SAM #36C24426Q0972

VISN 4 Teleradiology Staffing Services for VA Medical Centers

The Department of Veterans Affairs, Network Contracting Office 4 (VISN 4), is seeking vendors for a five-year teleradiology staffing services contract to support multiple VA medical centers in Pennsylvania and Delaware. - Government Buyer: - Department of Veterans Affairs, Network Contracting Office 4 (VISN 4 VA Healthcare System) - Scope of Services: - Remote interpretation of diagnostic imaging studies by licensed, board-certified radiologists - Coverage for overnight, weekend, and federal holiday periods - Imaging modalities include CT, MRI, ultrasound, mammography, nuclear medicine, PET/CT, and specialized scans - Estimated annual study volumes exceed 23,000 - Facilities Covered: - Altoona, Erie, Lebanon, Philadelphia, Pittsburgh, Wilmington, and Wilkes-Barre VA Medical Centers - Technical Requirements: - Contractor must be a U.S.-based corporation; all services performed within the United States - Experience with VA radiology systems: CPRS, VistA Imaging, Philips Intellispace PACS, Nuance PowerScribe - Compatibility with VA informatics systems required - Notable Requirements: - Strict credentialing and privileging for radiologists - HIPAA compliance and robust information security - 99% system uptime and quality assurance reporting - Vendors to provide FTE hours and rates for 21 scan types - Detailed turnaround time standards for STAT and routine exams - No specific OEMs or equipment brands are named; focus is on staffing and system compatibility - Pricing: - Firm fixed price based on FTE hours per scan type - Services Line Items: - Includes interpretation for CT, MRI, ultrasound, nuclear medicine, PET/CT, mammography, and more - Period of Performance: - Five years (base year plus four option years), annual subscription and FTE-based pricing - Estimated Contract Value: - Likely in the range of $5,000,000 to $15,000,000 over five years, based on scope and volumes

Description

PERFORMANCE WORK STATEMENT (PWS) Department of Veterans Affairs Teleradiology Staffing Services

SECTION 1   PURPOSE AND BACKGROUND 1.1 Purpose This Performance Work Statement (PWS) establishes the requirements for teleradiology interpretation services to support STAT and routine priority imaging studies at Department of Veterans Affairs (VA) medical facilities. Based on a 12-month analysis of 17,278 STAT priority imaging studies across five VA facilities (June 2025 - May 2026), 41.2% of STAT examinations failed to meet required timeliness standards, representing a significant patient safety and care quality risk. The Government requires a qualified contractor to provide licensed radiologist interpretation staffing services during identified high-risk coverage periods to reduce late reporting rates and ensure Veterans receive timely diagnostic care. 1.2 Background Physician personnel shortages and turnover in the Diagnostic Radiology Services at the covered VA medical facilities have created a significant need for additional professional diagnostic radiology interpretive capacity to ensure that both routine and emergent radiology imaging examinations are always available to Veterans. Contracted teleradiologists will provide final radiology interpretations for exams performed during off tours, and in some cases for exams performed during routine tours when other radiologist services are not available or insufficient to meet clinical demand. The use of teleradiology outsourcing provides a highly cost-effective and expeditious alternative to meet ongoing needs across the covered facilities. Data analysis of STAT imaging volume and timeliness identified three critical coverage gaps: Weekday Overnight Gap (Monday - Friday, 8:00 PM - 7:30 AM): STAT late rates range from 22% to 60% during overnight hours, with volumes averaging 2-10 studies per overnight shift per facility. Weekend Gap (All Day Saturday and Sunday): Saturday and Sunday represent the highest-volume and worst-performing periods, with late rates reaching 63.6% and average STAT volumes of up to 33 studies per day across facilities. Federal Holiday Gap: Federal holidays represent near-complete coverage failures, with late rates of 75-100% on holidays such as Presidents' Day, MLK Day, Labor Day, and New Year's Day across most covered facilities. The covered facilities use electronic image and health record management and distribution systems including CPRS, VistA Imaging, Philips Intellispace PACS, and Nuance PowerScribe. Contractors with prior experience connecting to VISN 4 radiology systems are preferred. 1.3 Covered Facilities The following VA medical facilities are covered under this contract: FacilityAddress Altoona VAMC2907 Pleasant Valley Boulevard, Altoona, PA 16602 Erie VAMC135 East 38th Street, Erie, PA 16504 Lebanon VAMC1700 South Lincoln Avenue, Lebanon, PA 17042 Philadelphia VAMC3900 Woodland Avenue, Philadelphia, PA 19805 Pittsburgh VAMC4100 Aliquippa Street, Pittsburgh, PA 15240 Wilmington VAMC: 1601 Kirkwood Highway, Wilmington, DE 19805 Wilkes-Barre VAMC: 1111 East End Boulevard, Wilkes-Barre, PA 18711 *Philadelphia VAMC and Pittsburgh VAMC are not currently placing orders under this contract. However, the awarded vendor must be able to fulfill future orders from these facilities if requested. 1.4 Period of Performance The estimated Period of Performance (POP) for this 5-year contract is from December 31, 2026, to December 30, 2031.

