36C24419R0074-002.docx

36C24419R0074

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

08-13-2019 Brandi Shellhammer, Contract Specialist 412-822-3797 10-22-2019

3:00 PM EDT

00244 Department of Veterans Affairs Network Contracting Office 4 VA Pittsburgh Healthcare System 1010 Delafield Road Pittsburgh, PA 15215

X

621498 $20.5 Million

N/A

Department of Veteran Affairs Network Contracting Office 4 Erie VA Medical Center 135 E. 38th St.

Erie, PA 16504 00244 Department of Veterans Affairs Network Contracting Office 4 VA Pittsburgh Healthcare System 1010 Delafield Road Pittsburgh, PA 15215

Austin Payment Center Department of Veterans Affairs

PO Box 149971 Austin TX 78714-9971

(877) 353-9791

(512) 460-5429

See CONTINUATION Page McKean County, PA Community Based Outpatient Clinic Services.

See Schedule of Services on pages 6-7.

Period of Performance: June 1, 2020 – May 31, 2030

Indefinite Delivery Indefinite Quantity (IDIQ) 5 Year Base Period with five option years that may or may not be exercised at the Government's Discretion.

In accordance with Performance Work Statement on pages 8-81 and all applicable terms and conditions included herein.

The Contractor shall be responsible for the correct title Classification of workers and compliance with all applicable Wage and Hour Laws.

See CONTINUATION Page

Mark Knorr Contracting Officer

Table of Contents

C.2 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011)………………………………………………………………………………………..88

C.10 52.245-1 GOVERNMENT PROPERTY (JAN 2017) ALTERNATE 1 (APR 2012)…….93

C.15 VAAR 852.219-71 VA MENTOR-PROTÉGÉ PROGRAM (DEC 2009)………………106

C.21 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008)…………………………………………………………………………………………….110

D.1. VA Privacy and National Rules of Behavior.

D.2. Conflict of Interest D.3. Form I9 D.4. New Patient Orientation Booklet.

D.5. Clinical Lab Manual

D.6. MCM 113-10

D.7. MCM 113-25

D.8. MCM 111-39

D.9. MCM 111-28

D.10. MCM 113-06

D.11. MCM 113-05

D.12. MCM 11-17

D.13. MCM 116-05

D.14. Connected Care - Telehealth Manual D.15. Home Telehealth Operations Manual D.16. VA Video Connect

D.17. MCM 11-34

D.18. MCM 11-37

D.19. 24VA10P2 Patient Medical Records

D.20. MCM 174-01

D.21. MCM 118-44

D.22. Rights and Responsibilities of VA Patients

D.23. MCM 00-15

D.24. Workload History

D.25. WD 15-4249

D.26. Past Performance Reference Questionnaire D.27. Congressional District McKean County D.28. Quality Assurance Surveillance Plan D.29. Proper-Use-of-Email-Memo-01-02-2018 D.30. MCM 00Q-001 Environment of Care Management Program D.31. MCM 00Q-119-33 Anticoagulation Clinic D.32. MCM 00Q-400 Emergency Operations Plan D.33. MCM 116-18 Behavioral health emergency Guidelines for CBOC's D.34. MCM 00Q-002 Environment of Care Orientation Plan D.35. B.2 Schedule

E.6 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008)...…131

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR NAME:

TITLE:

ADDRESS:

EMAIL:

PHONE:

b. GOVERNMENT: Contracting Officer: Mark Knorr; Mark.Knorr@va.gov; (570) 824-3521 ext. 7222 Contract Specialist: Brandi Shellhammer; Brandi.Shellhammer@va.gov; (412) 822-3797 Department of Veterans Affairs Network Contracting Office 4 VA Pittsburgh Healthcare System 1010 Delafield Road Pittsburgh, PA 15215

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Page 1 of Page 1 of

B.2 PRICE/COST SCHEDULE

The quantities listed in the Price Schedule below are estimates only and are not guaranteed nor are to be considered a minimum or maximum.

