MLRM RFP 36C10X22R0040__ 6_13_2022.docx

36C10X22R0040| MLRM Review Panelists

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1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C10X22R0040 06-10-2022 Hermann Degbegni(Hermann.Degbegni@va.gov) 240-270-4329 06-29-2022

10:00AM ET

36C10X Strategic Acquisition Center - Frederick Department of Veterans Affairs

5202 Presidents Court, Suite 103 Frederick MD 21703

X

541611 $21.5 million

N/A

Strategic Acquisition Center - Frederick Department of Veterans Affairs

5202 Presidents Court, Suite 103 Frederick 21703 36C10X Strategic Acquisition Center - Frederick Department of Veterans Affairs

5202 Presidents Court, Suite 103 Frederick MD 21703

TBD

VAFSC

See B.1 CONTRACT ADMIN DATA for

Instructions.

See CONTINUATION Page Veterans’ Health Administration (VHA)

Office of Medical-Legal Risk Manager (MLRM)Review Panelists

See B.2 Price/Cost Schedule and B.3 Performance Work Statement

Contract Type: Firm Fixed-Price

Anticipated Period of Performance:

Base Year: August 17, 2022 – August 16, 2023

Option Year 1: August 17, 2023 – August 16, 2024 Option Year 2: August 17, 2024 – August 16, 2025

Option Year 3: August 17, 2025 – August 16, 2026

Option Year 4: August 17, 2026 – August 16, 2027

Questions are due no later than June 17, 2022, at 10:00AM ET Proposals are due no later than June 29, 2022, at 10:00AM ET Proposal Intentions requested by June 22, 2022, at 10:00AM ET

Tiered-Evaluations are applicable to the Procurement. See

Section E for details.

TBD

See CONTINUATION Page

Jacky Jean-Jacques Contracting Officer

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: TBD

b. GOVERNMENT: Contracting Officer (CO) Jacky Jean-Jacques, Contracting Officer 36C10X

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with 52.232-33, Payment by Electronic Funds Transfer—System for Award Management

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

TUNGSTEN (fka OB10) ELECTRONIC INVOICE SUBMISSION FSC e-INVOICE PROGRAM THRU AUSTIN PORTAL

FSC MANDATORY ELECTRONIC INVOICE SUBMISSION FOR AUSTIN PAYMENTS

Contracting POC: Jacky Jean-Jacques| Jacky.Jean-Jacques@va.gov| 202-469-2501 COR (Contracting Officers Representative): TBD Contract/Task Order Number: TBD Purchase Order Number: TBD

Vendor Electronic Invoice Submission Methods:

Fax, email and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted data transmissions below.

· VA’s Electronic Invoice Presentment and Payment System – The Financial Services Center (FSC) in Austin, TX uses a third-party contractor, Tungsten, to transition vendors from paper to electronic invoice submission. Please go to this website: http://www.tungsten-network.com/US/en/veterans-affairs/ to begin submitting electronic invoices, free of charge.

· A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI Web site is http://www.x12.org.

Vendor e-invoice Set-up information:

Please contact Tungsten at the phone number or email address listed below to begin submitting your electronic invoices to the VA Financial Services Center in Austin, TX for payment processing. If you have questions about the payment status of a properly submitted invoice, the e-invoicing program, or Tungsten, please contact the FSC at the phone number or email address listed below.

· Tungsten e-Invoice setup information: 1-877-489-6135

· Tungsten e-Invoice email: VA.Registration@tungsten-network.com

· VA TUNGSTEN Number: AAA544240062

· FSC e-Invoice contact information: 1-877-353-9791

· FSC e-Invoice email: vafsccshd@va.gov

· http://www.fsc.va.gov/einvoice.asp

COMMUNICATIONS:

· https://www.federalregister.gov/articles/2012/11/27/2012-28612/va-acquisition-regulation-electronic-submission-of-payment-requests

· http://fcw.com/articles/2012/11/27/va-epayments.aspx?s=fcwdaily

6. ACKNOWLEDGMENT OF AMENDMENTS:

The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 PRICE/COST SCHEDULE

Base Period: August 17, 2022 – August 16, 2023

Priced at (50% CLIN 0002 Unit Price)

Option Period One: August 17, 2023 – August 16, 2024

Option Period Two: August 17, 2024 – August 16, 2025

Option Period Three: August 17, 2025 – August 16, 2026

Option Period Four: August 17, 2026 – August 16, 2027

B.3 PERFORMANCE WORK STATEMENT

MLRM Review Panelists

1. Background/Scope The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Medical-Legal Risk Management s (MLRM), MLRM oversees the evaluation of the standard of care associated with paid malpractice claims.