SECTION 2   SCOPE OF WORK 2.1 General Scope The Contractor shall provide professional teleradiology staffing services for diagnostic radiology imaging examinations performed at the covered VA medical facilities. Contract services will include off-campus image interpretation via a secure network connection to VA informatics systems, and as needed, providing advice by telephone to clinical providers and radiology technologists regarding protocols or for clarifying questions about radiology exams. The Contractor shall comply with each facility's policies related to reporting of examinations, use of diagnostic codes, and communication of results. The Contractor must be a U.S.-based corporation capable of final interpretation and reporting services via a secure teleradiology network. All services SHALL be performed within the territorial borders of the United States. Contracting to radiologists outside of the territories of the USA is prohibited. The Contractor shall provide all professional personnel and technical support, medical and other equipment, telecommunications, supplies, and supervision necessary to perform, implement, and administer teleradiology services to meet the specific medical needs of the covered facilities. The Contractor is responsible for all Contractor personnel, subcontractors, agents, and anyone acting for or on behalf of the Contractor. 2.2 Modalities Covered The Contractor shall provide interpretation services for the following imaging modalities, which may include imaging of the head, neck, chest, abdomen, pelvis, and extremities: ModalityDescriptionPriority Facilities CT / CTAComputed Tomography / CT AngiographyAll facilities - highest volume and highest late rate CR / XRComputed/Digital Radiography (plain film)All facilities - high weekend/holiday volume DXDigital RadiographyAll facilities - second-highest volume overall MR / MRAMagnetic Resonance Imaging / MR AngiographyWilkes-Barre, Altoona (limited volumes) USUltrasoundWilmington, Wilkes-Barre, Altoona, Erie, Pittsburgh (limited volumes) MammographyDiagnostic and screening mammographyAs occasionally requested Nuclear Medicine / PET-CTGeneral nuclear medicine and PET/CTAs occasionally requested 2.3 Priority Classification Studies transmitted under this contract shall be classified as either STAT or Routine: STAT: All imaging performed on inpatients and Emergency Department (ED) patients will be considered STAT. Other outpatient studies will be considered STAT if they have been ordered as such or if an expedited interpretation is requested by facility staff. Routine: Outpatient studies not otherwise designated as STAT, with a preferred turnaround of 24 hours and a mandatory turnaround of 48 hours. The Contractor shall not commingle STAT VA studies with routine or non-VA workloads in a manner that degrades turnaround time performance.

SECTION 3   COVERAGE PERIODS AND VOLUME ESTIMATES 3.1 Required Coverage Windows The Contractor shall provide continuous radiologist coverage during the following periods. Less often, teleradiology services may also be requested during regular business hours (Monday - Friday, 8:00 AM - 4:30 PM) during staffing shortages; the Contractor shall accommodate such requests when operationally feasible. 3.1.1 Weekday Overnight Coverage Monday through Friday: 8:00 PM to 7:30 AM (local facility time) (Excluding Federal Holidays - see Section 3.1.3) Estimated average STAT volume per overnight shift by facility and modality: FacilityCTCRDXMRUSTotal Avg/Shift Wilmington1.841.981.981.186.98 Lebanon2.442.132.156.72 Wilkes-Barre2.272.312.321.51.579.97 Altoona1.832.031.5811.077.51 Erie1.562.51.7916.85 Pittsburgh*4.122.182.761.331.2411.63 Philadelphia*2.894.333.691.601.2013.71 Active Facility Total9.9410.959.822.504.82~38.0 System Total16.9517.4616.275.437.26~63.4 3.1.2 Weekend Coverage All Day Saturday and Sunday: 12:00 AM to 11:59 PM (local facility time) (Excluding Federal Holidays - see Section 3.1.3) Saturday - Estimated Average STAT Volume per Day: FacilityCTCRDXMRUSTotal Avg/Day Wilmington7.33109.6326.96 Lebanon9.569.28.3227.08 Wilkes-Barre6.8810.68.861.332.2329.9 Altoona4.697.936.921.4220.96 Erie2.64.734.9212.25 Pittsburgh*11.483.276.942.151.8525.69 Philadelphia*18.9826.3324.423.001.5474.27 Active Facility Total31.0642.4638.651.333.65~117 System Total61.5272.0670.016.487.04~217 Sunday - Estimated Average STAT Volume per Day: FacilityCTCRDXMRUSTotal Avg/Day Wilmington7.1310.387.7425.25 Lebanon11.311.8810.4233.6 Wilkes-Barre7.7810.068.3512.2327.19 Altoona3.926.695.531.7117.85 Erie2.654.533.810.98 Pittsburgh*11.253.526.712.081.9025.46 Philadelphia*13.6824.8118.892.031.0660.47 Active Facility Total32.7843.5435.481.714.67~115 System Total57.7171.8761.445.114.67~201 Federal Holiday - Estimated Average STAT Volume per Day: FacilityCTCRDXMRUSTotal Avg/Holiday Wilmington5.3310.57.7523.58 Lebanon8910.1427.14 Wilkes-Barre5.148.58.422.04 Altoona4.71108.171.0023.88 Erie2.6744.6711.34 Pittsburgh*7.442.505.221.671.3318.16 Philadelphia*14.7525.5017.41.331.3362.58 Active Facility Total25.8542.0029.131.00~108 System Total48.0470.0061.355.673.66~189 Federal Holidays include: New Year’s Day - January 1 Martin Luther King Jr. Day - Third Monday in January Presidents Day - Third Monday in February Memorial Day - Last Monday in May Juneteenth - June 19th Independence Day - July 4 Labor Day - First Monday in September Columbus Day - Second Monday in October Veterans Day - November 11 Thanksgiving Day - Fourth Thursday in November Christmas Day - December 25 This list may also include any other day specifically declared by the President of the United States to be a national holiday. If a holiday falls on Sunday, the following Monday will be observed as the legal holiday. If a holiday falls on Saturday, the preceding Friday is observed as a legal holiday by U.S. Agencies. 3.2 Estimated Annual Volume The following annual volume estimates are based on the prior 12-month data and are provided for planning purposes only. The Government does not guarantee minimum volume. Actual volumes may vary ±25%. Coverage PeriodEstimated Annual STAT Studies Weekday Overnight (M-F, ~261 nights/yr)~9,900 Saturday (~52 days/yr)~6,100 Sunday (~52 days/yr)~6,000 Federal Holidays (~11 days/yr)~1,190 Total Estimated Annual Volume~23,200

