36C24218R0611-002.docx

36C24218R0611 Contracting Officer Allan Preston x X x 7.

Price Schedule of Services in Section B.2 beginning on page described herein.

within the boundaries of Plattsburgh, New York 12901 as Community Based Outpatient Clinic (CBOC) services located

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

Canandaigua NY 14424 400 Fort Hill Ave.

Department of Veterans Affairs

NCO 2

Albany NY 12208 113 Holland Avenue Albany Stratton VA Medical Center Department of Veterans Affairs X N/A X $20.5 Million 621498 X Canandaigua NY 14424 400 Fort Hill Ave.

Department of Veterans Affairs

9:00 AM EDT

04-22-2019 585-393-7297

HEATHER SCHRADER, CONTRACT SPECIALIST

03-22-2019 36C24218R0611

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

STANDARD FORM 1449

INFORMATION CALL:

7. FOR SOLICITATION

Prescribed by GSA - FAR (48 CFR) 53.212

PREVIOUS EDITION IS NOT USABLE

(REV. 2/2012)

AUTHORIZED FOR LOCAL REPRODUCTION

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

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

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

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

DATED ________________________________. YOUR OFFER ON SOLICITATION

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

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

ARE NOT ATTACHED

ARE

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

ARE NOT ATTACHED.

ARE

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

25. ACCOUNTING AND APPROPRIATION DATA

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

AMOUNT

UNIT PRICE

UNIT

QUANTITY

SCHEDULE OF SUPPLIES/SERVICES

ITEM NO.

24.

23.

22.

21.

20.

19.

SEE ADDENDUM

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

FAX:

PHONE:

DUNS+4:

DUNS:

TELEPHONE NO.

CODE

18a. PAYMENT WILL BE MADE BY

FACILITY CODE

CODE

17a. CONTRACTOR/OFFEROR

CODE

16. ADMINISTERED BY

CODE

15. DELIVER TO

RFP

IFB

RFQ

14. METHOD OF SOLICITATION

13b. RATING

DPAS (15 CFR 700)

RATED ORDER UNDER

13a. THIS CONTRACT IS A

12. DISCOUNT TERMS

SEE SCHEDULE

MARKED

TION UNLESS BLOCK IS

11. DELIVERY FOR FOB DESTINA-

SIZE STANDARD:

NAICS:

8(A)

EDWOSB

SMALL BUSINESS PROGRAM

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

WOMEN-OWNED SMALL BUSINESS

SMALL BUSINESS

VETERAN-OWNED

SERVICE-DISABLED

BUSINESS

HUBZONE SMALL

SMALL BUSINESS

% FOR:

SET ASIDE:

UNRESTRICTED OR

10. THIS ACQUISITION IS

CODE

9. ISSUED BY

TIME

8. OFFER DUE DATE/LOCAL

b. TELEPHONE NO. (No Collect Calls)

a. NAME

6. SOLICITATION ISSUE DATE

5. SOLICITATION NUMBER

4. ORDER NO.

3. AWARD/EFFECTIVE DATE

2. CONTRACT NO.

1. REQUISITION NO.

PAGE 1 OF

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINSTRATION DATA (Continuation of SF 1449 Blocks 5-18)

1. Contract Administration: All contract administration matters will be handled by the following individual(s):

a. Contractor _____________________________________________

Address _____________________________________________

City/State/Zip _____________________________________________

Facility Name _____________________________________________

Point of Contact (name) _____________________________________________

Telephone Number _____________________________________________

Fax Number _____________________________________________

Email Address _____________________________________________

TAX ID Number _____________________________________________

DUNS NUMBER _____________________________________________

b. Government:

Heather Schrader, Contract Specialist Department of Veterans Affairs, Canandaigua VA Medical Center 400 Fort Hill Avenue, Bldg. 34A Room 148 Canandaigua, NY 14424

CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer – System for Award Management [ ] 52.232-34, Payment by Electronic Funds Transfer – Other than System for Award Management [ ] 52.232-36, Payment by Third Party

INVOICES: Invoices shall be submitted in arrears:

GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72, Electronic Submission of Payment Requests.

The Financial Services Center: www.tungsten-network.com/us/en/veterans-affairs

2. 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.

3. SOLICITATION/CONTRACT: This solicitation and resulting contract adheres to the format defined in Federal Acquisition Regulation (FAR) Parts 12 and 15. An official copy of the FAR can be obtained at: https://www.acquisition.gov/far/

4. CONTRACT PERFORMANCE: Contractor shall be required to begin treating patients under this contract no later than 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’s price.

