B.3 PERFORMANCE WORK STATEMENT (PWS)

Medical Disability Examinations (MDEs) under Section 504 of the Veterans’ Benefits Improvements Act of 1996 (Public Law 104–275; 38 U.S.C. § 5101)

1.0 INTRODUCTION

The Department of Veterans Affairs (VA), through the Veterans Benefits Administration (VBA), administers the Compensation & Pension (C&P) Program, which provides benefits to Veterans, Service Members, and their dependents and survivors. To support disability compensation and pension determinations, VA conducts Medical Disability Examinations (MDEs), which serve as critical medical evidence for evaluating claimed conditions.

Public Law (P.L.) 104-275 (Oct. 9, 1996) authorizes VA to contract with non-VA medical examiners to perform these examinations. Under this authority, VA has awarded contracts to Prime Contractors to provide disability examination services, with additional contracts issued over time to expand examination capacity. The Medical Disability Examination Office (MDEO) manages and oversees these contracts on behalf of VA.

MDEs are performed by both Veterans Health Administration (VHA) clinicians and VBA Contractors. Examination findings are documented on Disability Benefits Questionnaires (DBQs) or other Government-approved formats and must be complete, accurate, and sufficiently detailed to support adjudication and withstand appellate review. VBA Rating Veterans Service Representatives (RVSRs) and Decision Review Officers (DROs) rely on these examination results, together with other evidence of record, to determine entitlement to disability compensation and pension benefits.

Claimants requiring MDEs may include Veterans and active-duty Service Members. Active-duty Service Members may participate in two joint Department of Defense (DoD)-VA disability evaluation programs. The Integrated Disability Evaluation System (IDES) evaluates Service Members' fitness for continued military service while simultaneously determining VA disability benefits, helping to streamline the transition to veteran status. The Benefits Delivery at Discharge (BDD) program enables eligible Service Members to file disability compensation claims before separating from military service. Both CONUS and OCONUS military installations participate in the IDES and BDD programs.

2.0 OBJECTIVE

VA’s objective is to provide Veteran-centric, efficient medical disability examinations using a robust network of qualified providers and reliable information technology (IT) systems to process examination scheduling requests (ESRs) and deliver examination results and related data that are complete, accurate, and sufficiently detailed to support adjudication and withstand appellate review.

3.0 GENERAL CONTRACT INFORMATION

3.1 SCOPE

This contract requires Contractors to perform private sector medical disability examination (MDE) services for Claimants through a skilled network of qualified and licensed Examiners and process all examination requests and data through secure information technology (IT) network capable of interfacing with VA systems.

Services under this contract will be performed for six different Service Groups as defined in Section B.1 and the MDE General Handbook, which geographically span the entire United States and international countries, based on the Claimants residence or military base. All requirements outlined in this PWS apply to all Service Groups except where specifically stated otherwise (e.g. Applies to Pre-Discharge Only).

Examinations are to be conducted within the same or surrounding geographic area of the awarded Service Group while adhering to this contract’s distance limitations. Contractors must comply with DBQ requirements defined in the DBQ Information Exchange Package Documentation (IEPD) and examination findings must be documented in accordance with this PWS and applicable MDEO Handbooks (see PWS Section 4.1). Contractors must provide Examiners, facilities, lab testing, support staff, and general administrative services (e.g. quality assurance, scheduling, notifications, and electronic transmission of reports).

3.2 PLACE OF PERFORMANCE

Performance must occur primarily at the Contractor’s place of business, examination locations, or other appropriate places as outlined in the MDEO Handbooks.

3.3 VOLUME

The volume of MDEs vary based on Congressional mandates, new legislation, Veteran populations and other factors. MDEO uses historical data to project the number of ESRs required from year to year and for estimating purposes; actual/expected volumes of ESRs to be performed will be specified at the task order level.

The following tables provide annual estimates or forecasts of ESRs anticipated to be processed in the upcoming calendar years, based on historical data of the number of ESRs processed under MDE contracts, as well as the average number of DBQs per ESR for each of the six Service Groups.

Annual Estimate/ Forecasted ESRs Per Service Group

*Data estimated for 2027 is adjusted to semi-annual figure to align with contract Base Period of 6-months.

2020-2025

**Pre-Discharge Average of DBQs per ESR based on 2022-2025 only; a change to the structure of the Separation Health Assessment (SHA) in 2024 may impact / reduce the number of DBQs per ESR though this average retains an even volume of DBQs based on current available data.

3.4 CONTRACT RAMP-UP

Contractors must:

A. Accept full ESR workload within awarded Service Group no later than one (1) year after award / 30 days after award for incumbent contractors with an established Examiner Network and Authority to Operate (ATO).

B. Establish an Examiner network capable of supporting anticipated ESR volume ahead of starting operations.

C. Complete development of IT systems within six (6) months of award (see Technology section).

D. Complete User Acceptance Testing (UAT) by 11 months to validate all system functionality.

E. Obtain an ATO, including all privacy/security requirements, within one (1) year of award (see Security Controls Compliance, Scans and Assessments).

