36C24219R0090 0001.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR

ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

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

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

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

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

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 20

0001 02-11-2021

Department of Veterans Affairs

Network Contracting Office 02

1304 Buckley Road

Suite 101

Syracuse NY 13212

Department of Veterans Affairs

Network Contracting Office 02

1304 Buckley Road

Suite 101

Syracuse NY 13212

To all Offerors/Bidders

36C24219R0090

01-13-2021

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: Thursday March 4, 2021 3:00 PM EST

This amendment addresses questions received through 2/11/2021.

RESPONSE DUE DATE IS CHANGED TO 3:00 PM EST ON MARCH 4, 2021.

All other terms and conditions remain unchanged.

Allan Preston

Contracting Officer

CONTINUATION PAGE

1. Paragraph 4.9.1.1 states, “Each exam room contains a consultation zone and an examination zone…,” and Paragraph 4.9.1.1.1 requires “Minimum of 3 exam rooms and 1 exam/consultation room per PACT teamlet.”

a. Is it anticipated that the “exam/consultation rooms” will be used by the Primary Care providers only, or are there additional anticipated uses, such as specialty or ancillary care?

b. Since all exam rooms have a consultation zone, is it acceptable to provide 3 exam rooms per provider (in lieu of 4 rooms per provider, i.e. 3 exam rooms and 1 exam/consultation room per provider) with the understanding that all exam rooms can also be used as consultation rooms?

ANSWER:

a. It is anticipated they will be primary care only. See 4.9.1.1.3 for requirements for specialty or ancillary care.

b. No, 4 rooms are needed. 3 exam rooms plus a consultation room.

2. Paragraph 4.9.1.1.2 requires one Women’s Health exam room with a minimum of 125 square feet.

a. Does the Women’s Health exam room count as one of the exam rooms required by paragraph 4.9.1.1.1?

b. If more than one Women’s Health exam room is provided, does each Women’s Health exam room count as one of the exam rooms required by paragraph 4.9.1.1.1?

c. Please confirm the space requirement for Women’s Health exam rooms under this contract effort is 125 square feet as identified in paragraph 4.9.1.1.2.

ANSWER:

a. No it does not count as one of the exam rooms required by 4.9.1.1.

b. See response “a” above.

c. Square footage is correct as stated.

3. If there is the availability of maintaining existing VA-approved clinic space for this effort, would the

VA allow for five-foot hallways and 36-inch doorways in already established clinic space?

ANSWER: Door openings shall be 3’-6”.

4. The PACT Space Module Design Guide identifies the possible use of sliding doors but does not require them. Does the VA have a preference for the use of sliding doors in the Watertown CBOC? If so, please confirm if sliding doors are preferred on the patient side of each exam room or on both sides of each exam room.

ANSWER: We do not have a preference for sliding doors.

5. What is the required setback distance of the site to the bollards required for physical security? Will a 25-foot setback be required if the clinic is in a shopping center? If so, can bollards or planters be used to keep the minimum distance 8 feet away?

ANSWER: Bollards or planters can be used to keep the minimum distance 8 feet away. We don’t see a distance requirement from site to bollard.

6. The Solicitation references several telehealth services that will be provided at the clinic, including teleretinal, teledermatology, telemental and telepharmacy (paragraphs 4.6.7.1-4.6.7.5). Please confirm that the two (2) telemental health rooms (as required by paragraph 4.9.1.3) and two (2) telehealth rooms (as required by 4.9.1.4) is the total number of required rooms for all telehealth and telemental health services.

ANSWER: Correct.

7. Paragraph 4.9.1.5 references “Another carpeted room…” However this is the first reference to a carpeted room that we have found. Could the VA clarify if there is a different carpeted room requirement that this reference is referring to?

ANSWER: This is the only carpeted room. “Another” should be deleted.

8. Regarding group room/conference room:

a. Please confirm one (1) group room/conference room of 360 square feet (as required by paragraph 4.9.1.5) is the total number of group/conference rooms required for the Watertown CBOC.

b. Is it anticipated that this room will be used by both Contractor and VA staff?

ANSWER:

a. One group room/conference room is the total number required.

b. The group/conference room can be used by both Contractor and VA staff. The room shall also be available for Mental Health Veteran groups as well.

9. Paragraph 4.9.1.8 requires “Lab/Blood Draw: Shall be a separate dedicated room located near the patient exam rooms,” and paragraph 4.9.1.17 requires “Patient Restroom: Situated between blood draw rooms with pass through windows on each side.” Is the requirement for one blood draw room? If more than one is required, is it acceptable to have multiple blood draw stations separated by privacy curtains rather than separate blood draw rooms?

ANSWER: One blood draw room is acceptable. It is acceptable to have multiple blood draw stations/chairs separated by privacy curtains.

