36C24218R0402-0003000.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

PAGE OF PAGES

10A. MODIFICATION

OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

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 ADM

INISTRATIVE 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 d ate specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

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 3

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) 04-26-2019

NONE

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

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

Canandaigua NY 14424 To all Offerors/Bidders

36C24218R0402 04-10-2019

X X X

This amendment to the above referenced solicitation hereby addresses vendor questions received on April 26, 2019, in Attachment 1 to this amendment. One additional question remains regarding provider licensure and it will be addressed in a separate amendment as soon as possible.

The hour and date for receipt of offers remains 3:00 PM EST on May 10, 2019.

All other t erms and conditions remain unchanged and in full force and effect.

Allan M. Preston Contracting Officer Attachment 1 Amendment 0003, RFP 36C24218R0402 Effective Date: April 26, 2019

This amendment addresses vendor questions received on April 26, 2019, as described below.

Q13: 4.6.9 PHARMACY SERVICES (PRESCRIPTION FULFILLMENT): The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic.

a. Please list all medications and vaccines that are to be kept in stock at the clinic and administered.

b. Please provide an accounting of how many of each of the medications and vaccines are likely to be administered within one year.

Response: Refer to the last sentence in 4.6.9: “Attachment D.9 provides historical utilization data for medications and immunizations administered in clinic for FY 18, however, patient care needs may dictate a requirement for other medications and immunizations, which will be the Contractor’s responsibility.”

Q14: 4.6.9.1 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 4.6.9, the Contractor shall be responsible for the provision of injectable naloxone for administration at the CBOC.

a. Please advise the number of Naloxone kits to be kept at the CBOC and how many will be needed to be administered in one year.

Response: Refer to the last sentence in 4.6.9: “Attachment D.9 provides historical utilization data for medications and immunizations administered in clinic for FY 18, however, patient care needs may dictate a requirement for other medications and immunizations, which will be the Contractor’s responsibility.” Attachment D.9 contains historical information regarding Naloxone.

Q15: 4.6.11.2 The Contractor shall provide space as detailed in space requirements, support staffing, and ancillary support to allow for the provision of clinical pharmacy services. The support services shall be consistent for the CPS as with other prescribers for each Contractor’s scheduled clinic to include but not limited to intake vitals by LVN/LPN, Unlicensed Assistive Personnel (health tech or nursing assistant), or similar, downloading of blood sugar from meters, POC INR testing and downloading, teaching patients how to use BP monitors at home, calling patients for lab reminders, scheduling patient visits and contacting patients who no-show for rescheduling. Does the Government want the contractor to provide 1.0 FTE in addition to the PACT staffing to perform support services? IF so, does the Government require an LPN or RN?

Response: No, an additional FTE is not required. Other team members can be cross utilized in this position.

Q16: 4.6.12.2 Contractor shall provide clerical support, including scheduling, and ancillary support for VA tele-pharmacy services as appropriate. The support services should be consistent for each scheduled clinic to include but not limited to intake vitals by LVN/LPN, Unlicensed Assistive Personnel (health tech or nursing assistant), or similar, downloading of blood sugar from meters, POC INR testing and downloading, teaching patients how to use BP monitors at home, calling patients for lab reminders, scheduling patient visits and contacting patients who no-show for rescheduling. The Contractor shall facilitate use of the equipment for the veterans. Does the Government want the contractor to provide 1.0 FTE in addition to the PACT staffing to perform support services?

Response: No, an additional FTE is not required. Other team members can be cross utilized in this position.

Q17: Who will supply telephone services to the Niagara CBOC, the VA or the Contractor?

Response: Refer to PWS paragraph 4.6.18, “…The telephones, telephone system, and telephone lines are a Contractor responsibility.”

Q18: 4.6.12.2 Contractor shall provide clerical support, including scheduling, and ancillary support for VA telepharmacy services as appropriate. The support services should be consistent for each scheduled clinic to include but not limited to intake vitals by LVN/LPN, Unlicensed Assistive Personnel (health tech or nursing assistant), or similar, downloading of blood sugar from meters, POC INR testing and downloading, teaching patients how to use BP monitors at home, calling patients for lab reminders, scheduling patient visits and contacting patients who no-show for rescheduling. The Contractor shall facilitate use of the equipment for the veterans. Does the government want the contractor to provide 1.0 FTE in addition to the PACT staffing to perform support services?

Response: Refer to Q16, above.

