36C24218R0013-002.docx

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24218R0013 07-18-2018

LISA M. TOMPKINS, ACO

315-425-4846 3:00 PM EST

8-20-2018 Department of Veterans Affairs Network Contracting Office 02 1304 Buckley Road Suite 101 Syracuse NY 13212

XX

621498 $20.5 Million X N/A X Department of Veterans Affairs Syracuse VA Medical Center 800 Irving Avenue Syracuse NY 13210-2716 Department of Veterans Affairs Network Contracting Office 02 1304 Buckley Road Suite 101 Syracuse NY 13212

Tungsten Network http://www.tungsten-network.com/us/en /veterans-affairs

See CONTINUATION Page Community Based Outpatient Clinic (CBOC) services located in Cayuga County, NY. Clinic will service the Veterans in Cayuga County and the surrounding area as described herein.

See CONTINUATION Page X X two Allan M. Preston Contracting Officer Table of Contents

ATTACHMENTS:

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA (Continuation from Standard Form 1449, Block 18A)

1. CONTRACT ADMINSTRATION: All contract administration matters will be handled by:

a. CONTRACTOR:

Name: ____________________________________________________

Address: __________________________________________________

City/State/Zip Code: _________________________________________

TAX ID Number _______________________________________________________

DUNS Number_________________________________________________________

Point of Contact/Title ___________________________________________________

Email: _______ ________________________________________________________

Telephone Number_____________________________________________________

Fax Number__________________________________________________________

b. Government:

Lisa Tompkins, Administrative Contracting Officer Dept. of Veterans Affairs 1304 Buckley Road, Suite 101 Syracuse, NY 13212 Phone: 315-425-4846

FAX: 315-425-4883

Lisa.Tompkins@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with 52.232-33, Payment by Electronic Funds Transfer – Central Contractor Registration (OCT 2003)

3. INVOICES: Invoices shall be submitted monthly in arrears.

4. GOVERNMENT INVOICE ADDRESS: Invoices will be electronically submitted to the Tungsten website at http://www.tungstennetwork.com/uk/en/

5. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

6. CONTRACT MODIFICATIONS:

The Contractor is advised that only the Contracting Officer, acting within the scope of the contract and his/her duties and responsibilities and after advice and consultation with the Contracting Officer’s Representative (COR), has the authority to make changes that will affect contract prices, quantity, quality, delivery terms and conditions, or the term of the contract. In no event shall any understanding or agreement, modification, change order, or other matters in deviation from the terms of this contract between Contractor and a person other than the Contracting Officer be effective or binding upon the Government. All such actions must be formalized by the proper contractual document executed by the Contracting Officer

7. CONTRACTING OFFICER’S REPRESENTATIVE:

Prior to award, the Contracting Officer will designate the Program Specialist for Primary Care to act as Contracting Officer’s Representative (COR). All work coordination shall be made through the COR. The Contractor shall be provided a copy of the letter of delegation authorizing the COR at the commencement of the term of this agreement. No other person shall be authorized to act in such capacity unless appointed in writing by the Contracting Officer.

8. TECHNICAL INQUIRIES: Technical inquiries shall be made in writing via email to Lisa Tompkins, Contract Specialist lisa.tompkins@va.gov Inquires must be received a minimum of 10 business days before the closing date listed in block 8 of Standard Form 1449. If warranted, responses to inquiries will be incorporated into a written amendment posted to the Federal Business Opportunities website at http://www.fbo.gov

9. SOLICITATION/CONTRACT:

This solicitation and resulting contract adheres to the format defined in FAR 12.303 for the acquisition of commercial items. This procurement is being conducted according to a combination of Parts 12and 15 of the FAR. The text of the FAR is available at http://www.arnet.gov/far/.

10. CONTRACT PERFORMANCE:

Contractor shall be required to begin treating patients under this contract no later than one hundred and twenty (120) days after the date of award of this contract.

Offeror should thoroughly review the specifications and become familiar with areas of coverage prior to submitting a proposal. Failure to understand the contract requirements shall not relieve the successful offeror from performing in accordance within the strict meaning and intent of the specifications. Pricing shall include all facility, management, professionals, technical and labor necessary to perform specifications as outlined herein. The Government will not reimburse any costs not incorporated into the Offeror price.

