Common use of VA will Clause in Contracts

VA will. 1. Provide CMS with electronic file(s) in a format defined by CMS, on a timeframe agreed upon by VA and CMS, no more than quarterly. VA will provide CMS with VA’s electronic files via the CMS Acumen Portal, a secured transmission pathway that has been given an Authority to Operate (ATO) and that is to be used as a means to transition the file to and from CMS. The electronic file(s) will include the data fields identified in Section V.C. of this Agreement. 2. Review the electronic file(s) returned by CMS containing the matched enrollment- related data, perform additional validation, and if deemed appropriate, conduct further investigation or refer the cases to OIG for further investigation. Based on additional validation/investigation if VA determines VA program requirements have been violated, VA intends to take action, or refer to OIG for action, against the VA internal and external providers. Such action may be premised on activities that are found to endanger patients of VA and/or evidence improper or erroneous billing practices that may have also occurred with respect to claims for health care provided to VA beneficiaries. The electronic file returned to VA from CMS will be stored on a secure network drive which has been given an ATO. VA will grant access to a limited number of people who have a need for the data. 3. Perform independent reviews for matched VA external providers returned by CMS, for any match VA determines may warrant action and was not referred to the VA OIG, such as reviewing the following: licensing information to determine if the external provider license is valid in accordance with licensing requirements; List of Excluded Individuals/Entities (LEIE) database to determine if providers and suppliers are excluded; court docket information for felony convictions to determine the appropriateness of continued participation in VA programs; provider billing practices to identify anomalies in VA data; and prescription records/Drug Enforcement Administration (DEA) registration information to identify potential issues related to treating Veterans. Actions VA may take include: terminating or modifying existing contractual agreements with the provider; stopping referral of VA patients to the external providers; or performing pre-payment or post-payment reviews of claims paid or submitted. 4. Perform independent reviews for matched VA internal providers returned by CMS, for any match VA determines may warrant action and was not referred to the VA OIG, such as reviewing the following: licensing information to determine if the internal provider license is valid in accordance with licensing requirements; LEIE database to determine if providers and suppliers are excluded; court docket information for felony convictions to determine the appropriateness of continued participation in VA programs; and prescription records/DEA registration information to determine the appropriate action based upon the VA internal providers prescribing privileges within VA programs. VA will refer the results of any such VA reviews to the appropriate Proposing Official to determine whether any personnel actions are appropriate. VA will take appropriate action in accordance with VA Handbook 5021. Actions may include taking disciplinary actions or removing, separating, demoting, or suspending the VA internal providers. 5. Provide Congress and OMB with notice of this matching program and, upon

VA will. 1. Provide CMS with electronic file(s) in a format defined by CMS, on a timeframe agreed upon by VA and CMS, no more than quarterly. VA will provide CMS with VA’s electronic files via the CMS Acumen Portal, a secured transmission pathway that has been given an Authority to Operate (ATO) and that is to be used as a means to transition the file to and from CMS. The electronic file(s) will include the data fields identified in Section V.C. of this Agreement. 2. Review the electronic file(s) returned by CMS containing the matched enrollment- related data, perform additional validation, and if deemed appropriate, conduct further investigation or refer the cases to OIG for further investigation. Based on additional validation/investigation if VA determines VA program requirements have been violated, VA intends to take action, or refer to OIG for action, against the VA internal and external providers. Such action may be premised on activities that are found to endanger patients of VA and/or evidence improper or erroneous billing practices that may have also occurred with respect to claims for health care provided to VA beneficiaries. The electronic file returned to VA from CMS will be stored on a secure network drive which has been given an ATO. VA will grant access to a limited number of people who have a need for the data. 3. Perform independent reviews for matched VA external providers returned by CMS, for any match VA determines may warrant action and was not referred to the VA OIG, such as reviewing the following: licensing information to determine if the external provider license is valid in accordance with licensing requirements; List of Excluded Individuals/Entities (LEIE) database to determine if providers and suppliers are excluded; court docket information for felony convictions to determine the appropriateness of continued participation in VA programs; provider billing practices to identify anomalies in VA data; and prescription records/Drug Enforcement Administration (DEA) registration information to identify potential issues related to treating Veterans. Actions VA may take include: terminating or modifying existing contractual agreements with the provider; stopping referral of VA patients to the external providers; or performing pre-payment or post-payment reviews of claims paid or submitted. 4. Perform independent reviews for matched VA internal providers returned by CMS, for any match VA determines may warrant action and was not referred to the VA OIG, such as reviewing the following: licensing information to determine if the internal provider license is valid in accordance with licensing requirements; LEIE database to determine if providers and suppliers are excluded; court docket information for felony convictions to determine the appropriateness of continued participation in VA programs; and prescription records/DEA registration information to determine the appropriate action based upon the VA internal providers prescribing privileges within VA programs. VA will refer the results of any such VA reviews to the appropriate Proposing Official to determine whether any personnel actions are appropriate. VA will take appropriate action in accordance with VA Handbook 5021. Actions may include taking disciplinary actions or removing, separating, demoting, or suspending the VA internal providers. 5. Provide Congress and OMB with notice of this matching program and, uponupon completion of OMB’s review, publish the required matching notice in the FR.