Telehealth_QA_Amendment_0002_FBO.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

05/24/2016000002

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 0002 includes the answers to questions received in accordance with RFP Section

L.2.

See Attachment 1.

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.

Attachment 1

Q&A_Telehealth

16-236-SOL-00023

Amendment 0002

# RFP Page Section# Section Title Question Answer

1 2 B.2 Contract pricing Is it possible to introduce stepped pricing for Kiosks and ED set up based on quantity ordered?

Yes. Offerors are allowed to provide discount terms based upon quantity. Discounted pricing shall be reflected on the submission under RFP section L.1.4.

2 17 C.3.1 General requirements

Will the full scope of telehealth services for Emergency department services be required or will limitations at the originating site be acknowledged e.g. space and technical capabilities?

The full scope of telehealth services for Emergency department services will be required. If needed, the government will make necessary adjustments.

3 18 C.3.3.2

Contract Administration (para 1)

What are the specifications for these records? Would an electronic payroll system serve to meet these requirements?

It is the contractor's responsibility to assign work effort and maintain proper and accurate time keeping records of personnel assigned to work on the requirement.

4 18 C.3.3.2

Contract Administration (para 2)

What are the specifications for these plans? Are templates available? There is no standard template for this requirement.

5 18 C.3.5

Contractor Personnel, Disciplines, Specialties

Does the telehealth program need to be accredited or does the contractor need to be accredited (i.e. JCAHO) Yes.

6 19 C.3.5

Contractor Personnel, Disciplines, Specialties

Is there flexibility in the event the market for labor shifts and changes are necessary to meet contractual requirements?

The Offeror should base their prepared solution with reasonable escalation to support Fixed-Price and Labor Hour CLINS.

7 19 C.3.6 Location and Hours of Work

The RFP states the originating site is the location of an IHS beneficiary at the time the service furnished via a telecommunications system. Will services always occur at an IHS service unit? Yes, services will only be within IHS healthcare facilities.

8 20 C.4.1.1 Performance Requirements

Does the IHS EMR have the ability to upload and store images for our providers to access? Yes.

9 20 C.4.1.1 Performance Requirements

Are there specific requirements for the timeframe a specialty service needs to be scheduled?. E.g.

appointments scheduled within 3 days?

No. However, the timeframe should meet commonly accepted access to care standards for referrals.

10 20 C.4.1.1 Performance Requirements

Is there latitude in the scope of telehealth services provided related to limitations on space identified at the originating site?

The full scope of telehealth services will be required by the government. If needed, the government will make necessary adjustments

11 20 C.4.1.1 Performance Requirements

Please define "Remote Control Monitor" requirement.

Does this mean there is a remote control that can be used for the monitor or that the monitor needs to be able to be controlled from a remote location?

The wording is "remote control enabled monitor." This means the monitor has a remote control for volume, power, inputs, etc. This does not mean that the monitor may be controlled from the distant site.

12 20 C.4.1.1 Performance Requirements

What are the specifications of a Telehealth Kiosk and are there vendor requirements and restrictions based on capabilities of originating site?

Telehealth kiosks should be televideo capable with connected medical devices (high resolution camera, stethoscope, otoscope, ophthalmoscope, and electrocardiogram).

13 20 C.4.1.1 Telehealth Equipment

As we read your RFP is was not completely clear to us what your specific vision / expectation is of the kiosks.

a. Are kiosks to serve as the “Originating Site” or the “Distant Site” in the treatment of patients - stated another way, are the kiosks for the patients or for the clinicians?

b. if the kiosks are “Originating Sites” to be used by clinicians, presumably to treat patients physically present at “Distant Sites,” how are you defining the “Distant Site.”

c. what are the required capabilities of the “Distant Sites” if they are not kiosks?

d. if the kiosks are the “distant sites” to be used by patients, please confirm.

Per the American Telemedicine Association Glossary - The distant site is defined as the telehealth site where the provider/specialist is seeing the patient at a distance or consulting with a patient’s provider. (CMS) Others common names for this term include – hub site, specialty site, provider/physician site and referral site. The site may also be referred to as the consulting site. Based on this definition, the kiosk is envisioned at the originating site with the patient at an IHS facility. Refer to answer to the question# 14.