11. POST AWARD ORIENTATION (Awards over $1M):

The Contracting Officer will schedule a post award orientation conference for contract orientation purposes as required by IL 003A3-12-04, which is available at http://www.va.gov/oal/docs/library/ils/il12-04.pdf.

12. PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL:

All personnel employed by the Contractor must comply with Homeland Security Presidential Directive 12 (HSPD-12). Office of Management and Budget (OMB) Guidance M-05-24 and Federal Information Processing Standards Publication (FIPS PUB) Number 201, which requires all federal employees, contractors, and affiliates to have a Personal Identity Verification (PIV) identification card. The PIV process will be initiated and completed by the VA Medical Center. The Contractor will be responsible for all costs associated with transportation of the employee to the VA Medical Center to initiate the fingerprinting and overall.

13. ATTENTION LARGE BUSINESSES:

A subcontracting plan is required in accordance with Federal Acquisition Regulation 52.219-8 and 52.219-9 and Department of Veterans Affairs Acquisition Regulation 852.219-9. Any proposed subcontracting plans must be submitted with initial offers. If during performance the subcontractor becomes ineligible to provide services, the Contractor must notify the VA immediately.

The subcontracting goals are as follows: Small Business- 17%; Small Disadvantaged Business -5%; Veteran-Owned Small Business-7%; Women-Owned Small Business-5%; Service-Disabled Veteran-Owned Small Business-5%; and HUBZone Small Business-3%.

14. LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes FAR 52.219-4 Notice of Price Evaluation Preference for HubZone Small Business Concerns. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

15. SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.

(End of Clause)

16. SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes FAR 52.219-9, Small Business Subcontracting Plan, and VAAR 852.219-9, VA Small Business Subcontracting Plan Minimum Requirement. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing the contractor's compliance with the plan, including reviewing the contractor's accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting plan.

(End of Clause)

B.2. SPECIAL CONTRACT REQUIREMENTS

1. CONTRACT COORDINATOR: The Contractor shall identify in writing to the CO their contact person(s) who shall serve as liaisons between the Contractor and VA and who shall ensure that services are performed in accordance with the contract specifications. The Contractor’s contact person(s) shall be available during VA regular administrative work hours, exclusive of national holidays.

Name ____________________________________________________

Phone Number ____________________________________________________

Email ____________________________________________________

1. AUTHORIZED NEGOTIATORS: The offeror represents that the following persons are authorized to negotiate on its behalf with the Government in connection with this Request for Proposals:

Name/Title ____________________________________________________

Telephone Number ____________________________________________________

Email Address ____________________________________________________

Name/Title ____________________________________________________

Telephone Number ____________________________________________________

Email Address ____________________________________________________

2. STATUS AS INDEPENDENT ENTITIES: None of the provisions of this contract are intended to create or shall be deemed or construed to create any relationship between VA and the Contractor other than that of independent entities contracting with each other solely for the purpose of effecting the provisions of this contract. Neither VA nor the Contractor, nor any of their respective agents, employees or representatives, shall be construed to be the agent employee or representative of the other.

3. NON-SOLICITATION: Neither the Contractor nor any employee, agent or subcontractor of the Contractor shall solicit or attempt to convince or otherwise persuade any veteran not to participate or to discontinue participation in the services provided under this contract.

4. NON-EXCLUSIVE CONTRACT: This contract is non-exclusive and shall not prohibit VA or the Contractor from entering into agreements with other health care providers or purchasers of health care services.

36C24218R0013

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B.3 SCHEDULE OF SUPPLIES/SERVICES

Under the authority of Title 38 U.S.C. 8153 the Contractor agrees to provide Primary Care services in accordance with the terms, conditions, and provisions stated herein at the prices specified in the Schedule of Supplies/Services. Proposed Contractor facility must be physically located within the boundaries of Cayuga County in the state of New York. Veterans to be serviced under this contract reside primarily in Cayuga County, however; residency is not restricted to this county. The Parent Facility for this CBOC is the Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY. Payment for primary care services shall be based on a monthly capitated rate, as further explained within this solicitation.

