PWS - Section 106 of the Dole Act - Dental Pilot Program.docx

SECTION 106 OF THE DOLE ACT – DENTAL PILOT PROGRAM

STATEMENT OF WORK

A. GENERAL INFORMATION

1. TITLE OF AGREEMENT

Dental Request for Services (RFS) Community Care Consult Clinical Provider Review. Providers will be remote for their location. The personnel will be managed by the Office of Dentistry conducting work for the following facilities in VISNS 15 and 01.

VISN 01 Facilities:

· Togus VA Medical Center (Augusta, ME)

· White River Junction VA Medical Center (White River Junction, VT)

· Manchester VA Medical Center (Manchester, NH)

· Edward P. Boland Department of Veterans Affairs Medical Center (Leeds, MA)

· Providence VA Medical Center (Providence, RI)

VISN 15 Facilities:

· Dwight D. Eisenhower Department of Veterans Affairs Medical Center (Leavenworth, KS)

· Colmery-O’Neil Veterans’ Administration Medical Center (Topeka, KS)

· Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita, KS)

· Kansas City VA Medical Center (Kansas City, MO)

· Harry S. Truman Memorial Veterans’ Hospital (Columbia, MO)

· John J. Cochran Veterans Hospital (St. Louis, MO)

· St. Louis VA Medical Center-Jefferson Barracks (St. Louis, MO)

· John J. Pershing Veterans’ Administration Medical Center (Poplar Bluff, MO)

· Marion VA Medical Center (Marion, IL)

· Evansville VA Clinic (Evansville, IN)

2. BACKGROUND

On January 2, 2025, the President signed into law the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (the Act; P.L. 118-210). Section 106 of the Act requires the Department of Veterans Affairs (VA) to hire general and specialist dentists for a two-year pilot program to help manage the approval process of treatment plans for VA covered dental care in the community. This contract aims to hire qualified dentists (3.0 FTEE) and a dental specialist (0.5 FTEE) to meet this mandate. Additionally, a dental assistant (1.0 FTEE) will be hired to support the pilot program and coordinate care among contracted dentists, the community, VA dental clinics, and the Office of Dentistry.

Scope of Work:

Objective:

The primary objective of this contract is to hire qualified dentists and a dental specialist to review and assess community care dental treatment plans, document findings, and submit a concise report to Office of Dentistry dentists for review and authorization. The contract dentists will ensure that all treatment plans comply with VA standards and guidelines before submitting them for final approval. This contract also requires the hiring of support staff to provide logistical and administrative support to the pilot program, helping to coordinate care between the contracted dentists, the community, the VA dental clinics, and the Office of Dentistry.

Contract Dentists and Dental Specialist Responsibilities and Deliverables:

1. Review of Community Care Plans

· Initial Assessment of Community Care Plans

· Evaluate initial community care plans submitted by external dental providers.

· Ensure that each plan considers the Veteran’s comprehensive patient history and provides a diagnosis and proposed treatment plan.

· Review approximately 8,750 treatment plans annually, averaging 4.4 plans per hour during standard work hours (40 hours per week for 50 weeks). Each consult is estimated to require 20 minutes for review.

· Coordinate with community and/or VA dental providers to address inquiries and discrepancies in submitted treatment plans.

· Follows VA guidelines for review and adjudication of treatment plan reviews.

· Treatment Plan Validation

· Verify the accuracy and appropriateness of the proposed dental treatments.

· Assess the necessity and potential outcomes of recommended procedures.

· Confirm that all proposed treatments align with VA standards and guidelines.

· Revise treatment plan as needed.

· Clinical Review and Recommendations

· Provide detailed clinical reviews and expert recommendations for each community care plan.

· Highlight any discrepancies or concerns and suggest modifications if necessary.

· Follow defined process in Electronic Health/Dental Record for documentation/adjudication of community treatment plan.

2. Request for Services (RFS) Communication and Approval Workflow

· Coordination with Stakeholders

· Communicate with VA dentists and community care providers as needed regarding the community care plans.

· Follows VA guidelines for review and adjudication of treatment plan reviews.

· Approval Tracking and Follow-up

· Monitor the status of submitted community care plans through the approval process.

· Proactively follow up with VA dentists and community care providers to address any questions or additional requirements.

· Maintain thorough records of approval timelines and outcomes.

3. Compliance and Documentation

· Regulatory Adherence

· Ensure that all reviewed community care treatment plans meet VA policies, standards and regulatory requirements for covered care under sections 1710 and 1712 of Title 38.

· Stay updated on any changes to VA guidelines and implement them in the review process.

· Accurate Documentation

· Maintain meticulous records of all assessments, recommendations, and communications related to community care plan reviews.

