FBODaily.com | FedBizOpps: FILE | Q | Medical Disability Exams (MDE) under P.L. 104-275 Request for Information (RFI) # VA119A-15-N-0078 (Follow-up RFI to RFI # VA119A-15-N-0055 that was issued on December 19, 2014 and closed on January 7, 2015.) - Attachment

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Q -- Medical Disability Exams (MDE) under P.L. 104-275 Request for Information (RFI) # VA119A-15-N-0078 (Follow-up RFI to RFI # VA119A-15-N-0055 that was issued on December 19, 2014 and closed on January 7, 2015.) - Attachment

Notice Date: 1/22/2015
Notice Type: Attachment
NAICS: 621111 — Offices of Physicians (except Mental Health Specialists)
Contracting Office: Strategic Acquisition Center - Frederick;Department of Veterans Affairs;321 Ballenger Center Drive, Suite 125;Frederick MD 21703
ZIP Code: 21703
Solicitation Number: VA119A15N0078
Response Due: 2/5/2015
Archive Date: 3/7/2015
Point of Contact: Stephen Nickles
E-Mail Address: n.Nickles@va.gov<br
Small Business Set-Aside: N/A
Description: Dear Vendor, On December 19, 2014, VA issued Request for Information (RFI) # VA119A-15-N-0055. Several responses were received by the due date of January 5, 2015. VA is issuing a follow-up RFI # VA119A-15-N-0078 that includes questions that were not included as part of the original RFI that was issued on December 19, 2014. To support VA in its market research, VA requests vendor responses to the following: 1)Provide an estimate of the number of days your company can complete an exam - from the initial exam request, scheduling, exam completion, and return of exam results to VA - keeping in mind the high volume of exams across your network of exam providers. 2)Provide an estimate of the ramp-up period (i.e. total number of days) necessary to bring performance to full capacity. This includes establishing all IT interfaces with VA systems necessary to transmit exam data between vendor and VA. 3)Provide the number of physicians available under your existing network of exam providers. Please include the number and types of any specialists. 4)Confirm whether your company intends to compete for this requirement under a teaming agreement or mentor/protégé arrangement with a larger business. 5)Confirm whether your company currently has the capability to satisfy the Federal Acquisition Regulation's (FAR) Limitations on Subcontracting (see FAR clause 52.219-14). Specifically, confirm whether your company has the capacity to successfully perform at least 50% of the contract requirements with its own employees (excluding exams handled by subcontracted exam providers). For example, your company must perform at least 50% of the work necessary to support administrative, management, and IT requirements under the contract. Please note that failure to respond to this RFI does not preclude any vendor from submitting an offer to any subsequent solicitation, should VA choose to issue a solicitation. If your company did not respond to the RFI that was issued on December 19, 2014, you may provide your response at this time. Other than a due date of February 5, 2015 for responses to this RFI and the questions listed above, the remainder of this document is identical to RFI # VA119A-15-N-0055 that was previously issued on December 19, 2014. ? This is a SOURCES SOUGHT NOTICE / REQUEST FOR INFORMATION (RFI); not a pre-solicitation notice or solicitation for proposals/quotations. Pursuant to FAR Part 10 (Market Research), the purpose of this notice is to: 1)Determine if sources capable of satisfying the agency's requirements exists; 2)Determine if commercial items suitable to meet the agency's needs are available or could be modified to meet the agency's requirements; and 3)Determine the commercial practices of company's engaged in providing the needed service or supply. Pursuant to FAR Part 6 and FAR Part 19, competition and set-aside decisions may be based on the results of this market research. This notice in no way obligates the Government to any further action. Requirement: This notice is issued by the Department of Veterans Affairs (VA), Strategic Acquisition Center - Frederick, MD (SAC-F) to identify sources capable of providing the following: Medical Disability Examinations under Public Law 104-275 [See Attached "Draft" Performance Work Statement (PWS) for details of the proposed requirements] Anticipated NAICS Code/Size Standard: The applicable NAICS Code is 621111, Offices of Physicians (except Mental Health Specialists) and the small business size standard is $11.0 million. Submission of Information: Companies having capabilities necessary to meet or exceed the stated requirements are invited to provide information to contribute to this market survey/Sources Sought Notice including commercial market information and company information. Companies may respond to this Sources Sought Notice via e-mail to Stephen.Nickles@va.gov no later than February 5, 2015 by 3:30 PM EST with the following information and/or documentation: 1)Name of Company, Address and DUNS Number; 2)Point of Contact and Phone Number; 3)Business Size applicable to the NAICS Code: 8(a) Business / HUBZone Small Business / Women-Owned Small Business / Service-Disabled Veteran-Owned Small Business / Veteran-Owned Small Business / Large Business; 4)A brief description of contracts of a similar nature (size, scope, and complexity) that your company has handled in the past 3 years; and 5)A positive statement of your intent to submit a quote as a prime contractor if a solicitation is issued as a result of this Sources Sought Notice. Please limit your submission to a maximum of 3 pages for this Sources Sought Notice. SAM.gov: Interested parties should register in the System for Award Management (SAM) website. The website can be obtained by accessing the internet at www.sam.gov. Disclaimer and Important Notes: This Sources Sought Notice is for market research purposes only and does not constitute a Request for Proposal/Quotation; and, it is not considered to be a commitment by the Government to award a contract nor will the Government pay for any information provided; no basis for claim against the Government shall arise as a result from a response to this Sources Sought Notice or Government use of any information provided. Failure to submit information in sufficient detail may result in considering a company as not a viable source and may influence competition and set-aside decisions. Regardless of the information obtained from this Sources Sought Notice, the Government reserves the right to consider any contracting arrangement as deemed appropriated for this requirement. