36C24219R0013-002.docx

36C24219R0013

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

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

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

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

ARE

ARE NOT ATTACHED.

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

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24219R0013 07-1 -2019

LAUREN M. HELMING, CONTRACT SPECIALIST

585-393-7590 08- 2-2019

3:00 PM ET

Department of Veterans Affairs Network Contracting Office 400 Fort Hill Ave., Bldg 34 Canandaigua NY 14424 X 621498 $20.5 Million N/A X Department of Veterans Affairs VA Western New York Healthcare System 3495 Bailey Avenue Buffalo NY Department of Veterans Affairs Network Contracting Office 400 Fort Hill Ave., Bldg 34 Canandaigua NY 14424

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

Community Based Outpatient Clinic (CBOC) services located within the city limits of Jamestown, New York, serving the Veterans of Chautauqua County, New York, as described herein Price Schedule is in Section B.2 of this solicitation, which begins on page 8.

X X

ONE

Allan M. Preston Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA (Continuation from Standard Form 1449, Blocks 5 – 18)

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

a. CONTRACTOR:

Name: _____________________________________________

Address: ____________________________________________

City/State/Zip: ________________________________________

TAX ID # ___________________

DUNS # ____________________

Point of Contact: _______________________________________

E-Mail: _______________________________________________

Phone Number: _________________________________

Fax Number: ___________________________________

b. GOVERNMENT:

Allan M. Preston, Contracting Officer (CO) Department of Veterans Affairs 2875 Union Road, Suite 3500 Cheektowaga, NY 14227

Phone: 585-297-1469 Email: Allan.Preston@va.gov

Lauren M. Helming, Contract Specialist (CS) Department of Veterans Affairs Canandaigua VA Medical Center Network Contracting Office 2 (NCO 2) 400 Fort Hill Avenue, Bldg. 34A Room 148 Canandaigua, NY 14424

Phone: 585-393-7590 Fax: 585-393-7883 Email: Lauren.Helming@va.gov

The VA shall provide a list of all VA Points of Contact (POC), including names, departments, telephone and fax numbers to the successful contractor upon award.

2. 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

3. INVOICES: Invoices shall be submitted in arrears:

4. 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, http://www.tungsten-network.com/us/en/veterans-affairs

5. ACKNOWLEDGMENT OF AMENDMENTS:

The Offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Signed copies of any issued amendments must be submitted with proposal response.

6. CONTRACT MODIFICATIONS:

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

7. CONTRACTING OFFICER’S REPRESENTATIVE:

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

8. 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 Attn: Lauren M. Helming, Contract Specialist Network Contracting Office 2 (NCO 2) 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.

Proposals shall be submitted following the format outlined in SECTION E.1 – ADDENDUM to 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS, beginning on Page 160. Offerors are cautioned to review these instructions carefully. Offeror shall address the evaluation factors listed in Section E.10 52.212-2 - Evaluation – Commercial Items, to be considered for award. Offeror 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.

In order to be considered "responsive" to this solicitation Offerors must provide pricing for the base period and all option periods and must include all required documentation. All offers are subject to terms and conditions of this document.

9. TECHNICAL INQUIRIES:

All technical inquiries shall be made in writing via email to Lauren M. Helming, Contract Specialist at Lauren.Helming@va.gov. Inquiries received via phone or facsimile will not be addressed.

Inquiries must be received a minimum of 10 business days before the closing date listed in Block 8 of the Form 1449. If warranted, responses to inquiries will be incorporated into a written amendment posted to the Federal Business Opportunities website at http://www.fbo.gov.

10. ATTENTION LARGE BUSINESSES:

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

The subcontracting goals are as follows: Small Business-17.5%; Small Disadvantaged Business-5%; Veteran-Owned Small Business-7%; Women-Owned Small Business-5%; Service-Disabled Veteran -Owned Small Business-5%; and HUBZone Small Business-3%.

11. 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/ .

12. 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.

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

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

14. CONTRACTOR 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.

Point of Contact: _______________________________________

E-Mail: _______________________________________________

Phone Number: _________________________________

15. 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 and have the actual power to legally bind the Offeror and make representations relative to the Offeror’s proposal and any resultant contract.

Name/Title ____________________________________________________

Phone Number ____________________________________________________

E-Mail: ____________________________________________________

Name/Title ____________________________________________________

Phone Number ____________________________________________________

E-Mail: ____________________________________________________

36C24219R0013

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B.2 PRICE SCHEDULE AND SERVICES

Under the authority of Title 38 U.S.C. 8153 the Contractor agrees to provide Primary Care services in accordance with the terms, conditions, and provisions stated herein at the prices specified in the Schedule of Supplies/Services. Proposed Contractor facility must be physically located within the city limits of Jamestown, New York. Veterans to be serviced under this contract reside primarily in Chautauqua County, however; residency is not restricted to this county. The Parent Facility for this CBOC is the VA Western New York Healthcare System (VAWNYHS), 3495 Bailey Avenue, Buffalo, NY 14215. Payment for primary care services shall be based on a monthly capitated rate, as further explained within this solicitation.

In order to be considered "responsive" to this solicitation Offerors must provide pricing for the base year and all option years using the Schedule provided below. No other version of the pricing schedule will be accepted. Tiered pricing will not be accepted. Pricing is on a “per-member per month (PMPM)” basis and represents an “all inclusive” reimbursement for clinical space and clerical support, routine delivery of primary care, including physician/physician assistants, nurse/nurse practitioner’s services, completion and follow up of multiple preventive health screens, flu vaccination and qualifying encounter, labs including VA ordered lab draws, nurse screening assessments, EKGs and other services as described herein.

PERIOD OF PERFORMANCE

BASE YEAR: March 1, 2020 through February 28, 2021

Estimated Total for Base Year $______________________________________________

OPTION YEAR 1: March 1, 2021 through February 28, 2022

Estimated Total for Option Year 1 $______________________________________________

OPTION YEAR 2: March 1, 2022 through February 28, 2023

Estimated Total for Option Year 2 $______________________________________________

OPTION YEAR 3: March 1, 2023 through February 29, 2024

Estimated Total for Option Year 3 $______________________________________________

OPTION YEAR 4: March 1, 2024 through February 28, 2025

Estimated Total for Option Year 4 $______________________________________________

OPTION YEAR 5: March 1, 2025 through February 28, 2026

Estimated Total for Option Year 5 $______________________________________________

OPTION YEAR 6: March 1, 2026 through February 28, 2027

Estimated Total for Option Year 6 $______________________________________________

OPTION YEAR 7: March 1, 2027 through February 29, 2028

Estimated Total for Option Year 7 $______________________________________________

OPTION YEAR 8: March 1, 2028 through February 28, 2029

Estimated Total for Option Year 8 $______________________________________________

OPTION YEAR 9: March 1, 2029 through February 28, 2030

Estimated Total for Option Year 9 $______________________________________________

ESTIMATED 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 $20,000,000.00.

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 qualifying encounter of billable roster which is further defined in PWS Section 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 (PWS)

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.