36C24223Q0754 0001 VENDOR QUESTIONS AND MODIFICATIONS TO PWS AND INSTRUCTIONS TO OFFERORS.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 11

08-01-2023

NONE

36C242

Department of Veterans Affairs Network Contracting Office (NCO) 2 Bath VA Medical Center 76 Veterans Avenue Bath NY 14810-0810 Danelle Wassink | Contract Specialist Danelle.Wassink@va.gov

36C242

Department of Veterans Affairs Network Contracting Office (NCO) 2 Bath VA Medical Center 76 Veterans Avenue Bath NY 14810-0810

To all Offerors/Bidders

36C24223Q0754

07-13-2023

X

X X

X ONE (1)

P0001: The purpose of this Amendment is to provide answers to vendor questions received in response to Solicitation Number 36C24223Q0754 and to modify Section 2.1.2 in the Performance Work Statement and remove an item in FAR provision 52.212-1 - INSTRUCTIONS TO OFFERORS- ADDENDUM, Page 90.

Reference Page 2-9 of this Amendment for all questions and answers.

Reference Page 10 of this Amendment for the change to Section 2.1.2 to the Performance Work Statement.

Please Reference Page 11 of this Amendment for revised page 90 of 52.212-1- INSTRUCTIONS TO OFFERORS.

The date and time for receipt of quotes is not extended and remains 08/16/2023 by 16:30 ET.

JADWIGA KUSTRA

CONTRACTING OFFICER

SOLICITATION NUMBER 36C24223Q0754: VENDOR QUESTIONS & ANSWERS,

MODIFICATIONS TO PWS AND INSTRUCTIONS TO OFFERORS

Question 1: Is this a new or existing requirement and what is the current contract number?

Answer: One (1) FTE CRNA is currently being provided through a multi-modality nursing services contract, 36C24223D0070.

Question 2: If this is an existing requirement, how many incumbent CRNAs are on this contract?

Answer: One (1) FTE.

Question 3: If this is an existing requirement, who is the incumbent company?

Answer: Bay Area Anesthesia d/b/a Worldwide Medical Staffing, LLC.

Question 4: If this is not a new requirement, has the scope of the work changed?

Answer: Yes, the incorporation of the 1 FTE CRNA into current contract 36C24223D0070 for multi-modality nursing services did not require the quantity of CRNA services being requested in the current solicitation.

Question 5: How many other CRNA's work there currently, and how many do you expect will work there during the time of the contract?

Answer: Currently, 1 FTE is permanently employed by VA and 1 temporary FTE is provided through contract 36C24223D0070. VA additionally utilizes multiple fee-basis providers (part-time nature, fee-basis providers are not permanently employed at VA) for CRNA services. VA intends to continue efforts to permanent hire CRNAs during the performance of this contract. It is unknown how many can be expected to work at the Syracuse VA Medical Center during the time of the contract due to the part-time nature of fee-basis assignments, the target is for 5 permanent VA CRNAs to be hired.

Question 6: How many Anesthesiologists are in the department now?

Answer: Currently there are 8 total anesthesia providers, but due to part time nature we have the equivalent of 5 FTE.

Question 7: How many CRNAs and/or Anesthesiologists equal a fully staffed department?

Answer: To be fully staffed, we are targeting 8 FTE Anesthesiologists and 5 CRNAs.

Question 8: If this is not a new requirement, do the current personnel have the right of first refusal?

Answer: Yes, please refer to FAR 52.207-3 on page 46 of the solicitation.

Question 9: How many cases are done on average per day and per month?

Answer: Historically we have done 2400 OR cases per year and about 1500 MAC GI cases.

Average cases per day—30, including GI cases.

Question 10: Are Federal holidays off? The on-call positions state for rotating weekends and federal holidays; please clarify.

Answer: Regularly scheduled CRNA onsite services are not required on federal holidays, but on-call coverage is required on federal holidays so the Syracuse VA Medical Center has 24/7/365 coverage.

Question 11: Will the COR and Anesthesia Chief provide the Contractor with the weekly signed timesheets?

Answer: The paper timesheets need to be maintained by the Contractor and signed by the Anesthesia Chief or designee prior to being submitted into the Tungsten Network. The design and format of the paper timesheets is determined by the Contractor, VA does not have a standard template. The timesheets should clearly show the date and hours of each shift worked, a total number of billable hours, and the signature of the contractor as well as the Anesthesia Chief or designee. The signed timesheets will be used by the COR to confirm hours/day and services provided against invoices.

