ATTACHMENT A PWS Dental and Medical Fee Schedules and Benchmarks.pdf

PERFORMANCE WORK STATEMENT

DENTAL DATA AND FEE SCHEDULE AND MEDICAL CHARGED AND ALLOWED

BENCHMARKS

SCHEDULE OF SUPPLIES/SERVICES

I. Introduction

This Performance Work Statement (PWS) describes the need of the Veterans Health Administration Department of Veterans Affairs (VHA) Office of Integrated Veteran Care

(IVC), Integrated External Networks (IEN) to:

• Obtain data via Current Dental Terminology (CDT) codes to support Veteran

Affairs (VA) standardization of local reimbursement rates for Veterans Affairs

Medical Centers (VAMCs) to use in determination of current market dental procedure payment and reimbursement rates,

• Develop a Dental VA Fee Schedule (DVAFS) that will be shared with Third Party

Administrators (TPAs) and dental providers,

• Obtain necessary data via allowed and charged medical benchmarks to support

VA’s sustainment of the proprietary Medical VA Fee Schedule (MVAFS) which is used to standardize local reimbursement rates. This task is restricted to obtaining data and does not include data analysis or recommendation and,

• Develop a Medical VA fee schedule (MVAFS) that is proprietary to the VA that will be shared with Third Party Administrators (TPAs) and medical providers.

This PWS sets forth the requirements that the contractor shall adhere to in the performance of work under this contract. This is a performance-based service in which the contractor shall provide all resources necessary to accomplish established objectives outlined herein.

The overall responsibility of the contractor is to plan, coordinate, organize, manage, and perform the activities described within this document

II. Title of Project

The title of the project is Dental Data and Fee Schedule and Medical Charged and Allowed Benchmarks, hereafter referred to as “Dental Fee Schedule and Medical Benchmarks”.

III. Background

A. Dental

1. VA provides dental treatment via private licensed dental providers in the community to eligible Veterans when VA medical facilities are not capable of providing care due to geographical inaccessibility or when the needed care is not available at VA, federal, or affiliated healthcare facilities. In cases where community dental treatment is necessary, dental care can be provided when the care is authorized by VA in advance of the treatment through a formal contract through a

Third-Party Administrator with the dental provider or contracted through the VA

PWS – VHA IVC Dental Fee Schedule and Medical Benchmarks directly through a Veteran Care Agreement (VCA). VA aims to pay rates commensurate with other Government entities and commercial payers for care delivery.

2. VHA may share the DVAFS with the appropriate outside parties, identified as

“End Users” (refer to PWS Paragraph X).

3. Additional information can be found in in Veterans Health Administration Dental

Program, Section 4f, Community Care (Appendix A). These reports are published on the VHA Dental Reporting and Analytics System for use by all VAMC facilities to aid in standardizing the determination of local reimbursement rates.

B. Medical

1. VA provides medical care in the community for eligible Veterans when VA medical facilities are not capable of providing care due to geographical inaccessibility, appointment availability, or when the needed care is not available at a VA, federal, or affiliated health care facility.

2. VA aims to pay commensurate rates as other Government entities and commercial payers for care delivery. To do so, VA leverages the MVAFS to make payments for medical care delivered in the community. The MVAFS is used by

TPAs, contract claim adjudicators, payment operations staff, and is also accessed by customer service and stakeholders when working with providers.

3. Unlike the DVAFS, the MVAFS is not considered proprietary. This is due to

VA’s blending of data, to include the data provided by the Contractor, to create the

MVAFS.

IV. Scope of Work

A. General Requirements

1. The contractor shall provide the coordination, organization, management, and performance of the activities outlined within the performance period to include support for the Program as described herein. All written deliverables shall be phrased in layperson language. Statistical and other technical terminology shall not be used without providing a glossary of terms.

2. The contractor shall comply with VHA approved formats (to be determined), submission timetables, and schedules.

3. The contractor shall provide data in clear, understandable terms outlining the outputs and work to be done in delivering the services to be performed under the contract.

B. Dental Fee Schedule and Medical Benchmarks Requirements

1. The Contractor shall provide the VHA necessary data via Current Dental

Terminology (CDT) codes to support Veteran Health Administration (VHA) standardization of local reimbursement rates for Veterans Affairs Medical Centers

(VAMCs) to use in determination of current market dental procedure payment and reimbursement rates. This task is restricted to obtaining data and does not include data analysis or recommendation.