The quantities listed in the Price Schedule below are estimates only and are not to be considered a minimum or maximum. The guaranteed minimum contract amount, including the base year and any option years exercised, is $500,000.00 and the maximum contract amount, including the base year and any option years exercised, shall not exceed $10,000,000.00. A task order shall be issued at the start of each performance period.

BASE YEAR – 12/1/2018 through 11/30/2019

EACH

Total for Base Year $________________________

OPTION YEAR 1 – 12/1/2019 through 11/30/2020

Total Estimated Cost

EACH

Total for Option Year 1 $________________________

OPTION YEAR 2 – 12/1/2020 through 11/30/2021

Price Per Unit

Total Estimated Cost

EACH

Total for Option Year 2 $________________________

OPTION YEAR 3 – 12/1/2021 through 11/30/2022

EACH

Total for Option Year 3 $________________________

OPTION YEAR 4 – 12/1/2022 through 11/30/2023

EACH

Total for Option Year 4 $________________________

SUM TOTAL FOR BASE AND OPTION YEARS $___________________________

Contractor will be provided a list of all enrolled patients to be followed at the beginning of the contract. Contractor will be able to bill for these patients immediately. In order to remain enrolled in the clinic, patients must be seen within 12 months of the latest Level 3 Evaluation and Management date. See Level 3 Evaluation and Management requirements in B.5 Performance Work Statement.

ORDERING PROCEDURES: VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management Model (PCMM) software program used to track primary care clinic Veteran rosters. Specific billable processes for issuing task orders under the resultant contract include: determining veteran eligibility, enrollment eligibility, and level 3evaluation and management (E&M) and billable roster which is further defined in PWS Section 6.2. Please review in detail to ensure compliance for issuance of subsequent task orders and payment processing.

AWARD BASED ON INITIAL OFFERS: Offerors are advised of the possibility that award may be made without discussion. Accordingly, Offerors are cautioned to submit their initial offers based on their most favorable terms, pricing and technical factors.

B.4 PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT (PWS) - Community Based Outpatient Clinic (CBOC) Services

1. GENERAL:

1.1. SERVICES REQUIRED: The Syracuse VAMC, Syracuse NY requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in Cayuga County :

1.1.1. Primary Care CBOC: offer both medical (physically on site) and mental health care (either physically on site or by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care CBOCs are required to provide both primary care and mental health services. Sites that do not provide both primary care and mental health services are classified as Other Outpatient Services. Access to specialty care is not provided on site, but may be available through referral or telehealth. A Primary care CBOC often provides home-based primary care (HBPC) and home telehealth to the population it serves to meet the primary care and mental health needs of Veterans who have difficulty accessing clinic-based care. Primary care in VA includes both medical and mental health care services, as they are inseparable in providing personalized, proactive, patient-centered health care. Primary Care Requirements. A point of service is said to provide primary care services if the site registers more than 500 primary care encounters within the primary care stop class within a given fiscal year. Mental Health Requirements. A point of service is said to provide mental health services if the site registers more than 500 mental health encounters within a single mental health clinic stop class within a given fiscal year. Mental health services may be provided using telehealth, if the workload at the point of service would not otherwise justify the presence of mental health providers. Mental health services will be provided by VA staff on-site.

1.2. PLACE OF PERFORMANCE: Contractor will provide CBOC services in Cayuga County, New York.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the Contractor on behalf of the Syracuse VAMC.

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the Contractor before implementation date. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, patient safety and performance, including, but not limited to, the following:

1.4.1. Title 21 C.F.R 900.12(c), “Mammography Quality Standards” http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf

1.4.2. Title 21 CFR, “Food and Drugs” Section 1300-end”. https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html

1.4.3. 38 USC. Section 7332, regarding a timely special consent for any medical treatment for drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus (HIV), or sickle cell anemia, to a Veteran with health insurance. A special consent from the Veteran is needed to allow VA to release bills and medical records associated with the treatment. http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html

1.4.4. 42 CFR Part 482, “Conditions of Participation” http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf

1.4.5. 42 CFR 493.15(b), “Laboratories Performing Waived Tests” http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf

1.4.6. Clinical Laboratory Improvement Amendments (CLIA): http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp

1.4.7. VHA Directive 2006-041, “Veterans Health Care Service Standards” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.8. VA Directive 1663, “Health Care Resources Contracting – Buying” http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

1.4.9. VA Directive 6371, “Destruction of Temporary Paper Records” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2

1.4.10. VHA Record Control Schedule 10-1 http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf

1.4.11. "Patient Medical Records-VA" (24VA19). 24VA19 http://vaww.vhaco.va.gov/privacy/SystemofRecords.htm.