14 20 C.4.1.1 Telehealth Equipment

The kiosks are required by the RFP to be "mobile and portable" (C.4.1.1). We’d like to know more about how you are defining mobile and portable. For instance, if we were to send a truck and a two man assembly / disassembly team to a kiosk site to break a kiosk down, truck it to another site and re-assemble the kiosk at a new site, would that meet your definition? Or, are the kiosks to be truly mobile such as if the kiosks were within dedicated RVs? Is your vision a telehealth kiosk similar to an ambulance with the addition of a telehealth capability?

The kiosk is envisioned to be a mobile cart for use within an existing outpatient examination room, include televideo capability and connected medical devices (high resolution camera, stethoscope, otoscope, ophthalmoscope, and electrocardiogram).

15 20 C.4.1.1 Telehealth Equipment

Assuming the kiosks are distant sites and not meant to be RV based, Are the kiosks you're asking for kiosks to be in installed indoors or outside?

a. if indoors, who is providing the inside space and what is the nature of the space the kiosks will occupy?

sq. feet, ceiling height, climate control, electrical, security, etc. Are their know space and high and weight requirements of the kiosks?

b. if these kiosks are to be free-standing outdoor kiosks (“distant sites”), will the IHS provide the locations? or must we budget to lease or buy land and create access, parking, etc.

c. would it satisfy the RFP if the proposed “Distant Site” kiosks were installed within existing, convenient, 3rd party, retail establishments?

d. would it satisfy if the same kiosks were also available to non American Indians?

Per the American Telemedicine Association Glossary - The distant site is defined as the telehealth site where the provider/specialist is seeing the patient at a distance or consulting with a patient’s provider. (CMS) Others common names for this term include – hub site, specialty site, provider/physician site and referral site. The site may also be referred to as the consulting site. Based on this definition, the kiosk is envisioned at the originating site with the patient at an IHS facility.

16 20 C.4.1.1 Telehealth Equipment

The RFP mentions the word “kiosk”. I have done a lot of Telemedicine installs around the country and “kiosk” can mean a couple things. Does the term kiosk in the RFP mean an enclosure or a walk up to station/telehealth cart?

The kiosk is envisioned to be a mobile cart for use within an existing outpatient examination room, include televideo capability and connected medical devices (high resolution camera, stethoscope, otoscope, ophthalmoscope, and electrocardiogram).

17 21 C.4.1.2 Performance Requirements

Would any of the following options be an acceptable alternative to documenting in the IHS EMR

• Print the provider dictation (note), send to you and then you scan it into your system.

• Interface a CCD document to your system.

• Interface using our system to yours.

• Send a Direct Message from our system to your provider.

• Other?

No, it is expected that providers will document directly into the

IHS EMR.

18 21 C.4.1.2 Performance Requirements

Do each of your facilities have their own instance of the EMR or are all 14 SU hosted on a single instance? Each site has their own EMR instance.

19 21 C.4.1.2 Performance Requirements

How will the reimbursement work for the clinical services?

Who will be responsible for patient billing?

Who will be responsible for coding of these visits?

IHS is responsible for billing and coding. The contractor is responsible for providing care and documentation, such that a billable visit is generated (if applicable). The contractor will be reimbursed according to CPT E/M coding rules based on received documentation in the EMR. The government will make reimbursements to the contractor in accordance with the award pricing which is to be produced under RFP Section B.2., CONTRACT PRICING. For reference, see PWS Section C.4.2.1, Performance Standards and AQL Criteria 1) Documentation, & RFP Section L.1.1, Element 10.

20 21 C.4.1.2 Performance Requirements

Will the scheduling and registration process be done within the IHS EMR? No.

21 21 C.4.1.2 Performance Requirements

What are the obligations of the IHS system to assure timely requirements noted in the deliverable schedule should problems reside with the IHS record?

IHS will provide access to the EMR and address issues in a timely manner. If the issue cannot be resolved in a timely manner, IHS will make necessary adjustments as needed basis.