2. The Contractor shall develop for VHA, the Dental VA Fee Schedule (DVAFS) that will be shared with Third Party Administrators (TPAs) and dental providers.

3. The Contractor shall provide VHA the required data via allowed and charged medical benchmarks to support VHA’s sustainment of the Medical VA Fee

Schedule (MVAFS) which is used to standardize local reimbursement rates. This task is restricted to obtaining data and does not include data analysis or recommendation. 4. (Optional Task) Develop a Medical VA fee schedule (MVAFS) that is proprietary to the VA that will be shared with Third Party Administrators

(TPAs) and medical providers. The contractor shall build a comprehensive medical

VA fee schedule (MVAFS) that is proprietary to the VA. The MVAFS will be utilized by VA employees, TPAs, and providers to determine rates of reimbursement based on current medical codes. This optional task that the government may exercise at any point during the contract.

C. Areas of coverage

Dental data, DVAFS rates, and the allowed and charged medical benchmarks are required for the United States, District of Columbia, U.S. Virgin Islands, Puerto

Rico, Northern Mariana Islands, Guam, and American Samoa.

D. Number of line items

The number of line items will be dependent upon the number of Current Dental

Terminology (CDT), Current Procedural Terminology (CPT) codes, Healthcare

Common Procedural Coding System (HCPCS), and 3-digit zip codes returned.

E. Regions

The Contractor shall provide regionally adjusted dental procedural cost data and medical benchmarks based on the map provided in Appendix B.

V. Schedule of Services

A. Dental

The Contractor shall provide current market dental procedure payment and reimbursement rates data via CDT codes for dental procedures as described by the

American Dental Association on a bi-annual basis on January 31 and July 31 of each year throughout the contract’s period of performance. The Contractor shall also provide interim data refreshes as updates/releases are available for all current and active CDT codes for dental procedures. Updates shall be provided within thirty (30) calendar days of availability. The Contractor shall develop for VHA, the Dental VA Fee Schedule (DVAFS) that will be shared with Third Party

Administrators (TPAs) and dental providers.

B. Medical

1. The Contractor shall provide Medical Charge and Allowed Benchmarks, on a bi-annual basis on January 31 and July 31 of each year throughout the contract periods of performance, for the following:

• Charged Amount Anesthesia

• Charged Amount HCPCS

• Charged Amount Medical

• Charged Amount Surgical

• Charged Amount Laboratory and Radiology

• Charged Amount Outpatient

• Charged Telehealth

• Allowed Anesthesia

• Allowed HCPCS

• Allowed Medical

• Allowed Surgical

• Allowed Laboratory and Radiology

• Allowed Outpatient

• Allowed Telehealth

2. The Contractor shall provide interim data refreshes as updates/releases are available for all medical charged and allowed benchmarks noted above. Updates shall be provided within thirty (30) calendar days of availability.

VI. Performance Period:

The period of performance is anticipated to be March 1, 2023 for a period of 12 months, hereto referred to as the Base Period of performance. The contract also includes four 12-month option periods which may be unilaterally exercised by the Government. Data submitted to the government during the period of performance under the contract shall be retained by VA upon contract completion for analysis and internal cost comparison on previous purchases and future purchases by VA only. All terms and conditions applicable to the base year shall extend to each option unless otherwise agreed upon.

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

Under current definitions, five are set by date:

New Year’s Day January 1

Juneteenth June 19

Independence Day July 4

Veteran’s Day November 11

Christmas Day December 25

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

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

Martin Luther King Day Third Monday in January

President’s Day Third Monday in February

Memorial Day Last Monday in May

Labor Day First Monday in September

Columbus Day Second Monday in October

Thanksgiving Fourth Thursday in November

VII. MANDATORY TASKS and ASSOCIATED DELIVERABLES:

A. The contractor shall complete the tasks below and associated deliverables by the scheduled dates within the overall PoP or as may be agreed to with the Contracting

Officer’s Representative (COR) and Contracting Officer (CO). If, for any reason, any deliverable cannot be delivered on time according to schedule, the contractor shall provide a written explanation within three (3) business days prior to the due date to the COR.