F. Electronically submit Contractor personnel onboarding documents (personnel with systems access/PIVs, see Sections 8.0 and 9.0) to the COR (Contracting Officer Representative) within five (5) days of award. This documentation must be error‑free; correct and resubmit within 24 hours if mistakes are found.

G. Provide a Ramp up Plan within five (5) days of award that demonstrates:

· Network adequacy (appointments available, Examiner count by specialty, and type of examination they are qualified to conduct);

· Phased implementation with milestones;

· Weekly status updates and documentation;

· Which Regional Office (RO) or service area within the Service Group coverage is ready to begin work with a timeline (Contractors cannot accept ESRs in any area until able to accept all DBQ types); and

· Readiness review criteria used to determine that an RO or service area is ready to begin receiving ESRs.

No ESRs will be sent until the necessary systems are developed, UAT has been passed, and the ATO is achieved. A full workload volume is all DBQ types across all ROs or service areas. A new Contractor must accept a partial workload, if feasible and in accordance with the Contractor’s Ramp up Plan, if the Examiner Network is partially established and ATO is obtained, as efforts continue to scale to a full workload. A partial workload is a reduced volume across one or more RO or service area within the Service Group across all DBQ types.

The Contractor must ensure its systems are aligned with evolving industry and VA standards and plan future system improvements as appropriate to support VA interoperability, data exchange, and security requirements. Systems must follow open, standards‑based architectures, including VA‑approved specifications.

The Contractor must use a configurable solution that supports controlled testing, acceptance, and implementation of changes. When VA requests an enhancement change or upgrade, the Contractor must implement the change by the mutually agreed‑upon date.

3.4.1 Additional Country Ramp-up (Applies to International Only)

Additional countries may be added when data shows sufficient volume of ESRs to warrant presence in the location. For any additional countries added to the International Service Group, the Contractor will be allowed a 90-day ramp-up to hire and train additional personnel.

4.0 GENERAL PROGRAM INFORMATION

4.1 MDEO HANDBOOKS

The M21-1 Adjudication Procedures Manual (M21-1) is a comprehensive VBA resource detailing the policies and procedures necessary for adjudicating C&P claims; Part IV Examinations is specifically relevant to this contract. To further define and provide programmatic information needed for contract performance, MDEO will provide written technical information and instructions in a series of MDEO Handbooks that align with VA, VBA, and MDEO policies for services required in this PWS. These Handbooks will be updated periodically, and Contractors are required to follow the most current version. Contractors must comply with all documents referenced in this PWS and MDEO Handbooks.

MDEO Handbooks

4.2 COMMUNICATIONS WITH REGIONAL OFFICES AND MILITARY SERVICE COORDINATOR

4.2.1 VBA Regional Offices

Contractors must not communicate with RO leadership or examination liaisons regarding local issues or general questions without MDEO permission. Contact with the RO examination liaison is permitted for questions related to specific ESRs. General inquiries should be submitted to MDEO. VA will provide contact lists for liaisons and alternates and update as needed.

Restrictions:

· Do not coordinate cancellations or create local processes with VA RO leadership.

· Do not discuss work distribution with ROs

· Do not request policy or procedural changes via RO leadership. Policy or procedural changes should be submitted to MDEO for consideration.

· Do not provide training materials to VA RO leadership. Suggestions for training should be submitted to MDEO for review and possible national dissemination.

4.2.2 International Locations (Applies to International Only)

Examinations for international locations must primarily be coordinated via the Pittsburgh, Honolulu, Manila, and San Juan Regional Offices.

4.3 MDEO SITE VISITS

VA reserves the right to inspect Contractor/Subcontractor locations and mobile clinics within the United States (including Territories) with or without notice. VA or a designated third party on behalf of MDEO may conduct site visits. Contractors must ensure the accessibility of all facilities. If access is denied or the location is unavailable, the Contractor must reimburse the Government for time and travel expenses incurred (e.g., via separate credit invoice). Site inspections will consider Claimant experience (e.g. facility cleanliness, accessibility, etc.) and MDEO facility requirements (see MDEO Operations Handbook).

4.3.1 Inspection/Visit Notice:

· Complaint-based, Contractor/Subcontractor locations: 24 hours.

· Corporate HQ and administrative offices: one (1) week minimum.

· No notice will be provided for unscheduled/impromptu visits.

4.3.2 Corrective Action:

Within 15 days of receiving Site Visit findings, the Contractor must submit a Site Visit Corrective Action Plan to address all findings, timelines for correction/resolution, COR feedback, as well as verification of correction/resolution of the finding to the COR.

5.0 SPECIFIC TASKS AND DELIVERABLES

5.1 TASK 1: MEDICAL DISABILITY EXAMINATIONS

The Contractor must provide MDEs in compliance with VBA standards, forms, practices, and ESRs. Disability examinations may be conducted through a variety of appointment modalities, including in-person evaluations, telehealth visits, and records-based reviews, depending on clinical needs, accessibility considerations and other organization requirements. Refer to the MDEO Examinations Handbook for additional information on Examination Services and MDEO DBQ Compliance Handbook for DBQ and Exam Compliance and Reviews.

