recovery audit contracts.

1.4 Place of

Performance (Pg. 16)

Will the Government authorize telework on this contract? The VA anticipates that tasks under this PWS shall be performed at the contractor’s facilities as specified in their proposal.

1.5 Government-

Where do contractor employees need to go to obtain a PIV card?

Is travel billable outside of a certain distance to obtain one?

There will be no reimbursement for travel under this contract. If awarded this will be addressed at

Furnished Information, Equipment, and Facilities (Pg. 16) the kickoff meeting.

1.9.2 Task 7

Associated with Auditing VA Paid Claim Data (Pg. 17-18)

Tasks 7a-7g give the total estimated value of the FY24 sample.

What percentage of these claims are reworked for an overage review?

There will be no reimbursement for travel under this contract. This matter will be addressed during the kickoff meeting for the awardee.

1.9.2 Task 7

Associated with Auditing VA Paid Claim Data (Pg. 17-18)

Tasks 7a-7g give the total estimated value of claims in the FY24 sample. What is the quantity that makes up these claims?

The Government has revised the B.2 table structure to be consistent with commercial and Government practice for no-cost (contingency fee) recovery audit contracts.

2.8.1 Key

Personnel (Pg. 23)

Are key personnel resumes a required part of the proposal submission?

Yes.

2.8.1 Key

Personnel (Pg. 23-24)

The PWS lists a Program Director, Certified Coding Specialist and Clinical Staff, and Information Technology Security Analyst as Key Personnel. What are the Government’s requirements for the number of personnel in each position for this contract?

VA is purchasing outcomes, and it is up to the contractor to determine its personnel needs to perform the required work.

2.8.1 Key

Personnel (Pg. 23-24)

How many team members from each key position are currently working on the project? Are they full-time and/or part-time employees?

VA does not have employees who perform the work described in this PWS.

3.4 Task 4 –

Secure Portal

(pg. 30)

The PWS states: "The successful contractor will identify which…