B. If the contractor is unable to meet the schedules for deliverables with turn-around times less than three (3) business days, the contractor shall provide to the COR a written explanation one (1) business day prior to the due date. This written transmittal shall include a firm commitment of when the work shall be completed. This transmittal to the COR shall cite the reasons for the delay and the impact on the overall project. The COR will notify and receive concurrence from VHA business owners and respond in accordance with the contract terms and conditions. All deliverables shall be provided in electronic format.

C. The contractor shall complete the tasks listed below within the stated timeframes:

1. Kick-Off Meeting

a. A technical kickoff meeting shall be held within seven (7) business days after award. The Contractor shall coordinate the date, time, and location (can be virtual) with the Contracting Officer (CO), the Contract Specialist (CS), and the COR. The

Contractor shall provide a draft agenda to the CO, CS or COR at least five (5) business days prior to the meeting.

b. Upon VA approval of a final agenda, the Contractor shall distribute to all meeting attendees. During the kickoff-meeting, the Contractor shall present, for review and approval by the Government, the details of the intended approach, work plan, and project schedule for each effort via a Microsoft Office PowerPoint presentation.

c. At the conclusion of the meeting, the Contractor shall update the presentation with a final slide entitled “Summary Report” as part of the meeting minutes and shall include notes on any major issues, agreements, or disagreements discussed during the kickoff meeting and will identify any action items and who is responsible for the action item. The draft kickoff meeting notes will be distributed electronically to all attendees for comment.

d. The Contractor shall address comments and submit the final updated presentation to the CO for review and signature within three (3) business days after the meeting.

The Contractor shall also prepare and distribute the meeting minutes of the kickoff meeting to the CO, COR, and all attendees within three (3) business days after the meeting. The Contractor shall obtain concurrence from the COR on the content of the meeting minutes prior to distribution of the document.

e. The CO signature or approval of the Summary Report confirms the discussion during the Kickoff Meeting; however, it does not authorize any changes nor supersede any of the requirements, terms or conditions included in the PWS.

f. Deliverables:

(i) Kickoff Meeting Presentation & Summary Report

(ii)Kickoff Meeting Minutes

2. Task 1: Implementation and Use of Data Subscription

a. The dental data will be utilized by VHA personnel who oversee the dental program to process historical claims and determine rates of reimbursement based on current costs. While access to dental data for all regions is a requirement, it is anticipated that between one to three individuals at approximately 150 parent VAMCs will routinely access information pertinent to their facility. A limited number of IVC and

VHA Office of Dentistry personnel will routinely access the information as required.

Data is accessed by individuals through a SharePoint for internal use only.

b. Dental data will be housed on one server location on VHA’s closed network. A non-operational backup copy will be housed on a second server in case of failure.

c. Data shall be provided to VHA via email in an excel file in addition to an

American Standard Code for Information Interchange (ASCII) or flat file format, database for integration into existing business information systems. No reporting functionality is required.

d. The deliverable shall reflect the most current data available.

e. First deliverable submission shall be provided within thirty (30) calendar days of contract award. All other submissions will follow the bi-annual cycle.

f. Data shall be provided at a minimum bi-annually on January 31 and July 31, and as updates/releases are available, for all current and active CDT code level for dental procedures as described by the American Dental Association.

g. Data shall be provided by the geozip code region (generally corresponds to the first 3 digits of the zip code).

h. Data shall be provided at varying percentile levels for each region at the 25th, 50th, 60th, 70th, 75th, 80th, 90th, and 95th percentiles.

i. Other module data shall be provided for all current and active CDT codes within thirty (30) days of availability.

j. Dental data is required for the United States, District of Columbia, U.S. Virgin

Islands, Puerto Rico, Northern Mariana Islands, Guam, and American Samoa.

k. Deliverables:

(i)Dental Data

(ii). The data provided shall be current, based on the most recent claim or survey data, with updates of not less than a semi-annual basis for all active CDT codes.

(iii). The Contractor shall submit the deliverable in draft form to this contract’s

VHA Contracting Officer’s Representative (COR) for review in accordance with mutually agreed upon required schedule of due dates determined upon award. The due dates shall be agreed upon within ten (10) business days of award.

(iv). VA will have thirty (30) calendar days after receipt to review draft deliverables, note deficiencies, or make other comments. The VA Stakeholder(s) will verify the accuracy of the submitted data and provide their written inputs with specific areas requiring rework or acceptability to the COR. The VHA COR will prepare a consolidated list of comments to the Contractor. In the event of any rejected deliverable, the Contractor shall be notified in writing by the COR of the specific reasons for rejection. The Contractor shall have thirty (30) calendar days to correct the rejected deliverable and return it per delivery instructions.