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. No proprietary, classified, confidential, or sensitive information should be included in your response to this Sources Sought Notice. The Government reserves the right to use any information provided by respondents for any purpose deemed necessary and legally appropriate, including using technical information provided by respondents in any resultant solicitation. At this time no solicitation exists; therefore, do not request a copy of the Solicitation. After a review of the responses received, a pre-solicitation notice and solicitation may be published on Federal Business Opportunities (FedBizOpps) website. It is the potential offeror's responsibility to monitor FedBizOpps for release of any future solicitation that may result from this Sources Sought Notice. However, responses to this Sources Sought Notice will not be considered adequate responses to any resultant solicitation. PERFORMANCE WORK STATEMENT GENERAL INFORMATION 1. Title of Project: Medical Disability Examinations Under PL 104-275 2. Scope of Work: The Contractor shall provide all resources necessary to accomplish the deliverables described in the Performance Work Statement (PWS), except as may otherwise be specified. The Contractor is to locate, subcontract, and train medical professionals in performing medical disability examinations for Veterans and separating service members within the following geographic areas: Eastern Region (Roanoke and Atlanta Regional Offices) anticipated 88,745 referrals in base (first) year; Central Region (Houston and Muskogee Regional Offices) anticipated 88,726 referrals in base (first) year; National Region (Providence, Winston-Salem, Seattle, Salt Lake City and San Diego Regional Offices, which include military bases participating in the Benefits Delivery at Discharge (BDD) and Integrated Disability Evaluation Systems (IDES) programs in the continental United States, Hawaii, Alaska, and Puerto Rico) anticipated 172,686 referrals in base (first) year. For the National Region, the Contractor shall perform services for each of the Regional Offices as well as each individual military base that participates in the BDD/IDES/JE program. Western Region (Los Angeles and San Diego) anticipated 49,496 referrals in base (first) year. Sites currently participating in BDD and/or DES programs include: 1.Camp Pendleton, CA 2.Fort Irwin, CA 3.Eglin Air Force Base, FL 4.Hurlburt Air Force Base, FL 5.Jacksonville Naval Air Station, FL 6.Key West Naval Air Station, FL 7.Kings Bay Naval Air Station, FL 8.Mayport Naval Air Station, FL 9.Pensacola Naval Air Station, FL 10.Tyndall Air Force Base, FL 11.Fort Benning, GA 12.Fort Gordon, GA 13.Fort Stewart, GA 14.Camp Lejeune, NC 15.Fort Bragg, NC 16.Pope Air Force Base, NC 17.Seymour-Johnson Air Force Base, NC 18.Altus Air Force Base, OK 19.Fort Sill, OK 20.Tinker Air Force Base, OK 21.Vance Air Force Base, OK 22.Fort Campbell, KY 23.Fort Knox, KY 24.Brooks Air Force Base, TX 25.Corpus Christi Naval Air Station, TX 26.Fort Bliss, TX 27.Fort Sam Houston, TX 28.Lackland Air Force Base, TX 29.Laughlin Air Force Base, TX 30.Randolph Air Force Base, TX 31.Sheppard Air Force Base, TX 32.Hill Air Force Base, UT 33.Fort Eustis, VA 34.Fort Lee, VA 35.Langley Air Force Base, VA 36.United States Coast Guard - Tidewater 37.Bremerton Naval Station, WA 38.Fort Lewis, WA 39.Beale Air Force Base, CA 40.Edwards Air Force Base, CA 41.Vandenburg Air Force Base, CA 42.Fairchild Air Force Base, WA 43.Mountain Home Air Force Base, ID 44.Robins Air Force Base, GA 45.Charleston Air Force Base, SC 46.Charleston Naval Hospital, SC 47.Twentynine Palms Naval Hospital, CA 48.Lemoore Naval Hospital, CA 49.Oak Harbor Naval Hospital, WA 50.Fort Drum, NY 51.Fort Polk, LA 52.Tripler Army Medical Center, HI 53.Naval Station Pearl Harbor, HI 54.Hickam Air Force Base, HI 55.Tripler Clinic (Coast Guard), HI 56.Fort Rucker, AL 57.Marine Corps Air Station Cherry Point, NC 58.Marine Corp Base Quantico, VA 59.Beaufort Naval Hospital, SC 60.Maxwell Air Force Base, AL 61.Keesler Air Force Base, MS 62.Holloman Air Force Base, NM 63.McChord Air Force Base, WA 64.Fort Leonard Wood - MO 65.Fort Worth Naval Air Station/Joint Reserve Base - TX 66.Little Rock Air Force Base, AR 67.Great Lakes Naval Base, IL 68.Red Stone Arsenal, AL 69.Eielson Air Force Base, AK 70.Fort Wainwright, AK 71.Columbus Air Force Base, MS 72.Patuxent River, MD 73.Dahlgren, VA 74.Fort Buchanan, San Juan, PR. 75.Travis Air Force Base, CA 76.Sewell's Point, VA 77.Quantico MCB 78.Fort Hood, TX Eastern RegionTogus, ME White River Junction, VT Manchester, NH Boston, MA Providence, RI Hartford, CT New York, NYBuffalo, NY Newark, NJ Philadelphia, PA Pittsburgh, PA Wilmington, DE Baltimore, MD Washington, DCRoanoke, VA Winston-Salem, NC Columbia, SC Atlanta, GA St. Petersburg, FL San Juan, Puerto Rico Huntingdon, WVCleveland, OH Indianapolis, IN Detroit, MI Louisville, KY Nashville, TN Jackson, MS Montgomery, AL Central RegionMilwaukee, WI Chicago, IL St. Paul, MN Des Moines, IA St. Louis, MO Little Rock, AR New Orleans, LAFargo, ND Sioux Falls, SD Lincoln, NE Wichita, KS Muskogee, OK Waco, TX Houston, TX Western Region Ft. Harrison, MT Cheyenne, WY Denver, CO Albuquerque, NM Boise, ID Salt Lake City, UT Phoenix, AZ Reno, NV Seattle, WA Portland, OR Oakland, CA Los Angeles, CA San Diego, CA Honolulu, HI Anchorage, AK VA reserves the right to add additional military bases to the BDD or IDES programs as necessary. Additionally, VA reserves the right to substitute the above regional offices with different regional offices within that region. These locations (both Regional Offices or IDES/BDD sites) are subject to change as required by the VA in which 60-90 days ramp-up will be provided to the contractor to hire and train additional personnel. If a Regional Office is substituted, it will be in accordance with the region of the replaced Regional Office (ex. An Eastern Region Regional Office will only be switched with an Eastern Region Regional Office). Any Regional Office may be substituted into the National Region. Note: Pricing is firm-fixed price per region and will not be re-negotiated if a VARO listed in the table at paragraph A.2 within the same region is substituted for a current VARO. For example, if Togus, ME is substituted for Atlanta, GA in the Eastern region, the Eastern region pricing will not be renegotiated or modified. 3. Background: The Department of Veterans Affairs (VA) through the Veterans Benefits Administration (VBA) administers the Compensation & Pension (C&P) Program for benefits to Veterans, their dependents, and their survivors. Entitlement determinations for disability compensation claims and disability pension claims are made by VBA Rating Veterans Service Representatives (RVSRs) and Decision Review Officers (DROs) working in VA Regional Offices (VAROs) across the country. VA Central Office (VACO) assists the VAROs. A medical disability examination is a critical piece of evidence for determining the extent of permanent impairment, and thus the percent of disability that defines the dollar benefit a Veteran is awarded. Because it is so critical, the examination report must be of high quality, providing essential information to support each disability diagnosed. It is not enough to simply state a diagnosis. The examination report must provide detailed findings sufficient for RVSRs and DROs to arrive at a determination that is able to withstand the scrutiny of appellate review. If a Veteran disagrees with a disability rating or findings, he/she can appeal such, and that is why examinations must be clear and strong enough to be upheld on appellate review. The Contractor therefore shall follow the requirements of the worksheets to ensure that sufficient criteria are met. On October 9, 1996, Congress enacted Public Law 104-275, which authorized VA to conduct a limited pilot program to contract for medical examinations from non-VA medical sources. The report went on to state a desire to see the contract medical examination authority expanded and made permanent. The pilot program was successful, and a subsequent contract was awarded under the same public law authority. In fiscal year 2009, 136,483 exams were requested and 130,263 examinations were conducted from the VAROs and Benefits at Discharge Delivery sites under the current contract. The current contract expires December 30, 2015. 