P01_PWS_Step-Down_Assisted_Living_Service_updated.docx

PERFORMANCE WORK STATEMENT:

ASSISTED LIVING RESIDENCE/ RESIDENTIAL TREATMENT FACILITY

1. Background/Introduction:

The Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC) also known as Veterans Affairs Eastern Colorado Health Care System (VAECHCS) has an ongoing requirement for Assisted Living Residences (ALR) with psychiatric step-down services in providing the appropriate level of care to veterans discharging from the RMRVAMC inpatient psychiatric mental health care unit (IPU).

2. Scope of Work:

The contract shall be effective for a one-year Base period, with the Government having the option to renew for four (4) additional one (1) year periods. Fees for services shall be structured via an indefinite delivery and indefinite quantity (IDIQ) contract type.

The successful Assisted Living Residence (ALR) shall be certified by the Colorado Department of Public Health and Environment (CDPHE) and shall provide room, board and at a minimum the following:

a. Provide transportation via contractor vehicle to ensure Veterans are engaged with care services and attending scheduled VA appointments at RMRVAMC.

b. Providing a physical environment that is safe and designed to support Mental Health residential treatment services.

c. A secured (locked) medication room/area and medication administration to Veterans by Contractor’s technicians who are Colorado Qualified Medication Administration Persons (QMAP) or Registered Nurses (RN).

d. Structured daily activities that focus on mental health and or substance abuse recovery needs.

e. Telephonic coordination of care and clinical updates on a weekly and as needed (when clinical care concerns arise) basis with the RMRVAMC Step-down Clinician.

f. Regular supervision of Veterans on a 24-hour basis. This includes monitoring the needs of patients to ensure the residents receive the services and care necessary to protect their health, safety, and well-being.

g. Contractor staff provide verbal prompting to encourage Veterans to complete activities of daily living that include getting out of bed in the morning, daily hygiene, attending groups, and appropriate social skills.

h. CDPHE licensure will ensure that the ALR meet established standards for health and safety which include resident rights, protection from abuse, quality of residents’ lives, and quality of residents’ care through unannounced annual surveys and complaint inspections.

3. Technical Requirements

a. Contractor agency must be currently licensed as an Assisted Living Residence (ALR) by the Colorado Department of Public Health and Environment (CDPHE).

b. The Contractor’s facility must be located with a 60-mile radius of the Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC) to ensure easy transportation of patients between the facilities. The RMRVAMC is located at 1700 N. Wheeling Street in Aurora, CO 80045.

c. All services under this contract must be performed by qualified, licensed staff including:

i) Psychiatrists, Psychologists, Master Social Workers (MSW) Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage & Family Therapists (LMFT), Registered Nurses (RN), Advanced Practice Nurses (APN), Licensed Professional Nurses (LPN), Psychiatric Technicians, Residential Counselors, Physicians Assistants and Pharmacists.

d. Psychiatrists must be board-certified in psychiatry or board-eligible in psychiatry.

e. Any staff administering medications must be certified in Qualified Medication Administration Person (QMAP). Services will be provided daily or on an as-needed basis based on clinical considerations and medical necessity. All medications and prescriptions will be issued according to the VA National Formulary unless explicitly authorized by the DVAMC via the Bed Flow Clinician. The current VA National Formulary can be found at the following link: http://www.pbm.va.gov/NationalFormulary.aspx

f. Staff must be proficient and trained yearly in patient rights and Basic Life Support (BLS) certification.

g. Care provision details:

1. Contractor agrees to assess veteran needs, develop residential service plans with guidance from DVAMC Bed Control Clinician, monitor veteran treatment progress, and plan discharge disposition in consultation with Denver DVAMC Bed Flow Clinician. Ensure veteran meets his scheduled appointments at VA medical center by providing transportation as needed to and from.

2. Psychiatric milieu management including verbal prompting for group participation, encouragement for hygiene and basic self-care, and prevention of disruptive behavior.

3. Contractor provides daily rehabilitative activities and or group psychotherapy in accordance with CDPHE ALR licensure requirements including but not limited to relapse prevention, development of coping skills for mental illness, and treatment goal planning.

