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FBO DAILY - FEDBIZOPPS ISSUE OF JUNE 09, 2017 FBO #5677
DOCUMENT

R -- Medical Record Peer Review - Attachment

Notice Date: 6/7/2017
Notice Type: Attachment
NAICS: 541611 — Administrative Management and General Management Consulting Services
Contracting Office: Department of Veterans Affairs;VA Black Hills HCS;Fort Meade Campus;113 Comanche Rd.;Fort Meade SD 57741
ZIP Code: 57741
Solicitation Number: VA26317Q0740
Response Due: 6/28/2017
Archive Date: 7/28/2017
Point of Contact: Pamela P Phillips
E-Mail Address: 0-7020<br
Small Business Set-Aside: N/A
Description: This is a PRESCOLICITATION NOTICE only. No proposals are being requested or accepted with this notice. THIS IS NOT A SOLICITATION FOR PROPOSALS OR PRICING AND NO CONTRACT SHALL BE AWARDED FROM THIS NOTICE. This notice shall not be construed as a solicitation or as an obligation on the part of the Department of Veterans Affairs (VA). The solicitation will be posted on the Federal Business Opportunities (FBO) website on approximately June 16, 2016. Applicable NAICS code is 541611. Contracting Office Address: VA Black Hills Health Care System, 113 Comanche Road, Ft. Meade, SD, 57741. Point of Contact: Pamela Phillips, Contract Specialist; Pamela.phillips@va.gov The Department of Veterans Affairs Veterans, VA Midwest Healthcare Network, Veterans Integrated Service Network (VISN) 23 has a requirement for qualified firms capable of providing Medical Peer Review services per the following statement of work: SCOPE OF CONTRACT The Contractor shall provide all necessary personnel, facilities and resources to perform External Clinical Peer Review Services in accordance with specifications contained herein, on an as needed basis, for the Department of Veterans Affairs health care facilities located within the VA Midwest Health Care Network (VISN 23). The contract effective period shall be for a one-year base period, 07/01/2017 through 06/30/2018, with the option for four (4) one-year optional renewal periods. DESCRIPTION/SPECIFICATIONS/WORK STATEMENT GENERAL INFORMATION Clinical peer reviews are conducted to improve the delivery of healthcare processes through evaluation of patient care, safety and actual clinical performance of practitioners. External clinical peer reviews performed by the Contractor shall provide an honest, unbiased, professional review of care. Reviews shall be utilized to assist in the determination of quality of patient care provided. Clinical Care to be reviewed shall primarily occur in Medicine (including subspecialties such as Nephrology, Cardiology, Pulmonary, Gastroenterology, Hematology/Oncology, Infectious Diseases, Neurology, and Dermatology) and Surgery (including such subspecialties Orthopedics, Podiatry, anesthesia, Thoracic, Ophthalmology, Urology, Otolaryngology, and Plastic Surgery), but may also be required in Psychiatry/Mental Health, Geriatrics, Dental, Radiology, and Pathology. DEFINITIONS a. Physicians: Medical Doctors and Doctors of Osteopathy who have an active, current, full and unrestricted license to practice within an individual profession in a state, territory, or commonwealth within the United States of America or District of Columbia. b. Non-physician Providers: Non-physician providers, such as Chiropractors, Clinical Pharmacists, and Psychologists who have an active, current, full and unrestricted license to practice within an individual profession in a state, territory, or commonwealth within the United States of America or District of Columbia. c. Clinical Peer Reviewers: Physicians and non-physician providers who have education and clinical expertise in the same specialty as the practitioner involved in the care. d. Clinical Peer Review Process: Evaluation of clinical care provided by physicians and provider(s) to determine the quality of care provided based on clinically recognized community standards. e. Clinical Peer Review Form: Review information shall be documented on the (VISN 23) Midwest Health Care Network External Clinical Peer Review Form (Attachment 2). STATEMENT OF WORK CONTRACTOR PERFORMANCE The Contractor shall perform external clinical peer review services as requested by the VISN 23 Contracting Officer's Representative (COR). The VA shall provide all necessary medical record and claim information necessary to render a review decision. The Contractor shall evaluate medical care according to clinically recognized community standards and/or practices including, but not limited to, clinical practice guidelines. Reviews shall be completed by physicians and providers from the same discipline/specialty as the practitioner(s) who provide care. The Contractor shall retrospectively review medical records to address any questions or areas of concern the VA may have related to the medical necessity of the admission, procedure, treatment and/or length of stay, identify discrepancies between preauthorization information and medical record documentation, or the quality of care provided. The VA shall specify the questions to be addressed by the Contractor on each case for which review is requested. Review determinations on all records submitted shall be based on the available information submitted by the VA only. The Contractor shall use the VA clinical peer review form to document the reviewer's findings. A