Performance Work Statement For

Service Dog Health Insurance

1. INTRODUCTION

1.1 The Department of Veterans Affairs (VA), Veteran Health Administration (VHA), Department of Prosthetic and Sensory Aids (PSAS), Office of Rehabilitation and Prosthetic Services has identified a need for Service Dog Insurance. VA’s objectives are to provide assistance to Service Dogs in optimal serviceable condition, relieve Veterans of the cost and administrative burden of caring for Service Dogs, and provide cost and administrative efficiency by providing appropriate service dog veterinary care in an organized and structured manner with clear goals and expectations.

1.2 VA requires veterinary insurance benefits for certain Service Dogs, which are defined by the Americans with Disability Act as dogs that perform work or tasks to mitigate a specific disability. Service Dogs are not pets, therapy dogs, or emotional support dogs.

1.3 Veterans are eligible for the VA veterinary insurance benefit (“the benefit”) for their

Service Dog if they meet the eligibility criteria found in Title 38 Code of Federal Regulations (CFR) § 17.148, which is subject to change.

1.3.1 VA will determine, at its sole discretion, whether a Veteran is eligible for the benefit, and will decide if the Veteran’s Service Dog will be added to the veterinary insurance policy defined in Section 5 below.

1.3.2 VA will also determine, at its sole discretion, when a Service Dog currently covered will no longer be covered, in accordance with the addition/removal requirements in Section 5.5 below.

1.4 The Service Dogs covered by the benefit are privately owned by their Veteran handlers, and not the VA. The Veteran, not VA, is personally responsible for arranging for the care or treatment of any Service Dog.

1.5 Pursuant to Title 38 CFR § 17.148, the benefit must meet the following criteria, to the extent commercially practicable:

1.5.1. Per Title 38 CFR § 17.148 (d)(1)i, the VA, and not the Veteran, will be billed for any premiums, copayments, or deductibles associated with the policy; however, the Veteran will be responsible for any cost of care that exceeds the maximum amount authorized by the policy for a particular procedure, course of treatment, or policy year. If there is a policy limit, the contractor shall define.

1.5.2 Also per (d)(1)I, if a dog requires care that may exceed the policy's limit, the insurer will, whenever reasonably possible under the circumstances, provide advance notice to the Veteran.

1.5.3 Per (d)(1)ii, the policy will guarantee coverage for all treatment (and associated prescription medications), subject to premiums, copayments, deductibles or annual caps, determined to be medically necessary, including euthanasia, by any veterinarian who meets the requirements of the insurer. The Veteran will not be billed for these covered costs, and the insurer will directly reimburse the provider.

1.5.4 Per (d)(1)iii, the policy will not exclude dogs with preexisting conditions that do not prevent the dog from being a Service Dog.

1.6 To summarize, the contractor shall provide veterinary health insurance coverage, which includes both a comprehensive wellness and health plan as well as sick/injured insurance coverage for all dogs screened and approved by VA for receipt of “the Veterinary Health Insurance Benefit”, hereafter referred to as “the benefits” regardless of age, breed, geographic location or pre-existing medical condition.

2. APPLICABLE DOCUMENTS In the performance of the tasks associated with this PWS, the Contractor shall comply with Title 38 CFR § 17.148, effective October 5, 2012, as described above in item

1.5.

All applicable Health Insurance Portability and Accountability Act

(HIPAA) Regulations, to prevent disclosure of Veteran health information.

Federal Acquisition Regulation (FAR) 52.224-1 Privacy Act Notification and FAR 52.224-2, Privacy Act, to protect the privacy of Veterans.

3. SCOPE OF WORK The purpose of this procurement action is to acquire veterinary health insurance and wellness coverage for all Veteran-owned Service Dogs approved by VA to receive “the benefits”. The number of Service Dogs eligible to be covered by veterinary health insurance is subject to fluctuation upward or downward as the program grows, or as changes occur. As covered in previous sections, veterinary healthcare insurance coverage shall be provided for all Service Dogs pursuant to Title 38 CFR § 17.148.

