36C24218R0169-0004000.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

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10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

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1. CONTRACT ID CODE

FACILITY CODE

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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:

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO:

Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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 letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS

ENTERED INTO

PURSUANT TO AUTHORITY OF:

D. OTHER

BY

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 11-08-2018

NONE

Department of Veterans Affairs Network Contracting Office 400 Fort Hill Ave.

Canandaigua NY 14424 Department of Veterans Affairs Network Contracting Office 400 Fort Hill Ave.

Canandaigua NY 14424 To all Offerors/Bidders

36C24218R0169 10-12-2018

X X X ** HOUR & DATE for Receipt of Offers is EXTENDED to:

This amendment to the above referenced solicitation hereby addresses vendor questions received through November 8, 2018, in Attachment 1 to this amendment. Attachment 1 also contains an update to Attachment D.9, as well as revisions to Performance Work Statement (PWS) paragraphs 2.4.3, 4.7.1.10, 4.7.9, 4.7.11.1.5, and 4.7.11.1.8 (removed). Refer to Attachment 1 for detailed explanation of changes.

The hour and date for receipt of offers remains 3:00 PM EST on November 23, 2018.

All other terms and conditions remain unchanged and in full force and effect.

Allan M. Preston Contracting Officer Attachment 1 Amendment 0004, RFP 36C24218R0169 Effective Date: November 8, 2018

This amendment addresses vendor questions received through November 8, 2018.

As a result of the questions received, Attachment D.9 Workload History, Page 4, Table “FY 18 Projected Medication & Immunization Utilization” is replaced with the following revised table:

FY 18 Projected Medication & Immunization Utilization

ZOSTER VACCINE RECOMBINANT (SHINGRIX) (0.5 mL) INJ VIAL (NOTE: This quantity may be artificially low due to vaccine shortages)

Q1: Page 23 – 2.5 Specialty care Staffing – subsection 2.5.2 Diagnostic or therapeutic radiology technician Is the contractor required to have a subcontract with a radiology group or hospital to provide radiology imaging in the local community of Dunkirk NY?

Response: No, the Contractor is not required to have a subcontract with a radiology group or hospital to provide radiology imaging in the local community. Refer to PWS paragraph 2.5.2 and 4.6.7. VA shall provide Radiology procedures offsite.

Q2: Page 25 – 2.5.6 Mandatory RN Clinic Manager If a non-RN clinic manager is in place now, is it allowed by the Government for that person to continue to perform in that role?

Response: Refer to PWS paragraph 2.5.6, which states that a Registered Nurse Administrative Clinic Manager is mandatory.

Q3: Page 35 – 4.6.6 Lab Services Who is responsible for the cost of the transportation of the lab specimens to the VA?

Response: Refer to PWS paragraph 4.6.6, which states: “LABORATORY SERVICES: Contractor is responsible for: …paying any costs associated with transportation of specimens to the VA and for arranging such transportation in a proper secure method…” Q4: Page 38 – 4.6.10 Pharmacy Services Is the contractor required to supply Prevnar 13, and Naloxone for use in the clinic?

Response: Refer to PWS paragraph 4.6.10 (Pharmacy Services), which states: “The Contractor will provide all medications (and supplies), including any necessary vaccines that are to be administered to patients in the clinic. (This includes but is not limited to: Diphtheria/Tetanus Toxoid, Hepatitis A Vaccine, Hepatitis A/Hepatitis B Vaccine, Influenza Vaccine, Measles/Mumps/Rubella Vaccine, Menomune A/C/Y/W meningococcal vaccine, Papillomavirus Human Vaccine, Pneumococcal Vaccine, Tetanus/Diphtheria/Pertussis Vaccine, Shingrix Vaccine, etc.).”

In addition, refer to PWS paragraph 4.6.10.1, which states: “The Contractor shall comply with VAWNYHS Center Memorandum 11-102, Naloxone Administration in Community Outreach Programs Per Protocol (and subsequent revisions). The protocol authorizes Registered Nurses (RN) to administer injectable naloxone as a reversal agent for suspected or known opioid overdose. A copy of the current Center Memorandum is found in Section D as Attachment D.30. In accordance with PWS paragraph 4.6.10, the Contractor shall be responsible for the provision of injectable naloxone for administration at the CBOC.”

Can the Government supply a list of the vaccines and immunizations used in 2017?

Response: Refer to Attachment D.9 Workload History, which provides historical utilization data for medications and immunizations on page 4 (NOTE: Revised table provided within this amendment). The Contractor is responsible for all medications and immunizations that are to be administered in clinic. VA has provided historical utilization data in Attachment D.9, however, patient care needs may dictate a requirement for other medications or immunizations, which will be the Contractor’s responsibility.

