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

Questions & Answers / Clarifications

This document contains responses to vendor questions regarding the Request for Information (RFI) for Community Care Referral, Authorization, Utilization Management and Care Coordination Systems (CCRA).

• Response Deadline: The RFI response date has been extended to February 2, 2026 (via Amendment 0001).
• Supporting Documentation: Only the rubric spreadsheet is requested for submission. Additional materials may be provided during the vendor demonstration.
• Demonstration Format: Videos are not permitted as standalone submissions; they may be incorporated into the one-hour live demonstration. Demo patient data or scenarios will not be provided.
• VistA Integration & ATO: VistA integration is required. An Authority to Operate (ATO) from the VA is required for all products, regardless of VistA integration.
• System Preference: While the VA is still in requirements development, they prefer Milliman Care Guidelines (MCG) for prior authorization and admit criteria and are interested in proposals for both AI-assisted Ambient Dictation and integration with VA-provided Ambient AI.
• Deployment & Hosting: The VA prefers VA-managed enterprise cloud hosting and anticipates a phased rollout approach. Vendors should assume responsibility for infrastructure costs and aim for a solution that can obtain a VA ATO within 6 months.
• Volume Estimates: The VA Community Care Program handles over 8.5 million referrals and authorizations annually, with estimated daily message processing between 10 million and 50 million.
• AI Capabilities: AI is expected to support analytics, prioritization, workflow optimization, and decision support, but final clinical and authorization decisions will remain with VA personnel.

This Q&A document clarifies requirements and extends the response deadline, impacting vendor proposal preparation and submission strategies. The VA is still in the requirements development phase and will review RFI responses before determining the final acquisition strategy, potentially leading to a more detailed follow-on RFI or RFP.

Form / Attachment / Pricing Sheet

This document outlines the technical and business capability criteria for vendors responding to a SAM.gov opportunity. It details specific requirements related to referral management systems, focusing on usability, architecture, security, interoperability, and various business functions.

Technical Capability Criteria:

• Usability & UX: Ease of use for VA staff and community providers.
• Architecture: Adherence to Service Oriented Architecture (SOA), loose coupling, and modularity.
• Portal: Functionality for community providers, including electronic submission alternatives.
• Automation: Emphasis on business rules, APIs, and automated workflows.
• Scalability: Ability to handle nationwide enterprise application needs.
• Security & Compliance: VA ATO, FedRAMP compliance, data encryption, NIST standards, FISMA, HIPAA.
• Interoperability: Integration with VA systems (HL7, FHIR, APIs), third-party tools, and EDI Gateway.
• Customization: Support for VA-specific data services (DAS), SEOCs, and RFS processes.
• EHR Integration: Compatibility with existing EHR/EMR systems.
• API Policy: Adherence to VA API standards, discoverability, and logging.
• Support: Robust community, documentation, and sandbox environments.
• Industry Standards: Compliance with HL7, FHIR, HIPAA.
• Analytics & Reporting: Built-in and custom reports, audit trails, referral analytics.
• User Authentication: Integration with VA IAM, SSO, JWT, SAML, OAuth.
• Monitoring: Integration with VA monitoring tools.
• Repository: Database options for referral management.

Business Capability Criteria:

• Workflow & Automation: Automated referral processes, tracking, and follow-up.
• Decision Workflow: Rules for evaluating and approving/denying requests.
• Communication: Features for care coordination and various communication channels.
• Portal: Community provider portal and electronic submission options.
• Patient Data Management: Data validation and status tracking.
• Clinical Viewer: Display of clinical information.
• Industry Adoption: Familiarity of the product with existing organizations.
• VA Custom Process: Handling of VA-specific referral workflows, SEOCs, RFS, and Program Authority.
• Scheduling: Options for appointment scheduling with community providers.
• Medical Documentation: Ingestion and processing of medical documents.
• Emergency Care & Precertification: Workflows for emergent situations and pre-authorization.
• Care Coordination: Features for managing complex patients, task management, and clinical views.
• Utilization Management: Prospective and retrospective review, clinical guidelines, authorization management.
• Clinical Review Tool: Integration with EHR-agnostic tools for peer review.
• Analytics: Referral lifecycle tracking, care coordination analytics.
• Interoperability: Receiving notifications via EDI, HL7, FHIR APIs.

This document is critical for understanding the detailed technical and functional requirements for any proposed referral management system. Bidders must demonstrate how their solution meets or exceeds these criteria, particularly concerning VA-specific customizations, interoperability standards, security mandates, and automation capabilities. It serves as a comprehensive checklist for proposal development and system design.

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 Patient Encounter (IPE) systems. The goal is to expedite Veterans’ access to community care by improving referral, authorization, utilization management, and care coordination processes.

Services include software maintenance, configuration, development, testing, integration, installation, implementation, training, customer support, optimization, cloud and network infrastructure sustainment, and adaptive, perfective, and corrective maintenance for the HSRM solution, which is hosted in the AWS FedRAMP High Government Cloud.