MLRM requires Contractor assistance to support MLRM’s provision of high-quality Paid Malpractice Claim Review Panel (RPs). This requires a Contractor that can provide a very diverse group of physician specialty/sub-specialty, allied health, and other professions that can participate, via phone, in RP discussions and determinations regarding standard of care and potential Veteran’s Health Administration (VHA) National Practitioner Data Bank (NPDB) reporting. Contract Panel Participants (CPPs) must be able to provide a thorough, accurate, well organized, CPP Written Summary and Evaluation of Care (WSEC) and participate in the required RP.

This contract is for an estimated 725 MLRM tasks per performance period. A task is defined as providing a WSEC and participating in the RP.

The entire process for NPDB can be found in: VHA Handbook 1100.17 National Practitioner Data Bank (NPDB) Reports, December 28, 2009, or in any subsequent document.

2. Period of Performance

a. MLRM Business Hours:

MLRM administrative office is open Monday through Friday, 10:00 am - 4:00 pm ET.

b. Review Panel Availability:

RPs are conducted within the hours from 10:00 am ET through 4:00 pm ET. Contractor must confirm the CPP, and Physician Panelist will have availability to participate in required RP discussions to coincide with these hours.

c. Federal Holidays:

Contractor key personnel is not required to work on Federal holidays or weekends. A list of applicable days can be found on the Office of Personnel Management website at www.opm.gov.

3. Type of Contract Firm-Fixed Price (FFP)

4. Place of Performance Contractor’s facility

5. Travel Not applicable

6. Material Other Direct Costs ODCs are not applicable to this contract.

7. Government-Furnished Information, Equipment, and Facilities No equipment will be provided. The Government will provide the contractor with necessary procedural guides, business rules, reference materials, and program documentation to meet task objectives.

8. Tasks

Task 1: Administration

Task 1.1 Meetings/Reports

1.1.1 Meetings

The contractor shall not commence performance on the tasks in this Performance Work Statement (PWS) until the Contracting Officer has conducted a kick-off meeting or the Contracting Officer has advised the Contractor that a kick-off meeting is waived. The kick-off meeting will be held via teleconference and will last approximately one hour.

The contractor shall meet with the program office once per week during the ramp up phase, or as often as needed to accomplish the ramp up. The COR will assess the effectiveness of the Contractor and may decrease the frequency of teleconference meetings.

The Contractor shall meet with the program office monthly or as needed to discuss users and technical aspects (e.g., errors in reports, one-off discussion points, panel depth concerns, individual on-boarding updates and concerns). The COR will assess the effectiveness of the Contractor and may decrease the frequency of teleconference meetings.

1.1.2 Reporting

The Contractor must provide a report to the MLRM team that includes: (See attachment F and G)

· Identification any potential barriers (as needed no more than once a day by 3pm ET)

· Responses to MLRM identified performance issues (as needed no more than once a day by 3pm ET)

· Status updates on previously identified issues (as needed no more than once a day by 3pm ET)

· Roster of key personnel and CPPs with dates of initial adjudication for security clearance and date of training completion. (By the 1st business day of the month)

· Proof of in-process or completed background investigations and completion/maintenance of mandatory annual training (as occurs)

· Status update of active task notifications. (24 hours before scheduled monthly meeting)

· For each type of task, the percent of tasks that have not met their original schedule due dates since last report and plans for remediation. (24 hours before scheduled monthly meeting) MLRM may provide a task status report to the contractor for reconciliation and potential remedy. The contractor is responsible to closely monitor these paid claim reviews and provide prompt remedy when indicated.