Q5: Page 41 – 4.6.12.2 Support Staff for Clinical Pharmacy Specialist Is this a dedicated support staff position for the CPS, or can other team members be cross utilized in this position?

Response: Other team members can be cross utilized in this position.

Q6: Page 57 – 4.6.22.4.2 Women’s Health PCP Would both providers need to be designated as Women’s Health PCP’s?

Response: Refer to PWS paragraph 4.6.22.4.2, which states: “The Contractor must develop a plan to assign women preferentially to the VA certified Women’s Health PCPs at the contracted site. All CBOCSs must have at least two WH-PCPs. (Because of small populations of women at most CBOCs, CBOC WH-PCPs will usually have mixed gender panels). It is necessary to have two WH-PCPs to provide full coverage for women during sick leave and vacation.”

Q7: Page 59 – 4.6.22.4.3.13 Women’s Health Exam Room Does the Women’s Health exam room require a shower?

Response: Bathing/shower facilities are not required.

Q8: Page 69 – 4.7.9 Closed Circuit Television (CCTV) Please specify what type, or model of CCTV will be required, since is it provided by the Contractor, will the VA be able to monitor as described in the RFP?

Response: PWS paragraph 4.7.9 has been revised and shall now read as shown below. The system shall be stand-alone and only viewable from the premises.

PWS paragraph 4.7.9 shall now read as:

4.7.9. Closed Circuit Television (CCTV): Contractor shall provide a stand-alone Power Over Ethernet (POE) CCTV system to monitor building entrances, restricted areas, mission critical asset areas, and alarm conditions. CCTV system shall be used for surveillance and observations of defined exterior areas, such as site and roadway access points, parking lots, and building perimeter, and interior areas such as hallways, common areas and waiting areas. The design, installation, and use of CCTV cameras shall support the visual identification and surveillance of persons, vehicles, assets, incidents, and defined locations. Contractor shall provide a CCTV system 32” monitor and DVR. The exact location shall be determined by the VA Physical Security Officer and must store recorded data for a minimum of thirty (30) days. The Contractor shall contact the VA Physical Security Officer at (716) 862-8749 prior to installation of CCTV system in order to ensure proper placement.

Q9: Page 70 - 4.7.11.1.5 Equipment, Office Supplies, and Technical Support

4.7.11 in the RFP states “all equipment attaching to a VA network will be owned by the VA and controlled by the VA. No other equipment will be connected to this network” However, 4.7.11.1.5 states “The contractor is responsible for the procurement, installation and maintenance of all printers, copiers, scanners, fax machines*, shredders, or other peripheral office equipment”.

How will the contractor be able to network the printers, copiers, scanners, fax machines, or other peripheral office equipment to the VA Network to be functional in the daily operation of the CBOC?

Response: PWS paragraph 4.7.11.1.8 is hereby removed from the PWS. The following subparagraph is added to PWS paragraph 4.7.11.1.5:

“4.7.1.1.5.1. VAWNYHS will provide printers, scanners and insurance cards scanners and will be responsible of the maintenance of this specific equipment. This equipment will be connected to the VA network to allow for printing and scanning to and from VA systems, such as CPRS, VISTA, and Microsoft Office products.”

Q10: RFP states 1 podiatrist per 950 patients… is that referring to number of podiatry patients or number of primary care patients enrolled? If podiatry patients, what is the expected number of podiatry patients likely to be enrolled in the CBOC?

Response: Refer to PWS paragraph 2.5.1 (PODIATRIST), which states: “Responsible Party: VA shall provide. Contractor shall use open scheduling or enter a consult for services.”, as well as PWS paragraph 4.6.14, which states “PODIATRY SERVICES: VA shall provide. Contractor shall use open scheduling or enter a consult for services.” The Contractor is not responsible for Podiatry Services.

Q11: RE: x-ray, the RFP states that the VA will have a Rad tech. Please confirm if X-Ray is required to be provided on site or if it can be contracted out. If it can be contracted, who is responsible for the cost?

Response: Radiology services are not required to be provided onsite at the CBOC. Refer to PWS paragraph 4.6.7, which states: “RADIOLOGY SERVICES: The Contractor is responsible for entering requests for Radiology procedures into VISTA utilizing CPRS. All imaging orders shall be clinically appropriate. Routine radiology procedures will be provided by the VAWNYHS.”

Q12: Will the Government be doing site visits prior to award? If so, how much notice will the contractor be given?