SECTION 4   CONTRACTORS PERFORMANCE 4.1 Turnaround Time (TAT) Standards The Contractor shall meet the following turnaround time standards, measured from the time the study is transmitted and available in the Contractor's worklist to the time a final, signed report is available in the VA electronic health record (VistA/CPRS): PriorityModalityRequired TATCritical Finding Communication TAT STATCT / CTA60 minutes60 minutes of identification; 15 minutes for immediately life-threatening findings STATMR / MRA60 minutes60 minutes of identification; 15 minutes for immediately life-threatening findings STATCR / DX / XR45 minutes60 minutes of identification; 15 minutes for immediately life-threatening findings STATUS60 minutes60 minutes of identification; 15 minutes for immediately life-threatening findings RoutineAll modalities24 hours preferred; 48 hours mandatory60 minutes of identification; 15 minutes for immediately life-threatening findings Stroke ProtocolNon-contrast Head CTVerbal callback 15 minutes; Final report 30 minutesImmediate Intraoperative RadiographsXR / CR30 minutes with direct callbackImmediate 4.2 Stroke Protocol Examinations The Contractor will perform expedited imaging interpretations of Non-Contrast Head CT studies for patients presenting within the eligible time window for alteplase administration or those within the extended time window for endovascular treatment. The covered VA facility staff will work with the Contractor to establish a workflow to identify those cases. The contracted teleradiologist will provide a verbal callback within 15 minutes of receipt of such a study. A final written report transmitted back to local CPRS will be provided within 30 minutes from receipt of the study. 4.3 Intraoperative Radiographs The Contractor will perform expedited imaging interpretations for intraoperative radiographs in support of VHA Directive 1103: "Prevention of Retained Surgical Items" or other intraoperative radiographs requiring emergent radiologist interpretation in support of clinical decision making while the patient is in the operating room. Covered facility staff will work with the Contractor to establish a workflow to identify these cases. The Contractor will provide interpretations within 30 minutes from receipt of the complete study and will provide direct callbacks on all operating room cases. 4.5 Timeliness Improvement Targets Based on current baseline performance, the following improvement targets shall be achieved within the periods stated: FacilityCurrent STAT Late Rate (Baseline)Target by Month 6Target by Month 12 Wilmington0.3920%10% Lebanon0.50925%10% Wilkes-Barre0.30918%10% Altoona0.3420%10% Erie0.22115%10% Pittsburgh*0.54425%10% Philadelphia*0.50925%10%