3.1 All dogs covered under this contract must be approved by VA for receipt of such insurance coverage.

3.2 The Contractor shall provide VA with full comprehensive, quality veterinary health care insurance coverage for all dogs approved by VA for receipt of insurance coverage regardless of age, breed, geographic location (as defined in item 4.2) or pre-existing condition.

3.3 The policy will not require out of pocket expenses for the Veteran, except for any cost of care that exceeds the maximum amount authorized by the policy.

3.4 The insurance policy shall include both a comprehensive wellness plan as well as sick/injured insurance coverage and is further detailed in Section 5 of this PWS.

The Contractor shall require that all veterinarians who are reimbursed for services rendered to Veteran-owned Service Dogs under this contract are properly licensed in their respective states. The Contractor shall also provide reports to include dates of service and treatment provided as outlined in Section 6 of this PWS.

4. PERFORMANCE DETAILS

4.1 Performance Period. The period of performance shall consist of a twelve (12) month base period, and four (4) twelve (12) month option periods and one six (6) month option period. Each task order issued under this contract will specify its own period of performance.

4.2 Place of Performance. The contractor shall provide veterinary healthcare insurance for Service Dogs located throughout the United States (U.S.) and all U.S. territories

5. TASKS AND DELIVERABLES

As the main deliverable, the Contractor shall provide comprehensive, quality veterinary healthcare insurance coverage for the cost of services for all eligible VA approved Service Dogs regardless of age, breed, sex, geographic location or pre-existing medical condition as outlined in Sections 5.1 and 5.2. The policy shall not require payment of any deductibles or copayments by either VA or the Veteran. The Contractor shall directly reimburse the veterinarian for all services covered within the policy.

5.1 When emergency veterinary care is required for an approved Service Dog before the veteran has received policy coverage information from the contractor, the contractor shall reimburse the Veteran for costs incurred that would normally have been covered under this contract.

5.1.1 The Contractor shall obtain approval from the CO prior to reimbursing the Veteran.

The COR will assist the CO by providing information to inform the CO’s decision.

5.1.2 Only a warranted Contracting Officer can financially obligate the government.

5.2 Healthcare Coverage – Wellness Portion. The Wellness Plan shall cover all

Service Dogs approved by VA for veterinary healthcare benefits during the period of performance of the contract.

5.2.1 Vaccinations. Wellness coverage shall include the following vaccinations

(vaccinations recommended by veterinarians will vary per dog per location):

Distemper Parvovirus Leptospirosis Hepatitis Rabies Lyme Disease Bordetella (2 per year) Non-core vaccinations recommended based on locality

5.2.2 Examinations. Wellness coverage shall include the following examinations:

Annual Comprehensive Exam Otoscopic Exam, Ophthalmic Exam, Rectal Exam, Dental Exam, Neurologic Exam, Cardiovascular Evaluation, Weight/Nutritional Counseling, Coat & Skin Evaluation, Abdominal Palpation, Urogenital Evaluation, Musculoskeletal Evaluation, Pulmonary/Lung Evaluation, Tonometry/Ocular Pressure, External Parasite Exam and Intestinal Parasite Fecal Exam

5.2.3. Other Procedures. Wellness coverage shall include the following:

Roundworm and Hookworm Dewormings and other parasite treatment as recommended by the licensed veterinarian

Blood Sample Collect/Prep Blood Cell Count Differential Exam of Blood Cells Internal Organ Function Screens (liver, kidney, calcium/phosphorus, cholesterol, and diabetes) Canine Dental Prophylaxis Protocol (utilizes one blood screening and one internal function screen, listed above) Urine Sample Collect/Prep – Free Catch or Direct Urinalysis, with

Individual Tests such as Urine Specific Gravity and Urine Sediment Exam Chest X-Rays (3 views) Electrocardiograms Ear Swab and Microscopic Exam Dental Cleaning (sedation/general anesthesia is required for all cleanings) Blood-borne disease testing (Heartworm/Lyme/Ehrlichia

/Anaplasma/Rocky Mountain Tick Fever Free Interstate Health Certificates (when needed) Semiannual Parasite and flea/tick examinations and medications as required.