complete and legible form shall be provided to the VA. The Contractor shall complete each requested review as shown in the schedule in the time frame specified after receipt of request and complete substantiating information in the format shown in attachment 2 to this document. PLACE OF PERFORMANCE The review process may be accomplished outside VISN 23; however, the Contractor shall provide a point of contact at the reviewing facility. This individual shall receive the medical records and external clinical peer review form, select appropriate clinical peer reviewer(s), ensure all sections of the clinical peer review form are complete and legible, and hand deliver or forward the information using a form of mail delivery that is mutually agreed upon by the VISN and the contractor. CONFIDENTIALITY REQUIREMENTS The information obtained during the review is considered confidential and privileged pursuant to 38 U.S.C. 5705 and 38 C.F.R. 17.541. CONTRACTOR PERSONNEL REQUIREMENTS Physicians performing external clinical peer reviews shall be board certified in the specialty in which clinical care is being reviewed, and maintain a current, valid and unrestricted license to practice within an individual profession in a state, territory, or commonwealth of the United States of America or District of Columbia. Minimum qualification is to be board certified in the specialty that the physician practices in. If the majority of the physicians working for the contractor have been certified for 10 years or more that would be more favorable. All Contractor staff providing services to Veterans under this contract must undergo NACI (National Agency Check with Inquiries) background investigation as required by the VABHHCS. The Contractor shall maintain current credentialing on all physicians performing reviews under the contract. MARCH 12, 2010 VA HANDBOOK 6500.6 APPENDIX C VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY LANGUAGE GENERAL Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures. VA INFORMATION CUSTODIAL LANGUAGE Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1). VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA s information is returned to the VA or destroyed in accordance with VA s sanitization requirements. VA reserves the right to conduct on site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements. Prior to termination or completion of this contract, contractor/subcontractor must not destroy information received from VA, or gathered/created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract. The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies in this contract. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed. If VA determines that the contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the contractor or third party or terminate the contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12. If a VHA contract is terminated for cause, the associated BAA must also be terminated and appropriate actions taken in accordance with VHA Handbook 1600.01, Business Associate Agreements. Absent an agreement to use or disclose protected health information, there is no business associate relationship. The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA s prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response. Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response. For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COTR. SECURITY INCIDENT INVESTIGATION The term security incident means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COTR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access. To the extent known by the contractor/subcontractor, the contractor/subcontractor s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident. LIQUIDATED DAMAGES FOR DATA BREACH Consistent with the requirements of 38 U.S.C. �5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract. The contractor/subcontractor shall provide notice to VA of a security incident as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination. Each risk analysis shall address all relevant information concerning the data breach, including the following: (1) Nature of the event (loss, theft, unauthorized access); (2) Description of the event, including: (a) date of occurrence; (b) data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code; (3) Number of individuals affected or potentially affected; (4) Names of individuals or groups affected or potentially affected; (5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text; (6) Amount of time the data has been out of VA control; (7) The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons); (8) Known misuses of data containing sensitive personal information, if any; (9) Assessment of the potential harm to the affected individuals; (10)Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and (11)Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised. d) Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following: (1) Notification; (2) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports; (3) Data breach analysis; (4) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution; (5)One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and (6)Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs. TRAINING All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems: (1) Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems; (2) Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training; (3) Successfully complete the appropriate VA privacy training and annually complete required privacy training; and (4) Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access. There is a specific courses for Managers, IT Specialists, Project Managers, and Procurement Specialists. b) The contractor shall provide to the contracting officer and/or the COTR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required. c) Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete. 6) VA HANDBOOK 6500.6 MARCH 12, 2010 APPENDIX D CONTRACTOR RULES OF BEHAVIOR This User Agreement contains rights and authorizations regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the Department of Veterans Affairs (VA). This User Agreement covers my access to all VA data whether electronic or hard copy ("Data"), VA information systems and resources ("Systems"), and VA sites ("Sites"). This User Agreement incorporates Rules of Behavior for using VA, and other information systems and resources under the contract. GENERAL TERMS AND CONDITIONS FOR ALL ACTIONS AND ACTIVITIES UNDER THE CONTRACT: a. I understand and agree that I have no reasonable expectation of privacy in accessing or using any VA, or other Federal Government information systems. b. I consent to reviews and actions by the Office of Information & Technology (OI&T) staff designated and authorized by the VA Chief Information Officer (CIO) and to the VA OIG regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA. These actions may include monitoring, recording, copying, inspecting, restricting access, blocking, tracking, and disclosing to all authorized OI&T, VA, and law enforcement personnel as directed by the VA CIO without my prior consent or notification. c. I consent to reviews and actions by authorized VA systems administrators and Information Security Officers solely for protection of the VA infrastructure, including, but not limited to monitoring, recording, auditing, inspecting, investigating, restricting access, blocking, tracking, disclosing to authorized personnel, or any other authorized actions by all authorized OI&T, VA, and law enforcement personnel. d. I understand and accept that unauthorized attempts or acts to access, upload, change, or delete information on Federal Government systems; modify Federal government systems; deny access to Federal government systems; accrue resources for unauthorized use on Federal government systems; or otherwise misuse Federal government systems or resources are prohibited. e. I understand that such unauthorized attempts or acts are subject to action that may result in criminal, civil, or administrative penalties. This includes penalties for violations of Federal laws including, but not limited to, 18 U.S.C. �1030 (fraud and related activity in connection with computers) and 18 U.S.C. �2701 (unlawful access to stored communications). f. I agree that OI&T staff, in the course of obtaining access to information or systems on my behalf for performance under the contract, may provide information about me including, but not limited to, appropriate unique personal identifiers such as date of birth and social security number to other system administrators, Information Security Officers (ISOs), or other authorized staff without further notifying me or obtaining additional written or verbal permission from me. g. I understand I must comply with VA s security and data privacy directives and handbooks. I understand that copies of those directives and handbooks can be obtained from the Contracting Officer's Technical Representative (COTR). If the contractor believes the policies and guidance provided by the COTR is a material unilateral change to the contract, the contractor must elevate such concerns to the Contracting Officer for resolution. h. I will report suspected or identified information security/privacy incidents to the COTR and to the local ISO or Privacy Officer as appropriate. GENERAL RULES OF BEHAVIOR a. Rules of Behavior are part of a comprehensive program to provide complete information security. These rules establish standards of behavior in recognition of the fact that knowledgeable users are the foundation of a successful security program. Users must understand that taking personal responsibility for the security of their computer and the information it contains is an essential part of their job. b. The following rules apply to all VA contractors. I agree to: (1) Follow established procedures for requesting, accessing, and closing user accounts and access. I will not request or obtain access beyond what is normally granted to users or by what is outlined in the contract. (2) Use only systems, software, databases, and data which I am authorized to use, including any copyright restrictions. (3) I will not use other equipment (OE) (non-contractor owned) for the storage, transfer, or processing of VA sensitive information without a VA CIO approved waiver, unless it has been reviewed and approved by local management and is included in the language of the contract. If authorized to use OE IT equipment, I must ensure that the system meets all applicable 6500 Handbook requirements for OE. (4) Not use my position of trust and access rights to exploit system controls