4. Performance Period: The period of performance will be five (5) years from date of award (i.e. 1 base year plus 4 option years). Exercise of options will be made at the sole discretion of the Government. If the VA chooses not to exercise an option, that shall not be deemed a termination of the contract. 5. Type of Contract: Firm Fixed-Price (FFP) Indefinite Delivery, Indefinite Quantity (IDIQ). 6. Place of Performance: Contractor's Office and Subcontractor's Examination Offices 7. Ordering: Task orders will be issued annually on a "lot" basis and funding will be provided in a lump sum amount for the total order. Individual Examination requests will be sent to contractors electronically through the Centralized Administration Accounting System (CAATS) a VA Information System. The contractor will receive an encrypted text file (Individual Examination request). Contractors will invoice monthly based on the actual examinations completed. The COR will verify invoices to ensure services were completed and billed in accordance with the contract and task order. The COR will also monitor the task order funding and request an order modification if additional funding will be required. GENERAL REQUIREMENTS 1. The Contractor shall provide Contract Medical Disability Examinations (MDE) for the VBA. The Contractor shall be required to provide these services within the jurisdiction of the listed VAROs as well as within the vicinity of military bases across the country participating in the BDD and IDES programs under the National Region. Whether the Contractor wishes to coordinate with the military bases to schedule examinations on the physical military bases is at the discretion and responsibility of the Contractor. Additional BDD and IDES sites may require service by the Contractor during the course of the contract. In instances where support in new or different sites is required, the Contractor will be provided 60-90 days ramp-up time, unless negotiated, to hire and train additional personnel. Ramp up performance consists of all the preparation activities, including but not limited to the following: making capital expenditures, ensuring a qualified workforce is in place, conducting background investigations and establishing security clearances where applicable, providing appropriate training, and implementing the information technology support necessary to fully perform the requirements contained in the PWS. 2. The Contractor shall furnish all required services, facilities, and equipment required to perform the contract in accordance with the terms, conditions, and specifications contained herein and at the established firm fixed price rates. SPECIFIC REQUIREMENTS 1. Contractor shall use the Disability Benefits Questionnaire (DBQs) provided by VA as the standard for all evaluations. Contractor shall complete Disability Benefits Questionnaires (DBQs) only with accompanying appropriate C&P worksheet completion. Contractor shall provide, based on specific VA request, the full range of medical disability examinations for the following areas: Musculoskeletal; organs of sense; infectious, immune, and nutritional deficiencies; respiratory; cardiovascular; digestive; genitourinary; gynecological and breast; hemic and lymphatic; skin; endocrine; neurologic; mental disorders; dental and oral examinations. Based on specific VA request, special purpose examinations shall be provided including: cold injury protocol, traumatic brain injury (TBI), and aid and attendance or housebound status examinations. Audiology, dental, eye, and mental examinations must be conducted by specialists in those fields. Specialists able to perform initial TBI examinations (TBI examinations where a previous diagnoses of Traumatic Brain Injury does not exist) are Psychiatry, Neurology, Neurosurgery, and Physiatry and who have training and experience with Traumatic Brain Injury (additionally, specialists in audiology are needed to evaluate any issue related to tinnitus due or hearing loss that may be a residual of a TBI, and an ophthalmologist or optometrist would be required to evaluate residuals of a TBI that effected the eyes). Examinations for the residual effects of TBI, where a traumatic brain injury has been diagnosed by a Neurologist, Neurosurgeon, Physiatrist or Psychiatrist may be conducted by non-specialist, C&P providers if TBI DMA certified. All other body systems claimed conditions examinations do not need to be conducted by specialists unless specifically requested on an individual case basis by VA. Scheduling at a central or subcontractor's facilities is at the Contractor's discretion. The Traumatic Brain Injury C&P exam worksheet allows for evaluation of any and all potential residuals of traumatic brain injury. The actual event, traumatic brain injury, is conceded by VA prior to scheduling of an evaluation. The evaluation includes a comprehensive examination to document all physical or mental effects. Specialist examinations may be needed as indicated for evaluation of residuals involving the eye, audiology and mental/cognitive and/or psychological issues. TBI Cognitive and /or any neuropsychologic assessment must be performed by a psychologist and/or psychiatrist. Subsequent specific neuropsychologic testing generated from the initial cognitive/neuropsychologic assessment will be performed by a psychiatrist and/or/psychologist. Non-specialty examinations will be grouped into the following categories: A.Comprehensive General Medical Examinations (CLIN 0001) represent complete base-line examinations covering all parts of the body. Cold injury protocol examinations and aid and attendance or household status examinations when requested are also included in the Comprehensive General Medical Examination category. Shared Examinations (BDD/DES/JE) are General Medical Examinations that are conducted in conjunction with Department of Defense. The Separation Health Assessment work sheet should be used instead of General Medical Examination Compensation and Pension (C&P) Worksheet. The Department of Defense may require additional laboratory, tests, and procedures to be performed than would normally be associated with a CLIN 0001 General Medical Examination. All costs are for Shared Examinations (exam, tests, procedures, labs, x-rays, photographs) are to be invoiced under CLIN 0004. Joint Examinations (JE) are exam settings resulting from collaborative efforts of VA and DoD. Disability Examinations conducted under this "Exam Setting" act as both the service member's separation physical for DoD purposes as well as the VA medical disability examination used for rating purposes. To fulfill its function as the DoD separation physical, certain pre-requisite diagnostic tests known as the Part 1 examination, are performed based on DoD instruction. This diagnostic testing will vary depending on the individual being examined, the branch of military and the military facility from which the service member is discharging and may not correspond to any claimed or referred conditions. Included in the approved diagnostic testing is: i. Audio Screening; ii. Snellen's Visual Acuity Screening; iii. Hem Occult; iv. PSA; v. EKG; vi. Chest X-Ray; vii. Lipid panel: CBC; viii. Lipid panel: CMP; ix. Hepatitis C Screening; x. Urinalysis; xi. PAP Smear; xii. HIV Screening; xiii. Fasting Glucose; and xiv. Rapid Plasma Regain (RPR). a.Detailed Examinations - Level I includes examinations limited to specific conditions without review of other systems, but requiring examination based on three or more examination