Description
Department of Veterans Affairs (VA) Veteran Health Administration (VHA) Community Care Referral, Authorization, Utilization Management and Care Coordination Systems (CCRA) Request for Information (RFI) Questions and Answers We respectfully request a 7-calendar-day extension to the current response deadline of January 26, 2026 (through February 2, 2026). Answer: See Amendment 0001. The RFI response date has been extended to February 2, 2026. Aside from the rubric spreadsheet, can any other supporting documentation/materials be submitted? Answer: No, the Government requests that the rubric is the only submission in the response. Per the instructions in the RFI, vendors electing to provide a demo will be allowed to submit additional materials at that time. Can we provide a 2- or 3-minute video of how the proposed solution will work at the VA and community care providers?  Answer: No. See response to Q2. A video may be utilized within the one hour demo. Can we provide evidence of such a system being demonstrated at a VA MIT Hackathon in the past?  Answer: No. See response to Q2. This may be highlighted during the demo. Will vendors have access to demo patient data or scenarios for the 1-hour live demonstration? Answer: No. Are there minimum accuracy or performance thresholds for OCR/NLP of medical documents? Answer: No, that information is currently not available. Additional information on performance standards may be released in a more detailed follow-on RFI or as part of the RFP. Is preference given to vendors with prior VA deployments, or will comparable commercial deployments suffice? Answer: No, preference will not be given to vendors with prior VA deployments. Is integration with VistA a must or just integration with Epic, Cerner, Meditech, Allscripts suffice for this RFI response? Answer: Yes, VistA integration is required. For integration with VistA, is Authority to Operate (ATO) from VA required or is that not a requirement? Answer: Yes, an ATO is required regardless of integration with VistA. All products should be registered with VA OIT through the ATO process. Would you provide a list of VA facilities that are willing to pilot such a solution?  Answer: No, not at this time as VA is still in the requirements development phase. VA does not currently envision pilots, but more likely a phased deployment. Is this a set aside for SDVOSB, MOSB, WOSB or SB?  Answer: The acquisition strategy has not yet been determined. Is there a preferred set of services you would like to see in the demo?  Answer: The vendors are required to demonstrate capabilities that are provided in the rubric. Is there a preference for such a system already operational within the VA? Answer: No. For prior auth and admit criteria, do you prefer to use InterQual (now Optum) or Milliman Care Guidelines (MCG)?  Answer: The Government currently prefers MCG in relation to community care referrals but wants the future system to work with whatever future standards (including VA-authored) are utilized. For post demo and post-pilot pricing models, do you prefer a fixed price (irrespective of usage) or usage-based pricing model?  Answer: The pricing model has not yet been determined as VA is still in the requirements development phase. Do you want artificial intelligence (AI)-assisted Ambient Dictation included in the proposal or would you prefer the proposal to integrate with VA provided Ambient AI or both? Answer: Yes, the Government would like to receive proposals for both solutions regarding AI technology as VA is still in the requirements development phase. Do you want AI-assisted billing code generation and claims processing as part of the proposal or would you leave that capability to Third Party Administrators? Answer: No, claims processing is not included in this requirement. Does the care coordination and collaboration functionality extend beyond VA users to include external providers? Answer: No, functionality will be for VA staff members to coordinate Veteran care within/between our VA direct care system and the community care program. Could you clarify the circumstances under which community providers would submit referrals in this system? Typically, a provider would accept a referral, treat the patient, and then return information to the referring provider, rather than directly refer the patient to a third provider. Is this functionality intended for veterans who receive all their care from community providers, such that a community primary care provider would refer a veteran to a community specialist? Answer: Community providers do not generally submit referrals. There are some cases where a provider receives a referral/authorization that includes approval for certain testing or treatments that may be provided by other services (e.g. an orthopedics referral that includes diagnostic imaging and physical therapy). More commonly, a community provider may recommend additional services beyond the scope (services or duration) of their referral, which is handled through the Request for Service (RFS) process. This could be to obtain approval to provide additional services within their practice, or to recommend other services for the Veteran. This RFS process, if approved by VA, will result in a separate referral/authorization. Referrals and RFS will be communicated via the Third Party Administrator (TPA) portals for community providers under the Community Care Network (CCN) contracts. These tools will be VA s counterpart system for managing care under the community care program and will primarily be used by VA staff to interact with the TPA portals. There is a potential cases where non-CCN community providers (such as those under Veteran Care Agreement contracts) would need to communicate directly with the portal via an EDI transaction. Could you clarify what specific metrics or benchmarks should be used to demonstrate the familiarity of existing organizations with the product? For example, are you seeking information such as KLAS rankings, market penetration data, user base size, or user satisfaction ratings? Answer: There are no defined or preferred metrics or measurements for the above listed criteria at this time. Is the requirement for the system to simply generate an authorization number for community providers to include on claims submitted to the VA, or is it intended to support the entire authorization determination process? It appears that the overview and criteria describe varying levels of workflow comprehensiveness. Answer: The intent of the system is to support the broader authorization process, picking up from the point the VA provider orders care in VA s Electronic Health Record. The system would support the full referral and authorization process, as well as utilization management, care coordination, and other designated functions. Could you please confirm whether the demonstration will be conducted in person or virtually? Additionally, will the demo be recorded? Answer: The Government has not decided at this time. Section 3 of the PWS only states the scope of this PWS is the operations, maintenance, and enhancements of the current HSRM system. There is no mention of VA's intent to modernize capabilities and the desire for a contractor to propose a new solution with demonstratable capabilities as other documents in the acquisition package describe. Answer: The included PWS is still a draft document and subject to change. VA is still in the requirements development phase and will review the responses to the RFI prior to determining the best solution for the Government. The Government encourages vendors to be innovative in their proposals as the current system does not include many of the future capabilities envisioned. Additional information, including a detailed requirements listing, will be provided in a more detailed follow-on RFI or as part of the RFP. Section 5 of the PWS starts by describing the current system, HSRM, and the requirement to maintain and enhance it. However, it then discusses performing system and capability demonstrations without introducing the need for anything beyond the current state system. Can the VA please update section 5 to distinguish between tasks to support current state and tasks covering the acquisition of a new modernized system that would require demonstrations of the requested requirements. Answer: See response to Q23. CCRA Requirements Backlog (Attachment A) was not included in the acquisition package. Will VA be providing this in future phases of the RFI? Answer: See response to Q23. With the intent to continue with enhancements to HSRM, while active deployment of a new modernized system, does the VA have a desired timeframe for the transition to occur, and is there an expectation that the contractor will complete the entire requirement backlog that is mentioned prior to that transition occurring? Answer: The Government cannot provide this information at this time. Can the VA clarify if the listed Technical Performance Metrics are intended to be how the contractor's performance will be measured, or are these the acquisition scoring criteria the VA will use to determine which contractor and solution best meets the VA requirements? Answer: See response to Q23. Can you share examples and process flows of the current workflows that will need to be recreated? Answer: No, that information is currently not available. The Government will provide an MS Visio diagram and Word document with the current CCRA dependencies in a more detailed follow-on RFI or as part of the RFP. Can you share a higher resolution view of Diagram 1 in the RFI Cover, as well as an architectural overview and data flow diagram with sample data? Answer: No, that information is currently not available. The Government will provide a higher resolution view of Diagram 1 in a more detailed follow-on RFI or as part of the RFP. An architectural overview and data flow diagram with sample data will not be made available. What are the expected SLAs for each service in scope? Answer: The Government cannot provide this information at this time. What is the expected volume breakdown between cloud and on prem deployments? Answer: The Government cannot provide this information at this time but prefers mostly cloud deployments. VA is still in the requirements development phase and will review the responses to the RFI prior to determining the best solution for the Government. Can you provide an example payload and schema for the DAS interface? Answer: Load & Traffic: The vendor platform can process X referral transactions per day and be able to run relatively complex Y business rules in their processing and respond within an hour. Can you provide examples of other applications the VA would like to be able to substitute? Answer: Currently, VA has Emergency Care Reporting (ECR) and VA Precertification Portal (VAPP). Can