(v). The Contractor shall receive written acceptance by VA of all final deliverables prior to acceptance or provided documented reasons for rejection for failure to comply with contract requirements within thirty (30) calendar days.

(vi). The Contractor shall describe the methodology used to determine the dental data and source for each data type upon submission of deliverables via a supplemental word, PDF, or excel document.

(vii). Any request for changes to the delivery schedule shall be coordinated with the Office of Dentistry’s Stakeholder, IVC Stakeholder, and VHA COR prior to final approval and implementation by the Contracting Officer.

(viii). The dental data and other module data provided shall be based on claim or survey data points occurring during the designated time periods, and of sufficient quantity to calculate the percentiles using the actual or derived methodology as described in the documentation.

3. Task 2: Dental VA Fee Schedule General Requirements

a. Contractor shall develop a comprehensive dental fee schedule that includes all current and active CDT codes based on the usual and customary 50% rates.

b. The DVAFS will be leveraged by VA Office of Dentistry personnel, TPAs, contracted TPA Dental providers and Dental providers being recruited by the TPA and VHA across the nation to determine rates of reimbursement based on current dental codes. DVAFS will also be available to TPA and VHA personnel responsible for claims and payment processing and adjudication of Dental provider complaints and concerns.

c. The DVAFS shall be developed within six (6) months of contract execution date.

d. The DVAFS shall be exclusive to VA upon delivery.

e. The DVAFS shall provide a schedule by the geozip code region (generally corresponds to the first 3 digits of the zip code).

f. DVAFS rates are required for the United States, District of Columbia, U.S. Virgin Islands, Puerto Rico, Northern Mariana Islands, Guam, and American Samoa.

g. Deliverables:

(i) The DVAFS provided shall be current, based on the most recent claim or survey data, with updates of not less than a semi-annual basis for all active CDT codes.

(ii) The Contractor shall submit the deliverable via email in draft form to this contract’s VHA Contracting Officer’s Representative (COR) for review in accordance with mutually agreed upon required schedule of due dates determined upon award. The due dates shall be agreed upon within ten (10) business days of award

(iii) VA will have thirty (30) calendar days after receipt to review draft will verify the accuracy of the submitted data and provide their written inputs with specific areas requiring rework or acceptability to the COR. The VHA COR will prepare a consolidated list of comments to the Contractor. In the event of any rejected deliverable, the Contractor shall be notified in writing by the COR of the specific reasons for rejection. The Contractor shall have thirty (30) calendar days to correct the rejected deliverable and return it per delivery instructions.

(iv) The Contractor shall receive written acceptance by VA of all final deliverables prior to acceptance or provided documented reasons for rejection for failure to comply with contract requirements within thirty (30) calendar days.

(v) The Contractor shall describe the methodology used to determine the dental data and source for each data type upon submission of deliverables via a supplemental word, PDF, or excel document.

(vi) Any request for changes to the delivery schedule shall be coordinated and approved by the Office of Dentistry’s Stakeholder, IVC Stakeholder, and VHA

COR prior to implementation.

(vii) The dental data and other module data provided shall be based on claim or survey data points occurring during the designated time periods, and of sufficient quantity to calculate the percentiles using the actual or derived methodology as described in the documentation.

4. Task 3: Medical Benchmark Data General Requirements

a. Data shall be provided to VA in an excel file in addition to an ASCII or flat file format, database for integration into existing business information systems.

No reporting functionality is required.

b. Medical benchmark data will be leveraged within IVC by VA employees.

Users will utilize the medical benchmarks in conjunction with various other data sources to create the MVAFS.

c. The deliverable shall reflect the most current data available.

d. Data shall be provided at a minimum bi-annually on January 31 and July 31, and as updates/ releases are available, for all charges and allowed healthcare benchmarks as outlined in PWS Section V(B).

e. Data shall be provided by the geozip code region (generally corresponds to the first 3 digits of the zip code).

f. The number of observations for each procedure code shall be provided in all data sets.

g. Healthcare benchmarks outlined in Section V(B). shall be provided at varying percentile levels for each region at the 25th, 50th, 60th, 70th, 75th, 80th, 90th, and 95th percentiles.

h. Other module data shall be provided for all current and active CPT and HCPCS within thirty (30) calendar days of availability as noted above.

i. Medical benchmark data will be housed on one server location on VA’s closed network. A non-operational backup copy will be housed on a second server in case of failure.

j. Medical healthcare charges and allowed benchmarks are required for the United States, District of Columbia, U.S. Virgin Islands, Puerto Rico, Northern Mariana Islands, Guam, and American Samoa.

k. Deliverables

(i) Medical Benchmarks

(ii) The data provided shall be current, based on the most recent claim or survey data, with updates of not less than a semi-annual basis for all active CPT and

HCPCS codes and within 30 calendar days of any updates that occur.