worksheets. b.Detailed Examinations - Level II include examinations limited to specific conditions without review of other systems, but requiring examination based on fewer than three examination worksheets. B. Quick Start Examinations (CLIN 0032) Quick Start is one of the Pre-Discharge programs, as evidenced on the VA Pre-Discharge website (http://www.vba.va.gov/predischarge/ ). Quick Start claims are received by VA within 59 days and 1 day prior to the discharge of the claimant from military service. Examinations for Quick Start claims are not shared with DOD. The examination will be handled as if the claim was received after the service member's military discharge date. Please use CLIN 0032 and respective sub CLINs when invoicing for this type of exam. 2. Examinations for the following categories will NOT be required by the Contractor except for special cases that will be agreed upon in advance by VA and the Contractor: pregnant service members or Veterans; protocol examinations for Original Gulf War Environmental Claims for undiagnosed illnesses; U.S. Court of Appeals for Veterans' Claims cases; examinations requiring hospitalization or surgical evaluation, such as sleep apnea or endometriosis needing laparoscopy; protocol examinations for former Prisoners of War; 38 USC 1151 initial determinations; Veterans residing in VA domiciles/nursing homes; and incarcerated Veterans. In addition, no request for review of records in the determination of Death Indemnity Compensation (DIC) or examinations for Veterans' or service members' spouses or dependents will be sent to the Contractor. 3. Contractor shall schedule examinations as close to the Veteran's home of record as feasible but generally no further than fifty (50) miles for non-specialist examination and one hundred (100) miles for specialist examinations. The VA may allow for greater distances where service in remote geographical areas is required, with remote geographical areas being those that are sparsely populated and have limited numbers of potential examiners. The Contractor shall reimburse the Veteran for mileage traveled in accordance with paragraph E.2 above. Proximity and travel time requirements are of higher priority than reimbursement costs. 4. Contractor shall schedule all examinations. The volume of requests per month may vary. At a minimum service level, the Contractor shall notify the Veteran telephonically, via electronically secure method, or via a mailed postage-prepaid letter, so that the Veteran will receive notification of the scheduled appointment at least five calendar days prior to the scheduled appointment. In lieu of the five calendar days, verbal confirmation of attendance to the appointment is acceptable. The Contractor must also provide the Veteran with a follow-up notice of the appointment(s) by an alternate means no less than 48 hours before the scheduled appointment. The Contractor must also post a copy of the Veterans' appointment notification letter to the Contractor's website. There is no preferred file format at this time but the Contractor's site must be �508-compliant. 5. Contractor shall provide examining physicians, examination facilities, available lab testing, and necessary support staff. Contractor shall also provide general medical administrative services to include: scheduling examinations; providing notification to the individual to be examined; and electronic transmission of examination reports. Contractor shall provide a copy of the examination notice letter documenting the mailing address used for any examination cancelled for failure of an individual to report for examination (or certification of telephone notification). 6.The Contractor shall provide physician(s) with a copy of the Veteran's medical records, if applicable or required by VA, prior to the examination in a secure, electronic manner. If applicable, the contractor shall scan the entire contents of the claims file to be transmitted to the physician(s) electronically. For examinations not being processed through the Veterans Benefits Management System (VBMS) and/or Virtual VA, the Contractor will be sent the hard copy of the Veterans' claims folders. For non-VBMS requests, the VARO shall send the Veterans' claims folders to the Contractor within four workdays of the exam request. For VBMS requests, the VA will have the medical records available in VBMS within 4 business days of the exam request. If the claims folders are not received or made available through VBMS within seven calendar days after exam request, the examination request may be cancelled by the Contractor. Contractor shall return the Veterans' claims folders to their originating source in the same order in which they were received not later than five workdays after completion of the requested examination in the same condition in which they were sent; e.g., stapled items must be re-stapled together in the same manner, order, etc. The Contractor shall ensure that the records are returned via a secure, traceable mailing method. Upon completion of the examination, the contractor shall also make the scanned electronic copy available for VA to obtain and upload into its Virtual VA system. A claims file will not be sent to the Contractor for every examination request. In cases where a service member and/or Veteran presents medical records to the examiner provider, the service member and/or Veteran shall be directed to send those records to their appropriate VARO, and the provider shall not review the file unless provided by the VARO. If this is a service member going through the Integrated Disability Evaluation System (IDES), the service member should be directed to give this information to their Physical Evaluation Board Liaison Officer (PEBLO), and the provider shall not review the file unless provided by the VARO/MSC. If the veteran or service member, the results submit recent test results to the VA will be forwarded to QTC and should be reviewed by the provider, at no additional cost to the VA. Diagnostic tests should not be repeated unless there is indication of recent changes in the condition examined. Any test conducted within a twelve month period prior to the current examination shall be considered recent and sufficient. A copy of test results pertinent to the conditions evaluated by the physician shall be submitted to VA along with completed exam reports. a.C-Files will not be shipped for examinations requested under the Veterans Benefits Management Systems (VBMS) examination setting or as otherwise denoted in the examination request as having medical records available in VBMS. For claim types requested under the VBMS exam setting, the contractor shall access C-Files electronically through VBMS as opposed to receiving hard copy C-Files from the Regional Office. C-Files will not be shipped for examination requests under the BDD, JE, QS, or IDES exam setting where the request specifically denotes the request as being a VBMS request. This shall be noted in the "Comments Regarding the Veteran" section of the examination request and will clearly state "This is a VBMS request. No C-file will be shipped." b.VA will issue PIV Cards and Government Furnished Equipment (GFE) to the contractor. "PIV Cards will be granted only to those who require access and those that have been NACI approved by the VA "GFE will consist of PIV Cards and laptops. The contractor shall obtain Windows XP drivers to be compatible with printers and scanners as appropriate. "The transfer of the GFE from VA to the contractor will be coordinated by the COTR or designee "The contractor shall keep all equipment secure and maintain an inventory of all equipment and items. "The contractor shall have PIV Card approved personnel utilizing the GFE laptops to access VBMS to retrieve the electronic C-Files for Original Claim types for which ordinarily a C-file hard copy would be sent. Electronic files can be saved to the contractor secured web application from the GFE. The contractor shall proceed with its internal process of indexing and providing the records to their providers. Upon receipt of completed VBMS examination reports from the clinician, the contractor will upload the completed reports and diagnostic information into VBMS under the specific claim folder. The contractor shall follow the procedures outlined on page 3 of the QTC Process Using VBMS Job Instruction Sheet dated April 16, 2013. 