Q201--CCN Next Gen Medical Network - West

The Department of Veterans Affairs is seeking contractors to establish and operate the Community Care Network Next Generation Medical Network for the western United States region, covering 25 states and territories including California, Colorado, Nevada, and Washington. The contractor will serve as a Third-Party Administrator responsible for creating a comprehensive network of qualified healthcare providers, processing medical claims, managing referrals and authorizations, providing customer service through contact centers, and delivering various healthcare services including medical, surgical, mental health, urgent care, pharmacy, and durable medical equipment services for veterans. Key performance objectives include meeting specific veteran drive time standards (85-87% pass rates in catchment areas), maintaining 90% appointment timeliness, achieving 97% provider data accuracy, and ensuring robust quality assurance and patient safety protocols. The procurement is currently in the Request for Information phase with Amendment 0003 posted on September 5, 2025, and responses due by September 12, 2025 at 2:00 PM Eastern Time, with the VA planning to issue a Request for Proposal in early Q1 of FY26. The solicitation (36C10G25Q0091) is classified under NAICS code 524114 for Direct Health and Medical Insurance Carriers and PSC code Q201 for Medical-Managed Healthcare.

This procurement does not include any set-aside designations and is open to all qualified contractors. No specific incumbent contractors or current service providers are identified in the documentation, though the VA references building upon lessons learned from the current Community Care Network program. While specific contract values are not disclosed in this pre-solicitation phase, the procurement involves complex pricing structures with multiple Contract Line Item Numbers covering healthcare services, administrative fees, vaccinations, and optional services, with reimbursement rates up to 100% of Medicare rates and specific provisions for rural and tribal health services. The contract includes an initial 18-month implementation period from award, with base and multiple option periods, and contractors must demonstrate capability to achieve full implementation within 6, 12, or 18 months under the new regional medical structure. The scope encompasses comprehensive network management, claims processing, technology integration including VA's DAS/EDI Gateway, and compliance with cybersecurity requirements at FedRAMP High Impact level.