Question 12: Can we set up a time to do a site visit prior to this contract being due?

Answer: A site visit will not be arranged for this requirement.

Question 13: Is an Anesthesiologist required to be in the OR when a CRNA induces a patient?

Answer: Yes.

Question 14: Is an Anesthesiologist required to administer induction medications for the

CRNA?

Answer: No.

Question 15: Is an Anesthesiologist required to be in the OR when a CRNA emerges/wakes up a patient?

Answer: No, but an Anesthesiologist should be available.

Question 16: Between how many anesthesia providers (CRNAs and/or Anesthesiologists) is called shared?

Answer: On call: 1 anesthesia attending and 1 CRNA are on call.

Question 17: Is it the Government’s intent that the On-Call requirements for the anesthesia department are covered solely by the CRNAs on this contract?

Answer: At the time of this solicitation, yes- until we are able to hire close to full complement.

Question 18: Is there a secondary On-Call person (CRNA or Anesthesiologist) that the primary On-Call person can summon should the patient’s condition warrant it?

Answer: Informal backups are available, but in general 1 MD and 1 CRNA are on call together.

Question 19: What are the historic call-back rates when a CRNA is on-call (i.e. the amount of times and/or hours the CRNA is called back, not the dollar rate)? / In an average month, how many times are on-call CRNA providers required to come in?

Answer: Call-back is dependent on special or emergent cases, all amounts listed are estimated based on historical data from the past year. We have computed about 300 hours of work after 4:30pm during weekdays with possibly 1/3 of days requiring someone to be present beyond 5:30pm—but we anticipate this amount going down when we are fully staffed. For weekends, the rough estimate is about 80-100 hours of work on weekends with working on about 25% of weekend days. The hours are estimated for 1 year.

Question 20: When On-Call, must the CRNA remain in-house?

Answer: No.

Question 21: If the CRNA must remain in-house while on-call, is there a private call room they may utilize?

Answer: The CRNA is not required to remain in-house while on-call.

Question 22: If the CRNA is not required to remain in-house while on-call, what is the recall time to arrive at the hospital if the CRNA is called back?

Answer: CRNAs are not required to stay in house, they must be available to work within 40 minutes when called.

Question 23: Please explain what are "When hours"?

Answer: “WHEN” hours are defined as Weekend, Holiday, Evening & Night hours, as defined on page 8 of the solicitation. These hours are outside of Syracuse VA Medical Center’s regular business hours where onsite CRNA services are required.

Question 24: What are the typical cases performed at this hospital? Can the Government answer if the following types of cases are performed at this hospital:

• Any cardiac procedures (i.e. open heart surgery, CABG, stent placements, etc.)? We do not perform cardiac surgery /open hear procedures, but we do cardiac cath lab which sometimes requires stent placements.

• Any vascular procedures (i.e. Carotid Endarterectomy, angioplasty, aneurism repair, etc.)?

Yes, all.

• Any neurosurgical procedures (i.e. Craniotomy, discectomy, fusions, etc)? Spine surgeries, Yes, but no craniotomy- we do discectomy and fusions etc.

• Any pulmonary procedures (i.e. VATS, lobectomy, balloon dilation, bronchoscopy, EBUS, etc.)? Yes, all.

• Any organ or tissue transplants? No.

• Does this hospital have trauma surgical services? No.

Answer: Typical cases performed at the hospital are general surgery cases (except hepatobiliary), all vascular (open and endovascular), all thoracic (no caridac surgery), ENT, opthomology, All urology, podiatry, orthopedics, spine cases (no craniotomy), out of OR procedures-- GI, pulmonary, cath lab and IR procedures.

Question 25: How many Operating Rooms (ORs) are in the department?

Answer: 7 total.

Question 26: Are there any out-of-the-OR procedure rooms the CRNAs cover (i.e. GI, GU, MRI, Cath Lab, etc)?

Answer: Yes, all- but mostly staff GI.

Question 27: Is there an Ultrasound Guided Regional Anesthesia (nerve block) program at this hospital?

Answer: There is not a formal program but we do these.

Question 28: If there is an Ultrasound Guided Regional Anesthesia (nerve block) program at this hospital, must the CRNAs be proficient in nerve blocks?