• Project Management: Contractor Project Management Plan (CPMP) and Bi-Weekly EPMO Status Reports.
• Referrals and Authorizations: Manage and track referrals and authorizations, accept prior authorization and emergency care transactions.
• Utilization Management: Support prospective, inpatient, and retrospective utilization management, including medical necessity evaluation and auditing with advanced analytics.
• Care Coordination: Workflow management for high-complexity patients, AI integration for workflow optimization, advanced analytics on care data, and integration with direct care systems.
• Clinical Review Tool Integration: Support clinical review for appropriateness using tools like InterQual and Milliman Care Guidelines.
• Interoperability: Seamless integration with VA and non-VA healthcare systems using standards like HL7, FHIR, and DICOM; connect with Health Information Exchanges.
• Medical Documentation: Accept structured and unstructured documents, automated data capture, and AI/ML for flagging cases.
• Reporting and Data Analytics: Provide standard and custom reports, support data warehouse integration.
• Security & Compliance: Adherence to VA policies, Technical Reference Model (TRM), Zero Trust controls, FICAM, IPv6, TIC, standard computer configurations, VIP/PLM, and Section 508 standards. Ensure protection of PII and PHI.

Performance will be assessed based on Technical/Quality of Product/Service, Project Milestones and Schedule, Cost & Staffing, and Management. Specific Technical Performance Metrics include Usability, Service Oriented Architecture, Automation First, Scalability, Security and Compliance (VA ATO or FedRAMP), Interoperability, EHR Integration, Modular Design, Performance, API Policy, Support, Industry Standards, Analytics & Reporting, User Authentication, Monitoring Integration, and Referral Management Repository.

• Performance Period: 12 months from award, with four (4) 12-month option periods. Potential total period of performance up to 62 months.

• Place of Performance: Contractor facilities. Travel may be required and will be in accordance with Federal Travel Regulations (FTR) with COR concurrence.

• Security: Strict adherence to VA security and privacy requirements, including PIV card enablement, RMF, Zero Trust, FICAM, and data protection (PII/PHI).

• Personnel: Contractor personnel require background investigations commensurate with task risk designation.

• Deliverables: Electronic format (MS Office Suite, PDF).

• Hosting: AWS FedRAMP High Government Cloud.

• Compliance: Adherence to VA Enterprise Architecture, VIP, PLM, and OIT Process Asset Library (PAL).

Request for Information (RFI)

This RFI solicits demonstrations for a new system to manage Community Care Referrals, Authorizations, and Utilization (CCRA) and Care Coordination. The Department of Veterans Affairs (VA) aims to gather information on industry capabilities, including AI integration, to inform a future recompete of the existing CCRA product. The VA envisions a next-generation system that transforms Veteran access to community care, ensuring timely, clinically appropriate, and high-quality care through modern technologies and interoperability.

Vendors are invited to demonstrate solutions covering:

• Referrals and Authorizations: Management, tracking, and prior authorization/emergency care transaction processing.

• Utilization Management: Prospective, inpatient, and retrospective UM, including medical necessity evaluation, auditing, and application of VA-defined rules and clinical guidelines (e.g., InterQual®, Milliman Care Guidelines).

• Care Coordination: Workflow management for complex patients, AI integration for optimized workflows, advanced analytics, and integration with direct care systems.

• Interoperability: Seamless integration with VA/non-VA systems using standards (HL7, FHIR, X12, DICOM), Health Information Exchanges, and transparent, auditable AI decisions.

• Medical Documentation: Acceptance of structured/unstructured documents, EHR integration, automated data capture, and AI analysis of medical records.

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

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

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

• Compliance and Security: Adherence to VA's Technical Reference Model (TRM), Section 508 standards, HIPAA, and secure handling of PII/PHI.

• Vendors must provide responses to a rubric spreadsheet, with higher scores prioritized for 1-hour demonstrations.

• Demonstrations must showcase fully deployable solutions with documented successful implementations and measurable outcomes.

• Due Date Extended to February 2, 2026, 12 PM ET.

• Responses are to be emailed to Felica.Griffin@va.gov with "36C10B26Q0120 CCR&A" in the subject line.

• Not specified as a set-aside. Vendors should indicate company business size and status, particularly referencing NAICS code 541512.

• This is an RFI for information and planning purposes only; it is not a solicitation.

• No marketing materials are allowed; only requested information will be reviewed.

• The VA may request a one-hour demonstration within 30 days after the submission deadline.

Amendment / Modification

• The due date for the Request for Information (RFI) has been extended to February 2, 2026, by 12:00 PM EST.

• Questions received are currently under review.

• An official amendment containing responses to questions will be issued shortly.

• Due Date

• Bidders now have until February 2, 2026, to submit their responses or questions for the RFI.

Other / Unclassified

This document is a Request for Information (RFI) related to "CCR&A Vendor Demonstrations" (VA-26-00031811). It includes several attached documents:

• RFI- Special Notice Extension
• RFI Cover CCRA Demos- extension
• PWS CCRA- final draft
• Rubric Criteria for Referral Management

This RFI serves to gather information from vendors regarding demonstrations for CCR&A. Potential bidders should review the attached documents, particularly the PWS and Rubric Criteria, to understand the scope of work and evaluation considerations. The response date is February 2, 2026, at 12:00 PM Eastern Time. The contracting office is the Technology Acquisition Center in Eatontown, NJ (ZIP code 07724). The Point of Contact is Felica Griffin, Contract Specialist, at Felica.Griffin@va.gov.

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.