DA01--RFI for CCR&A Vendor Demonstrations (VA-26-00031811)

Performance Work Statement (PWS)

To provide continued capability development and sustainment services for the HealthShare Referral Manager (HSRM) Managed Service solution, including Emergency Care Reporting (ECR) and Integrated Care (IPE) systems. The goal is to expedite Veterans’ access to community care by managing referrals, authorizations, utilization, and care coordination.

• Sustainment and development services for the HSRM solution, hosted in AWS FedRAMP High Government Cloud.

• Software maintenance, configuration, development, testing, integration, installation, implementation, training, customer support, optimization, cloud and network infrastructure sustainment.

• Support for adaptive, perfective, and corrective maintenance.

• Adherence to VA policies including the Product Line Management Playbook and Veteran-focused Integration Process (VIP).

• Creation and maintenance of a customer support call center for external VA users.

• Focus on usability, Service Oriented Architecture (SOA), automation, scalability, security (VA ATO or FedRAMP compliant), interoperability (HL7, FHIR, APIs), EHR integration, modular design, performance, API policy adherence, support, industry standards, analytics, user authentication, monitoring integration, referral management repository, and adherence to VA standards.

• Specific metrics include ease of use for design teams, VA staff, and community providers; loosely coupled services; automated workflows; nationwide enterprise scalability; strong data encryption; compliance with VA TRM and Section 508; HL7, FHIR, and API integration capabilities; EHR/EMR integration; modular business capabilities; performance under load; adherence to VA API governance; robust user support; adherence to industry standards (HL7, FHIR, HIPAA); comprehensive reporting and analytics; integration with VA Identity and Access Management (IAM); monitoring integration; and robust referral management technology.

• Period of Performance (PoP): 12 months from award, with four (4) 12-month option periods. Potential for up to 62 months if all options are exercised.

• Place of Performance: Contractor facilities. Travel to Government sites is anticipated and requires COR concurrence.

• Compliance with VA Enterprise Architecture, VA Technical Reference Model (TRM), Zero Trust security controls, FICAM, IPv6, TIC, Standard Computer Configuration, VIP, PLM, PAL, and Authoritative Data Sources.

• Strict adherence to security and privacy requirements, including PII/PHI protection, RMF, A&A, and FICAM mandates (PIV card enablement, NIST SP 800-63-3 compliance).

• Personnel security requirements include background investigations, prescreening, and adherence to VA Directive 0710.

• Deliverables include a Contractor Project Management Plan (CPMP) and Bi-Weekly EPMO Status Reports.

• All work must comply with Section 508 accessibility standards and VA’s cybersecurity requirements.

Request for Information (RFI)

The Department of Veterans Affairs (VA) is seeking demonstrations for a new system to manage Community Care Referrals, Authorizations, and Utilization, and Care Coordination. This RFI aims to gather information on industry capabilities to inform a future recompete of the existing Community Care Referral and Authorization (CCRA) product. The VA is looking for innovative solutions, including those leveraging artificial intelligence (AI), to ensure Veterans receive timely, clinically appropriate, and high-quality care.

Vendors are invited to demonstrate solutions covering:

• Referral Management: Coordinating, managing, and tracking referrals and authorizations, including prior authorization and emergency care transactions.

• Utilization Management: Prospective, inpatient, and retrospective utilization management, including evaluating services for medical necessity and applying VA-defined rules.

• Care Coordination: Workflow management for complex patients, AI integration for optimized workflows, advanced analytics, and tracking of ancillary services.

• Interoperability: Seamless integration with VA and non-VA systems using standards like HL7, FHIR, X12, and DICOM; connection with Health Information Exchanges.

• Medical Documentation: Accepting structured and unstructured documents, automated data capture, and AI for medical record analysis.

• Reporting and Data Analytics: Standard and custom reports, data warehouse integration.

• Member Tracking: Real-time status updates for referrals and notifications for Veterans.

• Identity and Access Management: Robust authentication, authorization, and role-based access control.

• Compliance: Adherence to VA's Technical Reference Model (TRM) and Section 508 Standards, HIPAA, and data security protocols.

• Vendors must provide responses to a rubric spreadsheet. Higher scores will be prioritized for 1-hour demonstrations.

• The solution must be fully deployable at the time of proposal submission, not conceptual.

• Documented examples of successful implementations in healthcare settings with measurable outcomes are required.

• Questions Deadline: January 16, 2026, 12 PM.

• Response Deadline: January 26, 2026, 12 PM.

• Submissions and questions are to be sent via email to Felica Griffin at Felica.Griffin@va.gov.

• Not specified in this RFI.