Q19: 4.6.5 LABORATORY SERVICES: Contractor is responsible for: 1) Entering orders for laboratory tests into VISTA utilizing the VA EHR. Information concerning the laboratory tests is available in VA EHR under the Tools Menu, as well as in Attachments D.19 – D.25 and D.40 – D.42 in Section D, 2) Sending specimens to the VAWNYHS at Buffalo VA Core Laboratory once daily, prior to the Contractor’s close of business of the workday, except for those specified in this PWS. 3) Paying any costs of all lab work, except for lab work sent to the VA or emergency lab work sent to another site which has been authorized by the VA Communications Center. VA shall provide courier services to pick up the laboratory specimens from the CBOC and transport to the Buffalo VA Core Laboratory. 4) ensuring that all courier service employees have completed VHA Privacy Awareness Training or equivalent. 5) Ensuring the proper collection, collection supplies, specimen collection and processing of specimens for preservation of specimen integrity, and providing appropriate specimen collection containers that are compatible with the instrumentation and methodology used by the VA laboratory. Will VA Buffalo ensure that privacy documents are signed and completed since Buffalo, NY is arranging for and paying for Courier Services?

Response: Yes, VAWNYHS will ensure that privacy documents are signed and completed for the courier services. The couriers are VA employees.

Q20: 4.6.5.3.6 All ancillary testing at the Contractor’s site will be under the oversight of the VA Ancillary Testing Program. The Contractor is required to use the same test systems/instruments; quality control and reagent lot numbers used for ancillary testing performed at the VA (see Attachments D.20 Ancillary Testing Policy and D.21 Ancillary Testing Quality Management Policy in Section D). When the VA Ancillary Testing Program upgrades waived test systems/instruments, the VA will furnish the Contractor with the new test systems/instruments to maintain the same standard of care. The Ancillary Testing staff will arrange for repair/maintenance in the event of system/instrument failure. If required, the Contractor shall provide a courier to transport instruments and/or reagents to the Contractor or the VA Ancillary Testing staff for linearity/correlation studies and minor repairs. The Contractor will purchase proficiency testing materials for the Contractor, and the Contractor must comply with the Pathology and Laboratory Medicine, CAP and TJC requirements/ regulations for testing proficiency materials and submitting results. Who is responsible for ordering and paying for CAP proficiency testing kits?

Response: The Contractor is responsible for ordering and paying for CAP proficiency testing kits. Refer to PWS paragraph 4.6.5.3.6, “…The Contractor will purchase proficiency testing materials…”

Q21: 4.6.17.9.4.15.2 Office-based Buprenorphine Treatment. Buprenorphine can be prescribed as office-based treatment in non-specialty settings (e.g., primary care), but only by a “waivered” physician. Buprenorphine is not subject to all the regulations required in officially-identified OTPs, but must be delivered consistent with treatment guidelines and Pharmacy Benefits Management criteria for use.

a. Will the CBOC physicians be expected to be “waivered” providers and order Buprenorphine in the clinic?

b. If we are ordering Buprenorphine, please provide a number of patients currently on this medication that will likely continue?

Response: This paragraph has been revised, per Q12 in Amendment 0002, and non-waivered providers shall refer patients to VA mental health. There will be no distribution of buprenorphine in the clinic without prior VAWNYHS approval.

Q22: 4.5.17.1 Cervical Cancer Screening: Cervical cancer screening must be performed in accordance with VHA guidelines. The results of normal (no evidence of malignancy (NEM)) cervical pathology must be reported to the ordering provider within 30 calendar days of the pathology report being completed. The interpreting pathologist must ensure the ordering provider is contacted with abnormal results within 5 business days. Who supplies the Pap Kits?

Response: The VA shall supply the supplies for pap smears. Refer to Attachment D.25, Supply List from Laboratory Service (VAWNYHS SUPPLIES TO CONTRACTOR) – ThinPrep vials and ThinPrep spatula/brush.

Q23: 4.7.1.1 Group Care Room/Meeting/Conference Space: Another carpeted room no less than 360 square feet, sufficient to accommodate up to 15 individuals, inclusive of any group facilitators, and one (1) Telehealth real-time video unit shall be made available. Mental Health meeting/conference space can be used for this purpose. The furnishings required for the larger room include a conference table and power outlets, phone lines, computer connections for equipment, in addition to the furnishing requirements for the mental health offices. Please clarify how many group care rooms/meeting/conference spaces are needed.

Response: One group care rom/meeting/conference space is required.

Q24: Will the VA be supplying a Pyxis machine in the CBOC?

Response: No, the VA will not be supplying a Pyxis machine.

Q25: 4.6.22.4.3.11 Emergency contraception (e.g. Levonorgestrel (Plan B) etc.) must be available to all women Veteran patients in a timely manner (same day of their appointment) even if a provider has requested to opt out from providing emergency contraception to the patient because of a Rights of Conscience (ROC) Claim. Who is responsible for procurement and payment of Plan B medications?

Response: Emergency contraception will be provided as an urgent/emergent medication and will be filled via contracted local pharmacy. VA will provide this contract.