5.1.1 DBQ Requirements and Types

DBQs provide detailed examination requirements based upon statutory, legislative and court mandated criteria for VA disability entitlement determinations. Changes are made periodically to the DBQs to reflect regulatory or medical requirements. The Contractor must update their systems and examination practices accordingly at no additional cost to the Government. Comments out of the context of the examination must not be included in the DBQ, such as merits of the claim, percentage of service-connected disability to be granted, likely outcome or benefits as a result of examination, correctness of a determination that a disability is or is not service-connected, or treatment recommendations.

All appointments must be conducted in accordance with the VA-issued DBQ, ESR, contractual, requirements, and VA instructions. The Contractor must provide, based on specific VA request, the full range of MDEs listed in the MDEO Examinations Handbook. All claimed contentions in the ESR must be examined. If the actual contention differs but is clinically consistent with reported symptoms, the Examiner must evaluate the actual contention, substitute the correct DBQ and or medical opinion, and complete a DBQ and Medical Opinion Substitution Report. For example, if a Wrist DBQ is requested but the Examiner determines the wrist symptoms actually represent carpal tunnel syndrome, the Peripheral Nerves DBQ should be substituted as this is what is actually needed to evaluate the contention.

In addition to substituting a DBQ with a more appropriate one to properly assess the actual contention, there may be instances when information or clinical findings identified during an examination may also trigger the need to complete additional DBQs that were not initially requested. See the MDEO Examinations Handbook for more information on Triggering Additional Examinations and DBQs.

To ensure examinations conducted are sufficient for rating purposes, the Contractor must ensure DBQ compliance of examinations conducted by its examiners. The Contractor plan for DBQ compliance must be described in its PMP (see Task 5.7.4) and comply with MDEO DBQ Compliance Handbook.

The Contractor must ensure that DBQ PDFs, or as otherwise determined by the COR, are not locked in Adobe and are available for review. Completed DBQs must reflect complete and accurate reviews. The Contractor must transmit completed DBQs, diagnostics, and other exam data with the date/time completed to Veterans Benefits Management System (VBMS) or other system as designated by the COR daily (see MDEO Handbook). The Contractor must retain copies of all DBQs and diagnostics for three (3) years.

5.1.2 Pre-Discharge Exams

The Separation Health Assessment (SHA) DBQ and SHA program is an examination process supporting Pre-Discharge programs. Within DoD, the SHA process is termed the Separation Health and Physical Examination (SHPE) process, however, it is the same process as the SHA. There are two components of the SHA: the Subjective Assessment of Health (DD Form 2807 -1), and the Objective Assessment of Health (SHA DBQ). Examiner review of the Subjective Assessment of Health, if of record, is required to complete the SHA DBQ.

The SHA DBQ, or other means as determined by the Government, should be used instead of General Medical Examination Compensation and Pension (C&P) DBQ for all IDES and BDD claims. General Medical Examination must be used in lieu of the SHA in cases where the Service Member is past his/her Release from Active Duty (RAD) date.

5.1.3 International Exams

5.1.3.1 Examinations in Identified Countries

For ESRs that are submitted for international locations, the Contractor must schedule an appointment that is in-person, Tele C&P, Acceptable Clinical Evidence (ACE) or combination thereof and follow the standard procedures set forth in the MDEO Examinations Handbook. ACE and Tele C&P do not require an in-person examination. Medical opinions and examinations completed via ACE or Tele C&P must only be completed for requests that meet the guidelines outlined in the MDEO Examinations Handbook.

5.1.3.2 Examinations in Other Locations

For ESRs that are submitted for international locations not specified in the MDEO General Handbook, and where ACE or Tele-C&P appointments are not appropriate, Contractors may use the Single Source Sub-Contracted Examination (SSSCE) or Alternative Medical Evidence (AME) Examination process to complete the examination.

SSSCE is a process used when a Contractor is unable to locate an Examiner within its network to conduct the examination. In these cases, the Contractor must arrange a one-time examination with an available contracted Examiner for the Claimant. The Single Sub-Contracted Examiner is exempt from the training requirements of this PWS. The AME process requires the Claimant to independently locate an Examiner to conduct the examination. In such cases, the Contractor will review the completed DBQ for sufficiency and compliance and provide reimbursement for the cost of the exam. See MDEO Operations and Systems Handbook for more details on SSSCE and AME.

Deliverable:

A. Completed DBQ(s), and/or SHA, and all associated examination results (including diagnostics) B. DBQ and Medical Opinion Substitution Report

5.2 TASK 2: SCHEDULING

5.2.1 Telephone Access and Call Recordings

The Contractor must provide toll-free telephone access to Claimants for administrative support on all days and hours during which appointments are conducted. The Contractor call system must include the ability to leave a message for a returned call. Return calls regarding appointments must be returned by close of next business day. All calls must be recorded, retained for a period up to three (3) years, and made available to VA upon request.

Upon request, the Contractor must provide calls identified by MDEO to review Contractor call recordings. The Contractor must provide the requested recordings to the COR within 15 days of the request. All recordings are subject to review and must be provided to VA upon request.