Deliverables:

a. Kick-Off Meeting (NSP)

b. Contractor/Program Office Weekly Meeting

c. Contractor/ Program Office Monthly Meeting

d. Reports per 1.1.2

Task 1.2 Project Management The Contractor shall provide the following project management documents within 10 business days of award:

· Description of the workflow required

· Identified resources such a specified Key Personnel

· Risk Management Plan

· Quality Control Plan

The following tasks are considered critical and must be included in at least one of the above referenced documents:

· Key Personnel/CPPs initial and ongoing readiness for use

· Appropriate document management and provision of review materials to CPPs

· Guidelines for how WSECs will meet technical and non-technical requirements

· Efficient process for establishing RP date/time

· CPP RP attendance and participation

· RP discussion and determination per schedule

· Contract transition and close out with completion of all deliverables

Any alterations made to project management documents must be made with concurrence of the Government.

Deliverables:

a. Workflow

b. Staffing/KP Roster

c. Risk Management Plan

d. Quality Control Plan

A large portion of paid claims involve multiple practitioners from diverse physician specialties and subspecialties as well as allied health and other professions. This requires readily available access to diverse types of practitioners for RP participation and determination.

1.2.1 Document Management

Contractors shall adhere to requirements of VA Handbook 6500.6 Contract Security, VA Handbook 6500.3 Certification and Accreditation of VA Information Systems, and VA Directive 6371 Destruction of Temporary Paper Records and all other VA and VHA privacy and information security policies and practices.

If the Contractor makes duplicate copies of provided review materials due to contractual need, these are at no cost to the Government.

Task 2: Written Summary and Evaluation of Care (WSEC)

The WSEC is a written report that consists of two main components: a comprehensive chronology of the episode of care (written by Clinical Abstractor) and rationale for standard of care determination including a self-written chronology of applicable health care encounters (written by the CPP). The WSEC focuses on the care provided by the practitioner(s) of the same specialty, subspecialty, or profession as the assigned CPP, and within the context of the episode of care under review. The WSEC is based on the pertinent medical records, statements from involved practitioners, and other review materials provided by MLRM.

WSEC Requirements

· MLRM requests for task notification will be communicated to the Contractor key personnel via encrypted email with the required CPP specialty needed to review the tort claim.

· WSEC shall be properly formatted per MLRM specifications, well written, free from grammatical, punctuation, and spelling errors, accurate, and without omissions of fact. (See attachments A and B)

· The Contractor shall communicate to MLRM if the need for additional review materials, practitioner statements and/or other specialty reviews is required for CPP to complete task.

· CPP rationale for determination may include specialties outside of their own. If statements are needed for those specialties, Contractor will notify MLRM of the need for additional information.

· The Contractor shall ensure all assigned CPPs have access to all review materials provided to Contractor and that the provided review material is sufficient to support the provision of a high quality WSEC and RP determination.

The WSEC must include:

· A cover page that shall include:

· Allegation of tort claim,

· List of practitioner statements

· List of review materials

· Acknowledgement certifying that the CPP had access to and reviewed the pertinent medical records and practitioner statements.

· A brief Summary of Care and a comprehensive chronology of the episode of care that led to the paid tort claim completed by Contractor Clinical Abstractor

· The assigned CPP’s Evaluation of Care

· Contractor shall securely provide MLRM with electronic copies of completed WSECs through Government approved methods i.e., encrypted emails.

· The start date is the business day after MLRM grants access to the document repository (VA SharePoint folder or alternative).

· All WSECs are due by 3 PM ET on the 20th business day.

· WSECs that require correction of deficiencies will be returned for revision.

· Contractor revisions for WSEC errors need to be submitted by the original due date.

Notations in WSEC asking for additional review materials, practitioner statements, etc. will result in a revision. Contractor revisions to address additional information or practitioner statements are to be provided within 10 business days of deliverance of the additional information per MLRM approval.

The Government may authorize an extension related to an assigned CPP’s VA-remote-access issue for cases where the CPP has attempted to log into the VA system and was not successful. Extensions require the remote access help desk ticket number. This extension will not be granted if the CPP failed to maintain VA systems access.

Deliverables:

a. WSEC Reports

Task 3: Review Panel (RP) Participation and Determination

CPPs are required to attend and participate in the RP portion that will discuss their assigned case(s). Physician Panelists are required to attend and participate in RP as assigned.