5.2.4. Procedures/Items Not Covered. Wellness coverage shall not include the following miscellaneous items under any circumstances:

Grooming Nail trimming Non-sedated teeth cleaning Non-prescription medications Non-prescription food Dietary supplements (unless prescribed as part of a veterinary treatment plan) Boarding (other than medically necessary) Non-prescription medications Elective or cosmetic surgeries such as tail or ear docking

5.2.5 Other Covered items. Wellness coverage shall include:

Any product designed to prevent and/or control parasite infestation or infection that is prescribed and PURCHASED FROM a licensed veterinarian. This shall include all flea/tick/heartworm preventative medications. The contractor has the right to limit the supply purchased by a Veteran at a visit as long as the period is at least 90 days.

Glucosamine medication may be prescribed by a veterinarian, if needed based upon clinical judgement, and shall be covered by the contractor.

The contractor shall develop a process to identify and report to the government non-prescription medications or supplements suggested by veterinarians for optimized animal health but not covered by the scope of this contract. This information will allow the government to decide if costs for such items should be covered at government expense using a mechanism outside the scope of this contract.

5.3 Healthcare Insurance Coverage - Sick/Injured Insurance Coverage shall include the following:

Full coverage for all treatments (and associated prescription medications), and surgeries determined to be medically necessary by a duly licensed veterinarian. This includes euthanasia and basic cremation services, medical and surgical care following accidents and illnesses, and medical and surgical care as needed for emergencies and hereditary conditions.

The Contractor shall bill VA directly for all contractually agreed to insurance premiums on a monthly basis.

The Veteran will not be billed for premiums, deductibles or copayments associated with Sick/Injured coverage.

No burial services, caskets or urns will be considered covered items under this coverage.

5.4 Fit for Service Certification/Recertification Requirements - The VA Program Office, Rehabilitation and Prosthetic Services is the sole entity authorized to certify or non-certify each Service Dog as fit/unfit for further duty. At the onset of, and periodically throughout the period of performance, the VA will provide a listing of dogs certified and approved for insurance coverage under this contract. Dogs determined by VA as no longer able to function as a Service Dog will be deemed ineligible for insurance coverage and the Contracting Officer, in accordance with Section 5.5.2, will terminate the veterinary healthcare insurance coverage. The contractor shall ensure that the government has access to the contractor records for each Service Dog for which benefits are paid, in order to aid in fit-for-service determinations.

Contractor records shall be made available to the government within 15 business days of request by the government and can be transmitted electronically when possible.

5.5 Adding and Deleting Dogs - In all cases, the Department of Veterans Affairs is considered the policy owner and has exclusive authority to add or delete dogs from coverage. The policy holder for Service Dogs will be the Veterans who own them.

5.5.1 Adding Service Dogs to Contract

Prior to a Service Dog’s coverage becoming effective, VA will provide the Contractor all pertinent dog and policy holder information to include: Veteran’s Name (policy holder) and Address, Phone Number, Service Dog’s Name, Age, Breed, and

Gender. If the Service Dog has been microchipped, the microchip number should be provided to the Contractor. This information will be stored by the vendor as part of the dog’s individual insurance record.

5.5.1.1 Contractor shall provide at least two different “Add Dates” each month, spaced at approximately biweekly intervals, when coverage can be started for new Service Dogs. Contractor will add any dogs for which the information specified in items

5.5.1.1 is provided by VA. Request will be submitted by the government at least one calendar day in advance of an Add Date. All policies shall start 1 second after midnight (12:00:01) on the Add Date.

5.5.1.2 Communication of Policy Information. Within 15 calendar days, the Contractor shall provide the Veteran with:

A copy of the insurance policy outlining coverage A unique policy number Toll free telephone hotline information An insurance identification card with unique policy number for that Service

Dog. The identification card should include: Veteran’s Name (policy holder) and Address, Phone Number, Service Dog’s Name, Age, Breed, and Gender. Policy information shall be provided by hard copy to the Veteran.

An email notification shall be sent to the COR to indicate the date the welcome package was sent to the Veteran at their mailing address.

