36C24225R0047 0001 VENDOR QA- REVISE PWS- SCHEDULE OF SERVICES- QASP.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)

1 125

0001 MSO-2025-COM-0018

36C242

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

36C242

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

To all Offerors/Bidders 36C24225R0047

07-23-2025 X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 09-11-2025 16:30 EDT

X ONE (1)

0001: The purpose of this Amendment is to provide answers to vendor questions received in response to Solicitation 36C24225R0047, Community Based Outpatient Clinic (CBOC) services in Kingston, NY.

-Please reference Attachment 1 starting on Page 2 for vendor questions and answers.

-The revised Schedule of Services is included in Attachment 2, starting on Page 17.

-The revised Performance Work Statement (PWS) is included in Attachment 3, starting on Page 20.

-PDF Attachment: -D.1- Quality Assurance Surveillance Plan (QASP) Revised -PDF Attachment: -D.52- PBM Guidance Access to Clinical Pharmacy Services at Contracted CBOCs.

The date and time for receipt of proposals is hereby extended to September 11, 2025 by 16:30 ET.

JADWIGA KUSTRA

CONTRACTING OFFICER

JADWIGA KUSTRA Digitally signed by JADWIGA KUSTRA Date: 2025.08.20 19:45:02 -04'00'

08-21-2025

Attachment 1- Vendor Q&A Solicitation 36C24225R0047 Amendment 0001

Number Question/Answer

1 Question: Section E.1 Specific Instructions PART IV PRICE PROPOSAL

(g) states in part that the proposal must be submitted for the base year and all (9) one-year options, however, Section B.2 Schedule of Services lists one base year and (4) one-year options. Please confirm that this project is for one base year with (9) one-year options.

Answer: This is a mistake. Section E.1 should read “four (4) one-year options,” to reflect the correct performance period.

2 Question: Recent VA CBOC solicitations have allowed offerors to address construction costs in their pricing. See solicitation language below:

"Offerors may submit alternative pricing or payment methods in their pricing proposal volume that address construction costs incurred during the build-out phase."

For the Kingston CBOC, may offerors submit alternative pricing or payment methods in their pricing proposal volume that address construction costs incurred during the build-out?

Answer: No, proposals that do not include pricing for all line items and sub-line items in all performance periods of the Schedule of Services (Price Schedule) will be considered incomplete. An alternative pricing sheet should not be submitted with the proposal, pricing should be submitted as outlined, using all-inclusive capitated, Per Member Per Month (PM/PM) rates.

3 Question: Section E.1 Specific Instructions PART IV PRICE PROPOSAL states that tiered pricing will not be accepted. Please confirm that offerors can adjust unit pricing each year to account for costs such as clinic build out costs, escalation, or other costs that may vary by year.

Answer: Tiered pricing will not be accepted. Adjusting unit pricing each year to account for costs such as clinic build-out costs, escalation, or other costs that may vary by year is separate from tiered pricing. Offerors can account for those variations in their annual pricing adjustments.

4 Question: Can the VA please provide the list of medications and volume expected (or historical)?

Answer: Please refer to Attachment D.11. VA has provided historical utilization data. However, patient care needs may dictate a requirement for other medications (such as ammonia inhalants, epinephrine auto-injectors, dextrose squeeze tubes, etc.) or immunizations other than those listed on D.11 which will be the Contractor’s responsibility.

5 Question: Can the VA please provide the actual enrollment this month?

Answer: The Schedule of Services states that the number of billable enrollees in May 2025 was 1,559. The estimated number of members is modified in Attachment 2, Schedule of Services.

6 Question: Can the VA please provide the volume for Podiatry spurs?

Answer: The requirement for contractor-provided Podiatry and Nail Technician is removed from the solicitation, please refer to Attachment 3.

7 Question: Is the current facility PACT design and/or are they compliant with space requirements?

Answer: Yes, the current facility uses the PACT design, and they are currently compliant with the space requirements. However, this solicitation contains changes to the required space and required staffing that could impact the floor plan and usage of the space at the facility.

8 Question: Please confirm the podiatry FTE expectations to be one podiatrist and one nail technician total? If not, what are the specific requirements?

Page 76 references a Podiatry Exam/Consultation/Nail Technician Room.

Answer: After further evaluation and discussion, the requirement for contractor-provided Podiatry and Nail Technician has been removed from the solicitation. Please refer to Attachment 3 for the updated PWS.

9 Question: Regarding the VA Exam Room, the VA Mental Health Exam Rooms & Telemental Health Rooms, are there to be four separate spaces, or will one of the VA Mental Health Exam Rooms or the VA Exam Room be used for Telemental health visits? Please see RFP excerpt below for context.