22 21 and 22 C.4.1.3 and C.4.1.4

Performance Requirements

The RFP includes “upon contract award” language – for example, in Sections C.4.1.3 and C.4.1.4. Please confirm that this language actually indicates that these requirements are due consistent with the Deliverable Schedule provided at C.6.1, as opposed to at the time of award.

Yes, deliverable schedule for section C.4.1.3 & C.4.1.4 are provided in section C.6.1.

23 22 C.4.1.4 Performance Requirements

What are the criteria used by IHS to determine approving or declining privileging by proxy. Can more detail be provided related to this?

IHS is committed to using credentialing by proxy when possible.

Privileging will take place at the originating site. In both cases, potential providers are held to the same standards as if they applied without the proxy process.

24 23 C.4.2.1 Performance Requirements

What or who determines whether it’s appropriate for the specialty telehealth provider to directly provide services to evaluate treat or follow up on a patient OR provide consult services to the originating site IHS provider. Is this the professional judgment of the specialty provider?

This decision will be based on input from the specialty provider, needs of the patient, and originating site capabilities.

25 23 C.4.2.1 Performance Requirements

Originating site Presenter. Will the Presenter be a medically trained professional?

In most cases, the presenter will be a medical assistant or nurse, but could be a medical provider or behavioral health provider.

26 23 C.4.2.1 Performance Requirements

What is the definition or criteria for a substantiated complaint and who makes that determination?

Each site has Policies and Procedures regarding complaints, and these will be followed. The originating site will review and/or investigate complaints for substantiation, as with any other received complaint/grievance.

27 23 C.4.2.1 Performance Requirements

What are the criteria to demonstrate the Specialty Consultant was directly involved. (i.e. do they need to be present in the exam or must they review the evaluation and plan on each patient and sign off?)

The specialty consultant at the distant site must directly interact with the patient at the originating site to demonstrate direct involvement. Direct interaction may be through an interpreter. A mid-level provider acting on behalf of the specialty consultant will not satisfy this requirement.

28 23 C.4.1. Tele-ED How many ER physicians are required. One for each 14 clinics?

The contractor will propose the appropriate number of Emergency Medicine physicians to meet the potential need of the 7 Emergency Departments.

29 23 C.4.1. Tele-ED Number of expected patient to be seen by Tele-ED MD.

Current workload volumes for the 7 Emergency Departments was provided. The contractor should estimate anticipated volume as a fraction of the current workload based on experience and current evidence.

30 24 C 4.2.2 Performance Requirements

What is the specific requirement for documentation of patient transfers to be completed “with haste” prior to a patient transfer. Is it possible to re state that the distant site will meet requirements of CMS and or JCAHO related to these requirements?

The requirement has been changed to: "Documentation for patient transfers will be completed in accordance with CMS and/or JCAHO regulations/policies/requirements." PWS Section 4.2.2 has been revised accordingly via RFP Amendment 0002.

31 25 C.4.2.3 Performance Requirements

What level of support is within the 15 minute timeframe? Call acknowledged, dispatched, resolved?

Acknowledgement and initiation of the support/troubleshooting process is expected within 15 minutes.

32 27 C.4.2.7 Performance Requirements

Is the CME training course provided by IHS or can the contractor utilize existing courses required by the organization to meeting this requirement?

The requirement is for 1 hour of CME/CE in cultural sensitivity/competence. It does not mandate a source for this training.

33 27 C.5.1 Security and Safety

What are the limitations of these requirements in conjunction or contrast to existing provider contracts? Is there latitude in relationship to this requirement in this regard?

Reciprocity will be allowed for background investigations as long as a full background investigation was conducted on the provider.

If there was no full investigation, a full investigation will need to be completed on each provider.

28 C.5.2 Reporting

Section C.5.2 of the RFP references “the reporting plan submitted as part of the proposal”; please identify the “reporting plan” to which the Government is referring.

The list of deliverables in Section C.6.1 does not include a “reporting plan”, nor is such a report clearly identified in Section L.

Bi-annual Status Report and Annual Performance Report requirements are hereby added under Section C.6.1, Deliverables Schedule. PWS Sections C.5.2 and C.6.1 have been revised via RFP Amendment 0002.