1.4.12. VHA Handbook 1101.11(2), “Coordinated Care for Traveling Veterans” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

1.4.13. VHA Directive 2007-033, "Telephone Service for Clinical Care," http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605

1.4.14. VHA Directive 2008-015, “Public Access to Automated External Defibrillators (AEDs): Deployment, Training, and Policies for use in VHA Facilities” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1665

1.4.15. VHA Directive 1088, “Communicating Test Results to Providers and Patients” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.16. VHA Directive 2009-038 “VHA National Dual Care Policy” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058

1.4.17. VHA Directive 1033, “Anticoagulation Therapy Management” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129

1.4.18. VHA Directive 1108.08, “VHA Formulary Management Process” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291

1.4.19. VHA Directive 1230 “Outpatient Scheduling Processes and Procedures” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

1.4.20. VHA Directive 2010-014, “Assessment and Management of Veterans Who Have Been Victims of Alleged Acute Sexual Assault” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2177

1.4.21. VHA Directive 2010-033, “Military Sexual Trauma (MST) Programming,” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6402

1.4.22. VHA Directive 2010-053, “Patient Record Flags”.

www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341

1.4.23. VHA Directive 2011-012, “Medication Reconciliation” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2390

1.4.24. VHA Directive 2011-020, “Automated Safety Incident Surveillance and Tracking System (ASISTS)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407

1.4.25. VHA Directive 1199, “Reporting Cases of Abuse and Neglect”, https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5624

1.4.26. VHA Directive 1300.01 National Viral Hepatitis Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6421

1.4.27. VHA Directive 1210 Chiropractic Care

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6425

1.4.28. VHA Directive 1341 Providing health Care for Transgender and Intersex Veterans https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6431

1.4.29. VHA Directive 2012-026, “Sexual Assaults and Other Defined Public Safety Incidents in VHA” The directive specifically includes contracted sites of care and defines procedures specific to patient disruptive behavior.

https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797

1.4.30. VA Handbook 0730, “Security and Law Enforcement”

http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=755&FType=2

1.4.31. VHA Handbook 1003.4, "VHA Patient Advocacy Program," http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

1.4.32. VHA Handbook 1004.07, “Financial Relationships between Health Care Professionals and Industry” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

1.4.33. VHA Handbook 1006.02, “VHA Site Classifications and Definitions” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970

1.4.34. VHA Handbook 1050.01, “VHA National Patient Safety Improvement Handbook” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389

1.4.35. VHA Handbook 1100.17, “National Practitioner Data Bank Reports”- http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.36. VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962

1.4.37. Amendment to VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962

1.4.38. VHA Handbook 1100.19, “Credentialing and Privileging” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.39. VHA Directive 1306, “Querying State Prescription Drug Monitoring Programs (PDMP)” www.va.gov/vhapublications/viewpublication.asp?pub_id=3283

1.4.40. VHA Handbook 1101.10, “Patient Aligned Care Team (PACT)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977

1.4.41. VHA Handbook 1105.03, “Mammography Program Procedures and Standards” http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=6423

1.4.42. VHA Handbook 1106.01, “Pathology and Laboratory Medicine Service (P&LMS) Procedures” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3169

1.4.43. VHA Handbook 1108.05, “Outpatient Pharmacy Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209

1.4.44. Handbook 1120.02,"Health Promotion and Disease Prevention Core Program Requirements" http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=5965.

