SF30_Amendment0004.pdf

(x)

16-236-SOL-00023

x x copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

Rockville MD 20857 5600 Fishers Lane, Mailstop 09E70 Division of Acquisition Policy Indian Health Service

06/10/2016000004

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

05/05/2016

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

Amendment 0004 hereby provides a summary of the Global Call Session that was conducted on

May 26, 2016. If any conflict of information exists between what was provided via the

Global Call Session and this Amendment, the information provided herein takes precedence over the information provided via the Global Call.

All updated information is reflected in the attached revised RFP in accordance with

Amendment 0004 and the responses to the questions are provided in the attachment 0001.

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

STEPHEN J. YUTER

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

# Question Answer

Per the minimum quantities provided in the price schedule, is the minimum specialty office visits considered guaranteed to the contractor?

Yes, IHS will hold to the published minimum quantities in the RFP, to the selected offer *See the reduced numbers of minimum quantities under RFP section B.2. Contracting Pricing.

**Administrative error on Section L.1.4, Price, has been fixed to correctly state the equation.

Is it possible to request that the deadline be extended maybe up to 30 days?

Yes, the RFP due date is hereby changed to July 7, 2016, 4 p.m.

EST. Past Performance Questionnaire due date has been adjusted accordingly.

Are there any federal requirements in terms of the security management operations and reporting from FITARA, or FIDASA, or

FISMA that are being waived in this acquisition? None have been waived.

Are there any subcontracting requirements for this RFP?

Yes, please refer to the Section L1.2, element 6, and small business administration website for the requirement detail. Small Business

Individual Subcontract Plan has been added via Appendix I.

Attachment 1

Q&A_Telehealth

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Amendment 0004

Per the ED flow, is the Government looking for overflow coverage for emergency departments or ER physicians to be available on a one to one basis in each ED?

The Government is looking to augment existing staff, not overflow.

Services are anticipated to be real-time and to provide multiple levels of support and assistance to onsite providers.

Per the coding of the patient, can we use the

EMR for coding CPD coding and the level of visit? Or we have to provide them separately?

The Government expects the contractor to use the IHS EMR and complete all the documentation, including recommendations on coding levels.

Will the IHS help the awardee getting the state license and hospital credentials?

No. The awardee is not required to have same-state licensure, but is required to meet all necessary federal licensing and credentialing requirements.

Is there a need for device integration with the patient? Will the proposed devices need to be able to capture vitals, or, include stethoscope, etc.? Will the consultants at the remote site need to see that information?

For the ED setting, no device integration would be needed.

However, for some referral and consultation, non-acute services device connectivity to the kiosk may be necessary (e.g., a stethoscope, EKG, otoscope, ophthalmoscope, and high definition camera, etc.).

Per the cloud hosting versus internal hosting, if we choose the internal hosting, will there be datacenter space available to host the platform?

Yes, there is optimal datacenter space at most of our locations and within the next few months, there will be additional space available.

Should we plan on providing the hardware for internal hosting? So should that be priced in as a part of price proposal? Or would IHS provide the hardware and we would just provide software? No, our virtual network has sufficient storage space.

Does the IHS have an existing Cisco video infrastructure? Will the awardee use the existing Cisco video infrastructure or responsible for providing additional video capabilities beyond the existing settings?

At this time, we have a polycom video infrastructure and we are in the process of evaluating additional or different platforms but we would want incorporate any and all changes through our existing video bridge/infrastructure.

Per the answer to the Question 11, we understand that a video core is not required to be a part of the solution. We are going to assume that there's going to be an existing infrastructure that our telemedicine software can integrate to? The assumption is correct.

Is the billing going to be handled all through

IHS since the contractor will submit CBT codes to IHS.

Yes, IHS will handle billing of third parties for reimbursement of the contracted services.

Billing on the provider services based off of the contractor generated CPT codes.

IHS will handle billing of third parties for the reimbursement of contracted services.

I think to further amplify the question a moment ago about the video core, you have polycom as your current system. Does that mean that the platforms for connection at the bedside should be polycom? Or could we have a software client as long as it's able to connect through the bridge?

Additional listing of the capabilities will be provided via another amendment in the near future.

We do a software video conferencing system, which can connect to a polycom but could also run in parallel. And so the question is could our docs go to our server to the bedside -- our server in your datacenter to the bedside as a parallel network? Or does it have to go through the polycom bridge, polycom border proxy, polycom gateway?

We should be able to run in parallel. The specification, however, telehealth services will be provided via the agency's existing video network and infrastructure as listed in appendix D. Please refer to

Appendix D. IHS has the capability, but we would need to go through the bridge, which can do IP calls as well as bridge calls.

What types of equipment are needed for emergency departments? Can we expect that only audio/video-call capabilities are needed?

Correct. For emergency department telemedicine, it's expected that only audio/video equipment are needed.

The total number of calls, minimum and max have been specified. Are there any traffic patterns available so we can plan peak staffing and minimum staffing?

Traffic pattern data will be provided via separate amendment in the near future.

Are the clinics reside in state territory, not tribal territory? These facilities are primarily in tribal territory.

Per the answer to the Question# 19, are they still governed by state license or is there a federal credential process?

As a contractor with the federal government, the employees of the contractor would not be bound to same-state licensure laws.

As the contractor employees are to be licensed at a state level -- do they have to be licensed in the particular states mentioned in the RFP, or in the contractor's state?

Contractors must be licensed in a state, but are not required to be licensed in the states mentioned in the RFP.

Will IHS be applying bidding preference to native proposers?

