36C24220R0147 0002.docx

36C24220R0147 Amendment #2

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) 5/12/2021 00000 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

36C24220R0147 05-12-2021

X X X ** HOUR & DATE for Receipt of Offers is EXTENDED to:

June 1, 2021 3:00 PM EST

Attached are responses to questions received through May 12, 2021.

Date and Time for receipt of proposals has been changed to June 1, 2021 at 3:00 PM EST.

Allan Preston Contracting Officer

1. According to the solicitation “At least one exam room should be available for telemental health services”.

Question: Can the telemental health exam room be included in the PACT exam count or is this a separate requirement”.

ANSWER: It is a separate from the PACT exam rooms.

2. The solicitation lists VA provided Clinical Pharmacist, Licensed Clinical Social Worker, and Dietitian as requiring separate furnished offices, Question: Are any additional VA specific behavioral health rooms required?

ANSWER: See 4.9.1 for space requirements.

Behaviorial health – 3 rooms Non-Mental Health – 3 rooms (CPS, LSW, Doctor on the move)

NOTE: Dietitian is provided by the Contractor.

3. Total Estimated Patients enrolled/assigned to site: 1865 as of January 2021.” Please provide the most recent 3-month billing figures/members/enrollees for primary care services

ANSWER: January 2021 - 1865; February 2021 – 1861 and March 2021 1871.

4. 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: Correct - Patient must be seen within 12 months of last vesting visit.

5. Over the past year, we have seen a shift to electronic (email) submissions of CBOC proposals in other VISNs throughout the country.

Question: Would the government be willing to accept email submissions of proposal rather than requiring printed copies?

ANSWER: Not at this time. Printed copies are required in the numbers listed in the RFP.

6. Section 4.11.1.1.CAT 6 wiring

Question: Will the Government please confirm if CAT 6 wiring is preferred and not CAT 6A?

ANSWER: Cat 6 is the minimum required.

7. Section 4.11.1.9 – One Fax Machine in the event the Multi-function device provided by the VA is not operational

Question: Will the Government please confirm if the additional fax machine is required?

ANSWER: Yes it is required.

8. Section 4.11.2.5 Power Requirements four (4) L6-20 receptacles and one (1) L6-30 receptacle in the closet.

Question – Could the Government please confirm the power requirements and if two 20-amp dedicated receptacles are acceptable?

ANSWER: that is acceptable.

9. 4.11.2.6.7.6 Racks – both racks will have 2 shelves on the bottom installed to hold IT computers.

Question: Could the government please confirm if shelves are required?

ANSWER: They are required.

10. 4.11.2.6.7.6 RACKS – APC smart-UPS 2200VA LCD RM 2U 120V – standard 120V plug.

Question: Could the Government please confirm if an APC is required.

ANSWER: APC is required

11. Question: Could the Government please confirm if VA IT or Contractor will be responsible for purchase and installation of the phone circuit and physical phones.

ANSWER: The Government is responsible for the phone circuit and physical phones. Contractor is responsible for the wiring.

12. Question: Will the Government consider an extension once responses to questions are released to allow Offerors sufficient time to incorporate potential impacts from pending clarifications?

ANSWER: An extension will be provided.

13. In section B.2 Schedule of Services on page 6 of the Solicitation states in Line Item Number 0001 the base year estimated enrollment is 1935. As the incumbent contractor, the latest billed enrollment quantity for Oswego CBOC was 1871 which is 64 enrollees lower than the estimated enrollment stated. Secondly this shows a slight increase through Option Year 3 which in fact, the enrollment has been steadily decreasing 1.43% over the last 5 years.

Question: Would the VA consider reducing the estimated enrollment in the base and outlying years that more closely aligns with historical enrollment?

ANSWER: The billable Veterans from Sept 2019 are as follows:

VA believes the estimate of 1935 is reasonable given historical enrollment at this clinic and also believes that there is an opportunity for outreach in the geographic region to increase enrollment.