P.76 “VA Exam Room: The space required is exclusively for VA use. This includes 1 exam room with a minimum of 125 square feet. Room is to be used for additional mental health services or other VA provided service, as coordinated. The exam room is to be located within the space allocated to other mental health exam rooms and primary care services to patients.” AND "Telemental Health: At least 1 exam room should be available for telemental health services. Exam room shall be approximately 125 square feet or at a minimum, identical in size or larger than the largest exam room being used for primary care services. Exam room must be capable of supporting standard office equipment (desk, two chairs of equal height and must meet ABA requirements, power outlets, telephone, phone lines, computer, computer connections, and videoconferencing equipment)."

Answer: Each of the rooms listed in the Space Requirements section of the PWS is its own separate space, unless otherwise explicitly indicated. The VA exam room, telemental health room, and mental health exam rooms are all separate rooms.

10 Question: The schedule of services has an enrollment of 1775 in the base year and 4 option years. However, enrollment has been below 1700 since before January 2023, there has been a consistent downward trend observed from 2023 - 2025 with over 350 unassigned patients, and June 2025 enrollment of 1559. What is the VA basing the enrollment of 1775 on?

Answer: Due to the discrepancy in current membership to the Schedule of Services, the estimated number of Veterans is modified. Please refer to Attachment 2. The enrollment was based off data retrieved from VA’s VSSC Enrollment Projection tool. There are opportunities to gain membership to the clinic, as unassigned patients can be assigned to the clinic and a population of new patients that are not currently using VHA healthcare could be attracted to start receiving services in the clinic. The number of Veterans that were assigned at the beginning of the current contract in 2020 was 1734 members, which has since decreased to 1559 over the past five years.

11 Question: CBOC Space Requirements: Does the current CBOC meet the government’s space requirements? If not, will the existing location be “grandfathered in” and available for rebid “as-is”?

Answer: Yes, the current CBOC has the potential to meet the Government’s space requirements. The floor plan may need to be altered to account for the changes in this solicitation.

12 Question: The RFP states that VA will provide a Registered Dietician/Nutritionist "either on-site or virtually as required." However, unlike other specialty services provided by VA, there are no space requirements outlined (pp. 75-78) for this position.

Is it VA's intent that the Dietician/Nutritionist use the designated VA exam room, or will another exam/consultation room be required?

Answer: It is VA’s intent to provide the Dietician/Nutritionist services virtually.

13 Question: The RFP calls for 1.0 Podiatry FTE per an estimated 950 patients requiring podiatry services. Will the VA provide workload data so that total required hours can be calculated?

14 Question: The RFP calls for "clinical support (such as a nail technician with state licensure) to support the podiatrist." This position is not individually identified elsewhere in the RFP.

Does the VA want the clinical support position hours to be the same as the podiatrist hours once workload requirements have been established?

15 Question: The RFP states, a copy of licenses shall be provided with offer and will be updated annually. However, in the Instructions to Offeror, there is no mention of providing the staff or licenses.

Is the contractor to provide the proposed staff and their licenses with the proposal submission? And if so, in what section should this be provided?

Answer: Yes, the contractor should provide the proposed staff and their licenses in the proposal submission in Part 1- Factor 1: Technical Capability.

16 Question: The RFP states, the contractor will provide all medications that are to be administered to patients in the clinic (including vaccines in accordance with current and future Advisory Committee on Immunization Practices (ACIP)/CDC recommendations and guidance). It also states, Contractor shall administer VA-provided medications which fall within the scope of primary care services to both primary care and mental health patients, as required.

Does the contractor or the VA provide all medications including vaccines for both primary care and mental health patients in the Kingston CBOC?

Answer: The contractor provides medications (including vaccines) that are administered to patients at the clinic within the scope of primary care services. VA may provide certain medications to be administered in the clinic, when authorized and required on a per patient basis, and the contractor should be prepared to administer these medications as well. The contractor does not provide mental health medications.

17 Question: The RFP states the Clinical Pharmacy Services will be provided by the Samuel S. Stratton VAMC via telehealth. The current Kingston CBOC is providing the PharmD, is it the VA's intention to take over this position in the clinic?

Answer: After further evaluation and discussion, VA’s requirement is revised to keep CPP services as contractor-provided services. Please refer to Attachment 3 for the updated PWS.

18 Question: The RFP states that Physical Therapy (PT) services will be provided by VA and that VA "may intermittently arrange to perform scheduled physical therapy services at the CBOC in a VA-designated exam room."

Does VA PT require designated PT room, or a specialized exam table?