or access information for any reason other than in the performance of the contract. (5) Not attempt to override or disable security, technical, or management controls unless expressly permitted to do so as an explicit requirement under the contract or at the direction of the COTR or ISO. If I am allowed or required to have a local administrator account on a government-owned computer, that local administrative account does not confer me unrestricted access or use, nor the authority to bypass security or other controls except as expressly permitted by the VA CIO or CIO's designee. (6) Contractors use of systems, information, or sites is strictly limited to fulfill the terms of the contract. I understand no personal use is authorized. I will only use other Federal government information systems as expressly authorized by the terms of those systems. I accept that the restrictions under ethics regulations and criminal law still apply. (7) Grant access to systems and information only to those who have an official need to know. (8) Protect passwords from access by other individuals. (9) Create and change passwords in accordance with VA Handbook 6500 on systems and any devices protecting VA information as well as the rules of behavior and security settings for the particular system in question. (10) Protect information and systems from unauthorized disclosure, use, modification, or destruction. I will only use encryption that is FIPS 140-2 validated to safeguard VA sensitive information, both safeguarding VA sensitive information in storage and in transit regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA. (11) Follow VA Handbook 6500.1, Electronic Media Sanitization to protect VA information. I will contact the COTR for policies and guidance on complying with this requirement and will follow the COTR's orders. (12) Ensure that the COTR has previously approved VA information for public dissemination, including e-mail communications outside of the VA as appropriate. I will not make any unauthorized disclosure of any VA sensitive information through the use of any means of communication including but not limited to e-mail, instant messaging, online chat, and web bulletin boards or logs. (13) Not host, set up, administer, or run an Internet server related to my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA unless explicitly authorized under the contract or in writing by the COTR. (14) Protect government property from theft, destruction, or misuse. I will follow VA directives and handbooks on handling Federal government IT equipment, information, and systems. I will not take VA sensitive information from the workplace without authorization from the COTR. (15) Only use anti-virus software, antispyware, and firewall/intrusion detection software authorized by VA. I will contact the COTR for policies and guidance on complying with this requirement and will follow the COTR's orders regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with VA. (16) Not disable or degrade the standard anti-virus software, antispyware, and/or firewall/intrusion detection software on the computer I use to access and use information assets or resources associated with my performance of services under the contract terms with VA. I will report anti-virus, antispyware, firewall or intrusion detection software errors, or significant alert messages to the COTR. (17) Understand that restoration of service of any VA system is a concern of all users of the system. (18) Complete required information security and privacy training, and complete required training for the particular systems to which I require access. ADDITIONAL CONDITIONS FOR USE OF NON- VA INFORMATION TECHNOLOGY RESOURCES a. When required to complete work under the contract, I will directly connect to the VA network whenever possible. If a direct connection to the VA network is not possible, then I will use VA approved remote access software and services. b. Remote access to non-public VA information technology resources is prohibited from publicly-available IT computers, such as remotely connecting to the internal VA network from computers in a public library. c. I will not have both a VA network line and any kind of non-VA network line including a wireless network card, modem with phone line, or other network device physically connected to my computer at the same time, unless the dual connection is explicitly authorized by the COTR. d. I understand that I may not obviate or evade my responsibility to adhere to VA security requirements by subcontracting any work under any given contract or agreement with VA, and that any subcontractor(s) I engage shall likewise be bound by the same security requirements and penalties for violating the same. STATEMENT ON LITIGATION This User Agreement does not and should not be relied upon to create any other right or benefit, substantive or procedural, enforceable by law, by a party to litigation with the United States Government. Performance Requirements Summary Matrix REQUIRED SERVICE (Performance Requirement) STANDARD (Performance Standards) MAXIMUM ALLOWABLE Degree of Deviation (AQL) METHOD OF SURVEILLANCE (Quality Assurance) MAXIMUM PAYMENT Percentage for Meeting/ Exceeding the AQL (Incentives) Medical and Dentistry Specialist Selection The Contractor adheres to the established medical