14. On page 14 Paragraph 2.1 of the solicitation 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” In addition, on page 46 paragraph 4.6.3.2.1 of the solicitation states, “Contractor to provide CPS support staffing, and ancillary support”.

Question: Is it acceptable to utilize a PACT team member for CPS support or will a dedicated MSA be required?

ANSWER: PACT team ember is acceptable for CPS support.

15. On page 14 paragraph 2.1 of the solicitation states, “Clinical pharmacist will be pharmacist will be provided by VA onsite or via telehealth.” On page 46 paragraph 4.6.3.1.7 of the solicitation states “the Contractor shall meet all requirements for anticoagulation management outline 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. On page 49, paragraph 4.6.4.5.3 of the solicitation states “anticoagulation services will be provided by the Syracuse VAMC”.

Question: Is the VA or the Contractor providing anticoagulation services?”

ANSWER: The responsibility for anticoagulation management is a shared responsibility between the contractor and VA. The VA provides monitoring and management services for veterans on warfarin and injectable anticoagulants, while the contractor provides those services for stable veterans on non-warfarin oral anticoagulants (so-called Novel Oral Anticoagulants).

Contractor is responsible for the following:

PCP enters electronic consult for the “Anticoagulation Clinic”.

Lab Draws as scheduled by the Anticoagulation clinic.

PCP communications with Anticoagulation Clinic regarding medicine change, notification for surgical procedure.

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

16. On page 23 paragraph 2.8 of the Solicitation states Telehealth Clinical Technician (TCT) FTE Raito 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: Is it acceptable to utilize an LPN or MA for the TCT position? With an enrollment of approximately 1935 in the first year, is it acceptable to hire a 0.4 FTE TCT or is the Contractor required to have a fulltime TCT available Monday through Friday, 8:00 AM to 4:30 PM? As the incumbent contractor, currently the Oswego CBOC has a full time TCT in place.

ANSWER: LPNs are acceptable. Contractor is required to have a full time TCT.

17. On page 31 paragraph 3.2 of the solicitation states, “The clinic shall be accessible to VA Behavioral Health staff from 7:00 AM to 7:00 PM Monday through Friday” and on page 56 paragraph 4.6.5.3 states, “The Contractor shall provide a dedicated MSA who provides the following clerical support services for mental health providers at the CBOC”

Question: Given the Behavorial Health staff being there from 7 am to 7 pm and the requirement for a dedicated MSA, is the VA requiring more than one MSA to cover the 12 hours per day Monday through Friday?

ANSWER: The VA is not requiring the CBOC to be open for extended hours to see Veterans face to face. However, staff do need access to the CBOC for those hours as some may be on a compressed tour of duty (i.e. 8:00 AM – 6:30 PM) during which time they may be seeing Veterans via VVC. MSA support is not required for extended hours.

18. On Page 42 paragraph 4.6.3.1 of the solicitation states, “The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic”.

Question: Will the VA please confirm that only the following vaccines are the responsibility of the Contractor?

f. Shingrix

ANSWER: all of the above and the following:

Meningococcal Polysaccharide Vaccine, MMR Vaccine, Tuberculin PPD 5 unit/0.1 ml injection, regular flu for younger Vets and Covid vaccine if becomes a common vaccine.

19. On page 42 paragraph 4.6.3.1 of the solicitation states “Urgent/Emergent medications needed will be filled via VA contracted local pharmacy for up to 10 days.”

Question: Are the urgent/emergent medications provided by the VA contracted local pharmacy provided at the VA’s expense?

ANSWER: Yes, pharmacy will be providing an emergency first fill contract at the VA expense, to allow Veterans to get up to a 10-day supply of a new start medication at a local pharmacy.

20. On page 55 paragraph 4.6.5.2.7 of the solicitation states, “Disaster preparedness: All contractor sites must have a designated Mental Health Disaster POW, who can serve as a member of the VA Parent facility’s Disaster Response Team”.