35 28 C.5.2 Reporting Is all of the data that is needed for the required reports captured in the IHS EMR? No, additional forms of data collection will be required.

36 28 C.5.2 Reporting If all information is captured in IHS EMR, will we have access to this data for report generation? Some reports from the EMR will be available.

37 28 C.5.2 Reporting Is the EMTALA report being generated in the IHS EMR today? No

38 28 C.5.2 Reporting What is the definition of official complaint and adverse outcome?

These are determined by the originating site Policies and Procedures.

39 31 C.6.1 Deliverables Schedule What are the penalties if there are schedule delays? Penalties will be handled on a case-by-base basis.

40 31 C.4.1.3 Deliverables Schedule

What are the consequences if required credentialing cannot be achieved due to delays with outside agencies?

Is there any latitude related to this requirement? Consequences for delays will be handled on a case-by-case basis.

41 36 G.7 Rights in Data

What are limitations of disseminating information – particularly within the Contractors own organization.

Does this apply to disseminating information in the organization to achieve quality improvement outcomes?

Is prior written approval required for internal organizational use as well?

Permission for disseminating information is dependent on the type of information. Non-identifiable and aggregated data may be disseminated within the Contractor's own organization without permission. Personally-identifiable and Protected Health Information dissemination is governed by HIPAA regulations.

42 36 and 60 G.4 and L.1.2 Key Personnel

Section G.4 of the RFP indicates that both Project Managers are required to have 3 years experiencing managing telehealth projects; Section L.1.2 specifies a minimum of 5 years’ experience working with telemedicine services. Please clarify this apparent conflict in the minimum requirements.

3 years is correct: section L.1.2. is revised via RFP Amendment 0002.

43 57 L

Instructions, Conditions, and Notice to Offerors

The Section L, Instructions, Conditions, and Notice to Offerors, state that “The section template to be used for the proposals is provided in L.4.” Please confirm that the Government is actually referring to Section L.5 of the RFP.

Correct: the section template is provided under Section L.5.: the section number is corrected via RFP Amendment 0002.

44 57 L.1 Content of the Technical Proposal

Section L.1 of the RFP states that font sizes shall be no smaller than Times New Roman 11 font. Will the Government allow a smaller font size for tables and figures; Times New Roman 8 font is often used in tables and figures.

No: font size for tables and figures shall not be smaller than Times New Roman 11 font.

45 61 L.1.2

Management Approach/Key Personnel

Section L.1.2, Element 6, references the Offeror’s small business subcontracting goals. Please confirm that Element 6 is not applicable to small businesses responding to this solicitation.

Correct: section L.1.2, Element 6, is not applicable to small business offerors.

46 61 L.1.2

Management Approach/Key Personnel

Section L.1.2 of the RFP indicates that the Small Business Subcontracting Plan is to be provided, and indicates that it is an attachment to the RFP. This plan is not identified as an Appendix in the Section C.1 Index. Please provide the attachment. The plan is hereby attached as Appendix I.

47 61 and 62 L.1.3 Relevant Past Performance

Section L.1.3 of the RFP states that Offerors are “required” to provide evidence of no less than 3 and “at most” 5 past performance contracts. Further, this Section specifies that proposed subcontractors must provide information on 3 contracts. With the understanding that the “Offeror” is the bidder (prime and all subcontractors), a Prime contractor submitting the minimum 3 required references with a single subcontractor, also submitting the required 3 references, will exceed the mandated maximum of 5. Please clarify the requirement.

The requirement is hereby changed to: "Proposed subcontractors must also complete the template for at least (1) contract." The submission instruction under L.1.3, is revised via RFP Amendment 0002.

48 61 L.1.3 Relevant Past Performance

Section L.1.3 of the RFP directs that “Offerors are instructed to complete the past performance reference template (see Attachment)” as well as “submit the past performance surveys” and that “[t]his submission shall be limited to 15 pages, excluding the questionnaires.”

Please confirm that these references to “template,” “surveys,” and “questionnaires” are all referencing Appendix H to the RFP.

Yes, the references to "template," "surveys," and "questionnaire" are all referencing Appendix H. The submission instruction under section L.1.3, is hereby revised via RFP Amendment 0002.