POST AWARD ORIENTATION: The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by Procurement Policy Memorandum (PPM) 2019-01 at: http://www.va.gov/oal/docs/business/pps/ppm201901.pdf.

5. TECHNICAL INQUIRIES: Direct all technical inquiries in writing to Contract Specialist, Heather Schrader via email at: Heather.Schrader@va.gov. ALL inquiries must be in writing.

6. PROPOSAL DELIVERY: Sealed offers for furnishing the services in the schedule are to be mailed or hand carried to the address listed below:

Department of Veterans Affairs Canandaigua VA Medical Center Attention: Heather Schrader, Contract Specialist 400 Fort Hill Avenue, Bldg. 34A Room 148 Canandaigua, NY 14424

Late submissions, modifications and withdrawals will be handled as described in 52.212-1 “Instructions to Offerors – Commercial Items.” Faxed or electronic offers will not be accepted.

Offeror shall address the evaluation factors listed in Section E.11 52.212-2 - Evaluation – Commercial Items, to be considered for award. Contractor is responsible to ensure the offer includes both a Technical Proposal and Price Proposal. There shall be no mention of pricing in the Technical Proposal.

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 ____________________________________________________

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 ____________________________________________________

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

B.2 PRICE SCHEDULE OF SERVICES

Under the authority of 38 U.S.C. §8153 the Contractor agrees to provide community based outpatient clinic services in accordance with the terms, conditions, and provisions stated herein at the prices specified in the Price Schedule of Services. Proposed contractor facility must be physically located within the boundaries of Plattsburgh, New York 12901. Veterans to be serviced under this contract primarily reside in Clinton County; however, residency is not restricted to this county. The parent facility for this CBOC is the Albany Stratton VA Medical Center, 113 Holland Avenue, Albany, NY. Payment for primary care services shall be based on a monthly capitated rate, as further explained within this solicitation.

PERIOD OF PERFORMANCE

BASE YEAR: 10/01/2019 through 09/30/2020

Total for Base Year $______________________________________________

OPTION YEAR 1: 10/01/2020 through 09/30/2021

Total for Option Year 1 $______________________________________________

OPTION YEAR 2: 10/01/2021 through 09/30/2022

Total for Option Year 2 $______________________________________________

OPTION YEAR 3: 10/01/2022 through 09/30/2023

Total for Option Year 3 $______________________________________________

OPTION YEAR 4: 10/01/2023 through 09/30/2024

Total for Option Year 4 $______________________________________________

OPTION YEAR 5: 10/01/2024 through 09/30/2025

Total for Option Year 5 $______________________________________________

OPTION YEAR 6: 10/01/2025 through 09/30/2026

Total for Option Year 6 $______________________________________________

OPTION YEAR 7: 10/01/2026 through 09/30/2027

Total for Option Year 7 $______________________________________________

OPTION YEAR 8: 10/01/2027 through 09/30/2028

Total for Option Year 8 $______________________________________________

OPTION YEAR 9: 10/01/2028 through 09/30/2029

Total for Option Year 9 $______________________________________________

CONTRACT TOTALS

ESTIMATED QUANTITIES: All quantities listed herein are estimated annual quantities. The Government is not obligated to purchase any specified amount of services under this contract but will be obligated to make payment for all services requested and received in the quantities and of the quality requested. The Government does not guarantee or imply that any fixed number of orders/referrals for services will be placed under the resultant contract.

GUARANTEED MINIMUM: The Government will order at least $250,000.00 in services during the base year of the contract. (Note: The guaranteed minimum order amount applies to the base year only. Award of the additional option years is not guaranteed nor is there a guaranteed minimum order amount in any given option year that is exercised.)

MAXIMUM TOTAL CONTRACT AMOUNT: The potential aggregate contract total over the term of the entire contract (base year and nine potential option years) is $25,000,000.00.

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 3 Evaluation and Management (E & M) of billable roster, to align with 6.2.1. Please review in detail to ensure compliance for issuance of subsequent task orders and payment processing. A task order will be issued for each performance period.

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.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. SERVICES REQUIRED: The Albany Stratton VA Medical Center requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in Plattsburgh, New York.

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 from the Albany Stratton VA Medical Center on-site and by telehealth.