Question: Given that the VA provides all mental health staff, wouldn’t the Mental Health Disaster POC be a VA mental health staff member.?

ANSWER: Yes, this will be a VA staff member and is the person who sits on the Emergency management committee.

21. On page 58 paragraph 4.6.7.5 of the Solicitation states, “Contractor shall provide clerical support including scheduling and ancillary support for VA telepharmacy services.

Question: Is it acceptable to utilize a PACT team member for support of VA telepharmacy or will a dedicated MSA be required?

ANSWER: PACT team member is acceptable. A dedicated MSA is not required.

22. Question: How many VA Staffed personnel will be providing services in the Oswego CBOC and how many offices will be needed for VA provided staff?

ANSWER: See 4.9 Space Requirements in the RFP for exact requirements for space required for VA staff for office and exam room requirements.

See 4.9.1.1.3 – Exam room – Doctors on the move See 4.9.1.9 – Clinical Pharmacist.

See 4.9.1.10 – Licensed Social worker

See 4.9.1.2 - For mental health (3) total rooms and access to group room.

Mental health Staff – 1 – OMH therapist 1 - OMH psychiatrist I(may not be 1 total FTE equivalent but will require a designated office for the staff while they are on-site) 1 - Potential of PCMHI Therapist

23. On page 69 paragraph 4.7.7 of the solicitation states, “Work Related Incident Treatment: When treating the Veteran for injuries sustained because of a work-related incident or an accident, the Contractor must complete the appropriate forms to allow the VA to assert a Federal Medical Care Recovery Act (FMCRA) or a Workers Compensation Claim.”

Question: What types of forms will the Contractor be required to fill out for Workers Compensation Claims?

ANSWER: NYS Workman’s Comp provider form (C4)

24. On page 77 paragraph 4.9.10 of the Solicitation states, “At the Contractors expense, the VA reserves the right to require documentation of proper operations, inspection, testing, and maintenance of fire protection systems, such as, but not limited to, fire alarm, fire sprinkler, standpipes, fire pump, emergency lighting, illuminated exit signs, emergency generator, prior to occupancy to ensure proper operation.”

Question: Is the VA looking for an emergency generator for the entire CBOC facility or for medication refrigerators?

ANSWER: The medication refrigerators need to be on a generator.

25. On page 79 paragraph 4.9.19 of the Solicitation states “Closed Circuit Television (CCTV) shall be provided by the contractor to monitor building entrances, restricted areas, mission critical asset areas, and alarm conditions. CCTV system shall be used for surveillance and observations of defined exterior areas, such as site and roadway access points, parking lots, building perimeter, and interior areas such as hallways, common areas and waiting areas, CCTV System will be viewed from a VA location within the clinic determined by the VA physical security officer. The design, installation and use of CCTV cameras shall support the visual identification and surveillance of persons, vehicles, assets, incidents and defined locations. The Contractor shall contact the VA Physical Security Officer at 315-425-4336 prior to installation of CCTV system to ensure proper placement.” The requirement for the VA to be able to monitor the CCTV activities remotely appears to be intended for a VA leased and operational facility as opposed to a contractor operated and leased facility. Our current contracted CBOC facilities across the U.S. utilize high resolution CCTV security cameras for both interior and exterior monitoring and routinely have recording capability of up to 30 days. This is the only specification that request the VA to monitor these cameras which require cellular based services and special equipment to accomplish.

Question: Was it the VA’s intent to utilize this level of monitoring by the VA, as opposed to the contractor responsibility, to monitor the camera activities at the privately leased contract facility? Was this requirement place in the specification in error as it was not normally utilized. Will you please clarify?

ANSWER: The VA does not need to monitor the CCTV activities remotely. The system is only required to record activity at the CBOC facility that is available for playback at the CBOC in the event of any criminal activity.

