The Department of Veterans Affairs, Veterans Health Administration has a requirement for a Community Care Network (CCN) services and healthcare resources, purchased under the authority of 38 United States Code (U.S.C.) § 8153, “Sharing of Health-care Resources.”

The VA provides care to Veterans through community providers when VA cannot provide the care needed or when Veterans are unable to access local VA medical centers. Community care is based on specific eligibility requirements, availability of VA care, and the needs and circumstances of individual Veterans.

In an effort to streamline VA’s community care programs, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act was signed into legislation on June 6, 2018, providing more choices and robust care coordination for Veterans using one consolidated program instead of multiple programs. Over time, community care program needs evolved with requirements for expanded healthcare services and improvements in customer service, accountability, health information exchange, referrals, scheduling, and provider payments. This evolution led to development of the VA Community Care Network (CCN).

The Contractor shall serve as a third-party administrator with responsibility to provide regional or national managed healthcare services. The Contractor shall (i) provide exemplary customer service; (ii) monitor and manage quality outcomes; (iii) use data and performance metrics to improve services; and (iv) process and pay claims for services ordered against the contract.

CCN is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care. CCN uses industry and VA standard approaches and guidelines to administer services, promptly pay for services, and manage the network to its full potential.

CCN is comprised of five (5) regional networks that serve as the primary contract vehicles for VA to purchase care for Veterans from community providers, covering all U.S. states and territories. VA is currently in its market research phase of its acquisition planning schedule for CCN Next Generation. The solicitation phase is tentatively scheduled for the latter part of fiscal year 2024. These dates are subject to change.

While the CCN program has sought to address expanding Veteran healthcare requirements and needed improvements, VA’s Office of Integrated Veteran Care (IVC) plans to further streamline and enhance community care processes and services through the CCN Next Generation (Next Gen) contract initiative. CCN Next Gen looks to build upon CCN lessons learned and implement industry best practices through extensive market research, innovative acquisition strategies, and review and analysis of acquisition and contract requirements.

• The Contractor shall serve as a third-party administrator (TPA) with responsibility to perform the requirements herein. The Contractor shall provide a Community Care Network (CCN) per the requirements defined in this Performance Work Statement (PWS).
• The Contractor shall receive and maintain enrollment and eligibility information to include Prior Authorizations provided by VA.
• The Contractor shall provide a network of licensed healthcare providers and practitioners for medical, surgical, complementary and integrative health services (CIHS), durable medical equipment (DME), pharmacy, and dental services. The Contractor shall establish and maintain a network of high performing licensed healthcare providers as well as healthcare practitioners to deliver patient-centered care.
• The Contractor shall:
  • provide exemplary customer service (measured by Veteran satisfaction surveys).
  • monitor and manage quality outcomes.
  • use data and performance metrics to improve services.
  • process and pay claims in order to enhance Veterans’ healthcare experiences.
• VA shall conduct Veteran satisfaction surveys and provide the results to the Contractor. VA does not expect the Contractor to survey Veterans. The Contractor shall deliver healthcare services through the use of tools and practices that drive efficiencies, cost savings, and a positive Veteran experience.

MULTIPLE DOMAINS

• VA plans to separate capabilities into different domains, each with its own oversight, including:
  • Two (2) regional medical care networks with pharmacy benefits management and claims processing.
  • One (1) national dental network and claims processing
  • One (1) Veteran Family Member Program (VFMP) claims processing system
  • One (1) National Call Center to support Veteran, Provider and VFMP customer service