specialist qualifications and selection criteria as appropriate on a case-by-case basis. Professional licensure Clinical specialty/sub-specialty Conflict of interest No Deviation 95% performance review of each Medical Review Analysis/Special Project Incentive: Outstanding performance review at the end of the contract period for meeting all mandated performance requirements. Disincentive: Less than satisfactory performance review at the end of the contract period for not meeting all mandated performance requirements. Medical Review Analysis/Special Projects Format The Contractor will provide these deliverables in accordance with the established OPM format The Contractor will maintain the ability to provide these deliverables in a secure electronic HIPAA compliant format in addition to traditional hard copy capability. No Deviation 95% performance review of each Medical Review Analysis/Special Project Incentive: Outstanding performance review at the end of the contract period for meeting all mandated performance requirements. Disincentive: Less than satisfactory performance review at the end of the contract period for not meeting all mandated performance requirements. Medical Review Analysis/Special Project Content Each Medical Review Analysis will include the following: Detailed Case Synopsis (comprehensive with inclusion of patient specific clinical information from the medical record) Accurate assessment and response to each Medical Inquiry Question(s) in accordance with Health Plan definitions/policy statements Credible medical/scientific literature and clinical practice guidelines cited to support determinations Provision of all aforementioned references (hard copy) upon written request by the COR for medical and dental case reviews Medical advisory opinion is consistent with prior and/or similar medical opinions rendered (when a standard of good medical practice has changed, the medical review acknowledges the change and appropriate references are cited and provided in hard copy- upon written request by the COR) Each Consultative Service/Special Project report will accurately reflect the current nationally accepted standards of clinical practice: Credible medical/scientific literature and clinical practice guidelines cited to support determinations Provision of all aforementioned references (100% hard copy)- for total references cited in excess of ten references, a mutually agreed upon number of hard copy references will be submitted with the reviewers report Consultative Service/Special Project medical advisory opinion is consistent with prior and/or similar medical opinions rendered (when a standard of good medical practice has changed, the medical review acknowledges the change and appropriate references are cited and provided in hard copy as noted above) No Deviation 95% performance review of each Medical Review Analysis/Special Project Incentive: Outstanding performance review at the end of the contract period for meeting all mandated performance requirements. Disincentive: Less than satisfactory performance review at the end of the contract period for not meeting all mandated performance requirements. Rejected for quality Medical Review Analysis/Special Project will be subject to non-payment. An Incomplete Medical Review Analysis/Special Project will be subject to a 50% reduction in payment of the established flat fee. Quality of Deliverable Product The Contractor will maintain a 95% satisfactory quality level of performance for all deliverable products No Deviation 95% performance review with written report submission as noted in the Quality Control Section below Incentive: 100% payment of the established flat fee. Disincentive: The deliverable product will be subject to non-payment as noted above. Timeliness of deliverables The contractor shall deliver 95% of all deliverable written redacted products in accordance with the established timelines: 21 calendar days for routine medical and dental cases 14 calendar days for expedite/priority medical and dental cases 10 calendar days after the redacted copy is sent electronically for all written signed copies and accompanying medical records and accessories Cited references will be submitted to OPM within 1 to 2 business days following receipt of the relevant work order No Deviation without prior approval from the COR 95% performance review Incentive: Outstanding performance review at the end of the contract period for meeting all mandated performance requirements. Disincentive: Less than satisfactory performance review at the end of the contract period for not meeting all mandated performance requirements. Deliverables not meeting established timeliness with prior notification and acceptance by the COR will be subject to a 50% reduction in payment from the flat rate if late greater than 2 business days at the discretion of the COR. Deliverables not meeting established timeliness without prior notification and acceptance by the COR will be subject to a 75% reduction in payment from the established flat rate. Quality Control The Contractor will maintain a database for OPM that tracks Medical Reviewers, Medical Reviews and Special Projects for the following minimum parameters: Individual Medical specialist activity for OPM: -Number of cases reviewed by category (Routine and Expedite) Number of cases rejected for