49 62 L.1.3 Relevant Past Performance

Section L.1.3, Element 2 states that “All Concerns shall submit….” Please define “Concerns” as it applies to this Element. The term "Concerns" refers to the prime and subcontractor(s).

50 63 L.2

Electronic Transmission of Proposals

Section L.2 of the RFP instructs the Offerors to email their proposals to the provided addresses NLT 4:00 PM (EST) on 6 June 2016. Is there a file size limitation for these email addresses?

The file size limitation for each email sent to IHS is 18 MB.

Separate emails can be sent with a proper subject identification title.

51 64 L.5 Proposal Section Template

Section L.5 of the RFP states that “Offerors are allowed to add additional information - before and after the mandated sections” of the proposal. For example, if an Offeror provides 2 pages of “additional information” to include introduction and company background, preceding the 30 pages of Technical Capability responding to the 17 Technical Elements (for a total of 32 pages), will the Government evaluate the Technical Element information found on pages 31 and 32? Please confirm that providing “additional information” before a mandated section will not be viewed as exceeding the page limit such that an Offeror’s mandated section materials will not be considered by the Government.

Additional information shall be limited to 2 pages and the submission will not be used for proposal evaluation. Page limitations for the technical factors shall not be increased due to the additional information submission. Submission instruction under section L.5., is hereby revised via RFP Amendment 0002.

52 68 Appendix A

ER Dept.

Description & Capabilities

Who is responsible for reading/interpreting stat ED imaging studies?

Stat ED imaging studies will be read/interpreted by either the facility radiologist or the contractor Emergency Physician.

53 70 Appendix A

ER Dept.

Description & Capabilities

Current status of Rosebud ER. How many of the physician, nurse/midwife and PA positions are currently vacant or are staffed with locums? Adequate level of staffing will be provided at the Rosebud ER.

54 76 Appendix D

IHS System Environment

What is the utilization on each of the circuits for all the 14 locations?

The majority of the sites are currently at less than 50% overall bandwidth capacity. For those that are greater than 50%, upgrades are currently in progress.

55 76 Appendix D

IHS System Environment

What is the acceptable call rate to each location, our standard call is 1 meg Up to 1Mb/sec is acceptable.

56 76 Appendix D

IHS System Environment What are "Upgrade pending" sites being upgraded to?

This varies from site to site, but the majority of sites are being upgraded to either DS3 (43Mb/sec) or 50M Ethernet circuits or higher. We do have a few small clinics that will be at 10 Mb/sec, 20 Mb/sec or 30 Mb/sec upon completion of the upgrades.

57 76 Appendix D Video Equipment

How many ports of the 4 PRI's can be dedicated to Telemedicine calls We can add PRI’s if needed.

58 76 Appendix D Video Equipment

How much IP bandwidth/calls could be dedicated to the IHS bridge for Telemedicine Up to 30 Mb/sec.

59 76 Appendix D Video Equipment

What is the current throughput configuration for the VBP and what is the average utilization today?

Current throughput is 25 concurrent calls at 384K, just under 10Mb/sec. We have additional capacity available.

60 76 Appendix D VPN Does IHS VPN have split tunneling enabled? No.

61 N/A N/A N/A Is this a follow-on requirement? If so, would it be possible for you to provide the incumbent information? This is a new requirement; there is no incumbent.

62 N/A N/A N/A

Should we present a proposal for our individualized services or do we need to find a partner and become a sub-contractor to them?

The Government is seeking an awardee that can provide a total solution to the requirement.

63 N/A N/A N/A

We noticed in your RFP that IHS already has a video platform and is planning to use your EMR for documentation. Would IHS consider alternative strategies to this model if we were able to show the value in our platform? And would you be interested in exploring that platform in more detail if you were unable to find a single vendor to meet the entire scope of your project?

No. IHS cannot use an alternate EMR. The Contractor shall be able to meet the scope of the RFP.

64 N/A N/A N/A

Could you please provide a list of prime vendors for your Department? We offer telehealth software as a solution but not the support staff for the Medical model you are seeking. We are hoping that we could find a prime who can deliver the support for on the back-end and VTConnect would provide the software solution. There is no list of IHS identified prime vendors.