7. The Contractor must provide toll-free telephone access to its administrative office from 7:00 a.m. to 7:00 p.m. (EST) Monday-Friday, excluding Federal Holidays. 8. The Contractor shall provide VA access to its secure Management Information System for real-time status information such as Veteran examination requests. Contractor shall provide information technology capability to receive on-line examination requests, messages from VACO, maintain status information accessible by VAROs and VACO, maintain completed examination reports accessible in a database for a period of not less than 18 months, and return completed transcribed examination reports electronically to VA. Contractor shall post sensitive exams (i.e. for sensitive-level claimants identified by VA) such that they are accessible only to VACO and designated VAROs. Contractor must comply with requisite VA data/privacy security policy having the same or the equivalent (or better) security controls to safeguard Veterans' sensitive personal information (SPI). 9. Contractor shall have the capability to send and receive encrypted e-mail in accordance with VA standards. The Contractor shall provide those addresses to the VAROs and VACO. See Security section of this document. 10. Within 60 - 90 days after contract award, Contractor will receive electronically an encrypted text file (format predetermined by the VA) containing the examination requests, and must process examination requests on a daily basis. Daily workload will fluctuate based on current VA workload trends that are always subject to change. 11. Contractor shall resolve bills sent by mistake to Veterans or Veteran's insurance related to examinations within 10 days. 12. For Contract Medical Disability Examination requests that require further clarification, the Contractor shall contact the requesting VARO Exam Coordinator &/or Military Services Coordinator (MSC). If response by VARO Exam Coordinator/ MSC is unsatisfactory and will unnecessarily delay/prevent/ interfere with completion of request obligation/s, Contractor will then notify VACO. Requests submitted using CAATS will use the following validation and triage process: a.The validation process is performed by the Contractor upon receipt of the request file in the Secure File Transfer Protocol (SFTP) folder. Electronic checks are performed to ensure that the request file is able to be processed. Duplicate requests and requests with an invalid format and/or missing data are rejected and returned to CAATS. Valid requests continue to the triage process. b.The triage process consists of a Contractor review of the request and results in one of the following actions: Accept, Reject or Cancel. c.Accept: Triage results in an acceptance of the request and Accept status is returned through a CAATS file transfer. i.When a request is accepted, the date of request is set to the current date. ii.If the triage process also identified updates to the requested worksheets, a Worksheet Addendum is created and sent through a CAATS file transfer. d.Reject: Triage results in rejection of the request and Reject status along with rationale for the action is returned through a CAATS file transfer. i.The VA can rework the request and resubmit it through the CAATS file transfer. It is treated as a new request and undergoes the validation and triage process. e.Cancel: Triage results in cancellation of the request. In order to cancel the request it is first accepted and then cancelled. These actions are sent separately through a CAATS file transfer. f.Automatic Accept: The Contractor automatically accepts Requests if status is not updated (either Accept, Reject or Cancel) after 3 full business days have elapsed. For example, a request is received on Monday and if the status has not been updated by Thursday evening, the request is automatically set to Accept status and returned through a CAATS file transfer. Business days are defined as Monday through Friday and exclusive of Federal holidays. 13. Contractor shall provide VA with an electronic version of their monthly invoices to the VA project manager for payment processing containing the following information: a list of services performed (an invoice, segregated by CLIN), including examination category or categories, tests completed with related Current Procedural Terminology (CPT) codes, descriptive titles and associated fees. 14. Contractors shall provide the name and contact information of a primary Point of Contact (POC) for each VARO. POCs can serve as the primarily liaison with multiple VAROs as long as there is sufficient coverage in this regard for each region supported as a result of the contract. 15. Examiners shall meet with Veterans within one (1) hour of scheduled appointment time. Contractor shall investigate tardiness and habitual delays with physicians and take corrective action to eliminate or minimize future delays. 16. The contractor shall follow the instructions on the worksheets. If the worksheet requires an examiner to conduct an examination of a Veteran or service member to determine suitability for a particular diagnostic test, then the contractor shall not schedule such diagnostic test prior to the Veteran's or service member's examination. 17. Contractor must be prepared to comply with requests for information, including those originating from Congress, using company letterhead, complete sentences, and professional English. 18. Contractor shall comply with the requests of Government and independent auditors during audits of this contract and all associated contract documentation, including but not limited to invoices and medical disability examinations. 19. Contractor shall prepare an emergency action plan for inclement weather or natural disasters for all scheduled exams in the region affected. 