36C24219R0013-0001001.docx

36C24219R0013

B.3 PERFORMANCE WORK STATEMENT (PWS) (REV. 07/26/2019)

1. GENERAL:

1.1. SERVICES REQUIRED: The VA Western New York Healthcare System (VAWNYHS) requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in Chautauqua County, however, residency is not restricted to this county:

1.1.1. [X] Primary Care CBOC: offers both medical and mental health care (physically on site and 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.

1.2. PLACE OF PERFORMANCE: Contractor facility must be physically located within the city limits of Jamestown, New York. Proposals for locations outside of Jamestown, New York are not eligible for award and will not be evaluated.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of the VA Western New York Healthcare System.

1.3.1. 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. Copies of current VA and VHA publications can be located at http://www.va.gov/vhapublications/ or at http://www.va.gov/vapubs/. 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, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/docs/List_contracted_clinic_policy_documents_05_07_19.xlsx#.

1.4. DEFINITIONS/ACRONYMS:

1.4.1. ABMS: American Board of Medical Specialties

1.4.2. ACLS: Advanced Cardiac Life Support

1.4.3. ACGME: Accreditation Council for Graduate Medical Education

1.4.4. ACPE: American Council on Pharmaceutical Education

1.4.5. ACO: Administrative Contracting Officer

1.4.6. ADE: adverse drug events

1.4.7. AED: Automatic External Defibrillator

1.4.8. AIS: Automated Information Security

1.4.9. ANA: American Nurses Association

1.4.10. AOA: American Osteopathic Association

1.4.11. ARRT: American Registry of Radiologic Technology

1.4.12. ASC: Ambulatory Surgery Clinic

1.4.13. 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.

1.4.14. BAA: Business Associate Agreement

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

1.4.16. BLS: Basic Life Support

1.4.17. BOS: Bureau of Osteopathic Specialists

1.4.18. CAHEA: Committee on Allied Health Education and Accreditation

1.4.19. CAP: College of American Pathologists

1.4.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.4.21. CBO: VA Central Billing Office.

1.4.22. CDC: Centers for Disease Control and Prevention

1.4.23. CEU: Certified Education Unit

1.4.24. CLIA: Clinical Laboratory Improvement Amendments

1.4.25. CME: Continuing Medical Education

1.4.26. CMS: Center for Medicare and Medicaid Services

1.4.27. CO: Contracting Officer

1.4.28. COPD: chronic obstructive pulmonary disease

1.4.29. COR: Contracting Officer’s Representative

1.4.30. COS: Chief of Staff

1.4.31. CPA: Collaborative Practice Agreement

1.4.32. CPS: Clinical Pharmacy Specialist

1.4.33. CPT: Current Procedural Terminology

1.4.34. CRNP: Certified Registered Nurse Practitioners

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

1.4.36. CPARS: Contractor Performance Assessment Reporting System

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

1.4.38. CVT: Clinical Video Telehealth

1.4.39. DICOM: Digital Image and Communication in Medicine

1.4.40. DIGMA: Drop in Group Medical Appointment

1.4.41. DRG: Diagnostic Related Group

1.4.42. DSS: Decision Support System

1.4.43. ECC Extended Care Center

1.4.44. 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.

1.4.45. EPRP: External Peer Review Program

1.4.46. FBCS: Fee Basis Claims System

1.4.47. FDA: Food and Drug Administration

1.4.48. FSMB: Federation of State Medical Boards

1.4.49. 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.

1.4.50. HHS: Department of Health and Human Services

1.4.51. HCFA: HealthCare Financing Administration

1.4.52. 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.

1.4.53. HRMS: Health Referral Management System

1.4.54. HT: Home Telehealth

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

1.4.56. INR: International Normalized Ratio

1.4.57. ISO: Information Security Officer

1.4.58. LIP: licensed independent practitioner

1.4.59. MCCR: Medical Care Cost Recovery

1.4.60. 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.