4. Physical Plant

a. The ALR must have current occupancy permit and/or license as required by the Colorado Department of Public Health and Environment. General licensure standards can be found in 6 CCR 1011-1, Chapter II, State Board of Health, General Licensure Standards (last Amended March 20, 2002, effective April 30, 2002).

b. Key Elements of the physical plant of the Contractor agency shall include:

1. Locked medication rooms

2. Patient records are locked and secured

3. Secure fax for transmitting/receiving patient records

4. Full Kitchen and Dining facilities providing regular nutritious meals and snacks to residents

5. Administrative Standard Operating Procedure

a. All aspects of contractor admissions, treatment and discharge planning shall be performed in consultation with the DVA Bed Flow Clinician during business hours.

b. DVA offers the following staff as primary and secondary points of contact:

i. DVAMC Bed Control Clinician - Pager (303) 613-0088; current email Caroline.kelly@va.gov DVAMC Inpatient Psychiatric Unit Administrative Director – Phone: (303) 399-8020 x 2490; current email Geoffrey.Smith@va.gov After hours call (303) 399-8020 x2805 for the Administrative Officer on Duty (AOD).

6. Admissions:

a. VAMC Bed Flow Clinician shall initiate all admission requests by contacting Contractor agency primary or secondary point of contact to offer brief clinical synopsis and check for bed availability via phone call requesting response via pager.

b. Contractor shall respond via pager to requests within two hours.

c. DVAMC Bed Flow Clinician may coordinate further phone consultation to exchange clinical information from VA nursing or psychiatric staff.

d. DVAMC will perform initial laboratory tests and assure medical clearance prior to transportation to ALR.

e. Once ALR grants admission, DVAMC Bed Flow Clinician will arrange transportation to ALR site with receiving facility and contractor will provide transportation to ALR site within two (2) business days.

7. Discharges/Transfers:

a. All discharge planning shall be done in coordination with DVAMC Bed Flow Clinician and includes faxing discharge summaries to DVAMC Bed Flow Clinician.

b. Discharge Summaries shall include: discharge medications, copy of VA safety plan, and documentation of scheduled aftercare appointments with VA providers.

c. Contractor staff shall meet with the veteran on the day of planned discharge to review the discharge plan and perform lethality and substance abuse relapse assessment.

d. All cases of unplanned discharge due to treatment non-compliance, positive drug testing and or disruptive behavior shall be discussed with the DVAMC Bed Flow Clinician or DVA AOD after hours. When possible, Contractor staff shall complete a lethality assessment and safety planning with the veteran. Contractor staff will conduct telephone consultation with DVAMC Bed Flow Clinician to determine if the next step is re-hospitalization at DVA, directing the veteran to report to the VA psychiatric Emergency Services, or release to a local homeless shelter, family or friend. after lethality assessment and safety planning has been completed by Contractor staff.

e. Contractor agency shall provide designated primary and secondary points of contact by title, name, phone number, pager, and email addresses for ongoing communication and coordination of all aspects of this service agreement both during and off business hours for efficiency of communication.

f. The Contractor shall make available, upon request, to the VAMC, documentary information deemed necessary by the VAMC to conduct utilization review audits for the mandated national evaluation study required by section (2) of Public Law 100-6; to verify quality of patient care for veterans, to assure confidentiality of patients records information, and to determine the completeness and accuracy of financial records via phone consultation with identified VAMC DEN Bed Flow Clinician who will input content into CPRS.

g. The DVAMC Bed Control Clinician shall offer clear recommendations for the Contractor to coordinate treatment and discharge planning reflecting a team assessment of health, social and vocational needs and the involvement of residents’ families and appropriate community resources in resolving problems and setting goals.

h. The DVAMC Bed Control Clinician team shall identify and refer all patients to the Contractor. All patients will be mentally ill (including chronically mentally ill veterans whose psychiatric disorder may include co-occurring chronic alcohol and/or drug abuse problems.)

8. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT(QI)

a. Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, and Peer Reviews. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE). Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

b. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. If the Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

c. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

d. Performance Standards:

i. Measure: Provider Quality Performance Performance Requirement: All Contractor’s physician(s)/ LIP(s) shall perform in accordance with clinical standards.

Standard: OPPE documentation for all (100%) staff providing services under the contract. All staff (100%) meet Standards.

Acceptable Quality Level: 90% meet Standards Surveillance Method: Random inspections of records. Minimum of 4 records per inspection Frequency: Quarterly

ii. Measure: Qualifications of Key Personnel Performance Requirement: All Contractor’s physician(s) shall have current board certified in accordance with ACC Standards for psychiatry.

Standard: All (100%) Contractor’s physician(s) s are board certified.

Acceptable Quality Level: 100% Surveillance Method: Random Inspection of qualification documents. Minimum of 2 random inspections of key personnel qualifications per quarter.

Frequency: Quarterly

iii. Measure: Scope of Practice/Privileging Performance Requirement: Contractor’s physician(s) perform within their individual scopes of practice/privileging.

Standard: All (100%) Contractor’s physician(s) perform within their scope of practice/privileges 100% of the time.