20. Contractor shall limit requests for rescheduling of any appointment(s) to one (1). Veterans and service members (including MSCs and PEBLOs who may request the reschedule on behalf of the service member) will have only one opportunity to request any or all appointment(s) to be rescheduled, unless otherwise requested and approved by VACO. If the Veteran or service member fails to show/or the rescheduled appointment(s), the Contractor notifies the VARO/military installation, the examination request will be considered "cancelled," the Contractor will invoice as a complete or partial no-show as applicable for that appointment(s), and the Veteran/service member must file a new request through the VARO/military installation. EXAMINATION REQUIREMENTS 1. All examinations shall be conducted in accordance with VA-issued examination worksheets specified in the examination request. The examination worksheets provide detailed examination requirements based upon legislative and court mandated criteria for VA disability entitlement determinations. Changes may be made periodically to the examination worksheets to reflect changing regulatory or medical requirements. The Contracting Officer's Representative (COR) will notify the Contractor's Program Manager in writing when changes occur. Within 60 days of notification and provision of required information for file transfers, Contractor shall accommodate all technical changes without revision of the price schedule unless the change results in the provision of a new service for which pricing had not already been established. Revisions to the VLER DAS file transfer (See Section Z) requirements for changes to existing DBQs and for the release of new DBQs will be reviewed upon receipt and Contractor will notify VA if price schedule updates are required. 2. All test and procedures the examination worksheets require shall be conducted unless not medically advisable or declined by the individual examined. The examination report must detail and document any reason for not performing a requested test or study. Waivers for declined tests must be attached to the exams upon submission to VA. VA will not be providing a specific waiver form. Tests listed in the examination worksheets represent guidelines. Additional standard tests may be used to establish a diagnosis or severity of disability. Any additional tests necessary to establish a diagnosis or to determine severity of disease or injury shall also be conducted. No invasive procedure shall be performed without the prior approval of all of the following entities: the requesting office, the individual to be examined, and the VARO and VACO. 3. If recent test results are documented in the record and available to the examining physician for review, those tests need not be repeated unless specifically requested by the VARO or there is indication of recent changes in the condition examined. Unless otherwise specified in the examination worksheets, any tests conducted within a twelve-month period prior to the current examination shall be considered recent and sufficient. 4. All claimed conditions identified on the examination request MUST be examined. All questions included in the examination worksheet must be answered. If the answer is either yes or no, a clear statement must be included explaining why a definitive answer could not be provided and specifying the probability of a positive response with a statement of the evidentiary basis for that assumption. A diagnosis must be provided or a statement included that the claimed condition was not found for each condition specified in the examination request. If a diagnosis cannot either be established or ruled out, the findings must be documented with a clear statement of why a diagnosis could not be established. A statement that a diagnosis could not be established because additional tests are required will not be an acceptable reason for returning an examination without establishing a diagnosis or providing a statement that the claimed condition was not found. Unless the required tests were not medically advisable or are declined by the individual examined, incomplete reports that include a statement of this nature will be deemed unacceptable. If a diagnosis is established which is different than an existing diagnosis for the same condition, the two diagnoses must be reconciled with a statement documenting the basis for change of diagnosis and whether the new diagnosis represents a progression of an earlier diagnosis, correction of a prior incorrect diagnosis, or a new independent entity. 5. The Contractor shall return corrected insufficient examination reports and requests for clarification on inadequate examination reports to the VA within 14 calendar days without additional charge to VA. The only exception will be for charges incurred due to additional tests authorized by VA. VA will send a CAATS file transfer to the Contractor indicating that the examination report is either insufficient or inadequate and include the specifics on the reason for return. Insufficient examination reports are those that do not meet the examination Compensation and Pension (C&P) Worksheets and Disability Benefits Questionnaires (DBQ) requirements (i.e. no diagnosis, no testing performed, etc.) Inadequate examination reports returned for clarification, correction, or completion will be amended and returned without additional charge. See paragraph W, Performance Review Standards (PRS). All IDES examination requests for clarification, insufficient or inadequate, from DOD must be submitted through CAATS and sent to the contractor through the daily examination request transfer file. The contractor will expedite the processing of the request for all IDES cases. Specifically, these requests will be expedited and are requested to be completed in no more than 5 business days from the date of receipt. If a clarification is required due to omission of a claim/referred condition within the original examination request, a new examination request for the added condition must be submitted for which the contractor will invoice accordingly. 6. Evaluation of musculo-skeletal conditions for functional loss of movement requires a minimum observation of three repetitions at the joint being examined. 7. Use of Goldmann Bowl Perimeter Testing is required for visual field tests. (The contractor can use other modern kinetic or automated perimetry devices but the resulting chart has to be translated on a Goldmann Bowl perimetry chart. The visual field will be tested only in cases of diplopia and/or blurred vision. The dry eye and visual deficits corrected with eyeglasses are not eligible for a Goldmann Bowl Test. 8. Comprehensive General Medical Examinations must document a complete review of each system. 9. Audiology exams will take place in a soundproof booth, as set forth in OSHA Standard 1910.95 App D. 10. At the Veteran's request, family members, caregivers, and significant others are permitted to accompany the Veteran during an examination but may not participate in and/or interfere with the examination. Only service animals are permitted. 11. The contractor shall schedule appointments for no less than the time length specified below for each type of Examination: a.Comprehensive General Medical Examination: 60 minutes b.Detailed Examination - Level I: 45 minutes c.Detailed Examination - Level II: 30 minutes d.Initial Post-Traumatic Stress Disorder (PTSD) examinations: 90 minutes e.Audiology: 30 minutes f.Dental: 30 minutes g.Ophthalmology: 30 minutes h.Ear/Nose/Throat: 30 minutes i.Psychiatry: 60 minutes j.Musculoskeletal: 45 minutes k.Infectious/Immune/Nutritional Diseases: 45 minutes l.Respiratory: 45 minutes m.Cardiovascular: 45 minutes n.Digestive: 45 minutes o.Genitourinary: 45 minutes p.Gynecological/Breast: 45 minutes q.Hemic and Lymphatic: 45 minutes r.Skin: 45 minutes s.Endocrine: 45 minutes t.Neurologic: 45 minutes The described schedule includes face-to-face time between the physician/audiologist/dentist/psychologist/psychiatrist/optometrist/ophthalmologist and Veteran. The number of disabilities to be examined determines the time frame needed as well as the criteria of the C&P examination worksheets. The time frames are what VA finds are the minimum amounts of time to be expected in order to evaluate the disabilities appropriately. Times are reflective of the times associated with CPT codes 99203 (30 minutes) 99204 (45 minutes) and 99205 (60 minutes). Changes in the allotted time for these CPT codes will result in changes in allotted time for Veteran appointments. There is no required scheduling timeframe for review PTSD examinations. Psychiatric testing is to only be performed as necessary for initial and review PTSD examinations. TBI will include a "comprehensive medical evaluation" which would be 60 minutes, and the psychiatric/ cognitive or mental evaluation part of the TBI exam would be expected to be a separate 90 minutes, if an initial PTSD exam is needed. 