1.4.61. MHV: My HealtheVet

1.4.62. MQSA: Mammography Quality Standards Act

1.4.63. MSN: Master of Science in Nursing

1.4.64. NCCPA: National Commission on Certification of Physician Assistants

1.4.65. NLN: National League for Nursing

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

1.4.67. OTC: Over the Counter

1.4.68. PA: Physician Assistant

1.4.69. PACS: Picture Archiving and Communications System

1.4.70. 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.

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

1.4.72. PCMH: Patient-Centered Medical Home

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

1.4.74. PCP: Primary Care Provider

1.4.75. Phar.D.: Doctor of Pharmacy

1.4.76. POC: Point of Care Testing

1.4.77. 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.

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

1.4.79. PWS: Performance Work Statement

1.4.80. QAPI: Quality Assessment and Performance Improvement

1.4.81. QASP: Quality Assurance Surveillance Plan

1.4.82. RME: reusable medical equipment

1.4.83. SOP (Clinical): Scope of Practice

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

1.4.85. SM: Secure Messaging

1.4.86. SMA: Shared Medical Appointments

1.4.87. SPD: Sterile Processing Division

1.4.88. SPE: Senior Procurement Executive

1.4.89. 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.

1.4.90. 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.

1.4.91. TJC: The Joint Commission

1.4.92. TIU: Text Integration Utility

1.4.93. TCT: Telehealth Clinical Technicians

1.4.94. VA: Veterans Affairs

1.4.95. VA EHR: Veterans Affairs Electronic Health Record (currently known as CPRS)

1.4.96. VAMC: Veterans Affairs Medical Center

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

1.4.98. VHA: Veterans Health Administration

1.4.99. 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 (PC-MHI 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 1200 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 VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary Care. 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. Throughout the contract term VAWNYHS may require that any changes in key personnel be pre-approved by VA prior to starting the onboarding process. If requested, the candidate’s name, CV/resume, etc. must be forwarded to the COR for VA concurrence. Total Estimated Patients enrolled/assigned to site: 1,500.

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). If Physician Director supervises mid-level providers, some states may have additional requirements (such as this physician needs to be on-site to fulfill supervision requirements.) Contractor shall ensure any state requirements regarding on-site supervision are met. 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. Experience Requirements: Five (5) years of primary care experience, two (2) years with board certification or eligibility.

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 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, however, 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, secure messaging, 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 a MSN from a 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. 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, secure messaging, 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 3: Physician Assistant (PA):Qualifications: PA’s (including subcontractors) must meet one of the three following educational criteria: a) A bachelor’s degree from a PA training program which is certified by the CAHEA; or b) Graduation from a PA training program of at least twelve (12) months duration, which is certified by the CAHEA and a bachelor’s degree in a health care occupation or health related science; or c) graduation from a PA training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician. The duration of approved academic training and health care experience must total at least five (5) years. Authorization for prescriptive authority is required. PAs must be certified by the NCCPA. PA shall have current, full, active, and unrestricted license and registration in the state of the Outpatient Site of Care (i.e. CBOC); VA Handbook 5005/78 Part II Appendix G8 Physician Assistant Qualification Standard: http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=763&FType=2. 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, secure messaging, 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.

2.3.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2 Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e. CBOC). Contractor is responsible for ensuring that at all times there is at least one RN per site that has Hospital and Community Patient Review Instrument (H/C PRI) certification. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

2.3.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. Contractor to propose the mix of Clinical Associate from the options below.

OPTION 1: Licensed Practical Nurse (LPN): Qualifications: VA Handbook 5005/3 Part II Appendix G13 Licensed Practical or Vocational Nurse Qualification Standard: http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC). Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, secure messaging, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. This individual may be cross-trained as back-up for telehealth services.

OPTION 2: Licensed Vocational Nurse (LVN):Qualifications: VA Handbook 5005/3 Part II Appendix G13 Licensed Practical or Vocational Nurse Qualification Standard: http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC) Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, secure messaging, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. This individual may be cross-trained as back-up for telehealth services.

OPTION 3: Medical Assistant (MA):Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination.Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, secure messaging, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas.