SECTION 5   DOCUMENTATION AND REPORTING STANDARDS 5.1 Report Content and Standards All image interpretations will meet or exceed established standards of care in timeliness, accuracy, and content. All reports shall comply with American College of Radiology (ACR) standards and shall include the following information (it is acceptable for some items to be included in electronic headers and metadata): Patient's full name, Social Security Number (SSN), and date of birth Reason for study / clinical indication Exam case number (accession number) Date of study and date of interpretation Requesting/ordering physician Relevant comparison studies reviewed Study technique and laterality (when applicable) Description of exam and findings (body of report)- listing pertinent positive and negative findings Impression and diagnostic codes Name and electronic signature of interpreting radiologist Only facility-approved abbreviations will be used. Any incomplete report shall be re-dictated, transcribed, and verified within 24 hours of notification at no additional cost to the Government. 5.2 Diagnostic Coding The Contractor shall code all studies (both normal and abnormal) with a diagnostic code inserted at the time of report generation, in accordance with each facility's coding policy. The standard diagnostic codes are as follows: CodeDescriptionPrints on ReportGenerates View Alert 1000NO ALERT REQUIRED - No urgent findings; ordering physician already aware of resultsNoNo 1001SIGNIFICANT ABNORMALITY, ATTENTION NEEDED - Finding requires follow-up but not urgentlyYesYes 1002CRITICAL ABNORMALITY - Finding must be addressed immediately per TJC definition; direct phone call to ordering provider requiredYesYes 1003POSSIBLE MALIGNANCY - Finding may represent malignancy (known or undiagnosed); includes pulmonary nodules, renal masses, suspicious hepatic lesionsYesYes Diagnostic code usage instructions may be updated from time to time by the facilities covered. The Contractor will be provided with updated instructions and shall distribute them to all interpreting radiologists and obtain signed receipt and acknowledgement of understanding. 5.3 Critical Findings Communication Protocol Critical test results in imaging are defined as radiology/nuclear medicine findings that indicate an immediately life-threatening condition. Critical findings include, but are not limited to: Ectopic Pregnancy Testicular or Ovarian Torsion Pneumoperitoneum (not post-operative) Acute Intracranial Hemorrhage Unstable Cervical Spine Fracture Thoracic or Lumbar Spine Fracture with cord compression Aortic Dissection Mediastinal or Retroperitoneal Hematoma Intracranial Mass with New Herniation Acute Pulmonary Embolism or Acute above-the-knee DVT Hemoperitoneum Acute laceration of the Liver, Spleen, or Kidney Acute cord compression Appendicitis Abscess requiring medical/surgical attention or intervention Bowel Necrosis Portal Venous Gas Acute Arterial Embolism/Occlusion Tension Pneumothorax Significantly malposition line or tube, or unexpected foreign body Radiologists may designate other abnormalities as critical based on professional judgment. The Contractor shall: Communicate critical results to the ordering practitioner or surrogate practitioner immediately during interpretation, but no later than one (1) hour after detecting the finding Follow a call cascade protocol if the ordering provider and designated surrogate cannot be reached; as a backup, calls about urgent findings will be routed through the facility's Emergency Room Obtain verbal readback confirmation of the patient's identity and result from the receiving provider Document in the radiology report: the communication of the critical result, the name of the notified provider, and the date and time of communication Apply diagnostic code 1002 - CRITICAL ABNORMALITY to the study Electronic communication (view alerts) will be used to communicate important/abnormal findings that require attention by the ordering practitioner but not necessarily in an immediate timeframe (codes 1001 and 1003). The Contractor will distribute the following facility-specific policies to all interpreting radiologists and obtain signed acknowledgement of receipt: 2024 New Critical Radiology Results Reporting of Critical Results SOP MCP 114-05 Supplementary and Nonstandard Communication of Imaging Abnormalities 5.4 Discrepancy Reporting If a preliminary interpretation is first rendered, the radiologist providing the final interpretation must determine whether the final report differs from the preliminary. Any change or discrepancy between the preliminary and final interpretations must be: Documented in the final report Communicated by phone to the referring clinician or their covering surrogate Documented with the date and time of that communication in the final report 5.5 Technically Limited Studies If a study is technically limited or incomplete and cannot be interpreted with certainty, the teleradiologist will notify the referring clinician for consideration of repeating the study. If repeating the study is not feasible, cannot be done immediately, or is not likely to be productive, the study must be reported with the technical limitations of the interpretation described in the report. 5.6 Quality Assurance and Peer Review The Contractor shall: Maintain an internal peer review program meeting ACR accreditation standard, with a minimum 5% random peer review of all VA interpretations; the number of cases reviewed will comply with VA requirements for Focused Professional Practice Evaluation (FPPE) and Ongoing Professional Practice Evaluation (OPPE) Provide quarterly peer review data (quality assurance cross-reads) for each radiologist providing interpretations to covered facilities; a copy will be provided to each facility for review Submit monthly quality metrics reports to the Contracting Officer's Representative (COR)/designated VA Point of contact (POC) including: total study volume by facility and modality, TAT compliance rate, critical findings count and communication compliance, peer review outcomes, discrepancy rates Participate in quarterly quality review meetings with VA facility radiology leadership, and in focus reviews and morbidity and mortality reviews for cases in which they provided care Provide FboNotice cause analysis within 10 business days for any month in which TAT compliance falls below the AQL at any covered facility Monitor for any sentinel events or potential sentinel events involving VA patients and report to the affected facility as soon as the event is detected; a comprehensive review of the case will be provided to the appropriate VA facility The Contractor's facilities, methodologies, and quality control procedures may be examined by the VA Contracting Officer or designee at any time during the life of the contract 5.7 Provider Contact and Consultation A method will be established to allow the teleradiologist to contact a provider or covering surrogate provider at each covered facility by phone. This allows the teleradiologist to: Seek additional relevant clinical information (history, progress notes, medications, laboratory values, prior reports) Discuss the patient's clinical status Relay critical results Covered facility staff will provide the Contractor's teleradiology operations team with contact information for ordering providers, either through electronic lists (e.g., Amion) and/or through submission of relevant information through an electronic portal. VA technologists performing procedures may also consult the radiologist with questions regarding exam protocol, possible contrast allergy questions, abnormal laboratory values, or premedication questions. 5.8 Deliverables - Reporting Requirements to the Government ReportFrequencyDue DateRecipient Monthly Performance Report (volume, TAT compliance, critical findings)Monthly10th calendar day of following monthCOR/POC Critical Findings LogMonthly10th calendar day of following monthCOR/POC + Facility Radiology Chief Peer Review / QA Cross-Read DataQuarterly15th calendar day following quarter closeCOR/POC + Radiology Service Chief Sentinel Event NotificationAs events occurImmediately upon detectionFacility + COR/POC Radiologist Roster / Credential UpdatesAs changes occurWithin 5 business days of changeCOR/POC TAT Discrepancy Root Cause AnalysisAs triggeredWithin 10 business daysCOR/POC Annual Quality SummaryAnnual30 days prior to option year exerciseContracting Officer