Deliverable(s):

A. Call Recordings

5.2.2 Appointment Scheduling

The Contractor must contact Claimants via phone, text, email, or other electronic means to schedule appointments (including diagnostics) based on formal ESRs from VA. All contact attempts to reach the Claimant must be documented. The Contractor will make three (3) contact attempts before moving forward with reserve scheduling an appointment, considering any Claimant preferences, if outlined in the ESR, and DBQ requirements. Reserve scheduling occurs when an appointment is scheduled without confirming the date and time with the Claimant. The Contractor must provide a monthly report of its contact attempts that resulted in reserve scheduling. A notification letter must be mailed or sent via email or text link, if Claimant has opted-in for email and/or text, within 24 hours of scheduling.

The Contractor must maintain a record or log of all Claimant opt-ins for receipt of email and/or text for scheduling and other communications. This opt-in log must be made available to VA upon request, or VA may require access to the Contractor’s opt-in system.

In the event multiple appointments are necessary, the Contractor must make every attempt to schedule appointments on the same day and at the same location to minimize the number of visits to different facilities. In cases where multiple appointments are scheduled for the same day at various locations, the Contractor must ensure the Claimant can reasonably attend all appointments at different locations considering travel time and other local factors.

5.2.3 Appointment Rescheduling

5.2.3.1 Regions 1-4 and Pre-Discharge

The Contractor must allow Claimants only one opportunity to request any or all appointment(s) to be rescheduled. If the Claimant fails to show for the rescheduled appointment(s),or is not available to attend a rescheduled appointment within five days following the original appointment date, the Contractor may submit a request for cancellation for the Contentions associated with that appointment selecting the appropriate reason (see MDEO Handbook).

5.2.3.2 Pre-Discharge Only

Contractors are not authorized to reschedule Servicemembers identified as IDES or identified as IDES in the ESR Event Package. For all Servicemembers identified as IDES, or identified as IDES in the ESR Event Package, Servicemembers must be instructed to seek reschedule through the Physical Evaluation Board Liaison Officer (PEBLO) who can coordinate through their Military Service Coordinator (MSC). If the Claimant’s MSC identified on the ESR seeks to reschedule the appointment, the Contractor must allow one opportunity to reschedule.

5.2.3.3 Force Majeure Impacted Appointments

Impacts by Federal and/or State Declared Emergencies, Force Majeure, or Acts of God may result in cancelled appointments. However, the Contractor must not cancel and/or return the ESR unless specifically requested by the Claimant, CO, or COR. The Contractor must hold the ESR until it is safe to conduct the examination and reschedule with the Claimant accordingly. If the Contractor’s operations are affected, the Contractor must notify the COR as soon as possible. The Contractor must provide daily updates of all impacted appointments and ESRs.

5.2.3.4 DELIVER Act Accessibility and Examiner Preference

As required by the DELIVER Act (PL 116‑315), prior to scheduling and to ensure locations can accommodate Claimant needs, the Contractor must inquire about Claimants’ accessibility needs (e.g., mobility, sensory/service animals, assistive devices) and examiner sex (male/female) preference. Additionally, the Contractor must review ESR flashes regarding accessibility as well as any special instruction.

A Claimant may designate the sex (male/female) of the Examiner for any contention that resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment. If a Chaperone or Assistant is necessary, a Claimant may also designate the sex (male/female) of the Chaperone or Assistant.

The Contractor must notify Claimants of the right to designate an Examiner preference and ensure that the Chaperone, Assistant, or Clinical Trainee (if present during the exam) are also consistent with the sex (male/female) designated by the Claimant. If unable to meet the preferred sex (male/female), the Contractor must follow the procedure outlined in the MDEO Communications Handbook. All Examiner sex (male/female) preference indicators must be recorded in all Appointment Scheduled Event packages per the Exam Management IEPD.

5.2.3.5 Public Law 118-196

In accordance with P.L. 118-196, the Contractor must contemporaneously transmit every communication regarding the scheduling of a covered medical disability examination to any person or organization (1) designated by the applicant by a power of attorney filed with the Secretary; and (2) recognized under sections 5902, 5903, and 5904 of title 38, United States Code, for the preparation, presentation, and prosecution of claims.

5.2.4 Claimant Notification

The Contractor must send appointment notification letters per the MDEO Communication Handbook via postage prepaid mail or commercial delivery, informing the Claimant of the appointment date, time, location, and Examiner information. For events not requiring a Claimant appointment, the Contractor must send a notification letter to the Claimant informing them that VA has requested a medical opinion (MO) or Acceptable Clinical Evidence (ACE) appointment for their claimed contention. Electronic secure notification may be used in addition to mailed notice. The Contractor must:

· Ensure Claimant receives notification letter at least three (3) days prior to the scheduled appointment, even if verbal confirmation is not obtained and the Claimant is reserve scheduled.

· Issue a notification letter if Claimant agrees to an appointment within three (3) days of the scheduled date or is at a claims clinic event. The requirement for the Claimant to receive the notification within three (3) days of the appointment is not required.

