ATTACHMENT A PWS IVC Clinical Contact Center (CCC) Nurse Telephone Triage Training.pdf

Performance Work Statement IVC Clinical Contact Center (CCC) Nurse Telephone Triage Training

1. Introduction

As telephone triage remains a significant form of telehealth nursing and a core service of the VA Health Connect Clinical Contact Centers nationwide, the U.S. Department of Veterans Affairs (VA) Office of Integrated Veteran Care (IVC) is seeking access to a commercial off the shelf (COTS) online web-based course for nurse triage in the clinical contact center (CCC) environment. In Fiscal Year (FY) 2022, through a contract with Telephone Triage Consulting, Inc. (TTC), owned and operated by Carol Rutenberg, VHA offered the Telephone Triage as Professional Nursing Practice: Improve Quality and Risk Education Seminar to ≈ 900 Registered Nurses (RNs) with great success. This seminar was originally taped in 2019 and updated in 2020. Moving forward, VHA is looking for a triage nursing course geared towards RNs in the clinical contact center environment to accommodate current recommendations and standards in telephone triage to telehealth nursing and encompass new best practices.

VA Health Connect is part of VA’s transformation of care delivery, providing Veterans even more control of their health, letting them choose how, when, and where to receive their care. VA’s Clinical Contact Centers (CCCs) will provide Veterans easier access to 24/7 virtual services using a single toll-free number at each Veterans Integrated Service Network (VISN) level CCC.

VHA is committed to supporting its staff with effective training opportunities to increase competency, work effectiveness, and leadership. By providing access to this training, VA Health Connect under IVC ) will reap a benefit of increased first contact resolution and improved Veteran satisfaction in Clinical Contact Center Modernization (CCCM) through provision of self-paced professional development offering for the triage RNs. These RNs are considered the cornerstone of telephone triage nursing. Staff in the clinical contact centers have identified a need for a robust nurse triage training. This clinical training will enhance VA Health Connect triage nurses’ understanding and, appropriate and effective use of Decision Support Tools (DST) through development of their critical thinking skills. The anticipated learning outcomes upon completion of the course will provide the learner with increased knowledge in professional, regulatory, and legal standards governing telephone triage; critical thinking, theory, and decision making in uncertain conditions of telephone triage; appropriate use of decision support tools;

documentation; and risk management.

2. Scope

The Contractor shall provide users online access to the agreed upon web-based clinical contact center RN triage course not to exceed (NTE) nine hundred (900) Registered Nurse (RN) users during a twelve

(12) month period, excludes continuing education units (CEU).

The course shall feature traditional and interactive content and be available 24/7 to users during the period of performance.

Course shall be applicable to the clinical contact center environment. The course framework shall address the various elements of telephone triage. The following elements shall be included at a minimum:

• Defining Telephone Triage

• Basic Standards in Nursing Telephone Triage

• Regulatory, and Professional Standards Directing Telephone Triage Nursing Today

• Common Legal Pitfalls and Practices

• Organizational Standards

• Critical Thinking and Competency

• Decision Making

• Communication

• Systematic Assessment

• Appropriate Use of Clinical Decision Support Tools

• Documenting the Telephone Triage Encounter

• Risk Management

Course materials shall build upon the foundation of the Telephone Triage as Professional Nursing Practice: Improve Quality and Risk Education Seminar by Carol Rutenberg.

Online access shall include access to all course modules, downloadable documents (e.g., guides, handouts, exercises, books, job aides, etc.) and permission to reproduce the course materials for internal VA distribution. There shall be no time limit on the ability to reproduce and share the course materials within the VA.

Users shall be able to access training via any private or public computer, tablet, or mobile device that they may have access to. Users shall be able to download course materials to any private or public computer, tablet, or mobile device that they may have access to. This includes Government Furnished Equipment (GFE). Users shall be able to access training within the VA Firewall.

Contractor shall have the course available for six (6) months from time of user registration to complete during the base period and each option period exercised as part of the transitioning out process.

The Contractor shall provide deliverable(s) in a format mutually agreed upon by the Government and the Contractor.

3. Task statement: Project Management and Education/Course Delivery

The Contractor shall provide all labor, supervision, and other resources required to successfully deliver the telephone triage nursing course to users NTE 900 in a twelve-month period.