Response: Refer to Page 153, Part II, Item c (Section 3 – Site Visits), which states: “Site visits may be conducted of proposed locations. Provide a point of contact for coordination of site visits.” In addition, refer to page 160, Factor 1, Subfactor D (Geographic Location), which states: “A site visit may be conducted as part of the evaluation process. Include mailing address, street address, city, etc.”

If a site visit will be conducted, the Contractor will be given approximately 48 hours notice.

Q13: How many VA staffed personnel will be providing services at the CBOC? Please list by job title and number of days per month.

Response:

· Licensed Clinical Social Worker, 5 days per week (1.0 FTE);

· Licensed Clinical Social Worker, 1 day per week (0.2 FTE);

· On occasion, other VA personnel may be onsite at the CBOC if the needs of a specific Veteran require a face to face appointment.

PWS paragraph 2.4.3 shall now read as:

“2.4.3 DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER: FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Responsible Party: VA shall provide. Contractor shall enter a consult for services. VA anticipates providing a 1.0 FTE LCSW, as well as a 0.2 FTE LCSW.”

Q14: 4.7.1.2 Patient care rooms (exam/consultations rooms)—Please specify minimum clearance for doors when fully open.

Response: Refer to the PACT Space Module Design Guide, which states: “Doors should have an opening of at least 3’6” for scooter and bariatric access.”, as well as, “Door Size: Provide a minimum 42” clear opening”.

Q15: For primary care exam rooms, does VA require sliding barn doors? If so, are both doors into exam room required to be sliding barn doors?

Response: Refer to the PACT Space Module Design Guide, which states: “Use of surface mounted sliding doors maximizes floor space and is strongly encouraged. Use of swinging doors leads to loss of functionality/useable area.” as well as, “In dual-entry Patient Care Rooms, provide surface mounted sliding doors to eliminate the space requirements for door swings.”

Q16: Will the new contractor inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contract award?

Response: Refer to PWS paragraph 4.6.24.2, which states: “The Contractor shall be responsible for ensuring within twelve (12) months of the last visit, the Veteran receives at least an Evaluation and Management exam by an authorized provider.”, as well as PWS paragraph 6.2.1.1.1, which states: “All patients assigned to the contracted clinic shall have a minimum of a Evaluation and Management (E&M) exam performed and documented within the last 12 months by an authorized provider.”.

The Contractor will be provided a list of all enrolled patients 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 twelve (12) months of their last visit.

Q17: Page 8, B.2 – Will the Government please provide the most current billable/enrollment figures?

Response: As of August 2018, there were 1,580 billable enrollees.

Q18: Page 38, 4.6.10 Pharmacy Services - The solicitation states: “Routine prescriptions will be dispensed by the VA and mailed to the veteran following appropriate Contractor’s provider order entry in CPRS…The Contractor will provide all medications (and supplies), including any necessary vaccines that are to be administered to patients in the clinic…Urgent/emergent outpatient prescription medications or supplies needed will be filled via contracted local pharmacy for up to 10 days. VA will provide this contract.” Question: If the VA is responsible for bearing the cost of routine and urgent/emergent prescription medications, what other medications (besides the vaccines listed) is the Contractor responsible for providing?

Response: Refer to PWS paragraph 4.6.10, which states: “…The Contractor will provide all medications (and supplies), including any necessary vaccines that are to be administered to patients in the clinic…” Additionally, refer to Attachment D.9 Workload History, which provides historical utilization data for medications and immunizations on page 4 (NOTE: Revised table provided within this amendment). The Contractor is responsible for all medications and immunizations that are to be administered in clinic. VA has provided historical utilization data in Attachment D.9, however, patient care needs may dictate a requirement for other medications or immunizations, which will be the Contractor’s responsibility.

Q19: Pages 53 and 72, 4.6.18.3 and 4.7.11.3.1 – In section 4.6.18.3 it states “Contractor’s shall 1) set up the clinic’s main number with an auto-attendant greeting with an option 7 transferring calls to the Veterans Crisis Line. Caller’s not selecting Option 7 will then be transferred to a “live person.” However, Section 4.7.11.3.1 states the VA will be responsible for, “providing PC workstations, software, primary telecommunications lines and networking equipment required to access the VISTA system.” Is the VA providing the phones throughout the clinic or is that a contractor responsibility?

Response: The phones and phone system are a Contractor responsibility.

Q20: Page 66, 4.7.1 – The RFP states a “Minimum of (3) three exam rooms and (1) one exam/consultation room per PACT teamlet,” which seems more rooms than necessary. The PACT design guide on page 34 states, “the modules utilizes a ratio of approximately 3 exam rooms per Teamlet.” Does 3 exam/consult room per team meet the requirements?