5.5.2 Deleting Service Dogs from Contract. During the period of performance of the contract, the VA shall provide the Contractor written notification via written communication from the COR (e.g. via electronic mail) that insurance coverage for a dog shall end. Insurance coverage shall end on an “End Date”, which shall be the day before the specified two monthly “Add Dates” (see item 5.5.1.2). Contractor will remove coverage for any dogs effective the end of the End Day when notification is provided by VA at least one calendar day in advance of an End Date. The claims report and invoice shall reflect the appropriate pro-rated (e.g. half-month versus full-month premium) price based upon the decrease in quantity and reflect the modified period of coverage.

5.5.3. Changing policy holder information. Contractor shall make any requested change of policy holder for Service Dogs effective within two business of the notification by the VA.

5.5.3 Payment of covered charges after policy termination. Contractor shall cover charges received for dates of service when policy was in effect, even if such charges are submitted after termination of policy.

5.6. Transition Plan

Transition-In. The contractor shall submit a detailed transition-in plan to include start-up activities, to include: Detailed transition methodology in logical sequence to ensure a smooth transition of all tasks/subtasks of the contract without interruption or degradation of Service Dog healthcare insurance coverage to include: Timeline for completion, Identification of risks and issues and risk mitigation strategies, and Attendance of a post award conference

5.6.2. Transition-Out. The contractor shall provide a transition-out plan no later than sixty (60) days prior to expiration of this contract. The contractor shall maintain complete documentation that is totally assessable to the designated Government representatives via a web portal or some other portal as the Government directs.

The contractor shall overlap with incoming contractor during transition for a nominal period of 30 days and will work with Government personnel and the incoming contractor to transfer knowledge, information and documentation for all projects and tasks related to this contract. The type of information and documentation to be transferred includes but is not limited to all files pertaining to projects, reports and analysis generated during the period of performance.

6. DELIVERABLES/REPORTING REQUIREMENTS

The Contractor shall maintain data of all Service Dogs covered by the insurance to include dates of coverage, dates of veterinary service, service provider, standardized identification of treatment provided, and cost of treatment. Additionally, the contractor shall maintain data on treatments procedures, and services not covered and the reason for denial of claim.

6.1 Monthly Reports: The Contractor shall electronically submit monthly reports to both the Contracting Officer Representative (COR) and Contracting Officer (CO). Monthly reports should differentiate between claims paid for different types of visits by claim type (example report available upon request), and will incorporate a unique policy numbering system to aid in clear differentiation between benefits paid for the Service Dog population. The monthly report shall include:

A listing of all Service Dogs deleted from insurance coverage including the following identifying information: Veteran’s name, Service Dog’s name, and policy number.

A listing of all dogs covered during the billing period.

Monthly claims report indicating the number of claims filed and for which dogs a claim was filed.

A listing of the specific procedure, medication or service paid on each claim, and the cost of each individually.

A listing of benefits or services not paid and not provided, the reason for denial of service shall be included in addition to the dog identification information required above.

Uniquely identify the type of claim paid or denied (e.g. wellness claim vs.

sick and injured claim vs. denied claim).

Identify briefly the claimed condition being treated/covered by the policy (i.e. Broken Foot, Joint Problems, Pancreatitis, Renal failure, Annual Exam, Skin Irritation, Ear Infection etc..).

Report should be searchable by policy number, Veteran last name, claim type, or cost of claim.

The Monthly Report will provide a “running tally” from the start of the task order for the following data points as of the date of the report: number of claims paid to date, dollar value of claims paid to date, break out of all costs paid to date based on classification or category of cost.

Monthly report shall be provided no later than ten (10) business days after the end of each month.

6.2 Annual Reports: No later than thirty (30) days after the end of the twelve (12) month period, the Contractor shall electronically provide to the COR and CO a task order close-out report which shall provide a summary of the following data:

Total number of participating Service Dogs Vaccinations: Number of Service Dogs vaccinated and total costs incurred Total number of Comprehensive Exams (annual service) Total number of Service Dogs examined and total costs incurred Teeth cleaning (sedation included in this service): Total number of Service

Dogs seen and total costs incurred.

Sick/Injured Services: Total number of cases, and total costs incurred.

The claimed condition being treated/covered by the policy (i.e. i.e. Broken

Foot, Joint Problems, Pancreatitis, Renal failure, Annual Exam, Skin Irritation, Ear Infection etc..).