10. Is there required to be any space for VA staff, services, or equipment beyond those spaces listed in section 4.9.1: 14 Mental Health offices (paragraph 4.9.1.2), two telemental health exam rooms (paragraph 4.9.1.3), one pharmacist office (paragraph 4.9.1.9), Mental Health MSA workspace (paragraph 4.9.1.15), and Mental Health TCT workspace (paragraph 4.9.1.16)?

ANSWER: Contractor must review space requirements listed in Section 4.9.1. Specifically, 4.9.1.1.3 requires 2 exam rooms needed for VA Staff to see patients. This is in addition to Patient Care rooms in 4.9.1.1 and Women’s Health room in 4.9.1.1.2.

11. Question: What is the veteran population in the catchment area by zip code?

ANSWER: See Table 3

12. Page 17, Section 2.1 states: CPS will be provided by VA via telehealth. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract.

Question: Specifically, what additional staff is required above primary care PACT team members?

Will contractor need to provide additional Registered Nurse Care Managers (RNCMs), Clinical

Associates, Administrative Associates)? If so, does the Government require one of each type of team member? Will both CPS require additional PACT team members?

ANSWER: Additional PACT team members are not required for the CPS.

13. Page 25, Section 2.6.1 ANCILLARY SUPPORT SERVICES STAFFING: The following ancillary support staffing shall be provided by the Contractor.

DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: Radiology staffing shall be per the machine types and demands of the facility for each Radiologic procedure/ modality.

Question:

a. How many radiologic technologists will the Contractor be required to provide at the Watertown

CBOC?

b. Please provide the volume/number of x-ray patients over the past 12 months.

ANSWER:

a. It is up to the contractor to determine how many are needed in order to provide services without interruption.

b. 2019 – 1432 Veterans were served;

2020 – 1147 Veterans were served.

Calendar year 2019 is provided since 2020 saw a decrease in face to face visits resulting in less x-rays.

14. Page 25, Section 2.8 TELEHEALTH SERVICES CLINICAL STAFF: The following telehealth staffing shall be provided by the Contractor. Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0

FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up

(e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services).

Question:

a. Specifically, how many TCT will be required to be staffed by the Contractor. Will back- up TCT from a PACT team LPN be adequate or will the Government require additional FTE as back- up?

b. Does the VA require the TCT to be an MA or LPN?

ANSWER:

a. The primary TCT shall be a separate LPN from the PACT team LPNs. The back-up TCT can be a

PACT Team LPN. If the primary is out for any reason the expectation is that all Telehealth appointments will continue with the back-up.

b. LPN

15. Page 27, Section 2.9 REGISTERED NURSE (RN) ADMINISTRATIVE CLINIC MANAGER (MANDATORY

FOR ALL SITES) AND ASSISTANT RN CLINIC MANAGER OR ADMINISTRATOR (MANDATORY FOR ALL

SITES OVER 4000): FTE Ratio Performance Standard: 1.0 FTE per location. Responsible Party:

Contractor shall provide.

Question: Does the Government require 2.0 FTE to fulfill these positions, or can the Assistant RN Clinic

Administrator also be a PACT RN?

ANSWER: 2 FTE are required. These positions are not part of the PACT team.

16. Page 34, EVENING HOURS: The clinic shall be accessible to VA Behavioral Health staff from 7:00

AM to 7:00 PM Monday through Friday.

Question: What additional Contractor-provided clinic staff will be required from 4:30 AM -7:00 AM?

How many evenings a week will the additional staff be required?

ANSWER: Contract staff do not need to be in the building during this time (4:30PM – 7:00 PM). It is required for the VA Staff to have access as their tour of duty may be an extended one.

17. Page 43, Section 4.6.2.4.6 Emergency contraception (e.g. Levonorgestrel (Plan B) etc.) must be available to all women veteran patients in a timely manner (same day of their appointment) even if a provider has requested to opt out from providing emergency contraception to the patient because of a Rights of Conscience (ROC) Claim.

Question: Will the Contractor be required to keep plan B on site, or write a script for a local pharmacy?

Who bears the cost of the Plan B script?

ANSWER: Emergency contraception can be provided through the emergency first fill contract provided by the VA.

18. Page 44, Section 4.6.3.1 PRESCRIPTION FULFILLMENT: The Contractor will provide all medications

(and supplies), including any necessary vaccines that are to be administered to patients in the clinic.

Question:

a. Please list all medication and vaccines that the contractor will be required to supply? Also, what is the estimated volume of each medication/vaccine to be administered monthly?

b. Please provide the volume data on medication and vaccine usage over the past 12 months.