Answer: VA does not require the contractor to provide a specialized exam table or designated PT room. If needed, the VA will provide services within their designated VA exam room space and the VA will be responsible for providing specialized furnishings. While the VA has no intention of immediately implementing PT services onsite at the CBOC, the PWS is written to reserve the option to provide certain specialty services within the VA designated exam room.

19 Question: The RFP states that "(s)pace for telemental health services will be available from 7 a.m. to 7 p.m., Monday through Friday, when required by VA. Contractor TCT staff are not required for the extended telemental health hours outside of 8 a.m. to 4:30 p.m., unless otherwise arranged and approved by the contractor and Contracting Officer."

What is the expected frequency of VA providing services outside of normal operating hours, and what will the notice period for these events be (e.g. one week, one month, 45 days)?

Answer: The expected frequency is rare to never. Notification timeframes may vary depending on the situation. The Contractor TCT staff would not be required to assist or be present for after-hours/ extended telemental health services, unless otherwise arranged and approved by the CO. Services would be provided virtually by VA staff, the patient would not be present at the clinic.

20 Question: The RFP states, The contractor shall make provisions for toll free telephone care, twenty-four (24) hours a day, seven (7) days a week, including evenings, weekends, and holidays, for all Veterans.

Is it acceptable to the VA if the Contractor uses the VA's after-hours call center to provide after-hours telephone access?

Answer: Yes.

21 Question: The RFP states, "Primary Care: Minimum of 3 exam rooms and 1 exam/consultation room per PACT teamlet."

Will the VA allow 1 of the 3 required exam rooms to be used as a Consultation Room?

Answer: Three exam rooms are required per PACT (one room for the LPN, one for the RN, and one for the provider). One of the three exam rooms can also be used as a consultation/exam room.

22 Question: The RFP states, one exam room to be utilized for women veterans. Will the VA allow the Women's Health Exam Room to count as one of the 3 exam rooms per PACT requirement?

Answer: No. The solicitation states “this room does not count as an exam room required for other Primary Care services.”

23 Question: The RFP states that 1 telemental health exam room, 1 telehealth room and 1 group care room with telehealth is required. Currently the Kingston CBOC utilizes 3 telehealth rooms full-time (including 1 telemental health) and a group room, however, the RFP is only asking for 2 telehealth rooms and 1 group room. There are additional telehealth services in the new contract, however, there is a decrease in telehealth rooms.

Is the VA decreasing telehealth utilization in the Kingston CBOC?

Answer: No, the VA is not decreasing telehealth utilization at the Kingston CBOC. The solicitation specifies the minimum requirements, which may be met through various configurations or different spatial layouts. The availability of telehealth space beyond the minimum requirement may provide added value to the Government, as efforts have been made to integrate new telehealth services in recent years.

The types of telehealth services mentioned in the solicitation are general descriptions of major telehealth categories and may be expanded as the VA enhances its capacity to deliver additional telehealth services. Not all telehealth services listed in the solicitation will be operational at the clinic until the VA has the capability to offer these services and provides the necessary training. One category not listed is Teleaudiology, which is currently available at Kingston CBOC. Please refer to Attachment 3 for the updated Performance Work Statement (PWS), including teleaudiology.

24 Question: The RFP states, Contractor shall meet VHA standards regarding EOC and shall provide EOC management plans addressing safety, security, hazardous materials, hazardous waste, emergency preparedness, life safety, medical equipment, infection control, and utility systems with the submission of their proposal and within 15 calendar days after contract award. However, nowhere in the Instructions to Offeror does it mention providing EOC management plans.

Does the VA want the contractor to provide the EOC with the proposal or can it be provided within 15 calendar days after contract award? If the VA wants it with the proposal, where in the technical proposal would the VA like to see the EOC management plans?

Answer: Ideally, the contractor will provide any/all information related to EOC with their proposal that will instill confidence with the VAMC that the facility is/will be appropriately designed, equipped and safe. This information would fit in Part I, Technical Capability relating to the geographic location.

Additional information requested by VA can be provided within 15 calendar days after the contract award and during/after build-out.

25 Question: The RFP states, Having a contingency plan for computer downtime that defines the processes to ensure continuity of patient care and maintenance of the integrity of the patient’s medical record during periods of loss of computer functions. The contingency plan shall be reviewed and approved by the CO prior to the award of the contract. However, nowhere in the instructions to offeror, does it mention providing a contingency plan for computer downtime.

Does the VA want the contractor to provide the contingency plan for computer downtime with the proposal and if so, where in the proposal is the contingency plan for computer downtime to be provided?

Answer: Yes, a contingency plan should be included with the proposal and submitted in Part IV, Miscellaneous.

26 Question: The RFP states, The contractor shall have 120 calendar days from contract award to commencement of the provision of medical care to VA patients.

