36C24419R0052-0001000.docx

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) 8/1/2019

NONE

00244 Department of Veterans Affairs Network Contracting Office 4

00244 Department of Veterans Affairs Network Contracting Office 4

To all Offerors/Bidders

36C24419R0052

X X X

9/11/2019 @12:00 PM EDT

1. Issuance of Amendment A0001 See Continuation Page for complete details for Questions and Answers.

2. Solicitation is hereby extended, proposal due date is September 11, 2019 at 12:00 PM EDT.

3. All other terms and conditions remain unchanged.

Brandi Shellhammer Contracting Officer Questions and Answers from Solicitation 36C24419R0052. Answers provided by Government are in Red Font.

1. Section B3. Price/Cost Schedule: The CLINS estimated quantity seems very large 18,240 to 19,320 over the 10 years of the contract. Are these numbers correct?

These numbers are correct. Year 1 is estimated 1520 PMPM X 12 months = 18,240 PMPM.

2. Will the new contractor inherit the patient’s last Primary Care vesting visit and be allowed to bill for one year from that date upon contract award? Refer to section 6.2.1 Billable Roster in the PWS.

3. How many providers are at the existing clinic and are they physician or NPs? The existing clinic has 2 providers. 1 Physician, 1 PA-C.

4. How many times per year does the VA anticipate that the Contractor staff will be required to travel to and attend VA mandated meetings on-site at the Wilkes-Barre VAMC or other VA Facility? After initial training requirements are met, not more than 4 times per year.

5. Section E.11. Sub-factor 3: Can the graduate certificate (Key personnel documentation, page 121) for Nurse Practitioners and Physician Assistants be submitted at the time of hire? To collect all of these required documents would demand that we essentially hire all the required staff in less than 30 days. Asking candidates to provide such documentation before there is an available position is not a common practice in recruiting/staffing. Certificate can be provided post award.

6. In the event, the VA requires the transcripts and graduate certificates for the required positions, would the VA accept a “DegreeVerify Certificate” from the National Student Clearinghouse? The National Student Clearinghouse is an agency the VA uses to confirm education. See example attached. Transcripts and Certificates can be provided Post award. Credentialing can accept degree verify certificate initially, but the remainder of the credentialing/privileging requirements would still need to be met post award.

7. Does the VAMC require a Practice Manager on site? A Physician Director is required. See requirements for Physician Director in section 2.2.

8. If a Practice Manager is required, does that position have to by an RN? Or what qualifications must the Practice Manager meet? See requirements for Physician Director in section 2.2. of the PWS. Practice Manager not required.

9. Is an LPN required for the Telehealth Clinical Technician position or can the contractor staff with a Certified medical assistant? TCT duties can be an ancillary duty of the PACT Teamlet staff. Contractor to decide if LPN or MA fills position.

10. Can the government confirm LCSW and Registered Dietician/Nutritionist will be provided by the VA.? VA Confirms that ancillary support of LCSW/Nutritionist will be provided by VA.

11. Can the government clarify how many office spaces they will require in the vendor space? See section 4.8.1 in PWS for minimum space requirements.

12. Is the current facility adequate to meet the size requirements for the current solicitation? Not currently set up as per minimum space requirements identified in section 4.8.1.

13. Does the current Columbia County CBOC facility meet the new contract PACT Space Module Design Guide requirements as stated in paragraph 4.8 of the solicitation? No.

14. Will the Contractors proposed space be required to meet the on-stage/off-stage design with the PACT Zone? Proposed space will be required to meet the on/off stage design. Please reference section E.1.4 VI Evaluation factors for award.

15. The solicitation states that Primary Care Mental Health Integration (PCMHI) will be provided by VA staff on site or via tele-health. Does the VA want a PCMHI-dedicated consult room or a telehealth room for these services? It does not need to be a dedicated room. It can either be one of the 3 tele-rooms, or the 1 room allocated for the onsite SW. Refer to section 4.8.1 in the PWS for minimum space requirement.

16. Is the Network/Data room detailed in paragraph 4.8.14.12 the same room listed as the “VA IT closet” in paragraph 4.8.1? ......Or are these two (2) separate and individually required rooms? The network/data room and the “VA IT” closet are the same room.