(iii) The Contractor shall submit the deliverable in draft form to this contract’s

VHA COR for review in accordance with mutually agreed upon required schedule of due dates determined upon award. The due dates will be agreed upon within ten

(10) calendar days of award.

(iv) VHA will have thirty (30) calendar days after receipt to review draft will verify the accuracy of the submitted data and provide their written inputs with specific areas requiring rework or acceptability to the COR. The VHA COR will prepare a consolidated list of comments to Contractor. In the event of any rejected deliverable, the Contractor shall be notified in writing by the COR of the specific reasons for rejection. The Contractor shall have thirty (30) calendar days to correct the rejected deliverable and return it per delivery instructions.

(v) The Contractor shall receive written acceptance by VA of all final deliverables prior to acceptance or provided documented reasons for rejection for failure to comply with contract requirements within thirty (30) calendar days of receipt.

(vi) The Contractor shall describe the methodology used to determine the benchmarks including actual values and derivatives of calculations as well as the source for each data type upon submission of deliverables.

(vii) Any request for changes to the schedule shall be coordinated with the IVC

Stakeholder and VHA COR prior to approval and implementation by the

Contracting Officer.

(viii) The healthcare benchmarks, and other module data, provided shall be based on claim or survey data points occurring during the sample time period, and of sufficient quantity to calculate the percentiles using the actual or derived methodology as described in the documentation. The sample period shall be taken from the most recent data available.

(ix) The Contractor shall provide a data dictionary or record layout for variable/field identification, interpretation, and formatting. This documentation shall be provided for each dataset and include field length, field position, field type, and a description of the variable or field. The data shall be specific to all of the

United States and U.S. Territories with capabilities to manipulate data to specific regional geographic locations (ex. Ability to pull claims or data from Alaska only).

(x)The Contractor shall provide a document explaining noteworthy inconsistencies, limitations, anomalies within their data.

(xi)The Contractor shall provide team access to their SMEs to validate/review questions related to the data and to troubleshoot issues and clarify findings.

(xii)The Contractor shall provide initial training/availability on their data sets and usage.

(xiii)The Contractor shall notify VHA of their release schedule thirty (30) calendar days in advance of release/upload/posting. Data provided shall identify the timeframe for the data included in the file(s).

5. Task 4: Medical VA Fee Schedule (MVAFS) General Requirements (Optional

Task)

a. In addition to Task 3 (Medical Benchmark data), Contractor shall develop a comprehensive medical fee schedule that includes all current and active billing codes.

b. The MVAFS will be used for processing VA contract and non-contract claims according to VA payment hierarchy. The VA Medical Fee schedule will be publicly available and accessible to VA Medical Centers, VA As, and community Providers.

c. The Medical VAFS will be developed utilizing various industry benchmarks according to VA specifications that will be outlined at the time of execution of optional task.

(i) Contractor shall recommend approaches to MVAFS rate setting and methodology based on industry expertise and analysis.

(ii) Contractor shall include the application of current VA Policy, Payment

Policy and Medical Policy and will require analysis and incorporation of industry payment and medical policies.

(iii) Contractor shall review options based on (i) and (ii) with VA for acceptance and concurrence before final deliverable.

(iv) The MVAFS shall be developed within six (6) months of execution date of

Optional Task.

(v) The fee schedule shall be exclusive to VHA upon delivery and will be published on the VA website at https://www.va.gov/.

(vi) The MVAFS shall provide a schedule by Medicare locality.

(vii) MVAFS rates are required for the United States, District of Columbia, U.S. Virgin Islands, Puerto Rico, Northern Mariana Islands, Guam, and

American Samoa. MVAFS rates will include schedules applicable to all payment authorities.

d. Deliverables

(i) The MVAFS provided shall be current, based on the most recent claim or survey data, with updates of not less than a semi-annual basis for all active billing codes.