· Upload Claimant proof of receipt (e.g., certified mail delivery confirmation) in the Contractor Portal ensuring the documentation complies with § 508 ‑standards and is in Portable Document Format (PDF).

· Provide a follow up reminder 24–48 hours before the appointment via phone/text/email.

· Upload all notification letters to the VBMS eFolder, Contractor Portal, Claimant Portal, and ensure compliance with PL 118-196 (see Public Law 118-196).

· Provide documentation of notification upon Government request (e.g., contact info, copies of letters/emails).

· Send an updated letter in the event that the Examiner changes.

Deliverable(s):

A. Claimant Notification Letter B. Contact Attempts Report

5.3 TASK 3: INFORMATION TECHONOLOGY (IT) SYSTEMS

The Contractor shall develop and/or maintain a Contractor Exam Management System (EMS) that interfaces with VA's EMS (including VBMS, DAS or other systems designated by VA), as described in Section 9.0, Government-Furnished Facilities, Information, and Equipment. The Contractor EMS shall include multiple secure portals/modules within a single platform, consisting of: (1) Provider Portal, (2) VA Client Portal, and (3) Claimant Portal. The Contractor EMS and all portals/modules must be within the ATO boundary and comply with Section 508, HIPAA, FISMA, and VA Handbook 6500 security requirements outlined in Section B.4.

The Contractor must upgrade or change its EMS and associated portals/modules to address changes required by VA to ensure interoperability and interface compliance with VA systems. Further, the Contractor must be able to decommission the use of any of these portals/modules due to a change in Government need/potential Enterprise solutions.

5.3.1 Contractor Exam Management System (EMS) and Maintenance

The Contractor must create and/or maintain a secure Contractor EMS and provide VA access for real-time status information, such as Claimant ESRs, Contentions and Results (e.g., DBQs, ancillary/diagnostics) as part of its VA Client Portal/Module. The Contractor EMS must be complete and active prior to receiving work (see Section 3.4 Contract Ramp-up).

The Contractor EMS will be the Contractor's system of record for receiving, scheduling, tracking, and reporting on ESRs issued by VA. The EMS must serve as the authoritative interface between VBMS and the Contractor's examination network, exchanging real-time event-based data on the status of each examination request throughout its lifecycle — from initial receipt through scheduling, completion, and results submission. The EMS is not a static data repository; it is a transactional, event-driven system that must reflect the current status of every ESR in near real-time and provides the data necessary to measure and report on contract performance and timeliness.

5.3.1.1 Data Interchange Requirements

The Contractor must send event messages immediately from Contractor EMS to VBMS EMS and the Portals/Modules to ensure consistent status of ESR, Contentions, and Appointments across all systems. The Contractor must provide information technology capability to send and receive on-line ESRs, messages from VA, maintain status information accessible by VAROs and VACO, maintain completed results associated with ESRs accessible in a database for a period of not less than 18 months, and return completed DBQ results, and all associated findings electronically to VA. Contractor must comply with requisite VA data/privacy security policy having the required security controls to safeguard Claimants’ sensitive personal information (SPI).

5.3.1.2 Integration and Connections

A. VA Data Access Services (DAS) Integration

Integration with DAS requires the Contractor to connect to two test environments and the production environment, supporting full end-to-end testing before production activation. All technical specifications for integration are provided in the MDEO Systems Handbook.

In future EMS releases, the Contractor will have direct connections to the Exam Management API to pull records, transitioning away from reliance on DAS transmissions for Exam Management message delivery. Also, in future VBMS releases, the Contractor will have direct connections to an eFolder to pull records, transitioning away from reliance on Caseflow and DAS transmissions for eFolder content delivery (see Section 9.4.1). These will require configuration changes with a reassessment and reauthorization for an existing ATO and may require contractor system connection updates.

B. Enterprise Scheduling Platform Integration

The Contractor must be required to interface the Contractor EMS with and utilize a Government-designated enterprise Examiner scheduling platform to support universal scheduling functions. This platform will serve as the centralized mechanism for coordinating and managing examination appointments across all participating entities. The Government may provide access, specifications, and technical integration requirements for the platform as they become available.

The Contractor must maintain flexibility to adopt, integrate with, and transition to the designated scheduling platform at any point during contract performance, in accordance with Government direction. If the platform or related interfaces are not fully functional at the time of contract award, the Contractor must perform Task 2 Scheduling activities using approved interim processes until formal notification is provided by the Government to transition. The Contractor must ensure continuity of scheduling operations and data integrity throughout any transition period.

5.3.1.3 VBMS Release Cycle, Testing and DBQ Uploads

The Contractor EMS must align with the VBMS release cycle, which is every two weeks all year, to prevent and reduce risk of production disruptions. The Contractor must maintain the capability to securely interface with VA information systems consistent with federal security requirements, including National Institute of Standards and Technology (NIST) SP800-47.

Contractors must participate in VA User Acceptance Testing (UAT), which is typically two to four weeks in duration for each release (depending on the release functionality). Release schedules will be communicated to Contractors in advance of the activities. Failure to comply or successfully complete UAT testing will result in a lapse in receiving new examination scheduling requests until Contractor passes UAT and has released the required new functionality.