12. Completed examination reports shall include an indication of the examiner's credentials (e.g. "MD" if performed by Medical Doctor) and signature. The person signing the examination shall have been the person who conducted the examination and the credentials HAVE TO appear in signature too, not only printed on the DBQ. Electronic signature is acceptable for examination reports. 13. The Contractor shall ensure that examination reports are adequate and in compliance with the examination request worksheets with review of test results by examiners documented, and any discrepancies resolved. 14. The Contractor shall document in the examination report that all gynecological, rectal/anal, and breast examinations are performed by a physician in the presence of an assistant. 15. The Contractor shall forward to VA completed examination reports no later than 38-calendar days from receipt. See paragraph W, PRS. Photographs shall be delivered within 24 hours of the report delivery date. 16. The Contractor's examination quality shall be no less than 92% sufficient, which VACO staff will measure quarterly through sampling. Quality will be determined based on completed examinations with all questions completely addressed and answered from the C&P examination worksheets; proper worksheets utilized; proper tests, procedures, laboratory work, and x-rays utilized; and correct billing codes and CLINs for examinations, tests, procedures, laboratory work, and x-rays utilized. See paragraph W, PRS. 17. The Contractor shall alert the Veteran or service member of any abnormal finding during the examination which the Veteran or service member should follow-up with their primary physician. 18. Conform to the CFR below; the Contractor is hired on behalf of the VA Secretary, as a result cannot perform Independent Medical Opinion exams. The Routine Medical Opinion is part of the exam and is considered one DBQ, which will add to the number of DBQs and be billed as part of CLIN level I or II depending on the total number of DBQs for the examination provided. (Please see as a reference the literature below). Routine Medical Opinions Under the provisions of the 38 U.S.C. 5103A (d). Medical examinations for compensations claim: 1. In the case of a claim for disability compensation, the assistance provided by the Secretary under subsection (a) Shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. 2. The Secretary shall treat an examination or opinion as being necessary to make a decision on a claim for purposes of paragraph (1) if the evidence of record before the Secretary, taking it into consideration all information and lay or medical evidence. (2.) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. Medical opinions requested under the above statue are to be provided by VA and contract clinicians, and are part of the normal claims process. Independent Medical Opinions Under the provisions of the 38 U.S.C. 5109, VA may request an expert medical opinion. In addition to that available in the Department, when it is considered to be warranted by the medical complexity or controversy involved in a particular case being considered. These advisory medical opinions will be obtained from one or more independent medical experts who are not employees of the Department (emphasis added). The provision of the 38 CFR 3.328 set out the requirements for an independent medical opinion: �3.328 Independent medical opinions (a)General. When warranted by the medical complexity or controversy involved in pending claim, an advisory medical opinion may be obtained from one or more medical experts who are not employees of VA. Opinions shall be obtained from recognized medical schools, universities, clinics or medical institutions with which arrangements for such opinions have been made, and an appropriate official of the institution shall select the individual experts(s) to render an opinion. (b) Requests. A request for an independent medical opinion in conjunction with a claim pending at the regional office level may be initiated by the office having jurisdiction over the claim, by the claimant, or by his or her duly appointed representative. The request must be submitted in writing and must set forth in detail the reasons why the opinion is necessary. All such requests shall be submitted through the Veterans Service Center Manager or Pension Management Center Manager of the office having jurisdiction over the claim, and those requests which in the judgment of the Veterans Service Center Manager or Pension Management. Center Management merit consideration shall be referred to the Compensation Service of the Pension Fiduciary Service for approval. Medical Opinions It is clear from the statue and regulations above, that a request for an independent medical opinion can only be initiated by the regional office having jurisdiction over the claim the Veteran or the Veteran's duly appointed representative. If warranted in the judgment of the VSCM or Pension Management Center Management, the request must be referred to the Compensation or Pension Service for approval. If approved, the medical opinion will be provided by a qualified expert who is not an employee of VA or hired contractor by the VA to serve the Veterans interests. 19. The Agent Orange three presumptive conditions, Ischemic Heart Disease (IHD), Parkinson's Disease (PD) and Hairy Cell/B-Cell Leukemia (HCL/BCL), Screening IMO (CLIN 0033). The contractor shall review the C-File Folder submitted for review and determine whether a disability request for the Agent Orange three presumptive conditions was previously made and can be construed as a disability request from the claimant. In addition, the contractor will identify if a grant of the Agent Orange three presumptive conditions was awarded, or if a previous disability request for the Agent Orange three presumptive conditions was denied between September 25, 1985, to August 31, 2010. a. The contractor shall review the entire claims folder and provide any additional information as to whether the Veteran in question qualifies for consideration as a Nehmer class member, based on the manifestation of the Agent Orange three presumptive conditions since the completion of military service in Vietnam, or actual exposure to herbicides during Vietnam military service. b. The contractor shall provide a completed document Titled: The Agent Orange Screening Checklist Review Template (please see Attachment C) which will include all necessary information required for the review. c. This template is a completely different document than the existing DBQs for the three presumptive conditions, Ischemic Heart Disease (IHD), Parkinson's Disease (PD) and Hairy Cell/B-Cell Leukemia, (HCL/BCL) and the IMO DBQ. At the moment, there is no Agent Orange Worksheet/DBQ that encompasses all three conditions. d. The contractor shall segregate and bill appropriately between the IMO (CLIN 0022) and the Agent Orange Screening IMO (CLIN 0033) in accordance with the Price Schedule. Both documents are examiner produced written documents required beyond the normal scope of an examination, and both documents are explicitly requested by the VAROs. The Agent Orange three presumptive conditions- IMO is completed after the examiner has reviewed the Veteran's disability requests and medical record and The Agent Orange Screening Checklist Review Template. Once submitted it shall be billed in accordance with the Agent Orange Screening IMO (CLIN 0033). 