Will the VA consider a 180-calendar day start up period from contract award to commencement of the provision of medical care to VA patients?

Answer: An award will be made with the intention of a 120-calendar day start up period. If additional time is deemed necessary, the timeline may be adjusted after the award of the contract.

27 Question: There are several attachments to the RFP that were not provided with the solicitation including Attachments 15, 21-25, 27-28, 30-31, 33-35, 37-40, and 43-50. Will the VA be providing all the missing attachments?

Answer: The attachments are all uploaded and available through SAM Contract Opportunities. Contractors must request access to the attachments in order to download them. Please be sure to login to your SAM.GOV profile to request access. The attachments in question are restricted because they contain local Albany VA Medical Center policies that are controlled by the Medical Center. Please notify the Administrative Contracting Officer and Contracting Officer if you are unable to access the attachments through SAM.gov and the SAM.gov Help Desk is unable to assist you with accessing the restricted attachments.

28 Question: The RFP states, The electronic files should be in Portable Document Format (PDF) and named as follows: Vendor Name – Part I/II/III/IV – 36C242225R0047 – Kingston CBOC. If file size necessitates breaking a section into more than one file, please append File X of X to the end of the file name.

What is the file size limit when submitting the proposal via email to the VA?

Answer: The file size limit is 20 MB. It is recommended that contractors request a read receipt when submitting multiple emails, for confirmation that each part is received.

29 Question: Will the VA please confirm if Part I - Technical Proposal, Part II - Past Performance, Part III SDVOSB/VOSB Status & Miscellaneous and Part IV - Price Proposal should all be in separate documents/files for a total of four separate documents?

Answer: Yes, each part should be in their own separate file.

30 Question: Veteran-Owned Small Business Set-Aside: Why was this solicitation not set aside for veteran-owned small businesses in accordance with the VA rule of two?

Answer: Market research, including an analysis of responses from the past 16 solicitations for similar/identical services in Veterans Integrated Service Network (VISN) 2, did not support a veteran owned small business set-aside.

In order to provide additional consideration for a Service-Disabled Veteran Owned Small Business (SDVOSB) and Veteran Owned Small Business (VOSB), the Contracting Officer included an evaluation factor that provides credit for SBA verified SDVOSBs and VOSBs that submit an offer or credit to a large business who proposed to sub-contract with SDVOSBs or VOSBs.

31 Question: Market Research: On what date was market research performed, and how many SDVOSBs responded?

Answer: Market research was performed from September 09, 2024 – December 27, 2024. Market research, including an analysis of responses from the past 16 solicitations for similar/identical services in Veterans Integrated Service Network (VISN) 2, did not support a set-aside. The determination was that it is in the Government’s best interest to solicit on an unrestricted basis to ensure maximum competition and award at a fair and reasonable price. While some interest was received from the SDVOSB community, interest alone is not the only consideration when determining a set-aside. Special credit is provided to SDVOSB/VOSB vendors and businesses who plan to subcontract with SDVOSBs or VOSBs.

32 Question: Billable Enrollees: Please confirm that CLIN enrollment starts at 1775 and remains constant, while the most recent billable enrollees total 1559. Is there a specific margin of error set by the government for comparing CLIN enrollment and the contractor's day-one rollover billable roster?

Answer: Please refer to Attachment 2 for the revised Schedule of Services.

Billable enrollment amounts are dependent on the number of members enrolled at the time of the effective date of the new contract. The contractor cannot bill based on estimated amounts. The contractor is paid a fixed monthly amount for each enrolled member, regardless of how much or how little care each member actually uses. Monthly payment= number of enrolled members x PM/PM rate. There is not a specific margin of error set by the Government for comparing enrollment and the rollover billable roster. The revised estimated membership provided by the Government in Attachment 2 represents an realistic amount based on current membership.

33 Question: Will the government provide an updated billable roster?

Answer: The Government provides the billable roster at the commencement of the contract. The Contractor is responsible for maintaining their own roster, which is checked against the VA’s records each month during invoicing.

34 Question: What is the reason for the consistent decline in the billable enrollment?

Answer: VSSC projections show a decline in the projected enrollment over the next ten years due to the aging population. Other factors such as economic conditions, demographic shifts and community changes could impact where Veterans choose to live and receive care. Contractor outreach and attracting new CBOC members will be an important component of the performance of this contract. Despite a projected decline, there are opportunities to gain new membership and the VSSC enrollment projection for Kingston CBOC is 1775.

35 Question: How many Kingston CBOC veterans currently require podiatry services?

36 Question: Onsite VA Staff: Please list all VA staff who will be onsite at the clinic and indicate the approximate number of days per week for each.