17. Section 2.5.1 states: DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: Radiology staffing shall be per the machine types and demands of the facility for each Radiologic procedure/ modality, i.e. CT, MRI, US, MAMMOGRAPHY, X-ray, etc. Radiologist staffing is based upon the number of exams and type performed in the typical 8-hour day. Is the VA requiring on site radiology services as listed in Section 4.7.6.1: RESPONSIBILITIES: Contractor is responsible for all daily/weekly quality assurance of imaging equipment as determined by the manufacturer and as required by the VA Healthcare System and for repairs and maintenance of that equipment. Repairs and maintenance of equipment is the responsibility of the Contractor and equipment down times cannot cause delays in patient care. The Contractor shall submit a contingency plan for equipment down time, network down times, and other systems down times to ensure that timely patient care is not affected. Patient anatomical positioning must provide optimal imaging and shall be of the highest quality control standards based on established practice standards of the ASRT. Contractor shall comply with protocols as outlined by the parent facility’s Radiology Service and provided as an attachment (attachment E) in Section D. At any time, the Wilkes-Barre VA Medical Center may ask for proof of Quality Control and/or a Physicist check/testing on the equipment. It is expected this information be available immediately. Yes, information would need to be readily available when requested.

18. If the VA is not requiring on site x-ray, will the plain and emergency films be contracted out locally? On site x-ray is required. Refer to section 4.7.6 in the PWS for requirements.

19. If plain and emergency films are contracted out locally, is the VA or the Contractor responsible to pay for these services? On site x-ray is required. Reference section 4.7.6 for requirements.

20. How many VA staffed personnel will be providing services at the CBOC? Please list by job title and number of days per month. On site VA staff is 1 LCSW, 2 days per week.

21. How many offices will be needed at the Columbia County CBOC for the VA provided staff (by position/function)? On site VA staff 1 LCSW, 2 days per week will require one office. Refer to section 4.8.1 in PWS for minimum space requirement.

22. Section 4.7.5.4.2 states: (a) Mandated POC testing includes: Provision Glucose Testing services; Pregnancy testing; Outpatient site of care must have point of care stat urine pregnancy testing at the same site of care; Other POC testing shall be provided by the Contractor if VHA mandates them.

Please specifically list all mandated POC testing other than stat urine pregnancy test that the Contractor will be required to perform and the estimated quantity of each POC test.

All are listed in section 4.7.5.4.1 and include:

Provision Glucose Testing services Pregnancy Testing Stat Urine Pregnancy testing Unable to provide an estimated quantity of each test, as this cannot be broken down in reporting by division location.

Does the Contractor or the VA provide proficiency testing through the American College of Pathologist (CAP)? VA provides. Refer to section 4.7.5.4.6. in the PWS.

23. Section 4.7.8 states: PHARMACY SERVICES (PRESCRIPTION FULFILLMENT): The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic. Please list specific vaccines to be supplied by Contractor and the estimated quantity.

Listing of vaccines/medication include the below. Unable to provide an estimated quantity.

MEDICATION

ACETAMINOPHEN 325 MG TABS

ALBUTEROL 0.083% INH SOLN *

AMMONIA INHALANTS

ANTACID STOCK - (MAALOX) UD LIQ (30 ML CUP)

ASPIRIN 81 MG TABS CHEWABLE UD

BACITRACIN OINTMENT FOILPAK

CEFTRIAXONE 1 GM VIAL/STERILE WATER FOR INJ

CLONIDINE 0.1MG

COLLAGENASE SANTYL OINTMENT

CYANOCOBALAMIN (B12) 1000MCG/ML INJ

DEPO PROVERA 150MG/ML

DEXAMETHASONE 4MG/ML INJ

DIPHENHYDRAMINE (BENADRYL) 50MG/ML INJ

DIPHENHYDRAMINE 50MG

ELIGARD INJECTION 45 MG

EPINEPHRINE INJECTION 1MG/MK

EPI-PEN

EPOETIN (PROCRIT) 20,000 units/ml INJ (1ML) *

ETHYL CHLORIDE SPRAY *FINE* (3.5OZ)

FLUORESCEINE/BENOXINATE OPHTHALMIC SOLUTION

FLUPHENAZINE DEC 25MG/ML INJ

GARDISIL HPV VACCINE (0.5ML)

GI COCKTAIL (MAALOX, XYLO VISCOUS 3:1)

GONIOVISC (HYPROMELLOSE 2.5%)

HALOPERIDOL DEC 100MG/ML INJ

HEPATITIS A VACCINE

HEPATITIS B VACCINE 20MCG/ML (Energix B)

HEP A / HEP B VACCINE TWIN-RIX 10/box

HYDROCORTISONE (SOLU-CORTEF) 100MG INJ

INFLUENZA VACCINE - LATEX FREE

INSTA - GLUCOSE ( 30.8GM)

INSULIN NPH 100 UNITS/10 ML

INSULIN REGULAR 100 UNITS /10 ML

IPRATROPIUM BROMIDE & ALBUTEROL SULFATE (DUONEB)

ISENTRESS (RALTEGRAVIR 400MG

KETOROLAC 30MG

LIDOCAINE 1% INJ ( 20 ML)