Acceptable Quality Level: 100% Contractor’s physician(s) perform within their scope of practice/privileges 100% of the time.

Surveillance Method: Random Inspection of records. Minimum of 2 random records per inspection.

Frequency: Quarterly

iv. Measure: Patient Access Performance Requirement: Contractor’s physician(s) shall be available and in location as needed to properly perform tasks as specified.

Standard: All (100%) Contractor’s physician(s) are on time and available to perform services.

Acceptable Quality Level: Contractor’s physician(s) are on-time and available to perform services 90%of the time.

Surveillance Method: Periodic Sampling of Time and Attendance Sheets. Minimum 4 records per inspection.

Frequency: Quarterly Incentive: Favorable contractor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contract personnel (s) meet qualification standard.

v. Measure: Patient Safety Performance Requirement: Patient safety incidents shall be reported using VA Patient Safety Reporting System. All incidents reported immediately (within 24 hours.)

Standard: All (100%) of patient safety incidents are reported using VA Patient Safety Reporting System within 24 hours of incident.

Acceptable Quality Level: 100% of patient safety incidents are reported using VA Patient Safety Reporting System within 24 hours of incident.

Surveillance Method: Direct Observation. Report of Conduct. Random sampling per inspection.

Frequency: Quarterly.

vi. Measure: Maintains licensing, registration, and certification Performance Requirement: Updated Licensing, registration and certification shall be provided as they are renewed. Licensing and registration information kept current.

Standard: All (100%) licensing, registration(s) and certification(s) for Contractor’s physician(s) shall be provided as they are renewed. Licensing and registration information kept current.

Acceptable Quality Level: 100% licensing, registration(s) and certification(s) for Contractor’s physician(s) shall be provided as they are renewed. Licensing and registration information kept current. No acceptable deviation.

Surveillance Method: Periodic Inspection or Random Sampling.

Frequency: Annually or at least once during the contract’s period of performance.

vii. Measure: Mandatory Training Performance Requirement: Contractor shall complete all required training on time per facility policy Standard: All (100%) of required training is complete on time by Contractor’s physician(s) Acceptable Quality Level: 90% completions.

Surveillance Method: Periodic Inspection or Random Sampling.

Frequency: Annually or at least once during the contract’s period of performance.

viii. Measure: Privacy, Confidentiality and HIPAA Performance Requirement: Contractor is aware of all laws, regulations, policies and procedures relating to Privacy, Confidentially and HIPAA and complies with all standards Zero breaches of privacy or confidentiality Standard: All (100%) Contractor’s physician(s) comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA Acceptable Quality Level: 100% compliance Surveillance Method: Periodic Inspection; Contractor shall provide evidence of annual training required by the facility, reports violations per VA Handbook 6500.6.

Frequency: Annually or at least once during the contract’s period of performance.

Contractor’s Company Name

Please complete and return the original signed document to the CO within the timeframe stated in the terms of the contract.

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY language FOR Inclusion into CONTRACTS, as appropriate

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.

1. ACCESS to VA INFORMATION AND VA INFORMATION SYSTEMS

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.

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.

a. 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.

b. 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.

c. 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.

2. 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).

e. 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 on-site 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.

f. 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.

g. 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.

h. 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.

i. 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.

j. 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.

k. 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.

l. 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.

m. 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.

n. 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.

3. SECURITY INCIDENT INVESTIGATION

1. 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 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.

p. 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.

q. 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.

r. 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.

4. LIQUIDATED DAMAGES FOR DATA BREACH

1. 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.

1. 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.

1. 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.

v. 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 $______ 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 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.

5. SECURITY CONTROLS COMPLIANCE TESTING

On a periodic basis, VA, including the Office of Inspector General, reserves the right to evaluate any or all of the security controls and privacy practices implemented by the contractor under the clauses contained within the contract. With 10 working-days’ notice, at the request of the government, the contractor must fully cooperate and assist in a government-sponsored security controls assessment at each location wherein VA information is processed or stored, or information systems are developed, operated, maintained, or used on behalf of VA, including those initiated by the Office of Inspector General. The government may conduct a security control assessment on shorter notice (to include unannounced assessments) as determined by VA in the event of a security incident or at any other time.

6. TRAINING

1. 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;

1. Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training;

1. Successfully complete the appropriate VA privacy training and annually complete required privacy training; and

1. Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [including TMS course # 10706 - Privacy & Information Security Awareness Training and TMS course # 10203 - HIPAA & Privacy Training]

x. 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 1 week of the initiation of the contract and annually thereafter, as required.

y. 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.