1.2. PLACE OF PERFORMANCE: The CBOC must be physically located within the boundaries of Plattsburgh, New York, 12901. Proposals for locations outside of Plattsburgh, NY 12901 are not eligible for award and will not be evaluated.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 and FAR Parts 12 and 15 to be furnished by the contractor on behalf of Albany Stratton VA Medical Center.

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 and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. 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. VA Directive 1663: “Health Care Resources Contracting – Buying:” https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2.

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

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

1.4.10. "Patient Medical Records-VA" (24VA10P2): https://www.oprm.va.gov/privacy/privacy_SOR.aspx

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

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

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

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

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

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

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

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

1.4.19. VHA Directive 2010-053: “Patient Record Flags” www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341

1.4.20. VHA Directive 2011-012: “Medication Reconciliation” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3133

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

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

1.4.23. 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

1.4.24. VA Handbook 0730: “Security and Law Enforcement” http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=755&FType=2

1.4.25. VHA Directive 1003.4: "VHA Patient Advocacy" https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

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

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

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

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

1.4.30. VHA Handbook 1100.18: “Reporting and Responding to State Licensing Boards” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

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

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

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

1.4.34. VHA Handbook 1101.1: “Patient Aligned Care Team (PACT)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977

1.4.35. VHA Directive 1105.03, “Mammography Program Procedures and Standards:” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6423

1.4.36. VHA Directive 1106.01: “Pathology and Laboratory Medicine Service (P&LMS) Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7477

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

1.4.38. VHA Directive 1120.02: “Health Promotion and Disease Prevention Core Program Requirements” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5965

1.4.39. VHA Directive 1122: “Podiatric Medical and Surgical Services” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5959

1.4.40. VHA Directive, 1330.01(2), “Health Care Services for Women Veterans:” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332

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

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

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

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

1.4.45. 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

1.4.46. “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

1.4.47. “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

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

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

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

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

1.4.52. VHA Directive 1134(1), Provision of Medical Statements and Completion of Forms by VA Health Care Providers: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300

1.4.53. VHA Directive 1192, “Seasonal Influenza Prevention Program for VHA Health Care Personnel:” https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.54. VHA Directive 1605.01, “Privacy and Release of Information” www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3233

1.4.55. VHA Handbook 1108.11, “Clinical Pharmacy Services” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3120

1.4.56. VHA Handbook 5005, Part 2, Appendix G20, “Dietitian Qualification Standard” www.va.gov/vapubs/viewPublication.asp?Pub_ID=764&FType=2

1.4.57. VHA Directive 1108.10, Promotion of Drugs and Drug-Related Supplies by Pharmaceutical Company Representatives: https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=6435

1.4.58. VHA Directive 1608, Comprehensive Environment of Care (CEOC) Program: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3171

1.4.59. VHA Directive 1003, VHA’s Veteran Customer Service Program: https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=268

1.4.60. VHA Handbook 1003.1, Key Elements of VHA’s Veteran Customer Service Program: https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=422

1.4.61. VHA Handbook 1003.2, Service Recovery in the Veterans Health Administration: https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=433

1.4.62. VHA Handbook 1330.03, Maternity Health Care and Coordination: www.va.gov/vhapublications/viewpublication.asp?pub_id=2803

1.4.63. VHA Directive 1330.02, Women Veterans Program Manager: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7484

1.4.64. VHA Directive 6300, “Records Management:” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8113

1.4.65. VHA Handbook 1660.03, Conflict of Interest for The Aspects of Contracting for Sharing of Health-Care Resources (HCR): https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3152

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

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

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

1.4.69. VHA Directive 1210, Chiropractic Care: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6425

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

1.4.71. VHA Directive, 1177 Cardiopulmonary Resuscitation: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7487

1.4.72. VHA Directive 1004.08, Disclosure of Adverse Events to Patients: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8120

1.4.73. VHA Directive 1005(1), Informed Consent for Long-Term Opioid Therapy for Pain: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3005

1.4.74. VHA Handbook 1907.01, Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.4.75. VHA Directive 1198, Intimate Partner Violence Assistance Program: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8192

1.4.76. VHA Directive 1031, Antimicrobial Stewardship Programs (ASP): https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8195

1.4.77. VHA Directive 1108.13, Provision and Use of Nursing Medication Management Protocols in Outpatient Team-Based Practice Settings: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8199

1.4.78. VHA Directive 1004.04, State-Authorized Portable Orders (SAPO): https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8240

1.4.79. VA Handbook 6500, Risk Management Framework for VA Information Systems - Tier 3: VA Information Security Program: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=793&FType=2

1.5. DEFINITIONS/ACRONYMS:

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: Adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. 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.