Response: This sentence is revised to read as “Minimum of two (2) exam rooms and one (1) exam/consultation room per PACT teamlet.”

Q21: Pages 66 and 23, 4.7.1.4 and 2.4.6 – Per Section 4.7.1.4., the three (3) Mental Health Offices required, “shall be available for the exclusive use of the VA during the regular operating hours of the clinic and at times the extended hour clinics.” Can the solicitation be amended to that the Medical Social Worker provided by the contractor (per section 2.4.6) use the mental health offices?

Response: Per PWS paragraph 4.7.1.4, the three (3) Mental Health Offices shall be available for the exclusive use of the VA.

PWS paragraph 4.7.1.10 shall be revised to read as “Medical Social Worker (Contractor Staff):” A dedicated Clinical Pharmacist office is not required as these services will primarily be provided via Telehealth.

Q22: Pages 23 and 66, 2.5.2 and 4.7 – Can the government please confirm that they are providing a Diagnostic or Therapeutic Radiologic Technologist for the Dunkirk CBOC, per Section 2.5.2; and if so, what are the space and equipment requirements to support this requirement?

Response: Refer to Q1 and Q11, above. Radiology services will not be provided onsite at the Dunkirk CBOC.

Q23: Page 66, 4.7 – Does the VA require on-stage/off-stage design elements listed in the PACT Manual?

Response: Yes

Q24: Page 66, 4.7 – Is the current facility designed to meet the VA’s standards to accommodate the PACT Model; is the current facility using the on-stage/off-stage plan?

Response: The current floorplan does not meet the current PACT guidelines. The VA requires the on-stage/off-stage design elements listed in the PACT Manual. The contractor is responsible for providing adequate space to meet the requirements in the solicitation and resulting contract. The space requirements in the current solicitation are different than the previous requirement.

Q25: Page 66, 4.7 – Is the current facility adequate to meet the size requirements for the current solicitation?

Response: See Q24, above.

Q26: Will the government be doing site visits prior to award? If so, how much advance notice will the contractor be given?

Response: See Q12, above.

Q27: Does the current Dunkirk CBOC location meet the new PACT Design Guide requirements and minimum room sizes referenced in section 4.7 of the solicitation?

Response: See Q24, above.

Q28: How many veterans are currently on the billable roster?

Response: See Q17, above.

Q29: Will the new contractor inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contract award?

Response: See Q16, above.

Q30: Will the government confirm that the following list of vaccines are the responsibility of the contractor?

0. TDAP

0. MMR

0. Menomune A/C/Y/W Meningococcal

0. Pneumovax 23

0. Prevnar 13

0. Flu, High dose flu

0. Shingrix

0. Twinrix (Hep A&B)

0. Hep A

0. Hep B

0. HPV

0. Depo-Provera & Depo-Estradiol

Response: Yes, the above vaccines are the responsibility of the Contractor. Refer to PWS paragraph 4.6.10 and Q4, above. The Contractor is responsible for all medications and immunizations that are to be administered in clinic. VA has provided historical utilization data in Attachment D.9 (NOTE: Revised table provided within this amendment), however, patient care needs may dictate a requirement for other medications or immunizations, which will be the Contractor’s responsibility.

Q31: Are there any additional vaccines required to be supplied by the contractor other than those listed in question 30?

Response: Refer to PWS paragraph 4.6.10 and Q4, above. The Contractor is responsible for all medications and immunizations that are to be administered in clinic. VA has provided historical utilization data in Attachment D.9 (NOTE: Revised table provided within this amendment), however, patient care needs may dictate a requirement for other medications or immunizations, which will be the Contractor’s responsibility.

Q32: How many vaccines, by type listed in question 5 and any additional vaccines added by the govt pursuant to question 6, were administered to that the Dunkirk Enrolled Veterans in the last 12 months.

Response: Refer to Q4, above.

Q33: What is the expected number of vaccines, by type listed in question 30 and any additional vaccines added by the govt pursuant to question 31, that the government expects the contractor to administer to the Dunkirk Enrolled Veterans on an annual basis.

Response: Refer to Q4, above. The Contractor is responsible for all medications and immunizations that are to be administered in clinic. VA has provided historical utilization data in Attachment D.9 (NOTE: Revised table provided within this amendment), however, patient care needs may dictate a requirement for other medications or immunizations, which will be the Contractor’s responsibility.

Q34: Is the VA supplying the phones and phone system?

Response: See Q19, above.