Page 15 of 17 THIS IS A SOURCES SOUGHT NOTICE (a) The Government does not intend to award a contract on the basis of this Sources Sought or to otherwise pay for the information solicited. (b) Although proposal, offeror, contractor, and offeror may be used in this sources sought notice, any response will be treated as information only. It shall not be used as a proposal. (c) Any information received from a contractor in response to this Sources Sought may be used in creating a solicitation. Any information received which is marked with a statement, such as proprietary or confidential, intended to restrict distribution will not be distributed outside of the Government, except as required by law. (d) This Sources Sought is issued for the purpose of collecting information about the availability of Board Certified /Board Eligible Pulmonary/Critical Care Physician Services from different sources for the desired service listed in the Performance Work Statement (PWS). (e) Contractors that feel they have an equal service are encouraged to provide a quote in response to this notice and/or email full information to Orville Landicho at Orville.
[email protected]. Contractors shall identify the NAICS code for the product being offered as well as their size status. Contractors shall identify whether they have a GSA contract or not as well as whether this requirement is on their GSA contract. Contractors shall furnish supporting documentation, which demonstrates that the proposed equal service meet or exceed the PWS. Contractor shall identify any concerns or questions regarding the PWS. Please respond no later than COB Monday 12/12/16. Performance Work Statement for Onsite Pulmonary/Critical Care Physician Services GENERAL: Services Provided: The Contractor shall provide Board Certified Pulmonary/Critical Care Physician Services on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Reno VAMC. Place of Performance 975 Kirman Avenue, Reno, Nevada 89502 Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority. Policy/Handbooks: - VA Directive 1663: Health Care Resources Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347 VHA Directive 2006-041 Veterans Health Care Service Standards (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 - VHA Handbook 1100.17: National Practitioner Data Bank Reports - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 - VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 - VHA Handbook 1100.19 Credentialing and Privileging - http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 - VHA Handbook 1400.01 Resident Supervision http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2847 VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 - Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern. ABIM: American Board of Internal Medicine www.abim.org ACGME: Accreditation Council for Graduate Medical Education ACLS: Advanced Cardiac Life Support AOD: Admitting Officer of the Day BLS: Basic Life Support CCNE:Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation CDC: Centers for Disease Control and Prevention CDR: Contract Discrepancy Report CEU: Certified Education Unit CME: Continuing Medical Education CMS: Centers for Medicare and Medicaid Services Contracting Officer (CO) The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings. Contracting Officer s Representative (COR) A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken. COS: Chief of Staff CPARS: Contractor Performance Assessment Reporting System CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status. DEA: Drug Enforcement Agency ED: Emergency Department FSMB: Federation of State Medical Boards Full Time Equivalent (FTE): VA s definition for full time- working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included. HHS: Department of Health and Human Services HIPAA: Health Insurance Portability and Accountability Act HR: Human Resources ISO: Information Security Officer Medical Emergency - a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part. MOD: Medical Officer of the Day National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org Non-Contract Provider - any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors NP: Nurse Practitioner NPPES: National Plan and Provider Enumeration System PA: Physician Assistant PALS: Pediatric Advanced Life Support POP: Period of Performance PPD: Purified Protein Derivative PWS: Performance Work Statement Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for 8independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual s license, based upon the individual s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific. QA/QI: Quality Assurance/Quality Improvement QM/PI: Quality Management/Performance Improvement QASP: Quality Assurance Surveillance Plan Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers in Michigan and Indiana. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient s medical record and with the hospital information system. VetPro: a federal web-based credentialing program for healthcare providers. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean the Reno, Nevada VA Medical Center. QUALIFICATIONS: Staff/Facility License The Contractor s physician (s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia) when services are performed onsite on VA property. All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor s physician (s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract. Board Certification - All contractor s physician (s) shall Board Certified /Board Eligible by the American Board of Internal Medicine in Pulmonary Disease (http://www.abim.org/exam/certification/pulmonary-disease.aspx) , and be currently certified in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). All continuing education courses required for maintaining certification must be kept up to date at all times. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance. Credentialing and Privileging Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any contractor s physician (s) prior to obtaining approval by the Reno VAMC Medical Executive Board and Medical Center Director. If a contractor s physician (s) is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government. Technical Proficiency - Contractor s physician (s) shall be technically proficient in the skills necessary to fulfill the government s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contractor s physician (s) and contractor s physician (s)shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. Contractor s physician (s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for contractor s physician (s). Training (ACLS, BLS, CPRS and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor s physician (s) as required by the VA. Required TMS training includes assigned HIPAA and Privacy training, Intubation training, and Moderate Sedation training. These courses will be assigned by the facility TMS coordinator once the physician establishes a TMS account. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all contractor s physician (s). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually. RUBELLA TESTING: Contractor shall provide proof of immunization for all contractor s physician (s)for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the COR. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all contractor s physician (s); provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal. DEA - Contractor shall provide copy of current DEA certificate for each physician nominated. Conflict of Interest: The Contractor and all contractor s physician (s)are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document. Citizenship related Requirements: The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals; While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all E-Verify requirements consistent with Executive Order 12989 and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contractor s physician (s)are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract. Non Personal Healthcare Services: The parties agree that the Contractor and all contractor s physician (s)shall not be considered VA employees for any purpose. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.  Prohibition Against Self-Referral: Contractor s physicians are prohibited from referring VA patients to contractor s or their own practice(s). Inherent Government Functions: Contractor and Contractor s physician (s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy. No Employee status: The Contractor shall be responsible for protecting Contractor s physician (s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract: Workers compensation Professional liability insurance Health examinations Income tax withholding, and Social security payments. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contractor s physician (s). When a Contractor or contractor s physician (s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor s (or contractor s physician (s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier. Key Personnel: The VA Full Time Equivalency (FTE) for the services required is one (1). FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays. The number of Board Certified /Board Eligible Pulmonary/Critical Care physicians required to be on site on a daily basis is one, as defined in paragraph Hours of Operation in this section. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event a scheduled physician is unable to complete an assigned shift, the contractor shall provide replacement physician coverage within 24 hours and notify the Contracting Office Representative (COR) at the Reno VAMC immediately of the schedule change. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within ONE calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least FIVE calendar days prior to making any permanent substitutions. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within FIVE calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel. Temporary substitutions are not authorized. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor s physician (s), s/he may request, without cause, immediate replacement of said Contractor s physician (s) .The CO and COR shall deal with issues raised concerning Contractor s physician (s) conduct. The final arbiter on questions of acceptability is the CO. Contingency Plan: Because continuity of care is an essential part of VAMC s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor s physician (s) leaves Contractor s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract. . VA HOURS OF OPERATION/SCHEDULING: THE ICU IS OPEN 24 HOURS PER DAY, 365 DAYS PER YEAR, INCLUDING HOLIDAYS. VA Business Hours: Standard business hours for VA outpatient clinic days are 0800 to 1630, Monday through Friday, excluding holidays. Critical Care (ICU) hours are 24 hours per day, 365 days per year. Accordingly, while assigned to the Critical Care (ICU) rotation (14 consecutive days), the physician will be considered on-call during this entire period. As a note of clarification, the established tour for the Pulmonary / Critical Care Physician is 14 days ICU, seven days off, one Patients must be seen by a contractor s physician (s) on-site in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure. Contractor s physician(s) shall be available and present in clinic during normal clinic hours, which are outlined in item 3.1; these clinic hours may be revised, as deemed appropriate for patient care by the Chief of Staff. Off-hours Coverage: Contractor must make the contractor s physician (s) available on-call during all hours when the VAMC clinic is closed, including evenings, weekends and holidays. On-call contractor s physicians must be available at all times for phone consultations with VA residents and physicians.  Patients must be seen within 60 minutes of the page when medically indicated. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs: New Year s Day President s Day Martin Luther King s Birthday Memorial Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Christmas Any day specifically declared by the President of the United States to be a national holiday. Cancellations: Unless a state of emergency has been declared, the Contractor shall be responsible for providing services. CONTRACTOR RESPONSIBILITIES Clinical Personnel Required: The Contractor shall provide contractor s physician (s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties. Contractor s physician (s) shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor s invoices. Standards of Care: The contractor s physician (s) care shall cover the range of Pulmonary services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized TJC, VA and national standards as established by: American College of Chest Physicians Guidelines: http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/Evidence-Based-Medicine-Overview VA Standards: VHA Directive 2006-041 Veterans Health Care Service Standards (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and; The requirements contained in this PWS Resident Supervision and Teaching: Resident Supervision/Teaching: According to the guidelines dictated by the Residency Review Committee of ACGME, the contractor s physician (s) performing the services shall be responsible for residents. Contractor s physician (s)shall be responsible for: Academic environment: Provide for an academic environment conducive to the training and professional development for residents rotating through the Internal Medicine/Pulmonary Service. Resident patient care documentation: Contractor s physician (s) shall be responsible for complying with the Residency review documentation and insuring that all notes and encounters are completed and shall appropriately document medical records in accordance with VA standards, equivalent to TJC compliance guidelines, standard commercial practice and guidelines established by the VAMC. The Contractor shall also perform any administrative duties relative to documentation of resident training, as required and directed by the VA COS or designated representative. Clinical Direction and Oversight: Contractor s physician (s) shall provide clinical direction to and oversight of residents/fellows consistent with current accreditation guidelines, clinical research, protocol development, data management of protocols, quality assurance conferences and meetings, and affiliate /VA staff meetings. Ensure on-site resident supervision in accordance with the national VHA Handbook 1400.01, Resident Supervision, dated December 19, 2012. http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2847 Attending Physician: Clinics/Pulmonary procedures shall not be conducted by residents in the absence of an attending physician. All procedures, inpatient admissions and consults shall be the responsibility of an attending physician. MEDICAL RECORDS Authorities: Contractor s physician (s)providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA). HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled Patient Medical Records-VA (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date. Disclosure: Contractor s physician (s) may have access to patient medical records: however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA s records, at VA s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VAMC. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual s Records, to process Release of Information Requests. In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Privacy Officer, Reno VAMC, 975 Kirman Avenue, Reno, Nevada 89502. Direct Patient Care: 100% of the time involved in direct patient care. Per the qualification section of this PWS, the Contractor shall provide the following staff: Board Certified/Board Eligible Pulmonary/Critical Care Physician Scope of Care: Contractor s physician (s) (as appropriate and within scope of practice/privileging) shall be responsible for providing Pulmonary/Critical Care, including, but not limited to : Clinic and Critical Care: Contractor s physician (s) shall provide clinical Pulmonary and Critical Care services. Contractor s physician (s) shall be present on time for any scheduled clinics/ICU tour as documented by physical presence in the clinic or operating room at the scheduled start time. Approximate case load is as follows: # of patients per clinic: 16 # of patients per ICU rotation: varies, maximum of 12. Operative Services: Contractor s physician (s) shall provide comprehensive clinical Pulmonary/Critical Care services including the diagnosis and treatment of pulmonary disease. Typical procedures include, but are not limited to: NOTE: CPT Codes provided for reference only. Not for billing purposes. 31615 Visualization of windpipe 94013 Meas lung vol thru 2 yrs 94014 Patient recorded spirometry 31620 Endobronchial us add-on 94015 Patient recorded spirometry 94016 Review patient spirometry 31622 Dx bronchoscope/wash 94060 Evaluation of wheezing 94060 26 Evaluation of wheezing 31623 Dx bronchoscope/brush 94060 TC Evaluation of wheezing 94070 Evaluation of wheezing 31624 Dx bronchoscope/lavage 94070 26 Evaluation of wheezing 94070 TC Evaluation of wheezing 31625 Bronchoscopy w/biopsy(s) 94150 Vital capacity test 94150 26 Vital capacity test 31626 Bronchoscopy w/markers 94150 TC Vital capacity test 94200 Lung function test (MBC/MVV) 31627 Navigational bronchoscopy 94200 26 Lung function test (MBC/MVV) 94200 TC Lung function test (MBC/MVV) 31628 Bronchoscopy/lung bx each 94250 Expired gas collection 94250 26 Expired gas collection 31629 Bronchoscopy/needle bx each 94250 TC Expired gas collection 94375 Respiratory flow volume loop 31630 Bronchoscopy dilate/fx repr 94375 26 Respiratory flow volume loop 94375 TC Respiratory flow volume loop 31631 Bronchoscopy dilate w/stent 94400 CO2 breathing response curve 94400 26 CO2 breathing response curve 31632 Bronchoscopy/lung bx addl 94400 TC CO2 breathing response curve 94450 Hypoxia response curve 31633 Bronchoscopy/needle bx addl 94450 26 Hypoxia response curve 94450 TC Hypoxia response curve 31634 Bronch w/balloon occlusion 94452 Hast w/report 94452 26 Hast w/report 31635 Bronchoscopy w/fb removal 94452 TC Hast w/report 94453 Hast w/oxygen titrate 31636 Bronchoscopy bronch stents 94453 26 Hast w/oxygen titrate 94453 TC Hast w/oxygen titrate 31637 Bronchoscopy stent add-on 94610 Surfactant admin thru tube 94620 Pulmonary stress test/simple 31638 Bronchoscopy revise stent 94620 26 Pulmonary stress test/simple 94620 TC Pulmonary stress test/simple 31640 Bronchoscopy w/tumor excise 94621 Pulm stress test/complex 94621 26 Pulm stress test/complex 31641 Bronchoscopy treat blockage 94621 TC Pulm stress test/complex 94640 Airway inhalation treatment 31643 Diag bronchoscope/catheter 94642 Aerosol inhalation treatment 94644 Cbt 1st hour 31645 Bronchoscopy clear airways 94645 Cbt each addl 94660 Pos airway pressure cpap 31646 Bronchoscopy reclear airway 94662 Neg press ventilation cnp 94664 Evaluate pt use of inhaler 31647 Bronchial valve init insert 94667 Chest wall manipulation $ 94668 Chest wall manipulation 31648 Bronchial valve remov init 94680 Exhaled air analysis o2 94680 26 Exhaled air analysis o2 31649 Bronchial valve remov addl 94680 TC Exhaled air analysis o2 94681 Exhaled air analysis o2/co2 31651 Bronchial valve addl insert 94681 26 Exhaled air analysis o2/co2 94681 TC Exhaled air analysis o2/co2 31660 Bronch thermoplsty 1 lobe 94690 Exhaled air analysis 94690 26 Exhaled air analysis 31661 Bronch thermoplsty 2/> lobes 94690 TC Exhaled air analysis 94726 Pulm funct tst plethysmograp 94002 Vent mgmt inpat init day 94726 26 Pulm funct tst plethysmograp 94726 TC Pulm funct tst plethysmograp 94003 Vent mgmt inpat subq day 94727 Pulm function test by gas 94727 26 Pulm function test by gas 94010 Breathing capacity test 94727 TC Pulm function test by gas 94728 Pulm funct test oscillometry 94010 26 Breathing capacity test 94728 26 Pulm funct test oscillometry 94728 TC Pulm funct test oscillometry 94010 TC Breathing capacity test 94729 Co/membane diffuse capacity 94729 26 Co/membane diffuse capacity 94011 Spirometry up to 2 yrs old 94729 TC Co/membane diffuse capacity 94750 Pulmonary compliance study 94012 Spirmtry w/brnchdil inf-2 94750 26 Pulmonary compliance study 94750 TC Pulmonary compliance study 94799 26 Pulmonary service/procedure Unlisted 94760 Measure blood oxygen level 94761 Measure blood oxygen level exercise 94799 TC Pulmonary service/procedure Unlisted 94762 Measure blood oxygen level 94770 Exhaled carbon dioxide test 95012 Exhaled nitric oxide meas 94772 Breath recording infant 94772 26 Breath recording infant 95782 Polysom paramtrs 94772 TC Breath recording infant 94774 Ped home apnea rec compl 95782 26 Polysom paramtrs 94775 Ped home apnea rec hk-up 94776 Ped home apnea rec downld 95782 TC Polysom paramtrs 94777 Ped home apnea rec report 94780 Car seat/bed test 60 min 95783 Polysom param 95810 Polysom 6/> yrs 4/> param 95800 Slp stdy unattended 95807 Sleep study attended 95811 Polysom 6/>yrs cpap 4/> parm 95801 Slp stdy unatnd w/anal 95806 Sleep study unatt & resp efft 99291 Critical care first hour 95803 Actigraphy testing 95805 Multiple sleep latency test 99292 Critical care addl 30 min Contractor s physician (s) shall provide consultative services at the patient s bedside if