OPTION 4: Health Care Technician (HCT) (as part of PACT teamlet not for other Telehealth responsibilities): Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, secure messaging, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas.

2.3.4. TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, secure messaging, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.4. DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated.

2.4.1. DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) –PACT: FTE Ratio Performance Standard: 1.0 FTE per 3 PACTs. Responsible Party: VA shall provide. Contractor shall complete view alerts/consults or schedule patient appointments directly utilizing the pharmacy grid.

2.4.2. DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-COAGULATION: FTE Ratio Performance Standard: 1.0 FTE per 5 PACTs. Responsible Party: VA shall provide. Contractor shall enter a consult for services.

2.4.3. DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER (LCSW): FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Responsible Party: VA shall provide at minimum an LCSW. Contractor shall enter a consult for services. VA anticipates providing a 0.5 FTE Psychologist (subject to change).

2.4.4. DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST: FTE Ratio Performance Standard: 1 FTE per 5 PACTs. Responsible Party: VA shall provide. Contractor shall enter a consult or use open scheduling to make an appointment for the Veteran.

2.4.5. DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH INTEGRATION (PC-MHI): FTE Ratio Performance Standard: 0.67 FTE per PACT. Responsible Party: VA shall provide. Contractor shall provide a warm handoff to VA Mental Health staff located on site. If Veteran does not want to wait or the VA Mental Health staff is not available, the contractor shall place a consult for Mental Health and the Veterans will be scheduled for the appointment using open scheduling prior to leaving the clinic.

2.4.6. DISCIPLINE SPECIFIC 6: MEDICAL SOCIAL WORKER: FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Responsible Party: Shall be provided by Contractor. Qualifications: Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC) Social Workers providing services under this contract must have a Master’s degree in Social Work (MSW) from a school accredited by Council on Social Work Education (CSWE). VA HANDBOOK 5005/23 PART II APPENDIX G39 SOCIAL WORKER QUALIFCATION STANDARD GS-185 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=481&FType=2 Position Responsibilities: Responsible for the provision of general social work services to enrolled and unassigned patients presenting for care.

2.5. SPECIALTY CARE STAFFING: The following specialty staffing shall be provided by the Contractor, unless otherwise noted.

2.5.1. PODIATRIST: FTE Ratio Performance Standard: 1.0 FTE per 950 active patients. Responsible Party: VA shall provide. Contractor shall use open scheduling or enter a consult for services. Services will be provided at VAWNYHS, via telehealth capabilities, or in the community, as appropriate. The VAWNYHS and contractor will work collectively to determine where the services will be provided (depending on the veteran’s circumstances, i.e., travel within the community, telehealth capabilities, etc.) and will notify the veteran of where to obtain the services.

2.5.2. DIAGNOSTIC OR THERAPEUTIC RADIOLOGIC TECHNOLOGIST: Responsible Party: VA shall provide. The Contractor is responsible for entering requests for Radiology procedures into VISTA utilizing VA EHR. All imaging orders shall be clinically appropriate. Radiology procedures will be provided by the VAWNYHS (either at the VAMC or through referral). The VAWNYHS and contractor will work collectively to determine where the procedure will be performed (depending on the veteran’s circumstances) and will notify the veteran of where to obtain the procedure.

2.5.3. PHLEBOTOMIST/LABORATORY TECHNICIAN: FTE Ratio Performance Standard: 1.0 FTE per site, with at least one (1) trained back-up to ensure Phlebotomy services are available at all times. Responsible Party: Shall be provided by Contractor. Qualifications: Phlebotomist (and back-up Phlebotomist) must be a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) in accordance with VA HANDBOOK 5005/3 PART II APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD: http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf and possess a current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC). Successful orientation/training with VAWNYHS laboratory is required onsite at the VAWNYHS and is typically broken into 3 separate instances. Position Responsibilities: Responsible for performance functions to include but not be limited to: recording specimens in the computer, collecting patient blood and/or urine specimens, labeling specimens, answering questions relative to patient specimen, instructing and assisting patients. Performs direct patient support work to include: collecting information from patients, providing personal patient care, and educating patients on pre-testing and post procedure activities. Functions as a resource for non-laboratory personnel on specimen collection requirements and patient preparation for any lab request, verifies laboratory orders, clarifies unusual requests with initiating provider, verifies identifiers such as patient identification, time of sample, type of test requested, and identifies unusual conditions and discrepancies which may cause erroneous test results. At the Contractor’s discretion and as time permits this individual may also provide back-up to other clinic personnel as appropriate.