MLRM will provide the Contractor with a listing of task notifications (cases) that are ready for RP scheduling, the required CPPs for each case, and the number of Physician Panelists.

Within 5 business days of the receipt of this list, the contractor shall provide MLRM, via secure email the dates and times (per below) that the required Panelists are available for RP.

Contractor shall provide three (3) separate dates and times that the required Panelists are available to attend RP and present the case(s).

When more than one CPP is required for a case, the Contractor shall provide three (3) separate dates and times that all the required CPPs are available to attend the RP and present the case.

CPP RP dates provided to MLRM shall be between 10 and 35 business days (preferably evenly spread over 2-3 weeks) after the MLRM notification to the Contractor to acquire CPP RP dates/times.

The Contractor is responsible to provide the Panelists with their agreed-upon call-in date with the specified time.

Review Panel conferences are scheduled for 15 minutes. If the case involves 4 or more reviewers, the panel is scheduled for 30 minutes.

A representative of Contractor key personnel shall be present on RP to ensure Panelist preparedness and attendance.

The expectation of RP can be found in the SOP which will be provided at Kick-off.

For a small portion of RP determinations, a practitioner identified for NPDB report may provide MLRM with substantive new information not available at the time of the RP determination. This new information may lead to an additional RP consisting of original Panel members. This additional task will be invoiced at half the CLIN price of the original RP.

Occasionally an additional review or provider statement will be identified at the RP. All members of original RP will be issued a half-cost task notification for the subsequent panel. The additional CPP will be issued a full-cost task notification.

At the Government’s discretion, MLRM may determine that a CPP will not be needed to attend the RP. The task will still be reimbursable at the full CLIN.

Attendance at Agreed-Upon Date/Time

· The Contractor shall ensure the assigned Panelists dial into MLRM’s RP.

· Failure to appear at agreed upon RP may result in Government request for Panelist to be removed from Contractor roster.

The Contractor shall provide deliverables associated with MLRM notifications for CPP RP participation and determination. Specialty of CPP will be specified by the Government and this will occur on an ongoing basis based on the needs of the Government.

Deliverables:

a. Panelists Review Panel Availability List

b. RP Attendance and Participation

9. Delivery Schedule

10. Contractor/ Key Personnel

All Contract Personnel – Conflict of Interest: The Contractor and all CPP (s) are responsible for identifying and communicating to the CO and/or COR conflicts of interest at the time of proposal and during the entirety of contract performance. CPPs assigned to this contract must disclose a conflict of interest with any other VA or VHA contract that involves the review of protected patient records or protected review materials such as peer review determinations. If conflict is found, CPPs involvement will be determined by the Government.

All Contractor personnel and all CPPs are subject to immediate removal from performance of this contract if they are involved in a violation of the law, VA security, confidentiality requirements, and/or other disciplinary reasons.

The Government reserves the right of refusal to any Contractor personnel and all CPPs on the roster.

CPP Personnel: In support of VHA’s required participation in the NPDB paid malpractice claim reporting process, the Contractor shall provide CPPs for RP Participation. The types of CPPs required are determined by each paid malpractice claim’s medical specialty and/or profession involved in the episode of care. MLRM historical data (attachment C) was used to develop a table of predicted yearly MLRM notifications for CPPs by type and volume. This is provided in attachment D. MLRM notifications for CPPs may vary from the types and amount listed. The requirements and qualifications for panelists are:

· License – The CPP shall have a current license to practice medicine (or non-physician license, if applicable) in any State, Territory, or Commonwealth of the United States or the District of Columbia.

· Experience - minimum of five years of experience in their specialty, subspecialty or profession for which they are listed.

· Board Certification - Shall be board certified in the specialty they are reviewing according to the American Board of Specialties or equivalent (e.g., American Board of Physician Specialties). With suitable credentials (e.g., multiple board certifications), Contractor may list the same CPP for more than one specialty listed in attachment D, which provides the Specialty for each Tier.

· Shall be in active practice at least 20-hours per month. Short-term exceptions to this requirement will be considered on a case-by-case basis by the COR.

· Possess knowledge of current evidence-based standards of care relevant to the case under review.