Answer: The VA staff members that may be onsite at the clinic include, but are not limited to:

• VA Mental Health – Behavioral Health Interdisciplinary Program (BHIP) Care Coordinator- two days a week

• VA Mental Health – Substance Use Disorder (SUD) Nurse Practitioner- Once every four weeks to provide sublocane injection clinic

• VA Mental Health - Psychiatrist- one day per week

• VA Mental Health – Therapist- five days per week

• Other VA health care providers will conduct scheduled clinics in the

VA-designated exam room, as needed. The VA exam room is outlined in Section 11 of the PWS. The VA exam room space is required exclusively for VA use.

Additional traveling VA staff may present to use the clinic’s Teamwork zone for intermittent visits, such as VA Home Based Primary Care (HBPC) staff, as coordinated with the contractor. The staff members listed above are for example purposes only.

37 Question: Patient Vesting Visits: Will the new contractor inherit the patients’ last vesting visits and be allowed to be billed for one year from contract award?

Answer: The new contractor inherits the members of the clinic. The members’ vesting visits don’t change based on award of a contract. Veterans need to be seen at least yearly to be included on the billable roster.

38 Question: Mission Act Referrals: How many Mission Act referrals for Primary Care were made in the past 12 months for enrolled veterans of the Kingston, NY CBOC?

Answer: Please advise at least ten calendar days before the proposal due date if this information has a cost impact on your proposal, the following amount is an estimate. The approximate number is 100.

39 Question: Start-Up Timeline: The current build-out timeline for this solicitation is 120 days. Would the government consider extending this period to 180 days, in light of potential supply chain challenges and material availability?

Answer: An award will be made with the intention of a 120-calendar day start up period. If additional time is deemed necessary, the timeline may be adjusted after the award of the contract.

40 Question: Vaccines: Please list all vaccines the contractor is responsible for purchasing and indicate the quantity used at the clinic in the past year.

Answer: Please refer to Attachment D.11. VA has provided historical utilization data. However, patient care needs may dictate a requirement for other immunizations other than those listed on D.11 which will be the Contractor’s responsibility.

41 Question: Mental Health Services Management: Please clarify how mental health will be managed in the clinic (provided by contractor, VA, or referred to VAMC).

Answer: All mental health services will be provided by VA staff onsite at the CBOC, referred to VAMC, or referred to care in the community.

42 Question: Telephones: Will the VA supply telephones, and will the existing number be transferred to the new contractor?

Answer: The contractor shall supply the telephones. The Contractor is responsible for providing telephones and phone lines; the VA will provide telecommunications (i.e. T1 lines). The preference will be for the existing number to be transferred to the new contractor.

43 Question: Price Realism: Will price realism language be added to the solicitation to prevent underbidding?

Answer: The Government is considering all aspects of proposal evaluation to ensure that bids reflect an understanding of the requirement and offer a fair value. Currently, the solicitation does not include price realism as an evaluation factor; however, if the Government determines that additional language is necessary, an amendment will be issued to address this. Please continue to monitor the solicitation for any updates or amendments.

44 Question: ThinPrep Solution: Will the VA provide the ThinPrep solution since contractors are unable to obtain it?

Answer: Yes.

45 Question: Female Veteran Enrollment: How many female veterans are currently enrolled?

Answer: 74.

46 Question: Annual Encounters: How many annual synchronous and/or asynchronous encounters are anticipated at the Kingston, NY CBOC throughout the contract period?

Answer: As stated in the PWS section 2.7, the Kingston CBOC had less than 1,050 annual synchronous/synchronous encounters in Fiscal Year 2024.

47 Question: VA Staff Offices: How many offices will be required for VA staff at the clinic (LCSW, Dietician, PCMHI, PACT PharmD, etc.)?

Answer: The minimum amount required in the solicitation is a VA Exam

Room, 2 Mental Health Exam Rooms, 2 Mental Health Administrative Offices and any other spaces specified for VA-use in the PWS.

48 Question: Homeless Program Outreach Specialist: The RFP states the VA provides social work services, yet on page 59 it specifies that all contractor sites must designate at least one outreach specialist, typically a clinical social worker, for homeless veterans. Please clarify if the VA Medical Center will provide this specialist at the Kingston, NY CBOC.

Answer: The VA Medical Center provides the Homeless Program Outreach Specialist. Only CBOCs with over 10,000 members need a dedicated specialist.

49 Question: Mental Health Treatment Services: The RFP states the VA provides mental health services, but page 59 requires contractor sites with over 1,500 unique veterans annually to provide mental health treatment services, including evidence-based therapies for PTSD as per VHA Directive

1160.3. Please confirm whether the VA Medical Center or the contractor is responsible for these services at Kingston, NY CBOC.