ANSWER:

a. See Table 1 – attached

b. See Table 2 - attached

19. Page 45, Section 4.6.2.4.7: Contractor shall provide all equipment [supplies] necessary to provide comprehensive women’s health services.

Question: Thin-Prep PAP testing supplies are not available for purchase by Contractor, will the VA supply?

ANSWER: VA will provide Thin-Prep Pap testing supplies.

20. Page 48, Section 4.6.3.1.7: The Contractor shall meet all requirements for anticoagulation management outlined in VHA Directive 1033 Anticoagulation Therapy Management (or subsequent revisions thereto) as well as local policy related to the management of patients on anticoagulation. Local policy is included in the attachments section. Outpatient anticoagulation is restricted to management of local Anticoagulation Clinic per facility policy which is attached in

Section D.

Question: If VA is supplying the anticoagulation CPS, specifically, what additional requirements will the contractor bear?

• PCP enters electronic consult for the “Anticoagulation Clinic”

• Lab draws as schedule by the Anticoagulation Clinic

• PCP communicates with Anticoagulation clinic regarding medicine change, notification for surgical procedure

• Documents in CPRS any calls or appointments related to Anticoagulation issues.

21. Page 51, Section 4.6.4.5.1 Pregnancy testing: Outpatient Site of Care must have point of care or stat pregnancy testing at the same site of care.

Question: Approximately how many pregnancy tests are done each month at the clinic?

ANSWER: approximately 5 tests per month – includes (QC/proficiency/competency)

22. Page 51, Section 4.6.5.3: Anticoagulation services will be provided by the Syracuse VA Medical

Center’s Anticoagulation Clinic for patients who are requesting or receiving anticoagulants from the

Syracuse VA Medical Center, using the Anticoagulation Clinic consult menu.

Question: Will the veteran’s blood be checked via blood draw or fingerstick? If by finger stick, who supplies the strips and machine contractor or VA?

ANSWER: Blood draw

23. Question: Will the VA provide Naxolone for veterans who require it as a precaution?

ANSWER: Yes, Naloxone is available via prescription for Veterans; order through CPRS to be mailed to the patient.

24. Question: Please confirm that the courier service costs will be borne by the Contractor.

ANSWER: Correct.

25. Question: Who is responsible for setting up a contract with a local ambulance company, the VA or the Contractor?

ANSWER: Contractor

26. Page 58, Section 4.6.5.3 HEALTH SUPPORT SERVICES: The Contractor shall provide back-up for the following clerical support services for mental health providers at the CBOC.

Question: Is the Contractor responsible to hire additional MSA to support MH services or can these services be provided by PACT team members?

ANSWER: The Contractor does not need to hire an additional MSA to back-up mental health. The back-up can be provided by primary care MSAs.

27. Question: What is the current PM/PM rate at the existing clinic?

ANSWER: This information must be requested through the Freedom of Information Act (FOIA)

28. Question: What is the most recent three (3) months of invoiced enrollment at the facility?

ANSWER: October 2020 = 4017; November 2020 = 4029; December 2020 = 4065

29. Question: Since its implementation, how many Mission Act referrals have occurred for enrolled veterans at the CBOC? Please specify how many were for Primary Care patients? Please specify the number of specialty services by number of patients.

ANSWER: 2019 – 2250 referrals

2020 – 2712 referrals

2021 – 1046 referrals thus far.

30. Page 73 under Primary Care:

4.7.1.1.1 Minimum of 3 exam rooms and 1 exam/consultation room per PACT teamlet. Exam rooms shall be a minimum of 125 square feet.

4.7.1.1.2 Women’s Health: One exam room to be utilized for woman Veterans. Room shall be a minimum of 125 square feet with an adjacent full restroom.

4.7.1.1.3 Exam Rooms in addition to the PACT exam rooms: 2 exam rooms needed for VA staff to see patients.

Question:

a. Can the Women’s exam room be counted as one of the PACT exam rooms or is this in addition to the 3 exam rooms and 1 consult room? CLARIFICATION: Women’s health room shall have a bathroom IN the exam room. The patient should not have to leave the exam room to go to the nearest bathroom.

b. Will the VA roll over current clinic enrollment to new Contractor on Day 1 of the contract?

ANSWER:

a. No it is not counted as part of the PACT exam rooms.

b. Yes the current enrollment will be turned over to the contractor on day 1.

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

ANSWER: No. The Contractor will be provided a list of all enrolled patients at the beginning of the contract and will be able to bill for these patients immediately. In order to remain enrolled in the clinic, patients must have a qualifying visit within 12 months of their last visit.

32. Question: Please confirm the number of toliets the VA requires in the reception room. Traditionally one is sufficient.

ANSWER: Two toilets are needed in the reception room.

33. Question: Please confirm a Pharmacist office is needed because it is required in the space requirements section, but VA says it will be provided by telemedicine earlier in the CBOC.