(ii) The Contractor shall submit the deliverable in draft form to this contract’s

VHA Contracting Officer’s Representative (COR) for review in accordance with mutually agreed upon required schedule of due dates determined upon award.

The due dates shall be agreed upon within ten (10) business days of award

(iii) VHA will have thirty (30) calendar days after receipt to review draft deliverables, note deficiencies, or make other comments. The VHA

Stakeholder(s) will verify the accuracy and provide their written inputs with specific areas requiring rework or acceptability to the COR. The VHA COR will prepare a consolidated list of comments to the Contractor. In the event of any rejected deliverable, the Contractor shall be notified in writing by the COR of the specific reasons for rejection. The Contractor shall have thirty (30) calendar days to correct the rejected deliverable and return it per delivery instructions.

(iv) The Contractor shall receive written acceptance by VHA of all final deliverables prior to acceptance or provided documented reasons for rejection for failure to comply with contract requirements within thirty (30) calendar days.

(v) The Contractor shall describe the methodology used to determine the fee schedule and benchmark sources for each data type upon submission of deliverables.

(vi) Any request for changes to the delivery schedule shall be coordinated and approved by IVC Stakeholder, and VHA COR prior to implementation.

VIII. Electronic Submission of Payment Requests for Billing

The process for submission of invoices after receipt of approval for submitted data is as follows:

A. The Contractor shall submit two separate invoices to the assigned VA COR for review. One invoice shall be for dental data and fee schedule services, and the other for medical data services. The invoices shall be separate using the two different Purchase

Order numbers.

B. Contractor shall upload the invoices without Personal Identifiable Information (PII) into OB10 where it will be processed by Financial Management Service (FMS) and then sent to the COR through Invoice Payment Processing System (IPPS).

C. The COR will approve and certify the submitted invoices for payment. Invoices considered incomplete or that require additional information for processing, will be rejected for correction and re-submission. Reasons for return may include but are not limited to missing VA required data, the need for additional supporting documentation, or correction and explanation of coding discrepancies on the claims. Invoices may require specific documentation prior to processing. The COR has thirty (30) calendar days to reject an invoice. Resubmission for reconsideration of payment shall be completed within thirty (30) calendar days of denial, but in no case less than twelve (12) months from date of denial.

IX. Deliverables

The Contractor shall be prepared to comply with requests for information, including those originating from Congress, using company letterhead, complete sentences, and professional English. Contractor shall comply with the requests of government and independent auditors during audits of this contract and all associated contract documentation, including but not limited to invoices. The Contractor shall respond to routine inquiries within two (2) business days of receipt. The Contractor shall respond to priority inquiries within 24 hours of receipt.

X. License Codes

A. Certain contractor data products contain CPT codes owned and copyrighted by the

American Medical Association (AMA), CDT codes owned by the American Dental

Association (ADA) or content owned by the American Society of Anesthesiologists (ASA)

(collectively, the “Licensed Codes”). The VHA acquires no proprietary interest in the

Licensed Codes. All rights in the Licensed Codes are owned and retained by AMA, ADA and ASA, respectively. VHA is not licensed to make or distribute copies of the CPT or CDT codes unless and until it has a valid license to do so from the AMA or ADA, respectively.

Any person or entity that VHA authorizes to obtain access to Licensed Codes shall comply with the provisions of this of this document.

B. All notices of proprietary rights, including trademark and copyright in the Licensed

Codes shall appear on all permitted back-up or archival copies made by VHA. CPT® is a registered trademark of the AMA. CROSSWALK®, Reverse CROSSWALK® and Relative

Value Guide® are trademarks of ASA.

C. VHA will not use Licensed Codes or information contained therein in any public computer-based information system or public electronic bulletin board (including the

Internet and World Wide Web). VHA will not create any derivative works (including translations) based on Licensed Codes and is prohibited from transferring, selling, leasing, licensing (including sublicensing) or otherwise making the Licensed Codes available to any unauthorized party. VHA may print or download the Licensed Codes from the data products solely for its own internal use, without any modification to the content, and in such a way that the appropriate citation is included. Contractor’s ability to deliver updated versions of

CPT to VHA is dependent upon Contractor continuing its contractual relations with the

AMA. This excludes the DVAFS.