2.5.4. GENERAL AND SPECIALTY MENTAL HEALTH STAFFING: Responsible Party: VA shall provide a LICENSED CLINICAL SOCIAL WORKER, as detailed above within Section 2.4. This individual will provide both general and specialty mental health services, as well as PC-MHI. Contractor shall use open scheduling or enter a consult for services.

2.5.5. TELEHEALTH SERVICES CLINICAL STAFF: Telehealth Clinical Technician (TCT) FTE Ratio Performance Standard: 1.0 dedicated FTE Telehealth Clinical Technician (TCT) per site, with at least one (1) trained back-up (e.g., another TCT or PACT Teamlet LPN(s), depending on size of clinic/clinic workload/clinic telehealth services). All staff providing telehealth related services (primary TCT(s) and back-ups) must be trained in teleretinal imaging, teledermatology, teleaudiology, tele-mental health, teleprimary care etc. The qualifications, competencies, and position responsibilities noted below apply to primary TCT(s) and back-ups. The Telepresenter can be any clinically trained person assisting the provider in the presentation of the Veteran using video-conferencing. Depending on the skills needed for the encounter, the Telepresenter can be a licensed independent provider (LIP), Registered Nurse, LPN, or Telehealth Clinical Technician (TCT). Telepresenters can also serve as TCT back-ups. The number and discipline of Contractor’s staff trained to function as a TCT back-up or Telepresenter will be based on the volume and type of telehealth services provided. Responsible Party: Shall be provided by Contractor. Qualifications: TCT (and back-up TCT) must be a Licensed Practical Nurse (LPN) in accordance with VA HANDBOOK 5005/3 PART II APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD: http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf and possess a current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC). All staff providing telehealth related services into the clinic shall be appropriately credentialed and; where necessary, privileged. All contractor staff who support and manage telehealth services must be working within permitted licensure and scope of practice. Where non-licensed staff is supporting telehealth services the Contractor’s licensed staff must provide appropriate clinical supervision. Competency: TCTs, Telepresenters, Store and Forward Imagers et al. and their back-ups, shall be expected to provide clinical care in compliance with established clinical protocol. Additional guidelines governing operations will be utilized and provided to Contractor by VA. TCTs, Telepresenters, Store and Forward Imagers and back-ups shall be expected to successfully complete training programs required for certification as a TCT, Telepresenter and/ or Store and Forward Imager and back-up including VA required training and any VA training mandated for TCT, Telepresenter, Teleretinal Imagers. TCTs, Telepresenters, and Store and Forward Imagers shall be responsible for maintaining imager and/or other required certification. TCTs, Telepresenters, and Store and Froward Imagers and back-ups shall be expected to demonstrate competency on the function and use of the telehealth equipment including digital retinal and dermatology imaging system, teleaudiology hardware and software. VA will provide training to TCTs, Telepresenters, Store and Forward Imagers and back-ups and document competency. Training: Contractor’s TCTs, RNs, LPNs, LIPs and support staff providing telehealth services shall be required to complete all Telehealth required training, both virtual and in-person. Contractor’s Telehealth Staff shall be required to attend conference calls intended to support and maximize delivery of care as required by the VA. TCT Position Responsibilities: TCT manages the Telehealth Services offered by the clinic (i.e., presenting, equipment management, training, imaging, audiology services, etc.) and is responsible for the provision of covered services to enrolled and unassigned patients presenting for care. The Contractor’s telehealth services shall include but are not limited to: coordinating telehealth clinic set up, scheduling, equipment management, provision of data on request, attendance on VA or Network Telehealth Team calls, maintaining records required for quality control processes, and participating in performance improvement activities. The TCT shall be responsible for conveyance of clinically appropriate in-person interaction or on-site observations (e.g., assisting with hearing aid fittings, detection of alcohol use, etc.) with the Veteran patient to the telehealth provider. The TCT shall be responsible for gathering and transmitting telehealth images, sounds, data and all other supporting data to the assigned VA providers or reading centers within time lines established by policy. The TCT shall provide technology education to patients including but not limited to: review of acquired data or images for anatomic and general findings, review of photos, and provision of VA approved handouts. The TCT shall communicate regularly with the Facility Telehealth Coordinator (FTC) to work out any process issues, equipment needs/problems, data collection and any other logistical issues. Telepresenter Position Responsibilities: Include, but are not limited to the following: Assist the primary care or specialty care provider with the Veteran physical exam as needed. Provide Veteran education, documentation and assistance with workload capture for the completion of the visit, per scope of practice. Manage required screenings and complete clinical reminders, documentation, scheduling and opening and closing the encounter.