MDEO will review and approve the Contractor's data transmission formats. VA will facilitate functional testing and identify any mapping issues requiring correction. Defects caused by the Contractor must be corrected at no cost to the Government.

Testing includes:

· Transmission of sample DBQ data files to VA

· Verification of expected results in VBMS eFolder

· Resolution of mapping or schema alignment issues

· End-to-end workflow testing based on EM IEPD/ DBQ IEPD requirements

Contractor simulations are not permitted. All testing must use the Contractor’s operational system to minimize production risk.

For EMS and DBQ/document uploads, the Contractor must coordinate connectivity, certificate exchange, development, testing, and acceptance with MDEO. VA will provide draft DBQ IEPDs and EM IEPDs approximately 90 days before scheduled implementation. Contractors must deploy testable changes in the UAT environment according to VA’s schedule.

5.3.1.4 EMS Process

The Contractor’s EMS process must follow the process outlined below. The Contractor must accept all ESRs immediately after receipt and automatically send an Acknowledgement Event Package (AEP) to begin the ESR timeliness calculation described in the Quality Assurance Surveillance Plan (QASP). System messages supporting MDEs are categorized as:

· Incoming Events: The Contractor’s system interface must allow incoming event messages from VBMS pushed from DAS in real-time. Contractors will not pull from the DAS data store, but accept messaging sent directly from DAS.

· Outgoing Events: The Contractor’s system must provide for real-time events to be sent to DAS, as activities are accomplished (e.g., Appointments Cancelled, Appointments Scheduled, Clarification Requested). No batch or bulk uploading of events must be used in order to keep events moving real- time, as activities are accomplished.

When VBMS DAS transmissions do not fully deliver all eFolder content, the Contractor must retrieve missing documents from Caseflow as outlined in the MDEO Systems Handbook.

5.3.2 Provider Portal/Module

The secure Provider Portal/Module must be part of the Contractor EMS to serve as the electronic interface between providers and VA, enabling providers to review Claimant records and complete DBQs electronically within the system. The Provider Portal must provide the ability to review records, and at a minimum must: support secure provider registration and identity verification (including credential/licensure validation and multi-factor authentication); enforce role-based access to records and functions; allow providers to view, download, and print applicable Claimant records and claim documentation; provide a dashboard/worklist of assigned tasks and status; support secure messaging/notifications for assignments and status changes; maintain audit logs of provider access and actions; and provide provider help desk support.

The Contractor must be able to decommission/not use the DBQ component while retaining all other Provider Portal functionality, in the event this task/deliverable is not ordered due to a change in Government need/potential Enterprise DBQ Portal. The DBQ component must, at a minimum: provide the current VA-approved DBQ form library by condition/exam type, updated automatically when VA revises forms; offer structured, fillable forms (not static PDF) with field validation and condition-based logic; allow providers to save and resume in-progress DBQs; support compliant e-signature for certification; link each DBQ to the correct Claimant record via VA-assigned identifiers with mismatch validation; auto-route completed DBQs to the appropriate VA system of record (e.g., VBMS); provide submission status visibility to providers and VA staff; support correction/amendment of submitted DBQs with version history; send automated provider notifications on submission, rejection, or requests for additional information; exchange data in a VA-approved format/standard (e.g., HL7 FHIR, XML/JSON); encrypt data at rest and in transit consistent with the security requirements above; and support Government oversight reporting (volume, turnaround time, rejection rates).

5.3.3 VA Client Portal/Module

The secure VA Client Portal/Module must be part of the Contractor EMS to provide VA real-time access to the following content: appointment statuses (Planned/Scheduled/Completed), Examiner facility locations, travel reimbursement status (check number, amount, date paid/cashed), Claimant notification letters, and scheduling attempt documentation.

5.3.4 Claimant Portal/Module

The secure Claimant Portal/Module (e.g. Veteran-facing portal) must be part of the Contractor EMS to provide real-time access for Claimants to include: appointment statuses, Examiner facility locations, travel reimbursement status, Contractor contact information, FAQs (e.g. cancellations, rescheduling, billing), ability for Claimants to make a mileage request, and other information to improve Claimant experience. The Contractor must send event messages immediately to VBMS EMS and the Portal. Any additional information not required by VA must not be included in the Claimant Portal. The Claimant Portal must be complete and active prior to receiving work.

Deliverable(s):

A. Contractor EMS

5.4 TASK 4: CLAIMANT MILEAGE TRAVEL REIMBURSEMENT (Applies to Regions 1-4, Pre-Discharge (past RAD) and International (U.S. Territories) Only)

The Contractor must pay eligible mileage expenses to eligible Claimants for travel to authorized facilities for scheduled C&P exams within the U.S. and U.S. Territories, in accordance with 38 U.S.C. § 111 and governing regulations. VA will reimburse the Contractor monthly for actual necessary mileage expenses up to allowable limits. Rideshare may be used at the Contractor’s expense.

5.4.1 Eligibility

Veterans who reside within the U.S. and U.S. Territories are eligible for mileage expenses. VA does not have regulatory authority to pay mileage for Active Duty service members or Veterans residing outside US and its territories. Any mileage paid to a service member or an overseas Veteran is not billable to VA.