1.4.45. VHA Handbook 1122.01, “VHA Handbook 1122, “Podiatric Medical and Surgical Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5959

1.4.46. VHA Handbook, “1330.01 Health Care Services for Women Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332

1.4.47. VHA Handbook 1330.03 “Maternity Health Care and Coordination” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2803

1.4.48. VHA Handbook 1160.01, “Uniform Mental Health Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762

1.4.49. VHA Handbook 5005, Part 2, Appendix G15, “Licensed Pharmacist Qualification Standards” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2

1.4.50. Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.4.51. Title 38 CFR §17.107, “VA Response to Disruptive Behavior of Patients” (2010) www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdf

1.4.52. Title 38 CFR § 1.203, “Information to be reported to VA Police” (2003) https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203

1.4.53. “Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers,” Occupational Safety and Health Administration (OSHA) OSHA 3148-01R 2004) https://www.osha.gov/Publications/osha3148.pdf

1.4.54. “Violence: Occupational Hazards in Hospitals, National Institute for Occupational Safety and Health” (NIOSH) NIOSH 2002-101, April 2002. http://www.cdc.gov/niosh/docs/2002-101/default.html

1.4.55. VA Assistant Secretary OSP Memo, Clarification of Policy for Sexual Assault Reporting, June 2011. http://www.diversity.va.gov/products/files/DAW/v10i05.docx

1.4.56. VHA Directive 1231 Outpatient Clinic Practice Management https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296

1.4.57. Provision of Medical Statements and Completion of Forms by VA Health Care Providers https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300

1.4.58. VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

1.4.59. Access to VHA Clinical Programs for Veterans Participating in State-Approved Marijuana Programs https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711

1.4.60. VHA Directive 1229, Planning and Operating Outpatient Sites of Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5439

1.4.61. VHA Directive 1192, Seasonal Influenza Prevention Program for VHA Healthcare Personnel https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.62. VHA Handbook 1660.3 Conflict of Interest for the Aspects of Contracting For Sharing of Health Care Resources (HCR) www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3152

1.4.63. VA Directive 6008 Acquisition and Management of VA Information Technology Resources https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=891&FType=2

1.4.64. VA Handbook 6500.6 Contract Security https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=471&FType=2

1.5. DEFINITIONS/ACRONYMS:

1.1.1. ABMS: American Board of Medical Specialties

1.1.2. ACLS: Advanced Cardiac Life Support

1.1.3. ACGME: Accreditation Council for Graduate Medical Education

1.1.4. ACPE: American Council on Pharmaceutical Education

1.1.5. ACO: Administrative Contracting Officer

1.1.6. ADE: adverse drug events

1.1.7. AED: Automatic External Defibrillator

1.1.8. AIS: Automated Information Security

1.1.9. ANA: American Nurses Association

1.1.10. AOA: American Osteopathic Association

1.1.11. ARRT: American Registry of Radiologic Technology

1.1.12. ASC: Ambulatory Surgery Clinic

1.1.13. Assigned: A veteran is “assigned” to an outpatient clinic via PCMM (i.e. CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

1.1.14. BAA : Business Associate Agreement

1.1.15. BI-RADS: Breast Imaging-Reporting and Data System; a quality assurance tool designed to standardize mammography reporting

1.1.16. BLS: Basic Life Support

1.1.17. BOS: Bureau of Osteopathic Specialists

1.1.18. CAHEA: Committee on Allied Health Education and Accreditation

1.1.19. CAP: College of American Pathologists

1.1.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.1.21. CBO: VA Central Billing Office.

1.1.22. CDC: Centers for Disease Control and Prevention

1.1.23. CEU: Certified Education Unit

1.1.24. CLIA: Clinical Laboratory Improvement Amendments

1.1.25. CME: Continuing Medical Education

1.1.26. CMS: Center for Medicare and Medicaid Services

1.1.27. CO: Contracting Officer

1.1.28. COPD: chronic obstructive pulmonary disease

1.1.29. COR: Contracting Officer’s Representative

1.1.30. COS: Chief of Staff

1.1.31. CPA: Collaborative Practice Agreement

1.1.32. CPS : Clinical Pharmacy Specialist

1.1.33. CPT: Current Procedural Terminology

1.1.34. CRNP: Certified Registered Nurse Practitioners

1.1.35. CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org/.

1.1.36. CPARS: Contractor Performance Assessment Reporting System

1.1.37. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.1.38. CVT: Clinical Video Telehealth