· Not be employees or contractors of VA providing direct care to Veterans; (limited exceptions may be considered on a case-by-case basis).

· Training (VA MANDATORIES): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor’s as required by the VA. Other training may become required. VA will communicate any changes to the training requirement to the contractor. All training required is listed below (TMS courses) and associated time to complete the courses.

· All VA on-boarded CPPs (required and optional) shall be contract personnel for the duration of the contract and are responsible for completion of all deliverables, unless a replacement is approved by MLRM.

· Submissions shall include a resume or curriculum vitae (CV) for each CPP listed. These shall clearly state the type of CPP practice and board certification(s).

· Not be excluded from receiving payment from any Federal healthcare program confirmed through screening through the Health and Human Services (HHS) Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE).

· The contractor shall verify eligibility of reviewers via current URAC credentialing standards.

· If contractor’s physician(s) is/are not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall remove the CPP from the roster. The Contractor must provide a substitute without any additional cost to the Government. If the CPP is removed in the midst of a task, the replacement is at no cost to the Government.

Type of CPPs: See attachment D for the type of CPP specialties to be provided for this contract.

· Required Specialty: Specialty is a requirement in panel roster

· Optional Specialty: Specialty is not a requirement in panel roster, however, MLRM may request to onboard if a task notification requires specified tort claim specialty.

Managing CPP turnover If Contractor is aware of a departure from employment of an existing CPP, the Contractor shall provide a CPP change form (attachment E) within 5 business days. Replacement CPP must meet the requirements as listed and onboard in compliance with this document.

MLRM CPP Addition If MLRM has a newly identified need for a specialty, subspecialty, or profession, MLRM will notify the Contractor of the needed CPP. The Contractor shall onboard in compliance with this document.

Domain knowledge criteria are specified below:

Contractor Personnel Requirements: Personnel proposed shall have an in-depth knowledge of health care processes in addition to the following:

· Provide key personnel to support cadre of CPPs

· Recruits retain a large, diverse group of experienced actively practicing practitioners with availability for scheduling RP participation and determination

· Support VA remote access to VA electronic review materials.

· Provide key personnel to support RP determination

· Coordinate schedules of diverse group of actively practicing practitioners

· Ensure attendance at agreed upon date and time

· Manage CPP RP participation in the RP determination

· Provide key personnel to support WSEC

· Provide in-depth knowledge of review of medical records for standard of care determinations

· Assess review materials for completeness and identify involved practitioners

· Ensure accuracy and completeness in WSEC

· Ensure format, clarity, spelling, and grammar meet requirements.

· Support quality deliverables per schedule

Key Personnel - Certain skilled experienced professional and/or technical personnel are essential for meeting the requirements. These individuals are defined as “Key personnel”. A list of key Personnel shall be included on the monthly roster deliverable.

Personnel assigned by the Contractor to the performance of work on this contract’s requirements shall be acceptable to VA in terms of personal and professional conduct and technical knowledge. Employment and staffing difficulties shall not be justification for failure to meet the timeliness metric in the QASP.

Team members that are included in Key Personnel and their qualifications must include:

· Project Manager

· Medical Director

· Be a Physician

· Represent knowledge and ability to perform oversight in the following Disciplines: Medicine, Surgery, Mental Health, Primary Care, Emergency Medicine

· Have access to consult with personnel with a requested medical specialty on an ad hoc basis.

· Review the WSECs for clinical sufficiency and serve as a resource for clinical guidance.

· Review the credentialing files and provide any other medical guidance for clinical oversight.

· Participate in calls at the request of the VA

· Clinical Abstractors

· Must be an RN, COR will consider exceptions on a case-by-case basis

· Review allegation of paid tort claim

· Compile chronology of health encounters for tort claim

· IT Personnel

· Quality Assurance

· Not required to be licensed clinician

· Physician Panelist

A cadre of at least 10 (ten) Physicians to be available at the Government’s discretion, to serve as a panel quorum member. Same qualifications apply as per CPPs. Physician Panelist will be present for panel purposes only, no task notification or WSEC deliverable required. There are no restrictions on Physician specialty but must be able to speak to the assigned task.