the patient is not ambulatory and in the clinic setting if the patient is able to report to the outpatient clinic. Procedures shall be scheduled for completion within 30 days of the date of the consult. Medications: Contractor s physician (s) shall follow all established medication policies and procedures. No sample medications shall be provided to patients. Discharge education: Contractor s physician (s)shall provide discharge education and follow up instructions that are coordinated with the next care setting for all Pulmonary clinical or surgical patients. ADMINISTRATIVE: None. Quality Improvement Meetings: The contractor s physician(s) shall not be required to participate in continuous quality improvement activities or meetings. Staff Meetings: The contractor s physician(s) shall not be required to attend staff meetings. QA/QI documentation: The contractor s physician(s) shall complete the appropriate QM/PI documentation pertaining to all procedures, complications and outcome of examinations. Patient Safety Compliance and Reporting: Contractor s physician(s) shall follow all established patient safety and infection control standards of care. Contractor s physician(s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to the COR VA Safety Policy. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and submit to the COR the Patient Safety Report, following up with COR as required or requested. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT(QI) Quality Management/Quality Assurance Surveillance: Contractor s physician(s) shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, and Peer Reviews. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE). Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor s conduct. The final arbiter on questions of acceptability is the CO. Performance Standards: Measure: Provider Quality Performance Performance Requirement: Standard: OPPE documentation for all (100%) staff providing services under the contract. All staff (100%) meet Standards. Acceptable Quality Level: 100% meet Standards Surveillance Method: Ongoing Provider Performance Evaluation (OPPE) data pertinent to care performed for each provider working under this contract. OPPE data will review the following elements: A. Patient Care Performance B. Medical/Clinical knowledge C. Practiced Based Learning and Improvement D. Interpersonal and Communication Skills E. Professionalism F. System Based Practice Frequency: Ongoing Incentive: Favorable Contractor Performance Evaluation Disincentive: Unfavorable Contractor Performance Evaluation, removal from contract until such time the contract physician(s) meet qualification standards. Deduction: none Measure: Qualifications of Key Personnel Performance Requirement: All contractor physician(s) shall be Board Certified /Board Eligible in accordance with the American Board of Internal Medicine s Pulmonary Standards and Board Certified/Board Eligible in accordance with the American Board of Critical Care Physicians. Standard: All (100%) contractor physician(s) are Board Certified /Board Eligible as noted above. Acceptable Quality Level: 100%, no deviations accepted Surveillance Method: Random Inspection of qualification documents Frequency: Ongoing Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation. Deduction: none Measure: Scope of Practice/Privileging Performance Requirement: Contractor physician(s) perform within their individual scopes of practice/privileging. Standard: All (100%) contractor physician(s) perform within their scope of practice/privileges 100% of the time. Acceptable Quality Level: 100% of contractor physician(s) perform within their scope of practice/privileges 100%of the time. Surveillance Method: Random Inspection of records. Frequency: Ongoing Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contractor s physician(s) meet qualification standard. Deduction: none Measure: Patient Access Performance Requirement: The Contractor shall provide contractor physician(s) in accordance with the operating hours and VA clinical schedule outlined in this PWS. Standard: All (100%) contractor s physician(s) are on time and available to perform services. Acceptable Quality Level: Contractor physician(s) on-time and available to perform services 97% of the time Surveillance Method: Periodic Sampling of Time and Attendance Sheets Frequency: Ongoing Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation, Deduction: none Measure: Patient Safety Performance Requirement: Patient safety incidents shall be reported using Patient Safety Report. All incidents reported immediately (within 24 hours.) Standard: All (100%) of patient safety incidents are reported using Patient Safety Report within 24 hours of incident. Acceptable Quality Level: 100% of patient safety incidents are reported using Patient Safety Report within 24 hours of incident. Surveillance Method: Direct Observation Frequency: Ongoing Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation, Deduction: none Measure: Maintains licensing, registration, and certification Performance Requirement: Updated Licensing, registration and certification shall be provided as they are renewed. Licensing and registration information kept current. Standard: All (100%) licensing, registration(s) and certification(s) for contractor physician(s) shall be provided