The Contractor shall be responsible for the arrangement of a post-award conference and shall present its approach for the delivery of the project activities. A post-award conference (e.g., face-to-face conference, teleconference, or videoconference) or “post-award conference” is a substantive review and analysis of the contract terms and conditions. A post-award conference aids both Government and Contractor personnel to (1) achieve a clear and mutual understanding of all contract requirements and

(2) identify and resolve potential problems. The post-award conference post-award conference shall be held within ten (10) business days after award. The Contractor shall submit an agenda, and any materials to be used for discussion, at least two (2) business days in advance of the post-award conference. The Contractor shall prepare and distribute minutes within three (3) business days of the conference. The conference minutes shall include at a minimum the contract number, project manager, a list of attendees, a description of the issues discussed, action items, assignments, and due dates.

The Contractor shall manage the onboarding of its staff. The Contractor shall be responsible for the creation of a Training Management System Profile/account. The Contractor shall submit Talent Management System (TMS) training certificates of completion for VA Privacy and Information Security

Awareness and Rules of Behavior; and Health Insurance Portability and Accountability Act (HIPAA) training ; as well as provide signed copies of the Contractor Rules of Behavior (CROB) to the COR.

The Contractor shall provide support to end users that experience trouble with online access to and navigation through the web-based course through completion of the course with backup from website technical support as necessary. The Contractor shall be responsible for providing instructions directly to each end user covering how to access the course/training.

Users shall be assigned by the Government. The Government shall provide users’ first and last names and email addresses to the Contractor for one-time registration.

The Contractor shall track and report monthly on the status of all users engaged on the Nurse Telephone Triage Education course. The User Statistic Report is due the 15th of each month. The User Statistic Report will be comprised at a minimum of a Cumulative Summary Sheet which will contain at a minimum the following data:

• Completions to date by month

• Authorizations to date by VISN

• Registrations to date by VISN

• Not Registered to date by VISN and for each VISN will track and report at a minimum the following data for each month per user:

• User Registration Date

• First and Last Name User

• Veterans Integrated Services Network (VISN)

• User Email Address

• User Course Completion Date

• Total Number of users accessing Course

Currently there are 18 Veterans Health Administration Veterans Integrated Services Networks (VISNs) Veterans Integrated Services Networks (VISNs).

The Contractor shall provide a Certificate of Completion to each user who fulfills the course requirements within ten (10) business days of user’s completion.

The Contractor shall grant permission to VHA’s IVC Office to reproduce downloadable course materials for internal VA distribution only.

The Contractor shall meet and participate in monthly status meetings with designated Government personnel to discuss the tasks and milestone status as well as address any questions and/or issues that may surface to carry out operations. If any newly identified issue(s) and/or concern(s) should arise and cannot be resolved via email communications, the Contractor shall make themselves available to meet for an ad hoc meeting(s) to discuss for resolution.

The Contractor shall provide a copy of all course materials to the Government. This includes curriculum, guides, handouts, exercises, books, job aides, etc. This also includes any new materials, changes and/or updates to the course curriculum and/or course materials throughout each period of performance.

The Contractor shall notify the Government thirty (30) days in advance in writing of any new materials, changes and/or updates to the course curriculum and/or course materials throughout each period of performance.

The Contractor shall notify the IVC PM and/or their designee(s) and VA COR, in writing, immediately if problems arise adversely impacting the performance of the PWS.

Deliverables:

A. Post-award conference includes presentation and meeting minutes B. Online Access to entire web-based Nurse Telephone Triage Education Course (includes downloadable course materials) C. Monthly user statistics report D. Users’ Certificates of Completion E. Monthly status meetings

4. Delivery Schedule

Deliverable Quantity Delivery Date Post-award conference Participation

1 within ten (10) business days after award

Post-award conference Presentation

1 at least two (2) business days in advance of the post-award conference

Post-award conference Minutes 1 within three (3) business days of the meeting

Contractor Staff Roster- Initial 1 within ten (10) business days after award

Contractor Staff Roster-Updates

LOT

within two (2) business days of change

Signed copies of the Contractor Rules of Behavior (CROB) Forms

LOT within ten (10) business days after award

Talent Management System (TMS) Training Certificates of Completion for VA Privacy and Information Security Awareness and Rules of Behavior and Health Insurance Portability and Accountability Act (HIPAA) training

LOT within ten (10) business days after award

Access to web-based Nurse Telephone Triage Education Course includes downloadable course materials

Not To Exceed (NTE) 900 users Due fifteen (15) business days after award

Monthly Status Meeting NTE 12 Due the 15th of each month

Monthly User (RN) Statistics Report

12 Due the 15th of each month

User Completion Certificates Individuals

LOT within ten (10) business days of user’s completion date

5. Period of Performance. Base Period twelve (12) months with a provisional two (2) twelve (12) month option periods to be exercised at the discretion of the government. All tasks shall be performed in the base and option periods, if exercised.