SECTION 6   RADIOLOGIST QUALIFICATIONS AND CREDENTIALING 6.1 Radiologist Qualifications All radiologists providing interpretations under this contract shall meet the following minimum qualifications: Possess the M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) degree Board certification or board eligibility in Diagnostic Radiology by the American Board of Radiology (ABR) or the American Osteopathic Board of Radiology (AOBR) Active, unrestricted medical licensure in the state(s) where covered facilities are located (Delaware, Pennsylvania) and/or the state from which interpretations are rendered, as required by applicable law; licensure must be current with no history of disciplinary action Minimum two (2) years of post-training clinical experience in diagnostic radiology (three years preferred) Subspecialty fellowship training required for MR neuroradiology and musculoskeletal studies exceeding institutional threshold volumes (defined in the Quality Assurance Surveillance Plan) General liability insurance: minimum $500,000 per occurrence Professional medical malpractice liability insurance: minimum $1,000,000 per occurrence; radiologists must carry their own malpractice insurance Barrier-free office environment, equipment, and space meeting JCAHO, Federal, and State standards Residents are not permitted to provide preliminary or final interpretations 6.2 Credentialing and Privileging All interpreting radiologists shall be fully credentialed and privileged prior to performing any interpretations under this contract. Credentialing may be accomplished by either: Direct Credentialing through each covered facility's Credentialing and Privileging (C&P) Committee, in accordance with VHA Directive 1100.20 Credentialing of Healthcare Providers and VHA Directive 1100.21 Privileging and Facility Medical Staff Bylaws; or Teleradiology Sharing Agreement (TSA), if subsequently established to allow the sharing of credentials between covered VA facilities and the contractor. Radiologists will only interpret those study types and modalities for which they are credentialed and privileged. Privileges at the facility where the procedure is performed will terminate at the time of contract termination or expiration. The Government is responsible for credentialing in a timely fashion. An application package will be provided by the VA, including Privileges, Credentialing Attestation, curriculum vitae, current references, signed release of information, and VET-PRO Internet process enrollment (http://fcp.vetpro.org/). Credentials will be updated every three years to ensure no lapse in licensure, insurance coverage, or other requirements. No changes in employee personnel will be allowed without prior written authorization by the Contracting Officer thirty (30) days in advance. The VA reserves the right to approve the assignment of individual personnel furnished by the Contractor. The Contractor shall appoint one radiologist to serve as a trainer for other radiologists assigned to work for the covered facilities. 6.3 Training Requirements The Contractor shall be responsible for ensuring that all providers and subcontractors complete training required by covered facilities prior to performance, including but not limited to: VA Ethics training Cybersecurity and Information Security (VA Handbook 6500) Privacy Act and HIPAA training Facility-specific critical results reporting (SOP and MCP 114-05) Any other mandatory training identified by covered facilities The Contractor will provide documentation of completion of all required training to the COR/POC.