Answer: VA shall provide all mental health treatment services. A primary care provider is expected to be able to perform a mental health evaluation/screening/assessment, when necessary. Also, contractor staff are expected to comply with VHA Directives, policies, and VA philosophies related to primary care treatment of Veterans with mental health conditions.

50 Question: In Part III of the submission, the government is asking for "Insurance Certificates" to be included in this volume. Please list the exact insurance certificates required.

Answer: Please refer to Clauses C.11, C.12 and C.20 relating to the insurance certificates.

51 Question: What is the file size limit for emailing this proposal?

Answer: The file size limit is 20 MB. It is recommended that contractors request a read receipt when submitting multiple parts to a proposal, so there is confirmation that each part is received.

52 Question: How will the geography section be graded based on its distance from liquor, cannabis, or firearm stores?

Answer: The solicitation does not explicitly specify how the proximity to these types of establishments will be graded or evaluated. However, providing services to Veterans in a safe, accessible, and suitable environment remains a primary concern. The contractor is to describe how the proposed facility can best serve Veterans.

53 Question: The solicitation requires “1 FTE per an estimated 950 patients requiring podiatry services and clinical support.” In order to provide accurate staffing estimates for pricing, would the Government please provide the estimated number of patients requiring annual foot risk assessments and ongoing clinical support at the Kingston VA Clinic?

Answer: The requirement for contractor-provided Podiatry and Nail Technician is removed from the solicitation, please refer to Attachment 3.

54 Question: The Government cites two different sets of option year numbers within the proposal. In the award based initial offer, page 9, the RFP cites base year + 4 one-year options. In two other locations, on pages 165 and 179, it is stated there are 9 one-year options. In the Contract Guaranteed Maximum section the Government cites a maximum of $15,000,000.00.

Can the Government please clarify if it is base year + 9 one-year options, what will be the maximum ceiling amount for the entire contract?

Answer: The maximum ceiling is $15,000,000.00 based on a base plus four option year period.

55 Question: The Government provides a list of instructions in relation to the document above called B1 (found on page 7), however the Government cites a series of numbers that do not exist in the B1 document above. The B1 document above, which only goes to #9.The citation asks the Contractor to "Complete B.1 #11, Complete B.1 #12, Complete B.1 #13."

Does the Government intend to clarify the instructions on page 164-165 to align with the appropriate numbering in B.1?

Answer: The Contractor should complete section 1, 2 and 9 in document B.1.

56 Question: The space requirements in Section 11 of the PWS do not mention a procedure room.

Can the government please confirm a procedure room is not required for the Kingston CBOC?

Answer: A procedure room is not specifically listed as a required element of the Kingston CBOC, but the contractor should ensure the clinic design complies with the PACT Space Module design guide requirements.

57 Question: In Section 2.3 of the RFP the Government advises the staff for the following positions will be provided by the VA either on-site or virtually as required. Can the Government provide historical data regarding the onsite services provided by these positions?

Positions:

CPP PACT

Licensed Social Worker Registered Dietician/Nutritionist

Answer: Please refer to Attachment 3 for description of CPP PACT services in the revised PWS. The current Kingston CBOC CPP has had 663 total encounters in Fiscal Year 2025 (10/01/2024- current), 316 unique patients.

Further information relating to the Licensed Social Worker and Dietician/Nutritionist shall be provided upon request during negotiations or after the award of the contract. This information is not related to a contractor-provided service being requested in the solicitation, since VA will be providing these positions and setting up their own scheduling grids. If this information results in a cost impact, please advise at least ten calendar days before the proposal due date.

58 Question: In Section 2.4 Specialty Staffing, Podiatrist’s clinical support staff position section does not provide minimum qualification description beyond example of nail technician with State Licensure.

Can the Government please provide role requirements?

Answer: The requirement for contractor-provided Podiatry and Nail Technician is removed from the solicitation, please refer to Attachment 3.

59 Question: In Section 2.6 General and Specialty Mental Health Staffing Requirements and Options, the Government indicates General and Mental Health Staffing shall be provided by VA at the clinic or parent VAMC.

Can the Government provide historical data regarding the onsite services provided by these positions?

Answer: Yes, this information can be explained in further detail during negotiations or after the award of the contract. This information is not related to a contractor-provided service being requested in the solicitation, since VA will be providing all mental health staffing and setting up their own scheduling grids. If this information results in a cost impact, please advise at least ten calendar days prior to the proposal due date.

Contractors are not required to provide Mental Health (MH) staff. However, a primary care provider is expected to be able to perform a mental health evaluation/screening/assessment when needed. The contractor is only to provide the space and general clinic supplies/ furnishings for mental health services.