Reimbursement eligibility for travel is determined by the RAD recorded in the Veterans Benefits Management System (VBMS) ESR. Appointments completed after the RAD date qualify for reimbursement. Claimants are considered Veterans when they are no longer on Active Duty. In instances where evidence of record shows that the Claimant has separated and has a RAD after the examination request has been sent, the Contractor must reimburse for beneficiary travel for all examinations completed after the RAD at the request of the Claimant.

Claimants in the IDES program are placed on temporary active duty for the purposes of completing the examination and are therefore not entitled to reimbursement for travel. These Claimants' ESRs will have the Pre-discharge Type field as: IDES. Examination appointments completed after the RAD date will be eligible for travel reimbursement.

Claimant has 30 days from the date of appointment to make a reimbursement request to the Contractor. Contractor must record each Claimant request and submit a monthly Claimant Mileage Reimbursement List of requests. Contractor must issue payment within 30 days of receiving the validated Claimant Mileage Reimbursement List from the COR. VA will only provide reimbursement when the Claimant has submitted a request. Contractor must issue travel payments to Claimants upon request upon approval by the Government.

5.4.2 Distance Limitations

The Contractor must make every effort to ensure the closest available appointment location. In the event mileage limitations are exceeded, the Contractor must obtain and record express consent to the travel from the Claimant and provide documentation in the Claimant Portal, Contractor Portal and VBMS eFolder, prior to scheduling the appointment. The Contractor (not the Claimant) must bear mileage costs beyond contractual limits and must provide proof of payment to VA.

· Non‑specialist exams/diagnostics: ≤ 50 miles from home of record or temporary address as identified by Claimant at the time of scheduling.

· Specialist exams/diagnostics: ≤ 100 miles (see MDEO Handbook for Specialty exams).

5.4.3 Veterans Claims Clinic Travel Expense

The Contractor must reimburse mileage expenses to Claimants who attend VA-sponsored claims clinic events, provided that an onsite examination is conducted. Reimbursement is limited to return-trip mileage to the Claimant’s residence, or the original point of departure if it is closer, in accordance with 38 CFR Part 70 and 38 U.S.C. § 111. VA will reimburse return mileage for up to 300 miles to the Claimant’s residence or point of origin, whichever is less. Mileage exceeding this limit requires approval from the COR. Common carrier travel is not eligible for reimbursement for claims clinic events.

The Contractor must report all Claimant mileage reimbursement costs in the Monthly Status Report (Deliverable 5.7.4.F) and copies of receipts must be provided to the COR via SMOT portal or other electronic means as designated by VA.

5.5 TASK 5: SPECIAL MODE OF TRANSPORTATION (SMOT) (Applies to Regions 1-4 and Pre-Discharge (past RAD) Only)

The Contractor is responsible for coordinating transportation services when SMOT is necessary, subject to prior approval from the COR or a designated third party on behalf of MDEO. Any costs incurred without preapproval may not be eligible for reimbursement. IDES/BDD Claimants (before RAD) are not eligible for SMOT services.

SMOT services include ambulance, ambulette, air ambulance, wheelchair van, or other vehicles specifically designed for the transport of individuals with disabilities (excluding bus, subway, taxi, train, airplane, or modified POVs). See MDEO SMOT Handbook for additional details on SMOT.

The Contractor must report all SMOT services and costs in the Monthly Status Report (Deliverable 5.7.4.F) and copies of receipts must be provided to the COR via SMOT portal or other electronic means as designated by VA.

5.6 TASK 6: EXAMINER TRAVEL

Examiner travel is not reimbursable, except for travel associated with examinations for:

· Regions 1-4 – incarcerated or housebound Claimants, Veterans Claims Clinics (VCCs) or otherwise requested by VA.

· Pre-Discharge and International – incarcerated or housebound Claimants only.

With prior approval from the COR, a medical assistant may accompany the Examiner to a housebound examination. For more information on medical assistants, see MDEO Communication Handbook.

No travel arrangements must be made without prior approval from the COR. The Contractor must provide mileage traveled for Examiners, assistants, and chaperones for incarcerated, housebound and VCC events, and retain all receipts supporting travel cost. Travel expenses should be billed in accordance with the MDEO Invoice Handbook and RFO 31.205-46. Mileage must be calculated using directional mapping tools (e.g., Google Maps, MapQuest, Bing Maps).

Travel time includes direct travel to/from the prison, Claimant residence or VCC, and prison entrance processing time.

Travel time excludes examination time and unrelated diversions (e.g., coffee stops, refueling, traffic citations).

5.7 TASK 7: ADMINISTRATION

5.7.1 Incident Reporting

Contractors must report incidents to the COR and contract examination mailbox (ContractExam.VBAVACO@va.gov) within 24 hours or as soon as capable. For specific situations that necessitate incident reporting, please refer to the MDEO Communications Handbook.