D. VHA cannot and will not permit unauthorized personnel to (a) copy the CDT; (b) alter, amend, change or modify the CDT, including the CDT codes, nomenclature and descriptors or other content of the CDT; (c) remove any copyright or other proprietary notices, labels or marks from the CDT or from output created by using the Data Products; (d) distribute, sell, assign, lease or otherwise transfer the CDT, including the codes or any portion thereof, in any printed, machine-readable or other form to any other person, firm or entity; or (e) use the

CDT, whether on a time-sharing, remote job entry or other multiple user arrangement. VHA will take reasonable measures to maintain the security of the CDT. VHA acknowledges and agrees that ADA owns all right, title and interest (including all copyrights and other intellectual property rights) in the CDT (in all print and machine-readable forms), all other rights of commercialization, rental or sale of the CDT or any part thereof, the right to make derivatives of the CDT and the right to distribute the CDT and copies thereof. VHA acquires no proprietary interest in the CDT, or any portion thereof. Except for the limited rights expressly granted to VHA herein, all other rights in the CDT are owned and retained by

ADA. VHA agrees to indemnify ADA (including reasonable attorneys' fees and costs of litigation) against and hold ADA harmless from any and all claims, liability, losses, damages and expenses resulting from VHA’s use of the CDT, in breach of any of the terms of this

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COPIES AVAILABLE TO CONTRACTOR.

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DOCUMENTATION ARE PROVIDED ‘AS IS’, WITHOUT WARRANTY OF ANY

KIND, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, WARRANTIES

OF PERFORMANCE OR MERCHANTABILITY OR FITNESS FOR A PARTICULAR

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CONSEQUENCES DUE TO USE, MISUSE, OR INTERPRETATION OF

INFORMATION CONTAINED OR NOT CONTAINED IN ASA CONTENT.

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1. CPT Codes. This product includes CPT which is commercial technical data, which was developed exclusively at private expense by the American Medical

Association (AMA), 330 North Wabash Avenue, Chicago, Illinois 60611. The AMA does not agree to license CPT to the Federal Government based on the license in FAR

52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data -

Commercial Items) or any other license provision. The AMA reserves all rights to approve any license with any Federal agency.

2. Other Data. The Data Products and Licensed Codes other than CPT Codes are

“Commercial Items” as that term is defined in 48 C.F.R. 2.101, and include commercial technical data or computer licensed databases or commercial computer software or commercial computer software documentation, as applicable, which were developed exclusively at private expense by Contractor, the ADA or the ASA. U.S.

Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data or computer licensed databases or commercial computer software or commercial computer software documentation are subject to the limited rights restrictions of 48 C.F.R. §12.211, 48 C.F.R. §12.212, 48 C.F.R. §227.7102-2, and 48

C.F.R. §227.7202, as applicable. Consistent with 48 C.F.R. §12.211, 48 C.F.R.

§12.212, 48 C.F.R. §227.7102-1 through 48 C.F.R. §227.7102-3, and 48 C.F.R.

§§227.7202-1 through 227.7202-4, as applicable, this commercial product and data are licensed to U.S. Government end users (i) only as Commercial Items and (ii) with only those rights as are granted to all other users pursuant to the terms and conditions of this Agreement. In case of conflict between any of the FAR and DFARS provisions listed herein and this Agreement, the construction that provides greater limitations on the Government's rights shall control, subject to applicable law. For purpose of any public disclosure provision under any federal, state or local law, it is agreed that this commercial product and data are a trade secret and proprietary commercial products and not subject to disclosure.

XI. END USERS

End Users are defined as members of the VHA and TPAs organizations responsible for billing and claims associated with dental services and/or responsible for the management, training and recruitment of the contractors’ dental network. VHA will permit TPAs to share the DVAFS with their dental providers who have entered into a formal contract with the VA and/or received individual authorizations to provide treatment to veterans, as contemplated by Section B.3 of our agreement. VHA will further consent to disclosing such fee schedules to specific providers whom the VA is actively working to recruit for such a formal contract or authorization. VHA personnel who oversee the dental program to process historical claims and determine rates of reimbursement based on current costs will have access. While access to dental data for all regions is a requirement, it is anticipated that between one to three individuals at approximately 150 parent VAMCs will routinely access information pertinent to their facility.

Appendix A

SEE ATTCH A1 - Veterans Health Administration Dental Program, VHA Directive 1130

Appendix B

VHA Regional Map