SECTION 7   TECHNOLOGY, SYSTEMS AND SECURITY 7.1 Systems Integration and Connectivity The Contractor shall: Maintain PACS connectivity compatible with VA enterprise imaging infrastructure, including VistA Imaging, Philips Intellispace PACS, Nuance PowerScribe, and CPRS Implement a VistA Rad/VistA Imaging/Philips Intellispace-compatible DICOM appliance for transfer of images from Philips Intellispace to the Contractor's DICOM server; the Contractor's proposal shall include the specific hardware and software to be utilized Provide HL7-compliant report transmission directly into VistA/CPRS within required TAT windows Connect to the VA through a VA-approved Business Partner Gateway (BPG); teleradiologists may also connect using the Citrix Access Gateway VPN Ensure all image transmission occurs over encrypted, HIPAA-compliant, VA-approved network connections; all data transmission security must be maintained at all times Comply with VA Handbook 6500 Information Security requirements and obtain an Authority to Operate (ATO) prior to contract performance Maintain a redundant, geographically diverse worklist and reading system with failover capability to ensure 99% availability during all covered hours; failure to maintain 99% uptime may result in contract termination Maintain a system capable of receiving DICOM images to the Contractor server via secure VA facility-initiated VPN connection over the Internet Access current and prior comparison studies using a secure VA Business Partner Gateway or similarly functional, rapid, and secure technology Provide and maintain a real-time dashboard accessible to VA facility radiology chiefs and the COR/POC showing pending study queue, average TAT, and critical findings log Notify covered facility personnel immediately of any equipment malfunctions that would hinder image transmission 7.2 Contractor-Furnished Equipment and Software The Contractor shall provide, configure, install, secure, and maintain: All hardware and software at the Contractor's facility, including facsimile, telephone, networking, and other telecommunications equipment All supplies, services, maintenance, repairs, and upgrades required at the Contractor's facility Virtual Private Network (VPN) and all remote workstation software on remote reading radiologist workstations, in compliance with VA Handbook 6500 External communication systems required for secure, VA-compliant image and data delivery to teleradiologists All remote workstation software at teleradiologists' reading stations; the Contractor shall ensure the security of all VA data The Contractor's equipment hardware, software, and supplies must be compatible with the VA's software (CPRS, VistA Imaging, PowerScribe, Philips Intellispace) and hardware used during contract performance, including critical patches and antivirus updates. The Contractor shall provide proof of installation of critical patches and/or antivirus updates upon request. 7.3 Government-Furnished Property and Responsibilities Prepare the site for installation and obtain VA authorization for installation of a separate network connection and the DICOM store and forward device Establish accounts and authorize radiology module privileges for contractor use Provide VPN or direct network access credentials for PACS and VistA connectivity Provide VA-issued digital certificates for HL7 report transmission Provide facility-specific radiology protocols, report templates, and diagnostic coding instructions Provide pertinent historical and demographic information on each patient sufficient for the Contractor to perform its services Designate IRM staff for testing and approval of the installed remote connectivity solution Provide physical security for computer systems 7.4 Information and Data Security The Contractor shall comply with all applicable cybersecurity and information security requirements, including: Federal Information Security Management Act (FISMA) Privacy Act of 1974 (5 U.S.C. § 552a) Health Insurance Portability and Accountability Act of 1996 (HIPAA) (45 CFR Parts 160 and 164); standard is zero breaches VA Handbook 6500 - Information Security Program VHA Directives 6500 and related policies Computer Security Act of 1987; Clinger Cohen Act of 1996; OMB A-130 Appendix III FAR clauses 52.224-1 and 52.224-2 Public Law 109-461, §5725 The Contractor shall: Maintain security measures consistent with VA Departmental Standards and provide VHA with full assurance of their implementation Ensure contractors' own computers used for diagnostic interpretation adhere to all VA security requirements Expeditiously provide all requested information to each covered facility's Information Security Officer (ISO) and Information Resources Management (IRM) Maintain an "Errors and Omissions" liability insurance policy insuring against negligent acts, errors, or omissions and violations of rights of privacy; maintain a Commercial General Liability Policy; provide evidence of coverage to facility credentialing departments upon request Maintain a Drug-Free Workplace in accordance with Federal regulations, including establishment and administration of a drug-free workplace program and disciplinary actions Background Investigations: All contractor personnel performing work under this contract shall satisfy all requirements for appropriate security eligibility in dealing with access to sensitive information systems belonging to or being used on behalf of the Department of Veterans Affairs. A Minimum Background Investigation shall be conducted prior to performing work under this contract, within 30 days of investigation initiation. Investigative history must be maintained in OPM or DISCO databases. Network Access: Each Contractor staff person must agree to the VA standard user application and sign and abide by the VA National Rules of Behavior Agreement prior to starting work. This agreement is necessary to ensure compliance and security. Records Access: Contractor personnel who access hardware or media that may store drug or alcohol abuse data, sickle cell anemia treatment records, HIV records, medical quality assurance records, or other sensitive information protected under 38 U.S.C. § 4132 or § 3305 shall not access those records unless absolutely necessary to perform contractual duties. Any individual with access will disclose the information to no one not involved in the performance of the contractual duty for which access was obtained. Violation may result in criminal penalties. The VA system of records to which Contractor personnel will have access is: "Patient Medical Records - VA (24VA136)." 7.5 Data Disposition The Contractor may temporarily store copies of reports and images but must delete or destroy all copies after contract expiration, except records required for billing and reimbursement purposes. A certificate of destruction will be provided to the VA. Upon completion or termination of the contract, VPN software will be removed from Contractor equipment, and all network accounts will be disabled. All VA data gathered, created, received, or processed during contract performance will be returned to the VA or a certificate of destruction provided. No data will be retained by the Contractor or subcontractors.