ANSWER: This office Space is required in the event the pharmacist provides services on site at any time after contract award.

34. Page 37, 4.3.1: Contractor shall provide at no additional cost approximately 40/month nurse-only visits and 10/month provider visits to Veterans who are not assigned for care at the Contractor’s outpatient site of care.

35. Question: How many traveling vets are anticipated per year?

ANSWER: it is not possible to provide an accurate number. The contractor shall be prepared to provide

40 nurse only and 10 provider visits per month.

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

ANSWER: It is not possible to provide a complete list of the staff that will be working at the clinic or the number of days per month as it has not been finalized and could vary from month to month. Below is a list of the staff for mental health that are known at this time. This information is subject to change.

This does not include the pharmacist or the VA staff that will be using the additional 2 exams rooms required for specialty clinics.

• 1 MSA

• 1 TCT

• 1 Peer Support Specialist

• 8 Therapists for general mental health (social workers, licensed mental health counselors, psychologists)

• 4 non-general mental health clinicians for other programs such as suicide prevention, homeless, PCMHI, PTSD (social workers, licensed mental health counselors, psychologists)

• 4 psychiatrist/Psychiatric Nurse Practitioner.

37. Question: Does the VA require sliding doors on the patient exam and consult rooms? If so, is one sliding door sufficient on the patient entrance if a swinging door is used on the provider entrance?

ANSWER: The VA has no preference to the types of doors used as long as the PACT design guide is followed. One sliding door is acceptable for exam rooms, if a swinging door is used on the provider entrance.

38. Question: The RFP requires two VA Exam rooms separate from Contractor exam rooms. Are the two VA exam rooms required to be attached to the Off-stage area?

ANSWER: Yes they are.

39. Question: If the Contractor chooses to expand in the current location, is the On-Stage/Off-Stage design concept still required?

ANSWER: yes

40. Question: Please provide specifications of freezers or refrigerators that the VA will require in the medication room. For example, do we need to provide a Freezer with extremely cold capability for

Covid-19 vaccine storage? If so, do they need to have battery back-up power?”

ANSWER: A pharmaceutical grade refrigerator (2-8’C) and freezer (-20) is needed. Must have battery backup or emergency power as required in VHA notice 2020-02.

41. Question: In the event of a change order during construction, how would the government review and approve them?

ANSWER: Contract modification

42. Question: For site visits to proposed locations, how much advance notice will be the contractor be given?

ANSWER: The VA will try to provide at least 48 hours’ notice of the need for a site visit.

43. Page 143, Instructions to Offerors/Evaluation Factors: Please forward Attachment D.2. (Past

Performance Reference Information). It does not appear to be on the Beta.sam web site.

ANSWER: Attached.

44. Question: Please clarify, should both the hard copy and the CD be submitted to the same address and recipient: Department of Veterans Affairs, Network Contracting Office 2 (NCO 2)

Attn: Lisa M. Tompkins, Contract Specialist, 1304 Buckley Road, Suite 101 Syracuse, NY 13212?

ANSWER: yes all copies should be submitted to the same address. Room number has been corrected.

Submit to 1304 Buckley Road, Suite C104.

45. Question: Are there page restrictions to any section/volume of this submission?

ANSWER: There are no page restrictions.

46. Question: The solicitation shows that the contract maximum is $100M. Did the Government conduct an Independent Government Cost Estimate (IGCE) for this requirement? If so, what is the value associated with this estimate?

ANSWER: Yes, an IGCE was done. Government estimates are not released.

47. Total Estimated Patients enrolled/assigned to site: 4135 as of July 2020.” Please provide the most recent 3-month billing figures/members/enrollees for primary care services

ANSWER: See response to question 28.

48. Can the VA please provide the list of medications and vaccines the contractor will be responsible for providing? Additionally, can the VA also provide estimated utilization numbers/quantity for each medication/vaccine required (or historical information)?

ANSWER: See Table 1 and 2

49. X-ray radiology procedures will be interpreted by the contractor or radiology facility.” This directive is a departure from CBOCs that we currently manage. Typically, X-rays performed on-site are interpreted by the local VAMC for security purposes. Will the Government please reaffirm that the contractor/3rd party vendor will be responsible for interpretation of X-rays?

ANSWER: Correct as written. Contractor is responsible for interpretation of X-rays.

50. Please confirm that the new contractor will inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contract award?

ANSWER: See question 31. Patient must be seen within 12 months of last vesting visit.

51. How many Women’s Health exam rooms are needed?

ANSWER: One Women’s Health exam room is needed.

52. Should the Lab/Blood Draw be one room or two separate rooms?

ANSWER: It can be one room provided the processing of the specimens is separated/away from the clean area where blood is drawn.