LiDOCAINE 2% JELLY ( 30 GM TUBE)

MENOMUNE (MENINGOCOCCAL POLYSACCHARIDE VACCINE)

METHYLPREDNISOLONE ACETATE (DEPO-MEDROL) 40MG/ML INJ

METHYLPREDNISOLONE ACETATE (DEPO-MEDROL) 80MG/ML INJ

MMR VACCINE & DILUENT (0.5ML SINGLE DOSE VIAL) *

NITROGLYCERIN 0.4MG SL TABLET

PHENYLEPHRINE 2.5%

PHENOL STICKS 30/pkg

PHYTONADIONE UNIT DOSE TABS

PNEUMOCOCCAL VACCINE

PREVNAR 13

PROPARACAINE 0.5% OPHTHALMIC SOLUTION 15ML

RESPERIDONE (RISPERDAL CONSTA) 25MG LA INJ

RESPERIDONE (RISPERDAL CONSTA) 37.5 MG LA INJ

RESPERIDONE (RISPERDAL CONSTA) 50 MG LA INJ

SILVER SULFADIAZINE 1% (SILVADENE CREAM) 80 GM

SODIUM CHLORIDE 0.9% FOR IRRIGATION BOTTLE (500 ML)

SODIUM CHLORIDE 0.9% INJ (PRESERVATIVE FREE) (10ML)

STERILE SALINE EYE WASH

STERILE WATER FOR IRRIGATION BOTTLE (1000ML)

SUMATRIPTAN 6MG./0.5ML INJ (IMITREX)

SUPARTZ

TETANUS TOXOID ABSORBED ( 5ML/VIAL)

TETANUS DIPTHERIA VACCINE

TETANUS DIPTHERIA PERTUSSIS VACCINE

TRIAMCINOLONE ACET 10 MG INJ (KENALOG)

TRIAMCINOLONE ACET 40MG/ML INJ (KENALOG)

TRIPLE ANTIBIOTIC OINTMENT SINGLE DOSE PKT (box of 100)

TROPICAMIDE OPHTHALMIC SOLUTION 1% 3ML

TROPICAMIDE OPHTHALMIC SOLUTION 0.5% 3ML

TUBERCULIN, PPD 5 T.U./ 0.1ML 10 TESTS (1ML/ VIAL)

WEA 1:16 PARTS SOLUTION 1000ML

ZOSTER VACCINE AND DILUENT

24. If the cost of vaccines is the responsibility of the contractor…. Are there any additional Vaccines required to be supplied by the contractor other than those listed? Comprehensive list provided in response to question 23.

25. If the cost of vaccines is the responsibility of the contractor…. What is the number of Vaccines, by type and any additional Vaccines added by the government, that was provided to the Columbia County CBOC Enrolled Veterans in the last 12 months? Unable to provide specific quantity data not tracked.

26. Pursuant to paragraph 4.7.8, please provide a list of Medications the government expects the contractor to dispense (at the cost of the Contractor) from the clinic that would not be a routine medication dispensed through the VA or an urgent/emergent medication dispensed through the VA’s Heritage contract. Medications are included in response provided for question # 23.

27. Section 4.7.8 states: Urgent/Emergent medications needed will be filled via contracted local pharmacy for up to 10 days. The current process contract is through Heritage Health and the contract is administered by the Wilkes-Barre VA Medical Center.

Will the VAMC continue to be responsible for contracting a local pharmacy and paying for 10-day emergent medications with the new contract. Yes, the VA is still responsible for contracting with a local pharmacy (Heritage Health current process is still active).

28. Section 4.7.9.8 states: NEW DRUG ORDERS: The Contractor shall ensure that at least 95% of all new drug order requests follow all VA National Formulary prescribing guidelines.

What is the current percentage of new drug orders that follow VA National Formulary prescribing guidelines? This is a new requirement for this contract, so this is currently not being monitored under the current contract no data is available.

29. Section 4.7.13.4.4 states: A Comprehensive MH diagnostic and treatment planning evaluation must be completed within 30 days of the same day evaluation. Will VA MH staff be required to do the comprehensive MH diagnostic and treatment planning evaluation? Yes, VA MH staff complete the comprehensive MH diagnostic and treatment planning evaluation.

30. Section 4.7.13.6.1 states: The Contractor shall arrange transfer to the WBVAMC via ambulance by contacting a local ambulance company to arrange transportation. Please refer to the entire section 4.7.13.6.1 *If advised by WBVAMC to contact local ambulance VA has a contract and will be responsible for payment.* Who is responsible for setting up a contract with a local ambulance company and who is responsible for paying the transport bill? VA or Contractor? Please see response above.