1.1.39. DICOM: Digital Image and Communication in Medicine

1.1.40. DIGMA: Drop In Group Medical Appointment

1.1.41. DRG: Diagnostic Related Group

1.1.42. DSS: Decision Support System

1.1.43. ECC Extended Care Center

1.1.44. Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC; however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

1.1.45. EPRP: External Peer Review Program

1.1.46. FDA: Food and Drug Administration

1.1.47. FSMB: Federation of State Medical Boards

1.1.48. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

1.1.49. HHS: Department of Health and Human Services

1.1.50. HCFA: HealthCare Financing Administration

1.1.51. HICPAC: Healthcare Infection Control Practices Advisory Committee- a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

1.1.52. HT: Home Telehealth

1.1.53. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.1.54. INR: International Normalized Ratio

1.1.55. ISO: Information Security Officer

1.1.56. LIP: licensed independent practitioner

1.1.57. MCCR: Medical Care Cost Recovery

1.1.58. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based Psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions;

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psycho-education, Family education, skills training, peer support, and Compensated Work Therapy (CWT) and supported employment;

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.1.59. MQSA: Mammography Quality Standards Act

1.1.60. MSN: Master of Science in Nursing

1.1.61. NCCPA: National Commission on Certification of Physician Assistants

1.1.62. NLN: National League for Nursing

1.1.63. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.1.64. OTC: Over the Counter

1.1.65. PA: Physician Assistant

1.1.66. PACS: Picture Archiving and Communications System

1.1.67. PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

1.1.68. Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.1.69. PCMH: Patient-Centered Medical Home

1.1.70. PCMHI: Primary Care-Mental Health Integration

1.1.71. PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.1.72. PCP: Primary Care Provider

1.1.73. Phar.D.: Doctor of Pharmacy

1.1.74. POC: Point of Care Testing

1.1.75. PRIMARY CARE VISIT: an episode of care furnished in a clinic that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

1.1.76. PWS: Performance Work Statement

1.1.77. QAPI: Quality Assessment and Performance Improvement

1.1.78. QASP: Quality Assurance Surveillance Plan

1.1.79. RME: reusable medical equipment

1.1.80. SOP (Clinical): Scope of Practice

1.1.81. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.1.82. SMA: Shared Medical Appointments

1.1.83. SPD: Sterile Processing Division

1.1.84. SPE: Senior Procurement Executive

1.1.85. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care, and is only provided through a referral.” These services are generally divided into two sub-categories: medicine specialties and surgery specialties. The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology; emergency; employee health; endocrinology; gastroenterology; general medicine; hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology; amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

1.1.86. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.1.87. TJC: The Joint Commission

1.1.88. TIU: Text Integration Utility

1.1.89. TCT: Telehealth Clinical Technicians

1.1.90. VA: Veterans Affairs

1.1.91. VAMC: Veterans Affairs Medical Center

1.1.92. VetPro: a federal web-based credentialing program for healthcare providers.

1.1.93. VHA: Veterans Health Administration

1.1.94. VISTA: Veterans Health Information Systems and Technology Architecture

2. STAFFING AND QUALIFICATIONS:

2.1. MINIMUM PACT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS: PACTs comprise the patients, the patients personal support persons, teamlets (primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Clerical Associates), and discipline specific team members (Clinical Primary Specialists (CPS) – Provided by VA), and Registered Dietician/Nutritionists. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the facility in accordance with PCMM Handbook 1101.02. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three support staff for each full time equivalent Primary Care Provider. The Clinical Pharmacy Specialist (CPS), provided by VA, shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contrtactor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of the maximum panel size assigned by the facility the Contractor shall communicate to the VA the Contractor’s future staffing plan to ensure VA contract staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: 1500.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT. Responsible Party: Shall be provided by Contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified (or board eligible) by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located; if proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP. (If so, authorization for prescriptive authority is required). Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site. This physician must be actively providing care in the CBOC clinic and maintain a panel of VA patients.

2.3. CLINICAL RN ADMINISTRATOR: A full time RN Clinical Administrator is required to oversee the day to day duties and operations of the CBOC. This is in addition to the Patient Aligned Care Team (PACT) RN staff

2.4. PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor.

2.4.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below.

OPTION 1: Physician (MD): Qualifications: Physicians shall demonstrate evidence of…