· Ensure that all documentation is secure, confidential, and readily accessible for audits or reviews.

· Submit detailed monthly reports summarizing activities, findings, and performance metrics.

4. Quality Assurance

· Peer Review and Feedback

· Engage in regular peer reviews with contracted and VA dentists to ensure consistency and accuracy in care plan reviews.

· Participate in meetings to discuss complex cases, share best practices, and receive constructive feedback.

· Document outcomes and integration of peer feedback in quarterly quality assurance reports.

· Comply with the Joint Commission and VHA Standards, as outlined below.

· Continuous Improvement Initiatives

· Identify trends, recurring issues, and areas for improvement from the review of community care plans.

· Develop and implement strategies to enhance the efficiency and accuracy of the review process.

· Report trends and issues arising from treatment plan submissions and approvals to contribute to process improvements.

5. Training and Development

· Mandatory Training Sessions

· Attend all required training sessions provided by the VA to ensure up-to-date knowledge and awareness of VA community care processes and VA policies and guidelines.

· Participate in periodic refresher courses and policy updates as mandated by the VA.

· Complete any VA-mandated certification programs within specified deadlines.

6. Communication and Collaboration

· Stakeholder Engagement

· Facilitate effective communication and collaboration between VA dentists, the Office of Dentistry, community care providers, and other stakeholders.

· Attend regular meetings and conferences to discuss community care plan review processes and outcomes.

· Provide comprehensive bi-monthly stakeholder engagement reports.

· Communicate with community dentists and Veterans regarding outcomes of community care treatment plan decisions as needed.

· Conduct teledentisry or phone visits with Veterans as needed.

Support Staff Responsibilities:

1. Documentation Management:

· Use electronic health/dental record to review community care requests and document findings.

· Organize and maintain all documentation related to community care plan reviews, ensuring that records are accurate, comprehensive, and up to date.

· Identify any missing medical/dental documentation that is required and collaborate with facility community care staff to obtain such documentation.

· Maintain a VA Microsoft Teams site for assignment of completed RFS reviews to designated Office of Dentistry dentists for authorization.

· Assist with the preparation of review summaries and correspondence.

2. Scheduling and Coordination:

· Support operations across all sites participating in the pilot.

· Assist in scheduling any required telephone and/or teledentistry visits between providers and Veteran patients.

· Coordinate meetings, training sessions, and conferences.

· Prepare and distribute meeting agendas and minutes.

3. Communication:

· Facilitate communication between the contracted dentists, Office of Dentistry team, VA dentists, community care providers, and other stakeholders.

· Ensure that all communications are clear, timely, and effectively documented.

4. Process Improvement

· Workflow Optimization:

· Assist in identifying inefficiencies and bottlenecks in the review process.

· Document and communicate changes to processes and ensure all internal and external stakeholders are aware of updates.

· Quality Assurance:

· Assist in developing and implementing quality control measures to ensure consistent and high-quality reviews.

· Prepare reports on the outcomes of quality assurance activities.

5. Training and Development Support

· Training Coordination:

· Attend all required training sessions provided by the VA to ensure up-to-date knowledge and awareness of VA community care processes and VA policies and guidelines.

· Participate in periodic refresher courses and policy updates as mandated by the VA.

· Complete any VA-mandated certification programs within specified deadlines.

· Assist in coordinating training sessions for the contracted dentists related to VA community care processes and policies.

· Maintain training schedules and records of attendance.

6. Compliance and Documentation

· Regulatory Adherence:

· Ensure that all documentation and processes comply with VA policies, standards, and regulatory requirements.

· Ensure knowledge of VA guidelines and assist in integrating them into the review process.

· Maintain secure, accurate, and accessible records for audits and reviews.

· Confidentiality:

· Ensure that all data and information related to community care treatment plans and patient records are handled with strict confidentiality.

· Adhere to VA policies on data security and patient privacy.

7. Stakeholder Engagement

· Collaboration:

· Act as a point of contact between VISN-level staff, dental providers, and program leadership to resolve operational challenges.

· Coordinate training and onboarding for program participants.

· Facilitate effective collaboration among the contracted dentists, Office of Dentistry Team, VA dentists, community care providers, and other relevant stakeholders.

· Organize and manage stakeholder meetings to discuss review processes, outcomes, and process improvement initiatives.

· Prepare and distribute meeting summaries and action items.

· Feedback Collection:

· Gather and analyze feedback from stakeholders regarding the review process and outcomes.

· Develop and implement strategies to address feedback and improve stakeholder satisfaction.

Support Staff Deliverables:

· Monthly Reports:

· Reports summarizing review activities and performance metrics.