31. Section 4.7.15 states: The Contractor shall provide administrative support for scheduling and answering and forwarding calls.

Does the VAMC require additional dedicated MH support staff or is it acceptable for the PACT administrative staff to provide this service? It is acceptable for PACT administrative staff to provide this service.

32. Section 4.7.13.16.1 states: Contractor sites seeing more than 1,500 unique Veterans each year must provide mental health treatment services for those who need them.

Will the Contractor be responsible for PTSD care or will VAMC provide care via telemedicine? Refer to section 4.7.13.2 in the PWS for contractors’ specific responsibilities on MH Care as part of Standard PC Services. Specialized PTSD services will be provided by VA staff either in person or via tele-medicine.

33. Section 4.7.20 states: SCHEDULING OF SERVICES AND CANCELLATIONS: It is VHA policy that Veterans’ appointments are scheduled timely, accurately, and consistently with the goal of scheduling Primary Care, mental health, and non-institutional extended care services appointments no more than 20 calendar days from the date an appointment is deemed clinically appropriate by a VA health care provider (Clinically Indicated Date (CID)), or, in the absence of a CID, 20 calendar days from the date the Veteran requests outpatient health care service (Preferred Date (PD)).

What web site, database will be used to determine the 20 calendar day access metric? VSSC reports are utilized along with scheduling audits performed by VA Business Office Health Administration Staff.

34. Section 2.22 states: RYAN HAIGHT ACT Pennsylvania DEA will not permit a Contractor to obtain a clinic DEA. What options will the Contractor have to be compliant with the Ryan Haight Act? Refer to section 2.22 in the PWS it outlines specifics of alternatives if state DEA does not permit obtaining a clinic DEA and would need to be followed.

35. Section 3.1 states: HOURS OF OPERATION: The RFP states hours of operations are 08:00-4:30 p.m. M-F. But the VA web site shows the current hours of operation as extended hours.

Is there a reason the VA chose to change the hours of operation to 08:00-4:30 pm? Will this have an impact on the patient population? Current clinic hours are established as 8am-4:30pm.

36. Section 4.7.8 states: PHARMACY SERVICES May we have a list of the vaccines and medications used in 2018 for the Columbia County, PA CBOC? See listing provided in response to question #23.

37. Section 4.8.14 states: EQUIPMENT OFFICE SUPPLIES AND TECH SUPPORT:

(second paragraph) No other equipment will be connected to VA Network. But page 63, Section 4.8.14.6 says the Contractor is responsible for printers, scanners, fax machine, and other peripheral office equipment.

Please explain who is responsible for the items listed in this section, and does that include the lab label printer? (VA or Contractor?) Contractor is responsible for the items above, including lab label printer.

38. Since the CLINS does not warrant two FTE PACT Teams, would the VA permit Primary Care Tele-Health visits to accommodate patient care in circumstances where the Primary Care Physician is not in the CBOC? No onsite care in the CBOC is required.

39. How many Choice/Mission Act referrals occurred in the past 12 months for enrolled veterans of the Columbia County CBOC? There have been no Choice/Mission Act referrals for Primary Care services for Veterans currently enrolled at the current Columbia County CBOC. I am unable to provide # of the amount of referrals for specialty services specifically for this CBOC as this cannot be broken down by division.

40. Who is responsible for providing the telephone systems and equipment for the CBOC? The contractor is responsible for providing the telephone system and equipment for the CBOC.

41. Will the VA provide the VOIP phones for the CBOC? No, the contractor is responsible.

42. Are offerors required to have references complete a Past Performance Questionnaires (PPQ)? There is a PPQ attachment listed in Section D, however, there aren’t any instructions/requirements listed in Section E to submit PPQs. The offeror is not required to have references complete the PPQ, but it is always a good idea to do so to support and verify past performance. Completed PPQ’s shall be emailto:Brandi.shellhammer@va.gov

43. Section E.11 states: PROPOSAL INSTRUCTIONS TO OFFERORS SUBMISSION: (2) PLEASE INDICATE THE NAME OF BUSINESS ON THE FIRST PAGE ONLY OF EVERY VOLUME IN THE PROPOSAL. DO NOT PLACE BUSINESS NAME ON EVERY PAGE OF THE PROPOSAL.

Is the VA requesting that the name of the company appear only on the COVER of each proposal volume and that the name of the company should NOT appear on the header/footer or in the text of any pages? In other words, throughout the proposal should we refer to ourselves as “our company” instead of using the proper company name? Should the business name also be removed from the letter of submission? Yes, The Company Name Should only appear on the front cover of each proposal Volume, you can leave the business name on the letter of submission- the Government can easily redact that.

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