• This is an RFI only, not a solicitation. No marketing materials are allowed.

• Vendors must indicate their company's business size and status, and relevant NAICS code (541512).

• Provide up to three references for similar solutions provided to VA, other government agencies, or non-government customers.

Solicitation / RFP / RFQ

This document is a Request for Information (RFI) for "CCR&A Vendor Demonstrations" related to the opportunity VA-26-00031811. The Department of Veterans Affairs, Technology Acquisition Center, is seeking information regarding vendor demonstrations.

This RFI references several attached documents that bidders should review:

• RFI Cover CCRA Demos- final.
• PWS CCRA- final draft.
• Rubric Criteria for Referral Managment.

Not specified in this RFI document.

• Response Date/Time/Zone: 01-26-2026 12:00PM EASTERN TIME, NEW YORK, USA

Not specified in this RFI document.

• Solicitation Number: 36C10B26Q0120
• NAICS Code: 541512
• Product Service Code: DA01
• Contracting Office Address: 23 Christopher Way, Eatontown NJ 07724
• Points of Contact: Felica Griffin (Contract Specialist), Kimberly Geran (Contracting Officer).

Form / Attachment / Pricing Sheet

This document outlines the technical and business capability criteria for a system related to referral management. It serves as a rubric for evaluating vendor solutions.

Technical Capability Criteria:

• Usability and User Experience: Focuses on ease of use for VA staff, designers, and community providers.
• Service Oriented Architecture (SOA): Emphasizes modularity, loose coupling, and independent service deployment.
• Portal for Community Providers: Details requirements for electronic referral submission and alternatives.
• Automation First: Prioritizes automation through business rules with manual fallback.
• Scalability: Requires ability to scale for nationwide enterprise applications.
• Security and Compliance: Mandates compliance with VA ATO or FedRAMP, data encryption, and relevant standards (NIST, FISMA, HIPAA).
• Interoperability: Requires integration with existing VA systems using HL7, FHIR, and APIs.
• VA Customization: Ability to support VA-specific data services, SEOCs, RFS, and Program Authority.
• EHR Integration: Need for integration with existing EHR/EMR systems.
• Modular Design: Business capabilities should be modular and substitutable.
• Performance: Ability to process a specified number of referral transactions and business rules within a timeframe.
• API Policy: Adherence to VA API and Data Governance standards, including discoverability and logging.
• Support: Robust user community, documentation, and sandbox environments.
• Industry Standards: Compliance with HL7, FHIR, and HIPAA.
• Analytics & Reporting: Capabilities for out-of-the-box and custom reports, dashboards, and audit trails.
• User Authentication: Integration with VA Identity and Access Management (IAM) and support for standard protocols (JWT, SAML, OAuth).
• Monitoring Integration: Ability to integrate with VA monitoring tools.
• Referral Management Repository: Technology to support referral management and updates.

Business Capability Criteria:

• Referral Workflow and Automation: Focuses on automated processes, tracking, and follow-up.
• Decision Workflow: Requirements for automated rules, manual review, and notifications for approval/denial.
• Communication and Collaboration Features: Enhancements for care coordination and various communication channels.
• Portal for Community Providers: Reiterates requirements for electronic submission and alternatives.
• Support myHealtheVet/VA.gov via referral API's: Specific API requirements for integration.
• Patient Data Management: Data validation and status tracking.
• Clinical Viewer: Display of clinical information associated with referrals.
• Industry Adoption: Familiarity of the product with existing organizations.
• VA Custom Process - Referrals and Authorization: Details VA's specific workflow for referrals and authorizations.
• VA Customization - SEOC, RFS, Program Authority: Addresses VA-specific constructs for managing care bundles, additional services, and financial obligations.
• Scheduling Appointments with Community Providers: Options for appointment scheduling and integration.
• Medical Documentation: Support for ingesting and processing medical documentation.
• Emergency Care: Requirements for handling emergent care notifications.
• VA Precertification: Process for generating and managing VA precertification IDs.
• Care Coordination: Features for managing consults, status updates, and patient history.
• Utilization Management: Support for prospective, inpatient, and retrospective UM, including clinical decision documentation.
• Clinical Review Tool: Integration with clinical review tools and support for peer review.
• Analytics: History of referral changes and advanced analytics for care coordination.
• Emergency Care and Precertification - Interoperability: Requirements for receiving notifications via EDI, HL7, or FHIR.

This document is crucial for vendors to understand the detailed technical and functional requirements for any proposed referral management system. It outlines the specific criteria against which solutions will be evaluated, including interoperability standards, security mandates, customization needs, and desired business workflows. Bidders must address each criterion to demonstrate their capability to meet the VA's requirements.