11. Contractor Responsibilities

The contractor shall abide by all Government requirements for dissemination of Protected Health Information (PHI) and Personally Identifiable Information (PII). Approved mechanisms are available from the Contracting Officer or COR.

11.1 Security Investigation, Required Trainings: The following is required for all Contract personnel (Key Personnel, support staff and all CPPs) as listed on the monthly roster deliverable.

· Contractor shall ensure all Contract personnel have completed Tier 1 security investigation and TMS trainings within 20 business days upon award. Government delays for initial adjudication will not be held against the Contractor.

· Contract personnel to complete the on-boarding requirements as defined by VA and OPM

· All onboarding documents and procedures will be given to Contractor at Kick-Off meeting.

· PIV card:

· All Contractor personnel are required to obtain VA issued PIV Badges to support this requirement. PIV badges shall be obtained in accordance with Homeland Security Personnel Directive (HSPD) requirements.

· PIV card readers are required to be in compliance with HSPD-12 and will not be provided by the Government.

· VA remote access:

· All Contract Personnel shall establish and maintain VA remote access to VA network and VA EMR systems.

· Contractor Personnel must log into their accounts at least once every 30 days.

· Contractor Personnel shall have and maintain national access to the EMR.

· Contractor Personnel shall have access to and maintain MLRM review materials.

12. SPECIAL CONTRACT REQUIREMENTS

Deliverables are due to VHA, Monday through Friday, No Later Than (NLT) 3:00PM, Eastern Time (ET). Any deliverable submitted after 3:00PM, ET shall be considered as received the following business day. See Deliverable Schedule for each type.

licenses, board certifications, NPI

13. Contract Quality Assurance Surveillance Plan (QASP)

DATA METRICS

(smaller is better)

Larger is better

Larger is better

Smaller is better

14. IT SECURITY REQUIREMENTS

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.

ACCESS to VA INFORMATION AND VA INFORMATION SYSTEMS

1. 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.

1. 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.

Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

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.

VA INFORMATION CUSTODIAL Language

1. 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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COTR.

INFORMATION SYSTEM DESIGN AND DEVELOPMENT

1. Information systems that are designed or developed for or on behalf of VA at non-VA facilities shall comply with all VA directives developed in accordance with FISMA, HIPAA, NIST, and related VA security and privacy control requirements for Federal information systems. This includes standards for the protection of electronic PHI, outlined in 45 C.F.R. Part 164, Subpart C, information and system security categorization level designations in accordance with FIPS 199 and FIPS 200 with implementation of all baseline security controls commensurate with the FIPS 199 system security categorization (reference Appendix D of VA Handbook 6500, VA Information Security Program). During the development cycle a Privacy Impact Assessment (PIA) must be completed, provided to the COTR, and approved by the VA Privacy Service in accordance with Directive 6507, VA Privacy Impact Assessment.

The contractor/subcontractor shall certify to the COTR that applications are fully functional and operate correctly as intended on systems using the VA Federal Desktop Core Configuration (FDCC), and the common security configuration guidelines provided by NIST or the VA. This includes Internet Explorer 7 configured to operate on Windows XP and Vista (in Protected Mode on Vista) and future versions, as required.

The standard installation, operation, maintenance, updating, and patching of software shall not alter the configuration settings from the VA approved and FDCC configuration. Information technology staff must also use the Windows Installer Service for installation to the default “program files” directory and silently install and uninstall.

Applications designed for normal end users shall run in the standard user context without elevated system administration privileges.

The security controls must be designed, developed, approved by VA, and implemented in accordance with the provisions of VA security system development life cycle as outlined in NIST Special Publication 800-37, Guide for Applying the Risk Management Framework to Federal Information Systems, VA Handbook 6500, Information Security Program and VA Handbook 6500.5, Incorporating Security and Privacy in System Development Lifecycle.

The contractor/subcontractor is required to design, develop, or operate a System of Records Notice (SOR) on individuals to accomplish an agency function subject to the Privacy Act of 1974, (as amended), Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Privacy Act may involve the imposition of criminal and civil penalties.

The contractor/subcontractor agrees to:

1. Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies:

(a) The Systems of Records (SOR); and

(b) The design, development, or operation work that the contractor/subcontractor is to perform.

2. Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every…