you provide an expected upper volume limit for the number of transactions per day and business rules? Answer: The Government estimates 10 million messages are processed per day with an upper volume limit of 50 million messages per day. The Government cautions that these are basic estimates and exact numbers of messages fluctuate. For purposes of this RFI and the anticipated future acquisition, does VA envision the referral, authorization, utilization management, and care coordination capability being procured primarily as a commercial software platform (e.g., subscription/XaaS), as a platform with separately scoped integration and sustainment task orders, or as a fully managed end-to-end service similar to the current CCRA sustainment model? Answer: The Government envisions a tool for CCRA that includes utilization management and care coordination capabilities. VA is still in the requirements development phase and will review the responses to the RFI prior to determining the best solution for the Government. Does VA anticipate that future vendors will be responsible for ongoing operational functions such as 24x7 support, call center operations, and large-scale staffing, or does VA expect these operational responsibilities to remain separate from the core platform capability being evaluated under this RFI? Answer: Operation of the source platform is expected to be provided by the vendor. VA is still in the requirements development phase and will review the responses to the RFI prior to determining the best solution for the Government. In the future-state model described in the RFI, should vendors assume that community provider interactions will occur exclusively through TPA systems using standardized electronic transactions, with no requirement to provision or support direct provider user accounts within the VA system? Answer: No, VA does not envision the need for community provider interaction with this solution. Community providers will receive information through the TPA systems.  How does VA currently envision the allocation of responsibility between the VA platform and TPAs for utilization management (UM) activities, specifically with respect to rule definition, maintenance of clinical criteria (e.g., InterQual, Milliman, VA-developed policies), and ongoing configuration versus execution? Answer: The IT solution will ingest the UM recommendations from the TPA and allow staff to review and approve or deny the request. For planning and sizing purposes, does VA anticipate that an initial deployment of a future system would be expected to operate immediately at full national scale, or is VA considering a phased rollout approach (e.g., by region, program, or referral type) during initial implementation? Answer: The Government is considering a phase rollout approach and a VA implementation manager may be assigned to assist. Does VA have target benchmarks or planning assumptions for referral volume, authorization volume, or utilization review throughput that vendors should use when estimating scale, infrastructure requirements, and cost models? Answer: The VA Community Care Program provides healthcare coverage across 50 states and annually issues over 8.5 million referrals and authorizations, and spending exceeds $35 billion. With respect to hosting and infrastructure, does VA anticipate preferring vendor-managed cloud environments (e.g., GovCloud) or VA-managed enterprise cloud hosting for a future solution, and should vendors assume responsibility for infrastructure costs as part of their pricing models? Answer: The Government would like to receive proposals for both solutions as VA is still in the requirements development phase but prefers VA managed enterprise cloud hosting. The Government expects the solution to possess a FedRAMP High Authorization/ATO or be able to obtain an ATO in a reasonable, i.e., within 6 months or less, amount of time. For compliance planning, does VA expect future solutions to already possess FedRAMP High authorization at time of award, to inherit a VA ATO, or to undergo a new VA A&A process, and how should vendors account for this expectation when shaping their responses? Answer: See response to Q41. Should vendors assume that multiple environments (e.g., development, test, staging, production, sandbox) are part of the baseline expectation for a future solution, or are sandbox and experimentation environments considered optional or separately scoped? Answer: Yes, multiple environments are part of the baseline expectation, whereas sandbox and experimentation environments will be considered optional or separately scoped. With respect to AI capabilities, can VA confirm that AI is expected to support analytics, prioritization, workflow optimization, and decision support, while final clinical and authorization decisions remain the responsibility of VA personnel and reviewers? Answer: The Government encourages vendors to be innovative in their proposals. However, AI will likely remain secondary to clinical decision-making. For example, tell VA what AI can do. Does VA anticipate that future procurements will favor modular acquisition of discrete capabilities (such as referral orchestration, utilization management, or care coordination) that can be independently priced and deployed, or is VA more likely to pursue a single integrated platform award? Answer: The Government is more likely to pursue a single integrated platform award.