60 Question: In Section 3.2 Evening Hours & 3.3 Weekend Hours, the Government indicated the Clinic may be required to provide extended hours for VA Mental Health Staff.

Due to insurance liability, contractor staff will be required to be onsite during these extended hours. As this would have cost impact, can the Government provide historical data regarding the frequency and number of hours the current CBOC has provided extended office hours to support VA Mental Health Staff?

Answer: Before 8:00am and after 4:30pm and at weekends, all mental health appointments (if any) will be conducted virtually by VA staff. Mental health patients would not enter the building. The Kingston CBOC has not provided any official mental health extended hours clinics in the past year but are required to provide accommodation for extended-hour clinics when necessary.

61 Question: The long-term solicitation requires the clinic to be in the city limits of Kingston. There are no suitable locations in the city limits.

Answer: Please review the Space Requirements revisions provided in this Amendment. Advise if there are no suitable locations within Kingston city limits after considering the change to space requirements. Please notify the Administrative Contracting Officer at least ten calendar days before the extended due date, noted on page 1.

Attachment 2- Revised Schedule of Services

B.2 SCHEDULE OF SERVICES

Under the authority of 38 U.S.C. §8153 the Contractor agrees to provide community based outpatient clinic services in accordance with the terms, conditions, and provisions stated herein at the prices specified in the Price Schedule of Services. The proposed Contractor facility must be physically located within Kingston in the State of New York. Veterans to be serviced under this contract reside primarily in Ulster County, however; residency is not restricted to this county.

The Parent Facility for this CBOC is the Samuel S. Stratton VA Medical Center located at 113 Holland Avenue, Albany, NY 12208-3410. Payment for primary care services shall be based on a monthly Per Member Per Month (PMPM) capitated rate, as further explained within this solicitation.

Contract Guaranteed Minimum and Contract Maximum:

The fixed-price indefinite-delivery indefinite-quantity (IDIQ) contract will have a base year period with four option year periods. All PMPM quantities are estimated. The total guaranteed minimum quantity of services that the Government will acquire under this indefinite delivery, indefinite quantity (IDIQ) contract is $25,000.00, which also represents a bona fide need of the current fiscal year. The guaranteed minimum award amount is for the entire contract duration.

The ceiling amount for the entire contract effort is $15,000,000.00. The aggregate value of orders placed under this contract shall not exceed the IDIQ contract maximum.

Ordering Procedures:

The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount of $25,000.00. Any services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the Contracting Officer or Administrative Contracting Officer. Firm‐fixed-price task orders (TO) will be placed under this contract via email by the CO prior to the start of each performance period with the fixed quantity of members for the upcoming performance period. See FAR clause 52.216-19, Order Limitations, for minimum and maximum values of each TO. Task Orders are contingent upon availability of funds per FAR clause 52.232-18. See Monthly Billable Roster and Invoice Reconciliation section in the PWS below regarding the invoicing instructions for reconciliation of task orders once the monthly billable roster is finalized.

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 at least one qualifying encounter by the Contractor’s primary care provider (PCP) within the previous 12 months.

Billing/Payment Procedures The contractor will be provided a list of all patients on the billable roster at the time when the contractor begins performing clinical services and will be able to bill for those patients on the billable roster in the following month’s invoice. In order to remain on the monthly billable roster, patients shall have at least one qualifying encounter during the previous 12 months. See the Billing and Invoicing Procedures section on page 96. for further information on the billable roster, qualifying encounters, and invoicing procedures.

For Veterans newly assigned in PCMM the contractor may bill for patients newly assigned in PCMM the month following a qualifying encounter.

For unassigned/unenrolled patient visits/encounters - PMPM includes cost of unassigned/unenrolled patient visits. Contractor shall not bill separately or propose an additional LIN for these costs. All quantities are estimated, the government will pay for services performed as certified by the COR.

See Section E instructions to offerors for further information regarding pricing proposals related to clinic buildout.

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.

*Please note the number of billable enrollees on the most current invoice (May 2025) is 1,559.

The Government will not accept an alternative pricing sheet.