53. Are staff locker rooms requested for the space allocated for team collaboration and individual work?

ANSWER: Refer to 4.9.1.14 - This area may contain a multi-purpose team conference space, staff break room, staff lockers, staff toilet, clean utility, soiled utility and equipment storage.

54. Can the Mental Health MSA be located in the teamwork zone or do they need to be situated in the

Mental Health area?

ANSWER: The mental health MSA is to be located with the Clinic/Contract MSAs so that they can check out the MH patients and schedule a follow up appointment when the Veteran leaves the CBOC.

55. Section 4.9.1.17 – Space requirements - Does this mean the bathroom is to be located between the blood draw room and the lab, or is the request for two blood draw rooms flanking the bathroom?

ANSWER: There should be at least one bathroom within the blood draw area for proper collection of laboratory specimens, urine, etc.

56. Paragraph 2.1 states “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. Clinical pharmacist will be provided by VA via telehealth.” Is the Contractor required to provide dedicated support staff for the VA-provided CPS? If so, please indicate the numbers of support staff needed.

ANSWER: The Clinical Pharmacist will be provided mostly via telehealth but in the event they do come to the CBOC to provide services they do not require dedicated support staff.

57. Would the VA consider allowing a 150 or 180 build out time frame instead of the 120 days indicated in paragraph 6.1.2? The basis of this request is that longer times frames are needed during the COVID-19 pandemic due to supply chain disruptions that are beyond the Contractor’s control.

Reflective of this issue, we note that recent VA CBOC solicitations by other VA hospital systems have called for 180-day build out time frame, such as 36C24920R0114 (Tupelo, MS) and 36C24920R0007 (Hopkinsville, KY).

ANSWER: The start-up is 120 days.

58. There are two versions of attachment D.1 and two versions of attachment D.2 provided at the end of the Solicitation. Could the Government clarify which versions should be included with the offeror’s proposal?

ANSWER: Attached.

59. Section D lists four attachments that are not included with the documents on sam.gov: D.24 LABORATORY SERVICES MANUAL; D.27 WORKLOAD HISTORY; D.28 HOME TELEHEALTH OPERATIONS MANUAL; and D.29 LIST OF VETERANS BY ZIP CODE. Could the Government provide these attachments?

ANSWER - Attached

60. Please clarify who will provide printers and a copier/scanner/fax machines. Paragraph 4.11.1.5 indicates this is the contractor’s responsibility, but paragraph 4.11.3.6 indicates the VA will provide these.

ANSWER – The VA will provide a multi-function device. The contractor needs to provide a small desktop color printer and one fax machine in the event the multi-function device provided by the is not functional.

61. Paragraph 4.6.3.3 on page 49 states “X-ray radiology procedures will be interpreted by the contractor or radiology facility.” Currently at the Watertown CBOC, the x-ray’s are uploaded to the Syracuse VAMC and the VA Radiology Department reads them, which provides benefit of CPRS accessibility and consistency of the radiology interpretation record. Under the upcoming contract, will the Contractor be required to have a Radiologist to read the X-rays completed at the CBOC? If so, please provide the qualifications for a radiologist.

ANSWER – see below and attachment D.32

• Qualifications

Basic Requirements:

o United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.

o Degree of doctor of medicine or an equivalent degree resulting from a course of education in medicine or osteopathic medicine. The degree must have been obtained from one of the schools approved by the Department of Veterans Affairs for the year in which the course of study was completed.

o Current, full and unrestricted license to practice medicine or surgery in a State, Territory, or Commonwealth of the United States, or in the District of Columbia.

o Completion of residency training, or its equivalent, approved by the Secretary of Veterans Affairs in an accredited core specialty training program leading to eligibility for board certification.

o Proficiency in spoken and written English.

o Physical requirements outlined below.

Preferred Experience: Board Certification strongly preferred.

Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-2 Physician

Qualification Standard. See attachment D-32

Education

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

62. Paragraph 4.6.3.1 on page 49 states, “Contractor must provide FDA approved equipment that conforms to the VA EHR Imaging listing for Digital Image and Communication in Medicine (DICOM) (3.0) DICOM imaging listing and HL7 communications information can be found in the attachments section.” Could the Government confirm which attachment has this information as we have not been able to find it?

ANSWER: Correction - there was no attachment.

63. Please confirm the VA will provide all telephones and telephone lines as this is our understanding of paragraph 4.11.3.1.

ANSWER: - The VA will provide the telephones. See paragraph 4.11.1.1 – 4.11.1.4 for contractor responsibilities.

64. Paragraph 3.2 says, “The clinic shall be accessible to VA Behavioral Health staff from 7:00 AM to 7:00 PM Monday through Friday.” Does the Contractor need to provide administration and/or building support during these extended hours?