· Quality Assurance Reports:

· Assisting with quarterly reports on quality assurance audits, findings, and the implementation of quality control measures.

· Training Support Records:

· Documentation of training sessions, materials distributed, and records of attendance.

· Stakeholder Engagement Reports:

· Bi-monthly reports summarizing stakeholder meetings, feedback collected, and actions taken.

Performance Standards

· Timeliness:

· Ensure that all administrative tasks are completed within designated timelines.

· Accuracy:

· Maintain a high level of accuracy in documentation and communication.

· Compliance:

· Ensure 100% compliance with VA policies, standards, and regulatory requirements.

Key Personnel:

· 3.0 FTEE General Dentists

· 0.5 FTEE Dental Specialist – Prosthodontist

· 1.0 FTEE Dental Assistant (Support Staff)

Minimum qualifications of key personnel are as follows:

Contracted dentist(s) must:

· Be a licensed practitioner who specializes in dentistry and branch of medicine focused on teeth, gums, and mouth. Dentist can diagnose, prevent, manage and treat diseases, injuries and malformations of the oral cavity and other aspects of the craniofacial complex.

· Have a Doctor of Dental Medicine (DMD) or Doctor of Dental Surgery (DDS) degree from a school approved by the American Dental Association (ADA) or the Commission on Dental Accreditation (CODA) or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained.

· Have passed the National Board Dental Examinations (NBDE) which are developed and administered by the Joint Commission on National Dental Examinations (JCNDE) and possess a current, full, and unrestricted license to practice dentistry in a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

· Recent employment as a full-time clinical dentist serving diverse adult patient population (recent VA dental clinic experience preferred).

· Have the ability to prioritize multiple tasks based on deadlines, importance, and scope of assignments.

· Be self-directed, detail oriented, excellent at meeting deadlines with well-developed time management, organization and project management skills.

· Have a mastery of oral and written communication skills with proficiency to convey complex information.

· Strong interpersonal skills with the ability to work with all levels of staff from varying backgrounds.

· Demonstrate comprehensive knowledge of industry best practices and evidence-based principles.

· Have comprehensive knowledge and skill of clinical terminology, Microsoft 365 Office programs, and electronic health record systems.

· Dental Specialist only: Successful completion of an educational program in Prosthodontics accredited by the ADA.

Contracted Support Staff must:

· Have at least one year of creditable experience as a full-time dental assistant with comprehensive knowledge related to the administrative management of delivering and coordinating dental care.

· Work must have involved a close working relationship with office/facility managers and coordination of administrative, clinical, or other service activities.

· Experience in dental clinic management and coordination of services.

· Ability to manage and refine administrative processes to enhance pilot program effectiveness and productivity.

· Ability to prioritize multiple tasks based on deadlines, importance, and scope of assignments.

· Self-directed, detail-oriented, excellent at meeting deadlines with well-developed time management, organization, and project management skills.

· Strong interpersonal skills with the ability to work with all levels of staff from varying backgrounds.

· Mastery of oral and written communication skills with proficiency to convey information clearly and effectively.

· Expert knowledge and skill in Microsoft 365 Office programs including Word, Excel, Teams, and Outlook.

· Comprehensive experience with electronic health record systems and clinical terminology.

JOINT COMMISSION AND VHA (VETERANS HEALTH ADMINISTRATION) STANDARDS

Contracted dentist(s) must meet or exceed Joint Commission or equivalent standards and maintain the standards for the duration of the agreement.

The Contractor shall be responsible to ensure that contracted dentist(s) providing work on this agreement are fully trained and competent to perform the work required.

The Contractor shall be required to maintain records that document competence/performance level of contracted dentist(s) working on this agreement in accordance with Joint Commission and other regulatory body requirements.

The VA will monitor the Contracted dentist(s)’ work to ensure agreement compliance.

If the contracted dentist(s) are not Joint Commission accredited, the contracted dentist(s) must perform the required work in accordance with Joint Commission hospital standards. A copy of these standards may be obtained from the Joint Commission on Accreditation Organizations, website at: http://jointcommision.org/accreditationPrograms Contractor shall ensure contracted dentist(s) are trained on, and comply with, the current Joint Commission Environment of Care standards and related Standard Operating Procedures.

The local VAMC may be surveyed by Joint Commission as part of the accreditation process during the term of this agreement. The contracted dentist’s facility may also be subject to a site visit and review by Joint Commission as part of the local VA survey process. The Contracted dentist(s) agrees to cooperate with the local VA and Joint Commission during the survey process.

The contracted dentist(s) must perform the required work in accordance with Joint Commission standards. The Contracted dentist(s) must comply with all annual updates as issued.