Answer: No, the MDs do these.

Question 29: I am seeking clarification on the 3.92 and 3.255 persons working request. Will the contractor be responsible for staffing three CRNA's Monday-Friday from 7:30-4PM, excluding holidays?

Answer: The 3.92 and 3.255 FTE is related to the total number of hours, not the number of contractors; contractors can fill either the onsite or on-call or a combination or both requirements. 1 FTE is 2080 hours per year including federal holidays. Federal holidays are not generally required for onsite CRNA services. The amount of hours included in the Schedule of Services is for 3.92 FTE onsite CRNA services, which is 4 FTE CRNAs minus federal holidays.

The onsite services are performed from 07:30am – 04:00pm and 09:00am - 05:30pm Monday- Friday, excluding holidays. The number of hours required for on-call services is the amount needed to cover all times when onsite CRNA contractors are not present, equaling 3.255 FTE.

Question 30: Does the VA anticipate 4 FTEs for the dayshift?

Answer: The FTE requirement relates to the total number of hours, not the total number of contractors. Contractor must organize CRNA staff schedules to ensure that there is 24/7/365 coverage, to include both onsite and on-call services and keep a detailed record of the contractor schedule. CRNA contractors must be willing to work both a mixture of onsite and on-call services to fill VA needs. The shifts for CRNA positions can be fixed or rotating. The Contractor can arrange individual CRNA schedules in various ways to meet the needs of the Syracuse VA Medical Center.

Question 31: How many FTEE (part-time employees) does the VA anticipate for on-call weekday evenings?

Answer: As many contractors that are needed in order to cover 3492 hours for one year.

Question 32: How many FTEE does the VA anticipate for on-call weekends?

Answer: As many contractors that are needed in order to cover 3276 hours for one year.

Question 33: PWS section 2.1.9.3. COVID-19 states “Contractor staff will be responsible for compliance with all COVID-19 precautions in place at the site they are performing services at.”

Can the Government state if Covid-19 vaccination is a requirement for these positions?

Answer: At this time, the Government does not require proof of COVID-19 vaccination for contractors. Other local precautions, such as masking/PPE requirements, social distancing during outbreaks and answering screening questions at the entrance of the building are still in effect at the Syracuse VA Medical Center.

Question 34: If Covid-19 vaccination is a requirement, will the Government accept CRNAs with medical or religious exemptions?

Answer: COVID-19 vaccination is not currently a requirement. Historically, when it was a requirement, the Government did evaluate and accept some contractor staff with medical or religious exemptions on a case-by-case basis.

Question 35: PWS section 3.2. Work Schedule: Based on the FTE and estimated quantities on page 8 of the PWS, in conjunction with the Work Schedule in section 3.2, it appears the Government requires:

• Two (2) CRNAs onsite for the 07:30AM – 4:00PM shift, as well as

• Two (2) CRNAs onsite for the 09:00AM – 5:30PM shift

• One (1) CRNA on-call (at a time) during WHEN hours call will start around 5 pm – 7:30am next day as long as we CRNA covering 9-5:30 shift. Can the Government confirm if the above is correct?

Answer: This is accurate, within best estimates. Currently, there are no onsite CRNAs working the 09:00am – 5:30pm shift. Without onsite coverage until 5:30pm, on-call shifts at this time are typically 3:30pm to 07:00am the next morning weekday. Currently, the typical weekend on-call shift is 3:30pm on Friday to 07:00am on Monday. Once onsite coverage is provided to 5:30pm the on-call coverage can be pushed back to start at 4:00 or 5:00pm.

Question 36: Can the Government confirm if more than one (1) CRNA is required to be on-call at a time (i.e. second call)? / How many other CRNA's will share the on-call schedule?

Answer: Only one (1) CRNA is required to be on-call at a time, second call is not required.

Please refer to Question 17 for additional information.

Question 37: Will the contractor be responsible for staffing an additional 3 CRNA's at all times during weekends, holidays, and weeknight on-call? Or will it be 1 CRNA on call at all times during weekends, holidays, and weeknight on-call?

Answer: 1 scheduled on-call CRNA is needed at all times during weekends, holidays and weeknights. The 3.255 FTE relates to the number of hours being requested.