ANSWER: See question 16

65. Would the Contractor be allowed to offer evening or weekend hours for primary care services?

ANSWER: Yes the contractor can provide evening or weekend hours with the permission of the COR.

http://ope.ed.gov/accreditation/ http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html

66. Paragraph 4.9.1.15 requires space for VA Mental Health MSA, and paragraph 4.6.5.3 requires the contractor to provide backup clerical support for mental health services at the clinic.

a. Can the Government confirm the quantity and FTE level of any VA-provided Mental Health MSAs?

b. Could the Government clarify what is meant by “backup” mental health clerical support? Would these services be provided on a daily basis based on patient volume or is backup support only needed in special circumstances?

c. Is it acceptable for backup support to be provided by the PACT Administrative Associates already on staff, or will the Contractor need to provide dedicated clerical support for Mental Health services?

ANSWER:

a. VA will have 1 MSA.

b. Back-up is only needed in the absence of the VA MSA

c. Dedicated clerical support is not needed.

67. Paragraph 2.8 requires the Contractor to provide a Telehealth Clinical Technician who “must be trained in teleretinal imaging, teledermatology, teleaudiology, tele-mental health, teleprimary care etc.”

However, paragraph 4.6.7.3 states that telemental health services will be provided by the VA, and paragraph 4.9.1.6 requires a work station for the VA-provided Mental Health TCT.

a. Could the Government clarify the role of the Contractor-provided TCT with respect to Tele-mental health services?

b. Could the Government confirm that 1.0 FTE TCT provided by the Contractor is sufficient for this contract, inclusive of the services cited above?

ANSWER:

a. For telemental health the contractor shall act as a backup in the event the VA staff is unavailable.

b. The contractor needs to provide TCTs in the numbers needed to provide sufficient support for required services.

68. The Schedule of Service in the Solicitation estimates 16% patient growth over the 10 year contract period. However, we note that it is projected for Veteran populations to decrease generally on a nationwide basis over the upcoming contract term. For example, “Current and Future Demographics of the Veteran Population, 2014-2024” published in Population Review Volume 57, Number 1 (2018), states “We project that the population of U.S. veterans will decrease by 19 percent over the next 10 years: from 21.6 million in 2014 to 17.5 million in 2024.” We also note that the patient size under the current Watertown CBOC contract has been extremely stable over the past two-year period. Given this history, could the Government indicate the factors that lead to the predicted long-term growth for the coming 10 year period under the current Solicitation, such as anticipated enlargement of the services area, anticipated influx of veterans to the area, etc.?

ANSWER: The clinic is near a military base and we believe there is the potential for growth in this geographic location.

69. Would the VA allow for the contractor-provided space to support the proposed VA-staffed mental health services (and/or the space utilized to deliver other specialty service under the contract) to be co-located at the same facility but in a non-contiguous space to the called for primary care services space under the Solicitation? This would provide greater flexibility for all offerors in meeting the VA’s requirement for such significantly sized overall clinic space in a real estate limited community such as Watertown, thereby creating greater optionality and value opportunities for the government's benefit.

ANSWER: No – they must be co-located in the same location.

70. The instructions require submission of “Completed copy of Attachment D.1. – Key personnel and page 196 lists Attachment D.5 Key Personnel list, however there was no attachment D.5 uploaded with the solicitation documents. Will the Government please clarify whether including a completed Key

Personnel list is required? If so, will the Government please provide the required attachment?

ANSWER: Key personnel is required. Documents attached.

71. Question: Who will provide phone circuit system and phones, the VA or Contractor? Please clarify.

ANSWER: The VA

72. 4.9.1.1 Patient Care Rooms (Exam/consultation Rooms): Each exam rooms contains a consultation zone and an examination zone and should be 125 square feet. Door openings should be 3’- 6” to allow for scooters, bariatric access and mobile equipment. Contractor shall provide services in a modern space that complies with the professional standards for providing health care. All exam rooms shall have two voice/data jacks.

Question: Typically, phones are not added in exam rooms. We have been putting just one voice jack in rooms that do require phones. We found this requirement to be outdated when VA was is using legacy phone systems. Will the VA remove the requirement for two voice jacks in exam rooms?

ANSWER: yes - No phone jacks needed in exam/consultation rooms

73. 4.9.1.7 Patient Transition Area (Reception/Greeting/Check-in/Waiting Room): Contains adequate seating for patients and family. Should have access to natural light. Wall mounted television with cable shall be located in the waiting room for patient use. One set of patient toilets shall be available in this area. Provide wall mounted TV with local news and programming. Privacy at check-in window is required. A computer area is part of the waiting room but separated and private for the MyHealtheVet computer. Area must be protected from excessive cold drafts in winter. Space should contain a wall mounted drinking fountain (or water cooler/cups), space for information board and floor mounted kiosk

(requires voice/data jacks and power). Lockable door to be provided between the waiting area and exam areas.