5.7.1.1 Protecting Vulnerable Claimants

The Contractor must ensure that each Examiner under its purview is aware of state or local policies related to mandatory reporting responsibilities. Many states and localities employ mandatory duty to protect/duty to warn policies, which require by law, that certain health care provider report to local authorities any individual who is deemed to be a significant danger to themselves or others, situations of Domestic or Intimate Partner Violence (IPV), child abuse, and/or vulnerable adult abuse. The credentialed Examiner must make any assessment of risk or reporting, in good faith and erring on the side of caution and safety for the Claimant and/or others involved. The assessment of risk by the Examiner and any mandatory reporting are required only when such risk is identified or reporting is warranted (i.e., suicidal ideation is endorsed or disclosed, statements reflecting an intent to harm someone are made, child abuse is identified or suspected, etc.)

Protecting Vulnerable Claimants guidance must apply to any examination in which the Examiner identifies that an assessment of safety risk or mandatory reporting is warranted. The applicability is not limited to Mental Health examinations. For ANY instance where mandatory reporting is required by law, and/or a duty to warn/protect is enacted, the Contractor must ensure that applicable mandatory reporting requirements have been completed and submit an Incident Report (see MDEO Communications Handbook) to the MDEO mailbox and the COR within 24 hours of the incident. The Incident Report must indicate the actions that were taken by the Contractor and/or Examiner to handle and resolve the incident. Documentation of the safety risks identified and assessed by the Examiner and any mandatory reporting that was completed (if applicable) must be provided in the Remarks section of the worksheet or DBQ to confirm adherence to policy.

For suicide risk specifically, in situations where the credentialed Examiner identifies that an assessment of risk or reporting is warranted, Examiners must refer to “Determining Level of Risk for Suicide and Appropriate Action” in the MDEO Communications Handbook. When high acute risk or intermediate acute risk for suicide is identified, the Contractor must submit an incident report to the MDEO mailbox and the COR within 24 hours of the incident, as well as follow any additional guidance set forth in the “Determining Level of Risk for Suicide and Appropriate Action” instructions. Documentation of the identified risk level and all subsequent action (if applicable) must be provided in the Remarks section of the worksheet or DBQ.

Non-examiner personnel may also encounter Claimants who are at imminent risk. Imminent risk is present when a Claimant is in immediate and/or significant danger of harming themself or others (e.g., phone call with a Claimant stating they want to die and have a gun in their possession, email correspondence in which a Claimant communicates a plan to harm themselves, or a Claimant stating they plan to harm their neighbor).

Although non-examiner personnel cannot perform a clinical assessment of risk (i.e., identifying the presence of high acute risk, intermediate acute risk, low acute risk), they must act in good faith, erring on the side of caution and safety for the Claimant and/or others involved. The Contractor must ensure that all non-examiner personnel who have access to VA systems and/or regular interactions (mail, email, phone, in-person) with Claimants are aware of the appropriate protocol when the non-examiner identifies an immediate and/or significant danger that the Claimant may harm themself and/or others.

In situations where immediate and/or significant danger is identified by non-examiner personnel the Contractor must ensure that 911/local authorities are contacted immediately and given the information necessary to initiate a wellness check on the Claimant and/or others involved. After engaging the involvement of 911/local authorities, the Contractor must also report the incident to the Veterans Crisis Line (VCL), 988 within 24 hours. The Contractor must submit an Incident Report to the MDEO mailbox and the COR within 24 hours of incident. Documentation of the circumstances (the identification of the immediate and/or significant danger and all subsequent action) must be provided in the Incident Report to confirm adherence to policy.

Deliverable(s):

A. Incident Report

5.7.2 Contractor/Subcontractor Site Inspection

Contractors must inspect all facilities virtually and/or in person where MDEs are conducted, except SSSCE (see Section 5.1.3.2 Examinations in Other Locations), for compliance with local laws/regulations and MDEO facility requirements (see MDEO Operations Handbook). Contractors shall ensure all facilities, in all service areas to include Regions 1-4, Pre-Discharge and International, are clean, safe, and accessible. The Contractor is responsible for delivering the following for facilities in the U.S. and U.S. Territories to ensure compliance:

· Certification of Facility Compliance to certify compliance with the Americans with Disabilities Act (ADA), Occupational Health and Safety Administration (OSHA) standards, local laws/regulations and MDEO facility inspection requirements at all facilities at the time of award and as any new facilities are onboarded. While OSHA and ADA do not apply in foreign locations, it is imperative that Contractor facilities are in compliance with the intent of OSHA and ADA standards.

· Site Visit Action Plan providing the Contractor’s plan to correct and address any Site Visit findings within 15 days of receipt of Site Visit results from MDEO (see Section 4.3 Site Visits).

· Attestation in Lieu of in Person Review (Ancillary Only Sites): To mitigate disruptions in operations at sites where laboratory tests or radiology tests are the only services performed on behalf of VA certain ancillary facilities, the Government will accept attestation forms in lieu of in-person visits or administrative site reviews. All sites that perform any other types of exams on behalf of VA are still subject to in-person visits and administrative reviews by the Contractor. Submission of an attestation does not exempt the Contractor from compliance with all applicable requirements of OSHA/ADA and MDEO program requirements.