quality issues or timeliness issues -corrective action taken for all rejected cases and timeliness issues Medical Reviews/Special Projects by specialty or case topic During the Base Year the Contractor shall submit quarterly written Quality Control Reports that reflects the efforts of the Quality Review Team; then bi-annually unless otherwise directed by the COR. Content of the written report will be mutually agreed upon. No Deviation without prior approval from the COR Quarterly Quality Control Review written report during the Base year then Bi-annual unless otherwise directed by the COR Incentive: Outstanding performance review at the end of the contract period for meeting all mandated performance requirements. Disincentive: Less than satisfactory performance review at the end of the contract period for not meeting all mandated performance requirements. SCHEDULE OF SUPPLIES/SERVICES (Continuation of Standard Form 1449, block 20) BASE PERIOD: 07/01/2017 06/30/2018 Item No. Description Est. Quantity Unit Unit Price Total 0001 Focused Peer Review (STND)-(See Below) 250 EA $ $ 0002 Focused Peer Review (EXP) (See Below) 50 EA $ $ 0003 Comprehensive Peer Review (STND) (See Below) 50 EA $ $ 0004 Comprehensive Peer Review (EXP) (See Below) 50 EA $ $ 0005 Comprehensive Medical Advisory Opinion 50 EA $ $ 0006 Non-Protected Administrative Case Review 150 EA $ $ 0007 Expert Medical Opinion 50 EA $ $ 0008 Ad Hoc Peer Review Committee Member 50 EA $ $ OPTION YEAR ONE: 07/01/2018 06/30/2019 Item No. Description Est. Quantity Unit Unit Price Total 0001 Focused Peer Review (STND)-(See Below) 50 EA $ $ 0002 Focused Peer Review (EXP) (See Below) 10 EA $ $ 0003 Comprehensive Peer Review (STND) (See Below) 10 EA $ $ 0004 Comprehensive Peer Review (EXP) (See Below) 10 EA $ $ 0005 Comprehensive Medical Advisory Opinion 10 EA $ $ 0006 Non-Protected Administrative Case Review 30 EA $ $ 0007 Expert Medical Opinion 10 EA $ $ 0008 Ad Hoc Peer Review Committee Member 50 EA $ $ OPTION YEAR TWO: 07/01/2019 06/30/2020 Item No. Description Est. Quantity Unit Unit Price Total 0001 Focused Peer Review (STND)-(See Below) 50 EA $ $ 0002 Focused Peer Review (EXP) (See Below) 10 EA $ $ 0003 Comprehensive Peer Review (STND) (See Below) 10 EA $ $ 0004 Comprehensive Peer Review (EXP) (See Below) 10 EA $ $ 0005 Comprehensive Medical Advisory Opinion 10 EA $ $ 0006 Non-Protected Administrative Case Review 30 EA $ $ 0007 Expert Medical Opinion 10 EA $ $ 0008 Ad Hoc Peer Review Committee Member 50 EA $ $ OPTION YEAR THREE: 07/01/2020 06/30/2021 Item No. Description Est. Quantity Unit Unit Price Total 0001 Focused Peer Review (STND)-(See Below) 50 EA $ $ 0002 Focused Peer Review (EXP) (See Below) 10 EA $ $ 0003 Comprehensive Peer Review (STND) (See Below) 10 EA $ $ 0004 Comprehensive Peer Review (EXP) (See Below) 10 EA $ $ 0005 Comprehensive Medical Advisory Opinion 10 EA $ $ 0006 Non-Protected Administrative Case Review 30 EA $ $ 0007 Expert Medical Opinion 10 EA $ $ 0008 Ad Hoc Peer Review Committee Member 50 EA $ $ OPTION YEAR FOUR: 07/01/2021 06/30/2022 Item No. Description Est. Quantity Unit Unit Price Total 0001 Focused Peer Review (STND)-(See Below) 50 EA $ $ 0002 Focused Peer Review (EXP) (See Below) 10 EA $ $ 0003 Comprehensive Peer Review (STND) (See Below) 10 EA $ $ 0004 Comprehensive Peer Review (EXP) (See Below) 10 EA $ $ 0005 Comprehensive Medical Advisory Opinion 10 EA $ $ 0006 Non-Protected Administrative Case Review 30 EA $ $ 0007 Expert Medical Opinion 10 EA $ $ 0008 Ad Hoc Peer Review Committee Member 50 EA $ $ TOTAL ESTIMATED COSTS FOR BASE AND ALL OPTION YEARS $__________ Explanation Notes: STND: Standard Review-Price: These must be completed within 21 days. EXP: Expedited Review Price: These must be completed within 10 days. DEFINITIONS: FOCUSED PEER REVIEW: Evaluates and addresses specific elements of the case and answers questions posed by the client. COMPREHENSIVE PEER REVIEW: Evaluates all aspects of the clinical care provided to the patient. MEDICAL ADVISORY OPINION: Review of medical care activities for the purpose of assisting the United States in consideration of tort claims or litigation under the Federal Tort Claims Act, particularly if done at the request of the Regional Counsel or the Assistant United States Attorney. ADMINISTRATIVE CASE REVIEW: Non-protected review of medical care activities for anticipated administrative or personnel actions. EXPERT MEDICAL OPINIONS: Review and documentation of medical findings related to a disability claim for VA compensation. AD HOC PEER REVIEW COMMITTEE MEMBER: Participate virtually as a medical specialty expert committee member, with use of review information and documentation provided related to case(s) being presented for discussion.
Web Link: FBO.gov Permalink
(https://www.fbo.gov/spg/VA/VABHHCS568/VABHHCS568/VA26317Q0740/listing.html)
Document(s): Attachment; File Name: VA263-17-Q-0740 VA263-17-Q-0740_1.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3561075&FileName=VA263-17-Q-0740-000.docx); Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3561075&FileName=VA263-17-Q-0740-000.docx; Note: If links are broken, refer to Point of Contact above or contact the FBO Help Desk at 877-472-3779.
Record: SN04535566-W 20170609/170607234706-8b65bb2db499d2d725c284369bdd7185 (fbodaily.com)
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