The Contracted dentist(s) shall meet all Federal, State, and local fire and life safety codes.

The Contracted dentist(s) shall comply with the policies of VA.

Quality Management reports which reflect mortality and morbidity statistics for all patients with VA referrals stratified out shall be compiled quarterly and provided to the VA. Copies of all performance improvement and quality activities with VA patients stratified (when appropriate) will be forwarded to the VA quarterly.

Notwithstanding other agreement requirements, upon request of the Contracting Officer, the Contractor will remove from the work site, any contracted dentist(s) employee who does not comply with orientation requirements or meet competency requirements for the work being performed.

When changes in Contracted dentist(s) personnel are approved in accordance with the “Key Personnel” clause of the agreement, the Contractor must provide evidence of orientation, the current competence assessment, and current performance evaluation within 30 calendar days.

Monitors & indicators must be reviewed, for appropriateness, by the VA Quality Management Department.

Outcomes of VA patients must be compared with other patients within the contracting institution (compare morbidity/mortality). The results should be no statistically significant difference for VA patients as compared with other patients within the contracting institution. The VA shall have access to this data on a monthly basis. A written report is required at least quarterly.

QUALITY ASSURANCE

1. A variety of quality assurance measures will be instituted, including but not limited to, peer review, morbidity and mortality conferences, monitor timeliness to ensure compliance with standards established by the VA, patient satisfaction studies, etc.

1. Contracted dentist(s) personnel shall be subject to the same quality assurance standards in meeting or exceeding current recognized National Standards as established by The Joint Commission. Copies of the quality assurance standards will be filed in the Quality Management Section of the VA. Contracted dentist(s) shall perform services in accordance with the ethical, professional and technical standards of the healthcare industry as consistent with VA Policy, regulations and procedures.

1. The Contractor shall ensure that all contract personnel have met qualifying criteria, including current and valid licenses and certifications. Ultimately, the decision to reject or accept Contract Staff rest with the Contracting Officer upon recommendation from the OoD. Non-acceptance of contract personnel does not relieve the Contractor from satisfying and fulfilling the agreement requirements.

1. Contractor will be expected to provide qualifying dentists. Accountability and remediation (as noted above) will be expected by the contractor even if a provider is no longer employed by the contractor.

1. Contracted dentist will show by training and/or experience to be cognizant of and take into consideration the medical conditions impacting dental care. This will be evidenced by post-graduate training and number of years practicing dentistry. Consideration will be given for the training and experience of proposed Contracted dentist(s).

Place of Performance. Providers will be remote for their location. The personnel will be managed by the Office of Dentistry conducting work for the following facilities in VISNS 01 and 15.

VISN 01 Facilities:

· Togus VA Medical Center (Augusta, ME)

· White River Junction VA Medical Center (White River Junction, VT)

· Manchester VA Medical Center (Manchester, NH)

· Edward P. Boland Department of Veterans Affairs Medical Center (Leeds, MA)

· Providence VA Medical Center (Providence, RI)

VISN 15 Facilities:

· Dwight D. Eisenhower Department of Veterans Affairs Medical Center (Leavenworth, KS)

· Colmery-O’Neil Veterans’ Administration Medical Center (Topeka, KS)

· Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita, KS)

· Kansas City VA Medical Center (Kansas City, MO)

· Harry S. Truman Memorial Veterans’ Hospital (Columbia, MO)

· John J. Cochran Veterans Hospital (St. Louis, MO)

· St. Louis VA Medical Center-Jefferson Barracks (St. Louis, MO)

· John J. Pershing Veterans’ Administration Medical Center (Poplar Bluff, MO)

· Marion VA Medical Center (Marion, IL)

· Evansville VA Clinic (Evansville, IN)

Travel. Travel may not be appropriate when virtual means of communication will suffice. If required, the Office of Dentistry may authorize 1 trip per year per provider for oversight and training at an average cost of $3,000 per trip, covering airfare, lodging, and per diem. Local travel within 50 miles is not reimbursable. Justification may be requested from program for required Contracted provider travel.

Material Other Direct Costs. Funding covers costs for communication platforms such as secure telehealth systems, videoconferencing licenses, and data connectivity.

Government-Furnished Information, Equipment, and Facilities. Computers, monitors, and mobile phones.

VA INFORMATION SECURITY/PRIVACY REQUIREMENTS FOR CONTRACTOR EMPLOYEES

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.

HIPAA COMPLIANCE

Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor may be required to enter into a Business Associate Agreement (BAA) with VA. VACO has recognized Enhanced Health Care Resources as an entity that does not require a BAA with their contractors as long as they are conducting health care on VA’s behalf – dental program qualifies as a medical service – therefore, no BAA is required.