See the RFP Section L.1.3., RELEVANT PAST PERFORMANCE, Element 2: All Concerns shall submit a short narrative that describes their experience in working with communities and organizations that represent a broad range of American Indian and

Alaska Native People. Also, offeror shall demonstrate their understanding of IHS mission, goals and customers. However, this requirement is not a set-aside for Indian Owned Businesses under the authority of HHSAR 326.6-Acquisitions Under the Buy Indian

Act.

It is our assumption that the IHS would accept both life video conferencing and store-forward for specialty care. However, IHS previously mentioned via amendment two, item 27, that specialty care services require direct interactions with the patient.

Is store-and-forward an acceptable modality?

Store and forward may be used when appropriate. It is expected that the specialist physician reviewing the information renders a diagnosis and recommendations for treatment.

What are the HIT staffing levels for the sites and will they be participating in supporting the telehealth systems at all?

As the sites are of varying size and operating hours, the staffing level varies. We can offer, as a minimum, a Point Of Contact at each site.

We request that they be made aware of and be involved with the support of telehealth systems but their ability to support calls is varied.

You reference at several points 24 by 7 by

365 support for IT system as well as a continuity for all telehealth services. And

I'm curious what the up time expectations are for these systems? Are you looking at

59s or are you looking at -- how are you going to be accounting for IHS network issues, equipment failures, personnel problems, taking a balance out -- or account for the 24 by 7 support IHS expects 99.9 (3 9s) support capacity.

On page 31, implementing these systems and implementing training -- is there an allowance for staged or phased training and staged or phased program implementation?

Or do all services have to be live at all sites three months from the state of the contracts?

The expectation is a phased approach of these capabilities across the

Great Plains Area.

Given that there will be an allowance for a staged implementation, are there any guidelines to help direct the timing and pace of that so we know kind of what minimum expectations are for rolling out a number of sites and services? Or will that be defined in the scope of work and additional contract negotiations?

It will be defined and in reference to the timeline, the deliverable timelines are indicated in Section C4. The expectation is that the selected contractor would be able to implement within the timelines that we specified in Section C of the RFP for those identified sites.

Can IHS give any more explanation or color behind the specialty volume expected in specialty consults? So trying to staff for that across all the top ten diagnoses, individual expectations of volume could be helpful.

The data that has been presented is (e.g., the top 10 admitting diagnoses) from across the Area. However, there is variance across the different sites in terms of the volumes they see within those categories.

Is IHS designing the kiosk to have an electrocardiogram included in the 24 card solutions?

No, we are not designing the kiosks. That is being left to the bidders to propose what the kiosk would look like and how it should function, but it should include the capability of collecting and transmitting an EKG.

Per the remote emergency care kits or mobile kits, do you intend to allow or have the capability of connecting via the VPN east and west coding that is in your website.

So there are specific VPN connectivity requirements for the east and west, and are you -- will you be enabling anyone from the

IT department to support us in building that

VPN connectivity? So in the mobile kit, for example, if you take it out in the field, do you need the VPN access included in the image that's on the device? Will you help us build that?

No, the telehealth equipment will reside inside the IHS network and, thus, won't require VPN. The only mobile component that we are seeking is not for emergency care. It's strictly within the outpatient clinic department for specialty referral and within the IHS network.

So the item, for example, in the RFP that says emergency services equipment set that you're asking for codes on, a line item of basically your 12 month period, 003 emergency services equipment set. So this is not the intention of this RFP to have a kit on wheels to be able to take out to the field?

No, the equipment is envisioned as being fixed to the facility and

IHS network.

So these emergency services equipment sets are fixed to a wall? It is up to the bidder to determine how best to meet the need.

So there's no (unintelligible) medicine that you are defining in this RFP at the moment.

You're not going -- using paramedics or anything like that to go to the facilities, to drive the facilities or anything like that. This RFP is entirely for telemedicine support within our facilities.

What is the plan to -- for IHS to evaluate the kiosk and their equipment sets? And the reason I ask is I know -- I can imagine that

IHS or the area has a standardized biomedical platform that they'd want to be consistent with and make standardized on so that we have usability between devices at similar levels. Could you walk us through how we should be anticipating the review of our equipment sets and how we can be consistent with the current inventory there?

This is effectively spelled out in Section C4.1.3 and in C4.1.1, specifically Section 4 complexity.

What is anticipated for the evaluation of the telehealth program by the contractor? Is there an evaluation of the efficiency of telemedicine delivered, the effectiveness or cost that you're looking for the contractor to help you understand so that we can get a better handle for how telemedicine might be a benefit to the rest of Indian country?

Refer to the RFP Section L.1.1, Technical Capability, Element 12:

Offerors shall propose a sustainable and effective Quality Assurance and Surveillance Plan to ensure quality Tele-Health services are being deployed. The proposed plan should contain monthly reporting deliverables that will be used by Federal staff to monitor services being performed at all locations.

What version of Outlook and Active

Directory is the IHS using? Currently, IHS is using Outlook 2013 and Server 2008 AD Schema.

In the likely scenario where the specialty provider cannot deliver the care necessary over telemedicine, for example a procedure, a surgery, even diagnosis in some cases, rheumatology, for example, often requires the touch and feel, where do those patients --where will they be treated?

The IHS site will have qualified medical staff to treat patients.

Telemedicine will be used to enhance the services available at the site. If additional services are needed, the established referral processes will be followed.

Where would those referrals go as that would be somewhat part of our network --the specialist to refer to another specialist or refer back to the primary care physician and then they would then provide that care --referral onto another specialist?

It is expected that the specialist consulting will make a recommendation back to primary care. The referral would then be executed by IHS.