Question 38: Page 86, Addendum to FAR 52.212-1 states “Quotations may exceed minimum requirements of the solicitation”, and the next paragraph states “The Government is not requesting or accepting alternate quotations”. Can the Government clarify if we may submit more than 3 relevant past performances?

Answer: Yes, it is acceptable to submit more than 3 relevant past performance references, but it is not required.

Question 39: PWS section 2.1.2. Certifications states “CRNAs must have a national certification through the American Association of Nurse Anesthesiology (AANA).” Will the Government change this to the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA), as the AANA is not a certifying body, but rather an optional membership association.

Answer: Yes, please see the modification to the Performance Work Statement attached to this Amendment.

Question 40: Page 90, Other Miscellaneous Items, the 2nd item in the checklist states “Offeror must be verified as a Service-Disabled Veteran-Owned Small Business (SDVOSB) in the U.S.

Small Business Administration’s VetCert program at the time of the offer”. The 13th item in the checklist states “Copy of VA CVE Verification”. Will the Government remove the 13th item since the VA transferred its responsibility for SDVOSB verification to the SBA effective January 1, 2023, and no longer manages CVE Verification.

Answer: Yes, the item requiring a copy of VA CVE Verification is removed- please see the modification to FAR 52.212-1- INSTRUCTIONS TO OFFERORS- ADDENDUM- attached to this Amendment.

Question 41: In reference to the just released solicitation for CRNA's will the VA let me utilize past performance from a subcontractor?

Answer: Past performance references must be able to answer questions about performance and adherence to contract requirements, if the reference is able to meet those requirements and the experience is relevant to the acquisition, you may submit past performance from an identified subcontractor. However, the quote of an offeror with no relevant past performance of its own may not represent the most advantageous offer to the Government. If your business is intending to use a subcontractor for critical aspects of the requirement, please remember, if awarded a contract, your business must comply with the limitations on subcontracting requirement as provided in the solicitation and the resultant contract. Refer to VAAR 852.219-75 and Attachment D.4 for more information.

Section 2.1.2 of the Performance Work Statement is modified as follows:

2.1.2. Certifications: CRNAs must have a national certification through the American Association of Nurse Anesthesiology (AANA). National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).

Page 90 of 52.212-1- INSTRUCTIONS TO OFFERORS- is modified as follows:

OTHER/MISCELLANEOUS ITEMS TO CONFORM WITH

SOLICITATION REQUIREMENTS

The miscellaneous items below are necessary for conformance to the solicitation requirements:

Offeror must be registered and active in the System for Award Management

(SAM) at the time of the offer.

Offeror must be verified as a Service-Disabled Veteran-Owned Small Business

(SDVOSB) in the U.S. Small Business Administration’s VetCert program at the time of the offer.

Complete Contract Administration Data from Section B.1, Item # 1, located on Page 4.

Complete Acknowledgement of Amendments from B.1, located on Page 7, as well as signed copies of any amendments, if issued. Ensure amendments are signed by the same official that has been authorized to sign the SF-1449.

Complete Section C.14, VA Notice of Limitations on Subcontracting- Certificate of Compliance for Services and Construction (NOV 22), on page 54.

Complete Attachment 1, Quality Assurance Surveillance Plan (QASP) from Section D.1 - Contract Documents, Exhibits, or Attachments, beginning on Page

68. (Fill-ins on Page 69, signature on Page 75).

Complete Attachment 2, Contractor Certification – Immigration and Nationality Act of 1952, from Section D.2 - Contract Documents, Exhibits, or Attachments, on Page 76.

Complete Attachment 3, Organizational Conflicts of Interest from Section D.3 – Contract Documents, Exhibits, or Attachments, beginning on Page 78.

Complete Attachment 4, VA Notice of Limitations on Subcontracting – Certificate of Compliance for Services and Construction from Section D.4 – Contract Documents, Exhibits, or Attachments, beginning on Page 80.

Complete response to E.2 FAR 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment, beginning on page 91.

Complete response to E.3 FAR 52.209-7 Information Regarding Responsibility Matters, beginning on page 94.

Complete response to 52.212-3(b) and any other sections of Section E.12, 52.212-3 as applicable to this procurement. Complete response to FAR 52.212-3 paragraph (b) of this provision only if the Offeror has not completed the annual representations and certification electronically in the System for Award Management (SAM), beginning on Page 99.

Copy of 2022 VETS-4212 Report or Filing Verification Copies of Insurance Certificates