SECTION 8   STAFFING AND CONTINUITY 8.1 Staffing Requirements The Contractor shall: Maintain sufficient radiologist staffing to meet all TAT requirements during all covered periods without reliance on a single point of failure Provide a minimum of two (2) board-certified radiologists available simultaneously during peak volume periods (Saturdays, Sundays, and all Federal Holidays), reflecting system-wide average daily volumes of 108-117 STAT studies on those days Designate a Program Manager as the single point of contact responsible for contract performance, available by telephone during all covered hours Designate one radiologist to serve as Medical Director / Lead Radiologist responsible for clinical oversight, interfacing VA radiology chiefs, and coordinating FPPE/OPPE data Notify the COR/POC at least 60 calendar days in advance of any planned reduction in radiologist staffing that could impact coverage capacity 8.2 Key Personnel The following positions are designated as Key Personnel requiring Contracting Officer approval prior to replacement: Program Manager Medical Director / Lead Radiologist IT Systems Integration Lead During the first ninety (90) days of performance, the Contractor shall make NO substitutions of key personnel unless necessitated by illness, death, or termination of employment. The Contractor shall notify the Contracting Officer in writing within 15 calendar days of such occurrences. After the initial 90-day period, the Contractor shall submit proposed substitution information to the Contracting Officer at least 15 days prior to any permanent substitution, including a detailed explanation, complete resumes for proposed substitutes, and any additional information requested. Proposed substitutes shall have comparable qualifications. For temporary substitutions where the key person will not report to work for two (2) or more days, the Contractor will provide a qualified replacement with comparable qualifications. Any substitution period exceeding one week requires the formal substitution procedure above. All temporary substitutions must have prior credentialing and privileging at the applicable VA facility. 8.3 Contractor Personnel Standards The Contractor shall: Assume full responsibility for protection of its personnel, including workers' compensation, professional liability insurance, health examinations, income tax withholding, and social security payments Develop and maintain written policies and procedures for licensure and certification, competency evaluations, orientation, and continuing education appropriate for the scope of care provided Maintain records documenting competence and performance levels of all personnel in accordance with JCAHO and other regulatory requirements Provide a current copy of the competence assessment checklist and semi-annual performance evaluation to the COR/POC for each Contractor personnel working on this contract Not resort to subcontracting as a means of circumventing non-discrimination requirements; the Contractor shall provide services to any person determined eligible regardless of race, color, religion, sex, or national origin Insurance Requirements: Workers' Compensation and Employer's Liability: minimum $100,000 (except where state law requires otherwise) General Liability: minimum $500,000 per occurrence Professional Medical Malpractice Liability: minimum $1,000,000 per occurrence The Contractor shall furnish certification to the Contracting Officer that required coverage has been obtained before commencing work. Insurance policies shall state: "THIS POLICY MAY NOT BE CHANGED OR CANCELED WITHOUT WRITTEN NOTICE TO THE VA."

SECTION 9   CONFIDENTIALITY AND MEDICAL RECORDS 9.1 Patient Confidentiality The Contractor understands and agrees that information in the medical records of all patients is strictly confidential. The Contractor and its personnel shall comply with: 38 U.S.C. §§ 3301, 4132; 5 U.S.C. § 552a (Privacy Act of 1974) HIPAA Privacy and Security Rules (45 CFR Parts 160 and 164) All VA regulations regarding sensitive information and patient confidentiality The Contractor is not authorized to release any medical record information. The covered VA facility is the sole entity authorized to release such information upon written patient request. The Contractor shall not provide copies of health information to any person other than the authorized requesting party. Any disclosure of protected health information will be limited to that portion of the medical record needed to fulfill the specific purpose of the disclosure. The covered facilities will not release psychiatric care records, alcoholism/drug abuse records, or HIV records without appropriate authorization; the Contractor assumes no responsibility for liability arising from faulty documentation furnished by the facilities. Any person who knowingly or willingly discloses confidential information from the VA Medical Center may be subject to fines of up to $50,000 and civil litigation from the patient. 9.2 Medical Records Standards The Contractor shall comply with the Medical Record Compliance Standards of the VHA. Medical center staff will provide Privacy Act training to appropriate Contractor staff. The Contractor, Contractor employees, and subcontractors shall be subject to the Privacy Act of 1974 and HIPAA of 1996. 9.3 Exchange of Data Patient medical records shall be exchanged as needed between the Contractor and covered facilities and shall remain confidential. Patient images, along with exam request forms, will be transmitted electronically via a push from the VA's PACS through a data line provided by the Contractor. Request forms will include patient and study information, CPT codes, study urgency (STAT vs. routine), and other relevant information. The Contractor will interpret the exam and transmit the radiologist's final report using Contractor-provided hardware/software compatible with CPRS, VistA, Intellispace PACS, PowerScribe, and related systems.