as they are renewed. Licensing and registration information kept current. Acceptable Quality Level: 100% licensing, registration(s) and certification(s) for contractor s physician (s)shall be provided as they are renewed. Licensing and registration information kept current. Surveillance Method: Periodic Sampling and Random Sampling Frequency: Ongoing Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation, Deduction: none Measure: Mandatory Training Performance Requirement: Contractor shall complete all required training on time per VAMC policy Standard: All (100%) of required training is complete on time by contractor physician(s). Acceptable Quality Level: 100% completions, no deviations Surveillance Method: Periodic Sampling Frequency: Ongoing Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation, suspension or termination of all physical and/or electronic access privileges and removal from contract until such time as the training is complete. Deduction: none Measure: Privacy, Confidentiality and HIPAA Performance Requirement: Standard: All (100%) contractor physician (s) comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA Acceptable Quality Level: 100% compliance. Surveillance Method: Periodic Sampling; Contractor shall provide evidence of annual training required by VAMC, reports violations per VA Directive 6500.6. Frequency: Ongoing Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contactor performance evaluation. Deduction: none Registration with Contractor Performance Assessment Reporting System As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates Contractor past performance on all contracts that exceed $150,000, and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for Contractor responsibility determination information. Each Contractor whose contract award is estimated to exceed $150,000 requires a CPARS evaluation.   A government Focal Point will register your contract within thirty days after contract award and, at that time, you will receive an email message with a User ID (to be used when reviewing evaluations).  Additional information regarding the evaluation process can be found at www.cpars.gov or if you have any questions, you may contact the Customer Support Desk @ DSN: 684-1690 or COMM: 207-438-1690. For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the Contractor s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the Contractor s designated representative for comment. The Contractor representative will have sixty (60) days to submit any comments and re-assign the report to the CO. Failure for the Contractor s representative to respond to the evaluation within those sixty (60) days, will result in the Government s evaluation being placed on file in the database with a statement that the Contractor failed to respond; the Contractor s representative will be locked out of the evaluation and may no longer send comments. GOVERNMENT RESPONSIBILITIES VA Support Personnel, Services or Equipment: The physician will use an available desktop computer in the ICU or Outpatient Clinic for clinical purposes. Standard administrative and nursing staff will be available for support as required. Contract Administration/Performance Monitoring: After award of contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to: (enter contract administration if not already listed in another area- list the title (not name) and contact information for COR, Clinical point of contact, and any other relevant personnel involved). CO RESPONSIBILITIES: CO - Name/Address/Phone/email The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract. The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof. In the event that contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for Contractor personnel to be provided by the VA; replacement of the contract personnel and/or renegotiation of the contract terms or termination of the contract. COR Responsibilities: The COR for this contract is: Title/Address/Phone/email The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer. The COR will be responsible for monitoring the Contractor s performance to ensure all specifications and requirements are fulfilled. Quality Improvement data that will be collected for ongoing monitoring includes but is not limited to: enter data that may be collected. The COR will maintain a record-keeping system of services by comprised of a standard paper timecard that will be submitted weekly or bi-weekly for review and approval; this must be completed prior to vendor submitting invoices for payment. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record-keeping system and those on the invoices. Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer. The COR will review and certify monthly invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference. All contract administration functions will be retained by the VA. SPECIAL CONTRACT REQUIREMENTS Reports/Deliverables: The Contractor shall be responsible for complying with all reporting requirements established by the Contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required. The following are brief descriptions of required documents that must be submitted by Contractor: upon award; weekly; monthly; quarterly ; annually, etc. identified throughout the PWS and is provided here as a guide for Contractor convenience. If an item is within the PWS and not listed here, the Contractor remains responsible for the delivery of the item. What Submit as noted Submit To Quality Control Plan: Description and reporting reflecting the contractor s plan for meeting of contract requirements and performance standards Upon proposal and as frequently as indicated in the performance standards. Contracting Officer Copy of Sub Contracting Plan (as required) Copy of Contractor Certification Statement if non-subcontracting possibilities exist. Upon proposal and as updated Contracting Officer Copies of any and all licenses, board certifications, NPI, to include primary source verification of all licensed and certified staff Upon proposal and upon renewal of licenses and upon renewal of option periods or change of key personnel. Contracting Officer with proposal; renewal submitted to VETPRO system. Certification that staff list have been compared to OIG list Upon proposal and upon new hires. Contracting Officer Proof of Indemnification and Medical Liability Insurance Upon proposal and upon renewals. Contracting Officer Certificates of Completion for Cyber Security and Patient Privacy Training Courses Before receiving an account on VA Network and annual training and new hires. Contracting Officer ACLS/BLS Certification Upon award and every two years after award. COR Contingency plan for replacing key personnel to maintain services as required under the terms of the contract Upon proposal and as updated COR Billing: Invoice requirements and supporting documentation: Supporting documentation and invoice must be submitted no later than the 20th workday of the month. Subsequent changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a proper invoice in accordance with FAR 52.212-4 (g), all invoices must include: Name and Address of Contractor Invoice Date and Invoice Number Contract Number and Purchase/Task Order Number Date of Service Contractor s physician (s)(Name of Contractor s employee) Hourly Rate Quantity of hours worked Total price Vendor Electronic Invoice Submission Methods Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below: VA s Electronic Invoice Presentment and Payment System The FSC uses a third-party contractor, OB10, to transition vendors from paper to electronic invoice submission. Please go to this website: http://ob10.com/us/en/veterans-affairs-us/ to begin submitting electronic invoices, free of charge. A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI Web site (http://www.x12.org). The Contract may contact FSC at the phone number or email address listed below with any questions about the e-invoicing program or OB10: OB10 e-Invoice Setup Information: 1-877-489-6135 OB10 e-Invoice email:
[email protected] FSC e-Invoice Contact Information: 1-877-353-9791 FSC e-invoice email:
[email protected] Payment Adjustments/Performance Related Payment Deductions: Invoices will be prorated for partial days/hours worked. The contractor shall be paid only for actual work performed onsite. In the event that the Contract provider works a portion of an hour, the government may adjust payments by 15 minute increments. Contract providers shall be responsible for reporting time worked accurately. The Contract shall be paid for actual hours performed. The contract shall be adjusted at the end of the performance period in accordance with actual performance. Performance Deductions: If the contractor fails to meet the Acceptable Quality Level on any performance measure that references a deduction as a disincentive, the following method for calculating and applying the deduction shall be employed: In the event of a physician no-show for duty, the Contractor will be liable for the costs associated with finding a suitable replacement for the shift or other period of absence. Payments in full/no billing VA beneficiaries: The Contractor shall accept payment for services rendered under this contract as payment in full. VA beneficiaries shall not under any circumstances be charged nor their insurance companies charged for services rendered by the Contractor, even if VA does not pay for those services. This provision shall survive the termination or ending of the contract. To the extent that the Veteran desires services which are not a VA benefit or covered under the terms of this contract, the Contractor must notify the Veteran that there will be a charge for such service and that the VA will not be responsible for payment. The Contractor shall not bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against, any person or entity other than VA for services provided pursuant to this contract. It shall be considered fraudulent for the Contractor to bill other third party insurance sources (including Medicare) for services rendered to Veteran enrollees under this contract. Contractor Security Requirements (Handbook 6500.6) 6.7.1 General 6.7.2 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. 6.7.3 ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS 6.7.4 A contractor/subcontrator 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. 6.7.5 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. 6.7.6 Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness. 6.7.7 Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor. 6.7.8 The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.