Question: We have been installing two data drops at Kiosk, since no phone is required at this station.

Will the VA accept only data drops at the kiosk without a voice jack? Please clarify.

ANSWER: yes. The VA needs phone jacks at the reception area, conference room, EKG and Nurse

Managers office.

74. 4.9.1.12 Teamwork zone: Supports individual teamlet work stations. Design of teamwork zone shall be in accordance with Pact Space Module Design Guide. Each work area shall have two voice and two data jacks as well as telephone.

Question: Typically, we have been installing only one voice jack in PACT area cubicles. We found this text to be outdated when VA is using legacy phone systems. Will the VA allow only one voice jack in the PACT cubicle area?

ANSWER: yes.

75. 4.11.2 The Contractor Shall provide the following requirements for Network/Data Rooms: No co-location with other tenants is permissible, Room size: min 10’ x 10’. Adequate lighting to work. All equipment will be mounted or stored off the floor. Floor will be tile or painted concrete. Physical and environmental protection shall be in accordance with VA Handbook 6500 Risk Management Framework for VA Information Systems - Tier 3: VA Information Security Program, to include physical and environmental protection policy and procedures, physical access authorizations, physical access control, access control for transmission medium, access control for output devices, monitoring physical access, visitor control, visitor access records, power equipment and cabling, emergency shutoff, emergency power, emergency lighting, fire protection, temperature and humidity controls, water damage protection, delivery and removal, alternate worksite, location of information system components, information leakage, and asset monitoring and tracking. Each IT and Telcom closet is required to have a card reader and motion alarm per VA Handbook 0730, Appendix B. IT and Telcom closet doors, locks and hinges and ceiling.

Question: Please confirm if this is required, we have not done this in the past for CBOC’s.

ANSWER: Yes, it is required.

76. 4.11.2.5.1 Power requirements:

4. 11.2.5.1 four (4) L6-20 receptacles

4.11.2.5.2 one (1) L6-30 receptacle in the closet

4.11.2.53.2each receptacle should be on a separate circuit

4.11.2.5.4 receptacles should be located in close proximity to the top or side of the rack, not to impede the walkway or cable management

Question: Please confirm if this is required. We have seen this as standard language and then have the

VA IT state it needs only Dual 20AMP dedicated power attached to top of rack is what is actually needed.

ANSWER: Correct as written.

77. 4.11.2.6.6 both racks will have 2 shelves on the bottom installed to hold IT computers

Question: Please confirm if this is required. We have seen this as standard language and then later the

VA IT department state that this is not required.

ANSWER: yes, it is required.

TABLE 1 – MEDICATIONS PER MONTH

Request Date 2020 MEDS/VACCINES Quantity january HEPATITIS A VACCINE INACT 1440 ELI UN/ML 10

January INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 30

January ZOSTER VACCINE,RECOMBINANT INJ 40

January INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 20

January PREVNAR 13 VACCINE 20

January TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 20

January PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 30

January INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 30

January PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 20

January TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 20

January ZOSTER VACCINE,RECOMBINANT INJ 30

January DIPHTH 2UNT/TETANUS TOX 5UNT/0.5ML INJ 10

January ZOSTER VACCINE,RECOMBINANT INJ 30

January INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 20

January PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 30

February HEPATITIS B VAC (ENGERIX-B) 20MCG/ML INJ 10

February INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 20

February ZOSTER VACCINE,RECOMBINANT INJ 20

February DIPHTH 2UNT/TETANUS TOX 5UNT/0.5ML INJ 10

February INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 30

February ZOSTER VACCINE,RECOMBINANT INJ 20

February INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 30

February ZOSTER VACCINE,RECOMBINANT INJ 30

March DIPHTH 2UNT/TETANUS TOX 5UNT/0.5ML INJ 10

March MENINGOCOCCAL POLY CONJ (MENACTRA) INJ 5

March PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 20

March TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 20

March ZOSTER VACCINE,RECOMBINANT INJ 30

March INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 10

March PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 20

March ZOSTER VACCINE,RECOMBINANT INJ 30

MAY HEPATITIS B VAC (ENGERIX-B) 20MCG/ML INJ 10

June ZOSTER VACCINE,RECOMBINANT INJ 20

July AMMONIA,AROMATIC 0.3ML AMP INHL 10

July ASPIRIN 325MG TAB 1

July EPI-PEN 0.3MG/0.3ML INJECTOR 1

July DIPHTH 2UNT/TETANUS TOX 5UNT/0.5ML INJ 10

July PAPILLOMAVIRUS QUAD-VALENT VACC INJ 10

July TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 20

July ZOSTER VACCINE,RECOMBINANT INJ 30

July MENINGOCOCCAL POLY CONJ (MENACTRA) INJ 5

July ZOSTER VACCINE,RECOMBINANT INJ 20

July TUBERCULIN,PPD 5UNT/0.1ML INJ 2

July ZOSTER VACCINE,RECOMBINANT INJ 20

July ZOSTER VACCINE,RECOMBINANT INJ 30

Aug HEPATITIS A VACCINE INACT 1440 ELI UN/ML 10

Aug ZOSTER VACCINE,RECOMBINANT INJ 30

Aug PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 10

Aug PREVNAR 13 VACCINE 10

Aug ZOSTER VACCINE,RECOMBINANT INJ 10

Aug HEPATITIS B VAC (ENGERIX-B) 20MCG/ML INJ 10

Sept PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 10

Sept PREVNAR 13 VACCINE 10

Sept ZOSTER VACCINE,RECOMBINANT INJ 10

Sept INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 20

Sept INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 20

Oct INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 40

Oct INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 60

Oct PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 10

Oct TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 10

Oct ZOSTER VACCINE,RECOMBINANT INJ 30

Oct INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 50

Oct INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 50

Oct MEASLES/MUMPS/RUBELLA VACCINE,LIVE INJ 10

Oct TUBERCULIN,PPD 5UNT/0.1ML INJ 1

Oct ZOSTER VACCINE,RECOMBINANT INJ 20

Oct TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 20

Oct DIPHTH 2UNT/TETANUS TOX 5UNT/0.5ML INJ 20

Oct INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 50

Oct INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 40

Oct ZOSTER VACCINE,RECOMBINANT INJ 30

Oct INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 50

Oct INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 50

Oct PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 20

Oct INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 40

Oct INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 50

Oct ZOSTER VACCINE,RECOMBINANT INJ 20

Nov INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 50

Nov INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 20

Nov PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 20

Nov TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 20

Nov ZOSTER VACCINE,RECOMBINANT INJ 20

Nov INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 30

Nov ZOSTER VACCINE,RECOMBINANT INJ 20

Dec DIPHTH 2UNT/TETANUS TOX 5UNT/0.5ML INJ 10

Dec ZOSTER VACCINE,RECOMBINANT INJ 10

Dec INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 20

Dec INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 20

Dec ZOSTER VACCINE,RECOMBINANT INJ 10

Total 1935

TABLE 2 – MEDS ORDERED IN THE LAST 12 MONTHS

AMMONIA,AROMATIC 0.3ML AMP INHL 10

ASPIRIN 325MG TAB 1

DIPHTH 2UNT/TETANUS TOX 5UNT/0.5ML INJ 70

EPI-PEN 0.3MG/0.3ML INJECTOR 1

HEPATITIS A VACCINE INACT 1440 ELI UN/ML 20

HEPATITIS B VAC (ENGERIX-B) 20MCG/ML INJ 30

INFLUENZA VACCINE HIGH DOSE 0.7ML SYR 300

INFLUENZA VACCINE,QUAD (PF) SYR 0.5ML 550

MEASLES/MUMPS/RUBELLA VACCINE,LIVE INJ 10

MENINGOCOCCAL POLY CONJ (MENACTRA) INJ 10

PAPILLOMAVIRUS QUAD-VALENT VACC INJ 10

PNEUMOCOCCAL 23-VAL VACCINE 0.5ML VIAL 190

PREVNAR 13 VACCINE 40

TETANUS/DIPHTHERIA/PERTUSSIS VACCINE 130

TUBERCULIN,PPD 5UNT/0.1ML INJ 3

ZOSTER VACCINE,RECOMBINANT INJ 560

TABLE 3

VETERANS BY ZIP CODE

ZIP CODE MALE FEMALE TOTAL

13601 2735 316 3051

13602 13 8 21

13603 451 191 642

13605 318 45 363

13606 299 0 299

13607 125 11 136

13612 370 25 395

13615 126 10 136

13616 89 0 89

13618 151 16 167

13619 940 216 1156

13622 207 18 225

13624 387 54 441

13626 122 7 129

13628 20 10 30

13634 306 6 312

13636 30 0 30

16337 549 125 674

16368 7 0 7

13640 22 0 22

13641 15 3 17

13643 0 0 0

13650 108 0 108

13651 26 2 28

13656 215 19 234

13659 17 2 19

13665 75 2 77

13673 150 14 164

13674 8 0 8

13675 15 0 15

13682 62 3 65

13685 254 32 286

13691 349 29 378

13692 7 0 7

13693 52 0 52