Base Year – April 1, 2026 – March 31, 2027 Line Item

Services Unit

Estimated Quantity

Price per Unit

Total Estimated Cost per month

Total Estimated Cost per year

0001 Primary Care Services at capitation rates per member per month

(PMPM)

PMPM

Estimated Total for Base Year $__________________

Option Year One- April 1, 2027 – March 31, 2028 Line Item

Total Estimated Cost per month

Total Estimated Cost per year

1001 Primary Care Services at capitation rates per

Estimated Total for Option Year 1 $__________________

Option Year 2 – April 1, 2028 – March 31, 2029

Item

Total Estimated Cost per month

Total Estimated Cost per year

2001 Primary Care Services at capitation rates per

Estimated Total for Option Year 2 $__________________

Option Year 3 – April 1, 2029 – March 31, 2030

Item

Estimate d

Price per

Total Estimated Cost per month

Total Estimated Cost per year

3001 Primary Care Services at capitation rates per

Estimated Total for Option Year 3 $__________________

Option Year 4 – April 1, 2030 – March 31, 2031

Item

Estimate d

Total Estimated Cost per month

Total Estimated Cost per year

4001 Primary Care Services at capitation rates per

Estimated Total for Option 4 $__________________

ESTIMATED TOTAL FOR BASE AND 4 OPTION YEARS:

BASE YEAR $

OPTION YEAR 1 $

OPTION YEAR 2 $

OPTION YEAR 3 $

OPTION YEAR 4 $

TOTAL ESTIMATED COST $

Attachment 3- Revised Performance Work Statement

PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1 Services Required: The Samuel S. Stratton VA Medical Center in Albany, NY requires the following services to be provided in a private hospital, office, or clinic environment for Veterans, primarily residing in Kingston, New York. The intended facility/resources to be devoted exclusively to the service of VA patients.

1.2 Site Classification: This site is classified as a [X] Primary Care CBOC [] Multi-

Specialty CBOC [] Health Care Center (HCC) designated as Ambulatory Surgery Clinic (ASC) [] HCC NOT designated as ASC [] Other Outpatient Services Site.

1.3 Place of Performance: Services shall be performed by contractor within the city limits of Kingston, NY on behalf of the Samuel S. Stratton VA Medical Center.

1.4 Authority: Title 38 United States Code (USC) 8153 and FAR 12 in combination with 15.

1.5 Policy and Regulations: The contractor is required to meet VHA performance and quality criteria, policy and standards including, but not limited to, access, quality of care, Veteran satisfaction, coordination of care, 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/vapubs/ or at http://www.va.gov/vhapublications/. Some VA policy documents include Standard Operating Procedures (SOPs) located on internal VA websites that are not available to the public. SOPs relevant to this requirement are provided as attachments under Section D. 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-of-contracted-clinic-policy-documents.xlsx#. A link to the VA Qualifications Standards is also included in this document.

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties ACGME: Accreditation Council for Graduate Medical Education ACIP: Advisory Committee on Immunization Practices ACLS: Advanced Cardiac Life Support ACO: Administrative Contracting Officer ACPE: American Council on Pharmaceutical Education ADE: Adverse Drug Events AED: Automatic External Defibrillator AIS: Automated Information Security ANA: American Nurses Association AOA: American Osteopathic Association APRN: Advanced Practice Registered Nurse ARRT: American Registry of Radiologic Technology ASC: Ambulatory Surgery Center

Attachment 3- Revised PWS

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.

Asynchronous Care: Care provided outside of bookable time and includes but is not limited to the following activities: refilling prescriptions, reviewing outside records, huddles and case management, team meetings, processing view alerts, secure messaging and training.

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

BLS: Basic Life Support BOS: Bureau of Osteopathic Specialists CAHEA: Committee on Allied Health Education and Accreditation CAP: College of American Pathologists CARF: Commission on Accreditation of Rehabilitation Facilities CBO: VA Central Billing Office.

CCNE: Commission on Collegiate Nursing Education CDC: Centers for Disease Control and Prevention CEU: Certified Education Unit CLIA: Clinical Laboratory Improvement Amendments CME: Continuing Medical Education CMS: Center for Medicare and Medicaid Services CNP: Certified Nurse Practitioner CNS: Clinical Nurse Specialist CO: Contracting Officer COPD: Chronic Obstructive Pulmonary Disease COR: Contracting Officer’s Representative COS: Chief of Staff CPA: Collaborative Practice Agreement CPARS: Contractor Performance Assessment Reporting System CPP: Clinical Pharmacist Practitioner CPT: Current Procedural Terminology CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org.

CVT: Clinical Video Telehealth DICOM: Digital Image and Communication in Medicine DIGMA: Drop-in Group Medical Appointment DRG: Diagnostic Related Group DSS: Decision Support System ECC: Extended Care Center 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.

EPRP: External Peer Review Program FDA: Food and Drug Administration FSMB: Federation of State Medical Boards FTE: Full Time Equivalent 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.

HCFA: Health Care Financing Administration HHS: Department of Health and Human Services HICPAC: Healthcare Infection Control Practices Advisory Committee - a federal advisory committee made up of 14 external infection control experts who provide advice and guidance…