Miscellaneous services/chargeable itemized breakdown with total costs incurred

Total number of Service Dogs removed from contract. Total number of Service Dogs added to contract

Total number of Service Dogs for which no claim was filed

6.3 Additional Stipulations:

6.3.1 Emergency Customer Hotline. - Contractor shall provide a toll-free twenty-four

(24) hour emergency customer hotline with representatives appropriately trained to answer questions about the current VA Service Dog Health Insurance contract. The purpose of the hotline is to answer questions and provide information about policy coverage and reimbursement procedures for Veterans and veterinary clinics at all times.

6.3.2 Dedicated account manager. Contractor shall provide a designated account management team for the VA to contact with regard to any issues within the scope of this contract. Contractor must respond to VA inquiries by phone or email within twenty-four (24) business hours.

6.3.3 Monthly Billing Calculations. The monthly billing cycle shall start on the first Add

Day of that month and end on the second End Date of that month. Contractor shall invoice for monthly or half monthly insurance coverage for each dog covered in a given billing month. The half-monthly coverage shall be one-half the amount of the cost for a full month of coverage, per the CLIN schedule. If the contract period of performance ends on a date other than an End Day, contractor shall invoice for the number of days of coverage for that billing period based upon the monthly cost (per applicable CLIN schedule) divided by 30. If a Base Year or Option year ends on a date other than an End Day, the pricing in place at the beginning of the billing cycle will be used throughout the billing month.

7. GOVERNMENT AUTHORITIES/ROLES AND RESPONSIBILITIES

7.1 CONTRACTING OFFICER (CO) The CO has the overall responsibility for the administration of this Contract. The CO, without right of delegation, is the only authorized individual to take actions on behalf of the Government to amend, modify or deviate from the contract terms, conditions, and/or requirements. If the Contractor makes any changes at the direction of any person other than the CO, the change will be considered to have been made without authority and no adjustment will be made to cover any increases in charges that may result. The CO may delegate certain specific responsibilities to its authorized representative – the COR via written letter of delegation.

7.2. CONTRACT SPECIALIST (CS): The CS performs the routine, day to day oversight of the contract and reports directly to the CO.

7.3 CONTRACTING OFFICER’S REPRESENTATIVE (COR) The COR will represent the CO in the administration of technical details within the scope of the Contract.

The COR is also responsible for recommendation to the CO the final inspection and acceptance of Contract deliverables, review and payment of submitted invoices and such other responsibilities as may be specified in the Contract. The COR is not otherwise authorized to make any representations or commitments of any kind on behalf of the CO or the Government. The COR does not have authority to alter the Contractor's obligations or to change the Contract specifications, price, terms or conditions. If, as a result of technical discussions, it is desirable to modify Contract obligations or the specification, changes will be issued in writing and signed by the

CO.

7.4 Government Furnished Information: Prior to activation of each Service Dog’s coverage, the COR shall provide the Contractor with the following data: Veteran’s Name (policy holder) and Address, Phone Number, Service Dog’s Name, Age, Breed, and Gender.

8. DATA

Confidentiality of Data and Privacy Act. Any information systems involved with this contract are classified as systems of records subject to the Privacy Act of 1974 (Public Law 93-579) and all applicable Health Insurance Portability and Accountability Act (HIPAA) regulations. The contractor may, during performance, observe or handle information subject to the Privacy Act or other Federal regulations. Duplication or disclosure of data and other information to which the contractor may have access because of this contract is prohibited by law. It is understood that throughout the performance of the contract, the contractor may have access to confidential data that is either the sole property of VA or is the sole property of other than the contracting parties. The contractor hereby agrees to maintain the confidentiality of all such data to which access may be gained throughout contract performance, whether title thereto vests in VA or otherwise. The contractor hereby agrees not to disclose said data, any interpretation thereof, or data derivative thereto unauthorized parties in contravention of the provisions, without the written approval of the CO, or the party in which the title is wholly vested. Also, FAR 52.224-1 Privacy Act Notification and FAR 52.224-2, Privacy Act, as stated in Section I, Contract Clauses, apply to this contract. All contract personnel performing on this contract will be required to sign a Certificate of Confidentiality and Non-Disclosure prior to commencing work. The Certificate will be provided and maintained by the COR.