2.5.6. REGISTERED NURSE (RN) ADMINISTRATIVE CLINIC MANAGER (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 1.0 FTE per location. Responsible Party: Shall be provided by Contractor. Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in that state of the Outpatient Site of Care (i.e. CBOC). Position Responsibilities: Responsible for the overall management of all day to day clinic activities. Serves as the primary point of contact between VA staff and the CBOC clinic. This is in addition to the PACT RN staff.

2.5.7. OTHER REQUIRED STAFF BASED ON NUMBER OF PATIENTS SERVED AT SITE:

2.5.7.1. Suicide Prevention Coordinator (SPC): The VA performance standard for sites with 10,000 patients or more is maintaining a Suicide Prevention Coordinator (SPC) with a full-time commitment to suicide prevention activities. In smaller sites serving less than 10,000, this may be a collateral assignment. Responsible Party: VA shall provide a LICENSED CLINICAL SOCIAL WORKER, as detailed above within Section 2.4. Contractor shall use open scheduling or enter a consult for services.

2.5.7.2. Homeless Outreach Specialist: To ensure the availability of outreach and referral services to homeless Veterans, all sites with 10,000 patients or more must designate at least one outreach specialist, usually a clinical social worker, to provide services to homeless Veterans. NOTE: In smaller facilities, this may be a collateral assignment. Responsible Party: VA shall provide a LICENSED CLINICAL SOCIAL WORKER, as detailed above within Section 2.4. Contractor shall use open scheduling or enter a consult for services.

2.6. LICENSE AND ACCREDITATION: Contract physician(s) and all other contract licensed providers assigned by the Contractor to perform the services covered by this contract shall have a current license to practice in the state where the outpatient site is located. All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contract providers who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.6.1. Technical Proficiency/Board Certification: Personnel shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently.

2.6.2. The Contractor must ensure that all individuals who provide services and/or supervise services at the Contractor’s Outpatient Site of Care, including individuals furnishing services under contract are qualified to provide or supervise such services.

2.6.3. Position specific competencies shall be completed for all staff annually.

2.6.4. Contractor staff qualifications, licenses, certifications and facility Joint Commission or equivalent accreditation must be maintained throughout the contract period of performance. If Contractor’s staff is not directly employed by the treating facility, documentation must be provided to the COR to ensure adequate certification. All actions required for maintaining certification must be kept up to date always. Documentation verifying current licenses, certifications and facility accreditation must be provided by the Contractor on an annual basis.

2.6.5. The Contractor is responsible for assuring that all persons, whether they be employees, agents, subcontractors, providers or anyone acting for or on behalf of the Contractor, are properly licensed always under the applicable state law and/or regulations of the provider’s license, and shall be subject to credentialing and privileging requirements by VA.

2.6.6. The Contractor shall not permit any employee to begin work at an Outpatient Site of Care prior to confirmation from the VA that the individual’s background investigation has been reviewed and released to the Office of Personnel Management…