26. On page 79 paragraph 4.9 Space Requirements in the RFP states, “Davis-Bacon Wages (https://www.dol.gov/agencies/whd/government-contracts/construction ) must be paid to any personnel working on the buildout/construction of the space and certified payrolls for all buildout/construction workers are due to the COR and Contracting Officer, no later than 10 business days prior to the clinic opening.” The use of the Davis-Bacon specification and clause is normally utilized in GSA/VA facilities based contracts, and not in service contracts that are paid PMPM rate with the facility and all other services and components inclusive in the PMPM rate for each billable enrollee. In short, there is no construction contract vehicle, as part of the specification in this personal services contract vehicle being solicited and procured by the VA. Davis Bacon unintentionally, is being utilized out of context for this type of service contract procurement and raises construction costs by over 50% unnecessarily.

Questions: Based on this information and in an effort to reduce the cost of preparing space, would the VA consider removing its David Bacon Act requirement from this CBOC solicitation in an effort to save substantial costs in startup and thus save costs to the VA?

ANSWER: The VA will not remove the Davis Bacon Act Requirement. The Davis-Bacon and Related Acts, apply to contractors and subcontractors performing on federally funded or assisted contracts in excess of $2,000 for the construction, alteration, or repair (including painting and decorating) of public buildings or public works. Davis-Bacon Act and Related Act contractors and subcontractors must pay their laborers and mechanics employed under the contract no less than the locally prevailing wages and fringe benefits for corresponding work on similar projects in the area. The Davis-Bacon Act directs the Department of Labor to determine such locally prevailing wage rates.

27. On page 81 paragraph 4.11.2 of the Solicitation states “Each IT and Telcom closet is required to have a card reader and motion alarm per VA Handbook 0730, Appendix B.” Then on page 82 paragraph 4.11.2.1.4 states “Primary lock, and a deadbolt (this can be one combined unit). If separate the locks will be keyed the same”.

Question: Is primary lock and deadbolt sufficient, or is there a card reader requirement? If a card reader is required, is that something the VA supplies or the Contractor? If the contractor supplies, what are the specs and do they need to connect to the VA somehow? Could not find the card reader requirements in the Handbook 730 appendix B.

ANSWER: Card reader is required and is supplied by the contractor.

SPECS:

Electronic Physical Access Control System (PACS). For monitoring and controlling access to areas identified as requiring high or medium levels of assurance. PACS systems are not used for recording employee time and attendance.

Access Safeguard. To prevent learning condes through keypad observations or use of stollen or found access cards.

Time Sensitive. The ability to program access by user, by shift and day.

Area Sensitive. The ability to program access by door and area for each individual user.

Fail Safe. The ability to maintain access security if the system goes down (i.e. bypass key).

Access Record/Audit Trail. The ability to provide for periodic or on demand print-out of names and time/dates of individual accessing. Records of access or audit trails will not be used for employee time and attendance purposes.

User Coverage. The number of individual access codes that the system will accommodate.

28. On page 83 paragraph 4.11.3.1 of the solicitation states, “The VA will be responsible for: providing PC workstations, software, telephones, primary telecommunications lines and networking equipment required to access the VA EHR.

Question: Is the VA providing all telephones and equipment and telephone lines to the Clinic? The contractor does not have to supply any telephones, equipment or telephone lines for the CBOC?

ANSWER: The VA is providing PC workstations, Software, telephones, primary telecommunication line and networking equipment required to access the VA EHR. The contractor shall provide phones or PCs that cannot be connected to the VA Network. For example, PCs that will be connected to the Contractor network.

29. On page 95 paragraph 6.1.2 of the solicitation states, “The Contractor shall have 120 days from contract award to commencement of the provision of medical care to local Veterans.”

Question: Based on the size scope and logistics of drawings, permits and realistic construction timeframes, would the VA consider a 180 day start-up period for the cost effectiveness and efficiency for all systems start-up components.?

ANSWER: The contractor is required to begin providing services to Veterans 120 days after contract award.