1.5.14. BAA: Business Associate Agreement

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

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: Chronic Obstructive Pulmonary Disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

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

1.5.36. CPARS: Contractor Performance Assessment Reporting System

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

1.5.38. CVT: Clinical Video Telehealth

1.5.39. DICOM: Digital Image and Communication in Medicine

1.5.40. DIGMA: Drop in Group Medical Appointment

1.5.41. DRG: Diagnostic Related Group

1.5.42. DSS: Decision Support System

1.5.43. ECC: Extended Care Center

1.5.44. EHR: Electronic Health Record

1.5.45. 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.

1.5.46. EPRP: External Peer Review Program

1.5.47. FDA: Food and Drug Administration

1.5.48. FSMB: Federation of State Medical Boards

1.5.49. 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.

1.5.50. HHS: Department of Health and Human Services

1.5.51. HCFA: HealthCare Financing Administration

1.5.52. 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.

1.5.53. HT: Home Telehealth

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

1.5.55. INR: International Normalized Ratio

1.5.56. ISO: Information Security Officer

1.5.57. LIP: licensed independent practitioner

1.5.58. MCCR: Medical Care Cost Recovery

1.5.59. 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.

1.5.60. MQSA: Mammography Quality Standards Act

1.5.61. MSN: Master of Science in Nursing

1.5.62. NCCPA: National Commission on Certification of Physician Assistants

1.5.63. NLN: National League for Nursing

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

1.5.65. OTC: Over the Counter

1.5.66. PA: Physician Assistant

1.5.67. PACS: Picture Archiving and Communications System

1.5.68. PACT: Patient Aligned Care Team Background and 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.

1.5.69. PARENT FACILITY: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.70. PCMH: Patient-Centered Medical Home

1.5.71. PC-MHI: Primary Care-Mental Health Integration

1.5.72. PCMM: Primary Care Management Module: A software program used to track Primary Care Clinic Veteran rosters.

1.5.73. PCP: Primary Care Provider

1.5.74. Pharm.D.: Doctor of Pharmacy

1.5.75. POC: Point of Care Testing

1.5.76. 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.

1.5.77. PCMHI: Primary Care-Mental Health Integration

1.5.78. PWS: Performance Work Statement

1.5.79. QAPI: Quality Assessment and Performance Improvement

1.5.80. QASP: Quality Assurance Surveillance Plan

1.5.81. RME: Reusable Medical Equipment

1.5.82. SOP (Clinical): Scope of Practice

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

1.5.84. SMA: Shared Medical Appointments

1.5.85. SPD: Sterile Processing Division

1.5.86. SPE: Senior Procurement Executive

1.5.87. 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.

1.5.88. 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.

1.5.89. TJC: The Joint Commission

1.5.90. TIU: Text Integration Utility

1.5.91. TCT: Telehealth Clinical Technicians

1.5.92. VA: Veterans Affairs

1.5.93. VAMC: Veterans Affairs Medical Center

1.5.94. VETPRO: A federal web-based credentialing program for healthcare providers

1.5.95. VHA: Veterans Health Administration

1.5.96. VISTA: Veterans Health Information Systems and Technology Architecture

2. STAFFING AND QUALIFICATIONS:

2.1. MINIMUM PATIENT 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, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff). The contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. 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 1,200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA 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 full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) 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 Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The contractor 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 maximum panel size assigned by the facility the contractor shall communicate to the VA, the contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Any changes in key personnel must be approved by the VA prior to starting the onboarding process. The candidate’s name, resume, etc. must be forwarded to the CO and COR for VA concurrence and approval. Total Estimated Patients enrolled/assigned to site: 2,200.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT. Responsible Party: Shall be provided by the 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). Experience: Five years of primary care experience without board certification or eligibility; two years with board certification or eligibility. 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. If the Physician Director supervises mid-level providers, this physician shall be on-site to provide supervision requirements and additional time may be required.

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

2.3.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1,200 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. At least one PCP must be a physician.

OPTION 1: Physician (MD): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. 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. Authorization for prescriptive authority is required. 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. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications: CRNP’s (including subcontractors) must have an MSN from an NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e. CBOC); Reference VA Handbook 5005, Appendix G6: http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2.