SECTION 10   INSPECTION, ACCEPTANCE AND CONTRACT MONITORING 10.1 Method of Surveillance Radiology Service at each covered facility will appoint a Contracting Officer's Representative (COR)/POC upon contract award. The COR/POC will be responsible for verifying contract compliance captured in the Quality Surveillance Plan (QASP). The Government will periodically evaluate Contractor performance using the following surveillance methods: Automated Monitoring: Monthly PACS/worklist reports providing TAT data for 100% of studies Random Sampling: COR/POC review of a random 5% sample of completed monthly reports for quality and completeness Critical Findings Audit: 100% audit of critical findings log compliance quarterly Peer Review Monitoring: Errors in interpretation or incomplete communication of urgent findings may be aggregated and compared across radiologists Credential Audit: Annual review of all active radiologist credential files Customer Satisfaction: Quarterly survey of VA facility radiology chiefs and ordering providers; complaints and compliments regarding interactions, availability, responsiveness, and usefulness of consultations will be reviewed Timeliness Monitoring: Timeliness of STAT results notification and report verification will be monitored; the COR/POC will periodically evaluate workload accomplished to ensure necessary services are consistently provided The Government may increase the frequency of quality assurance inspections in the event of repeated failures or customer complaints. The Government may also decrease inspections if performance warrants. 10.2 Acceptance Criteria Final reports shall be accepted when they are: Delivered within the required TAT window Transmitted directly into VistA/CPRS in the correct format with all required diagnostic codes Clinically complete, containing all required report elements per ACR standards and facility protocol Signed electronically by a credentialed, privileged radiologist 10.3 Non-Conformance and Remedies If the Contractor fails to meet performance standards, the following remedies apply: Performance AreaLevel of non-conformanceConsequence STAT Timeliness (AQL: 90%)85-89% on timeWritten notice; corrective action plan within 5 business days STAT Timeliness80-84% on timeFinancial deduction of 5% of monthly invoice for affected facility STAT Timeliness75-79% on timeFinancial deduction of 10% of monthly invoice for affected facility STAT TimelinessBelow 75% on timeFinancial deduction of 15% of monthly invoice; Contracting Officer may issue cure notice STAT TimelinessBelow 75% for two (2) consecutive monthsGrounds for termination for default Routine TimelinessAny late report > 48 hoursWritten notice; zero tolerance standard Radiologist AvailabilityAny period of non-availabilityZero tolerance; written notice; corrective action plan Privacy/HIPAA BreachAny confirmed breachImmediate notification of CO; remediation at Contractor's expense; potential termination System UptimeBelow 99% in any monthWritten notice; cause analysis within 5 business days If services do not conform to contract requirements, the Government may require re-performance at no additional cost, or a reduction in price, or termination. Any incident of Contractor noncompliance shall be immediately forwarded to the Contracting Officer.

SECTION 11   SPECIAL CONTRACT REQUIREMENTS 11.1 Contractor Experience Requirements The Contractor must have a minimum of three (3) years of experience providing off-routine teleradiology interpretations for VA Medical Centers and must demonstrate consistent coverage (> 99% uptime for a 3-year period). Prior experience connecting to VISN 4 radiology systems is preferred. 11.2 Transition-In Period The Contractor shall complete all credentialing, privileging, system integration, and testing within 60 calendar days of contract award. Services shall commence no later than 90 days after award. A detailed transition-in plan shall be submitted within 10 days of award, including: Radiologist roster with credential status and timeline to full C&P IT connectivity and ATO timeline Test transmission schedule with each facility Staffing plan for each coverage window Site preparation and telecommunications VistA interface strategy Policies and procedures, training plan, and operational readiness schedule The Contractor will assist in site preparation and support during transition. 11.3 Transition-Out Period Upon contract expiration or termination, the Contractor shall provide a minimum 30-day transition-out period, during which they shall: Continue full performance without degradation Cooperate with successor contractor or Government staff Transfer all records to the COR/POC Remove VPN software and disable network accounts Return or destroy all VA data 11.4 Subcontracting All personnel not employees are regarded as Subcontractors. The Contractor shall: Identify all subcontractors in the proposal Obtain prior approval for any additions or substitutions Be responsible for the quality of care delivered by subcontractors Monitor subcontractor performance systematically Subcontractor radiologists are subject to the same credentialing and privileging requirements. 11.5 Regulatory Compliance The Contractor shall comply with all applicable standards and regulations, including JCAHO, ACR, HIPAA, VA policies, state laws, FDA regulations, FAR, and VAAR. The Contractor shall not participate in activities conflicting with Federal or State guidelines and shall notify the COR/POC or Contracting Officer of conflicts. 11.6 Term of Contract and Pricing This contract is projected to start within 90 days of award, effective for one year with four option years, based on VA funds. Pricing will be a flat fee per CPT code. Invoices are to be submitted monthly, listing all studies interpreted, with date/time details. 11.7 Payment Invoices are to be submitted electronically via Tungsten Network. Payment will be made within 30 days of approval. Each invoice must include company name, Tax ID, contract and obligation numbers, description of services, period, amount, and remit-to address. The Contractor is responsible for all payroll and taxes. 11.8 Modifications Services may be changed by written modification from the VA Contracting Officer. Services outside the scope require authorization. The Contractor shall perform under the direction of the Chief of Staff and Imaging Service Chiefs at each facility. End of Performance Work Statement

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