6. Type of Contract. Firm Fixed Price (FFP)

7. Place of Performance. Contractor’s facility, virtual delivery

8. Travel. Not Applicable

9. Material Other Direct Costs. Not Applicable

10. Government-Furnished Information, Equipment, and Facilities. Not Applicable

11. Security Requirements.

The position sensitivity and the level of background investigation commensurate with the required level of access for the following tasks within the Performance Work Statement (PWS) are:

Position Sensitivity and Background Investigation Requirements

Position Sensitivity and Background Investigation Requirements Task Number Low/NACI Moderate/MBI High/BI 3.1

1. GENERAL

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

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.

3. VA INFORMATION CUSTODIAL LANGUAGE

a. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).

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. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA’s information is returned to the VA or destroyed in accordance with VA’s sanitization requirements. VA reserves the right to conduct onsite inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.

c. Prior to termination or completion of this contract, contractor/subcontractor must not destroy information received from VA, or gathered/created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract.

d. The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations, and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations, and policies in this contract.

e. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.

f. If VA determines that the contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the contractor or third party or terminate the contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12.

g. 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.

h. The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated.

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.

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.

k. 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.

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 Contracting Officer Representative (COR) .

6. SECURITY INCIDENT INVESTIGATION

a. The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COTR and simultaneously, the designated Information Security Officer (ISO) and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.

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

c. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach.

Notifications need to be made in accordance with the executed business associate agreement.

d. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.

7. LIQUIDATED DAMAGES FOR DATA BREACH

a. Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.

b. The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.

c. Each risk analysis shall address all relevant information concerning the data breach, including the following:

(1) Nature of the event (loss, theft, unauthorized access).

(2) Description of the event, including:

(a) date of occurrence.

(b) data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code.

(3) Number of individuals affected or potentially affected.

(4) Names of individuals or groups affected or potentially affected.

(5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text.

(6) Amount of time the data has been out of VA control.

(7) The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons).

(8) Known misuses of data containing sensitive personal information, if any.

(9) Assessment of the potential harm to the affected individuals.

(10) Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and

(11) Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised.

d. Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following:

(1) Notification.

(2) One year of credit monitoring services consisting of automatic daily monitoring of at least three (3) relevant credit bureau reports.

(3) Data breach analysis.

(4) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution.

(5) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and

(6) Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.

8. TRAINING

a. All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems:

(1) Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems.

(2) Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training.

(3) Successfully complete the appropriate VA privacy training and annually complete required privacy training; and

(4) Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document – e.g., any role-based information security training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.]

b. The contractor shall provide to the contracting officer and/or the COTR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within one (1) week of the initiation of the contract and annually thereafter, as required.

c. Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete.

9. Task Order Quality Assurance Surveillance Plan (QASP)

Deliverable or Requirement

Performance Standard

Surveillance Method

Outcome

Quality of Deliverables

Documents are delivered with 95% accuracy (less than 5% of the document requires revision) as determined by the COR

100% inspection.

The TO COR will review each Deliverable for quality/ timeliness according to criteria established in this

TO.

Poor performance may result in issuance of a Contractor Discrepancy Report (CDR). The contractor’s performance on this TO will be reported to the Contractor Performance Assessment Reporting System (CPARS) on an annual basis. The CO and COR will make use of information from CDRs, as well as any additional knowledge and information available to them with respect to the contractor’s performance, to complete the

CPARS.

Delivery of Services

Services shall be provided in accordance with the Project Management Schedule 100% of the time

100% inspection.

The TO COR will review Services for timeliness according to criteria established in this TO and/or the Project Initiation Agreement.

The Government will not pay for services that do not conform or do not meet performance standards or have not been properly rendered.

The contractor will be given an opportunity to correct non-conforming services at no cost to the Government if the services are non-conforming or the contract requirement is unacceptable.