20. Peripheral Neuropathy Screening IMO (CLIN 0034). The contractor shall review the Veteran's disability requests and medical evidence folder (C-file hardcopy or electronic) submitted for review and determine whether a disability request for Peripheral Neuropathy was previously made and can be construed as a disability request from the claimant. In addition, the contractor will identify if a grant of Peripheral Neuropathy was awarded, or if a previous disability request for Peripheral Neuropathy was denied between September 25, 1985 and the date of the grant. a. The contractor shall review the entire disability request folder (C-file) and provide any additional information as to whether the Veteran in question qualifies for consideration as a Nehmer class member based on the manifestation of Peripheral Neuropathy within one (1) year of completion of military service in Vietnam, or actual exposure to herbicides during Vietnam military service. b. The contractor shall provide a completed document titled: Agent Orange (AO) Peripheral Neuropathy (PN) Review Checklist (please see Attachment G) which will include all necessary information required for the review. This document is different from the existing Peripheral Neuropathy DBQ and the IMO DBQ. Currently, there is no Peripheral Neuropathy Worksheet/DBQ. c. The contractor shall segregate and bill appropriately between the IMO (CLIN 0022) and the Peripheral Neuropathy IMO (CLIN 0034) in accordance with the Price Schedule. Both documents are examiner produced written documents required beyond the normal scope of an examination, and both documents are explicitly requested by the VAROs. The Peripheral Neuropathy IMO is completed after the examiner has reviewed the Veteran's disability requests and medical record and completed the Peripheral Neuropathy Review Template. Once submitted it shall be billed in accordance with the Peripheral Neuropathy IMO (CLIN 0034). 1. Evidence required to be reviewed includes, but is not limited to, the DD214/separation documents; all Service Treatment Records (STRs); Outpatient and inpatient treatment records, and overall, the full-claims' folder or "C-file". The size and volume of the claims folder is unique to each Veteran's claims history within the Veterans Benefits Administration (VBA). Some records may be only a few pages, while others may include multiple pages. 2. Multiple exams by different doctors in the same practice that occur on the same day are reimbursable by VA. Same day appointments are allowed to expedite the claims process and prevent unnecessary travel by claimants. 3. Number of x-rays performed in one day can be more than allowed by Medicare to expedite the claims process. The VA encourages multiple same day appointments to expedite the claims process and improve timeliness of the claims. The scheduling of these appointments on the same day is expected to take into account the location of different appointments and accessibility of the claimants to attend all appointments in a timely manner. 4. Earwax removal at same appointment as audiology exam/testing: Again for the convenience of the claimants and to expedite the claims process, VA is in favor of audiologists/ENT physicians who note earwax impaction at time of the C&P exam removing the cerumen and proceeding with the audiology/ear exam if possible. This practice expedites the claims process rather than sending claimant to a different doctor or back to their own treating physician/audiologist to remove the wax prior to the audiology exam. Under these circumstances, Earwax removal - CPT 69210, would be allowed and reimbursed with CPT 92557, Comprehensive audiology testing and CLIN 0005, Complete Audiology/ENT exam. 5. According to the C& P Audiology worksheet, the Air Conduction and Speech testing is required. Bone Conduction is also required if Air Conduction threshold is greater than 15dB. The Contractor shall use CPT Code 92557 to invoice all Audiological testing regardless of whether Bone Conduction threshold is required to be performed. 6. Incorporate Medicare Approved National Correct Coding Initiative (NCCI) edits in the invoicing of CPT codes. The NCCI edits are used in accordance with a Medicare Fee Schedule, which is published annually, and are revised on a regular basis. Below is a Sample: CPT codes and descriptions are a registered trademark of the American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Modifier Explanations Column 1Column 2Effective DateModifier 800748670920131010 800748680320131010 800768224820131011 800768224820131011 Modifier Explanations NumberExplanation 0Separate billing is not allowed 1*Allowed *Approved without the use of a Modifier. CONTRACTOR EXPERIENCE REQUIREMENTS - KEY PERSONNEL The following positions are designated as Contractor Key Personnel: Program Manager, Medical Director, Subcontracting Plan Manager (IAW FAR 52.219-9(d) (7)), Quality Assurance Specialist, and Training Director. These skilled experienced professional and/or technical personnel are essential for successful Contractor accomplishment of the work to be performed under this contract and subsequent task orders and option. These are defined as key personnel and are those persons whose resumes were submitted. The Contractor agrees that the key personnel shall not be removed, diverted, or replaced from work without approval of the CO and COR. Any personnel the Contractor offers as substitutes shall have the ability and qualifications equal to or better than the key personnel are replaced. Requests to substitute personnel shall be submitted to the COR and approved by the CO. All requests for approval of substitutions in personnel shall be submitted to the COR not later than 30 calendar days prior to making any change in key personnel. The request shall be written and provide a detailed explanation of the circumstances necessitating the proposed substitution. The Contractor shall submit a complete resume for the proposed substitute, any changes to the rate specified in the order (as applicable) and any other information requested by the CO needed to approve or disapprove the proposed substitution. The CO will evaluate such requests and promptly notify the Contractor of approval or disapproval thereof in writing. The minimum qualifications for the Key Personnel are as follows: Program Manager: Four years of experience in program management. Medical Director: Must have a medical degree and be a Licensed MD or DO Quality Assurance: Three years of experience in similar work. Subcontracting Plan Manager: Two years of experience in similar work (recruitment/staffing). Training Director: Two years of experience in similar work.
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Q -- Medical Disability Exams (MDE) under P.L. 104-275 Request for Information (RFI) # VA119A-15-N-0078 (Follow-up RFI to RFI # VA119A-15-N-0055 that was issued on December 19, 2014 and closed on January 7, 2015.) - Attachment