The Government will order the below specified minimum contract value of services and may order up to and including the below specified maximum contract value of services through task orders under this basic Indefinite Delivery Indefinite Quantity (IDIQ) contract during the duration of the contract inclusive of all option periods. The maximum amount under this contract is not guaranteed.

The guaranteed minimum award amount for this contract is $175,000.00. The maximum aggregate value of all orders placed under this contract shall not exceed $16,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.

Ordering Procedures: VA has the sole authority to assign Veterans treated by the contractor into the Primary Care Management Manual (PCMM) software program. Refer to section 6.2.1 Billable Roster for Specific billable processes under the resultant contract. Refer to section 6.2.2 invoicing and payments for payment processing.

POP Begin: 06/01/2020 POP End: 05/31/2025

Contract Period: Base POP Begin: 06/01/2020 POP End: 05/31/2021

Contract Period: Base POP Begin: 06/01/2021 POP End: 05/31/2022

Contract Period: Base POP Begin: 06/01/2022 POP End: 05/31/2023

Contract Period: Base POP Begin: 06/01/2023 POP End: 05/31/2024

Contract Period: Base POP Begin: 06/01/2024 POP End: 05/31/2025

Base Period Estimated Total POP Begin: 06/01/2020 POP End: 05/31/2025

Contract Period: Option 1 POP Begin: 06/01/2025 POP End: 05/31/2026

Contract Period: Option 2 POP Begin: 06/01/2026 POP End: 05/31/2027

Contract Period: Option 3 POP Begin: 06/01/2027 POP End: 05/31/2028

Contract Period: Option 4 POP Begin: 06/01/2028 POP End: 05/31/2029

Provide primary care services in accordance with attached performance work statement for McKean County PA.

Contract Period: Option 5 POP Begin: 06/01/2029 POP End: 05/31/2030

Page 1 of Page 1 of Page 1 of

B.3 PERFORMANCE WORK STATEMENT (PWS)

PERFORMANCE WORK STATEMENT (PWS)

DRAFT

Outpatient Site of Care per VHA Handbook 1006.02 “VHA Site Classifications and Definitions”

1. GENERAL:

1.1. SERVICES REQUIRED: The Erie VA Medical Center; requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in the McKean County, PA area:

1.1.1. [X] Primary Care CBOC: offers both medical and mental health care (physically on site and by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care CBOCs are required to provide both primary care and mental health services. Mental health services will be provided by VA staff via telehealth.

1.2. PLACE OF PERFORMANCE: McKean County, Pennsylvania within the 15th Congressional District (per the Congressional District Map).

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of the Erie VA Medical Center, 135 E. 38th St., Erie, PA 16504.

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index 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/vhapublications/ or at http://www.va.gov/vapubs/. 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/Resources.asp.

1.5. DEFINITIONS/ACRONYMS:

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. 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.

1.5.14. BAA: Business Associate Agreement

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

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: chronic obstructive pulmonary disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

1.5.35. CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org/.

1.5.36. CPARS: Contractor Performance Assessment Reporting System

1.5.37. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.5.38. CVT: Clinical Video Telehealth

1.5.39. DICOM: Digital Image and Communication in Medicine

1.5.40. DIGMA: Drop in Group Medical Appointment

1.5.41. DRG: Diagnostic Related Group

1.5.42. DSS: Decision Support System

1.5.43. ECC Extended Care Center

1.5.44. 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.

1.5.45. EPRP: External Peer Review Program

1.5.46. FDA: Food and Drug Administration

1.5.47. FSMB: Federation of State Medical Boards

1.5.48. HCC: Health Care Center. An 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.

1.5.49. HHS: Department of Health and Human Services

1.5.50. HCFA: HealthCare Financing Administration

1.5.51. HICPAC: Healthcare Infection Control Practices Advisory Committee- a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

1.5.52. HT: Home Telehealth

1.5.53. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.54. INR: International Normalized Ratio

1.5.55. ISO: Information Security Officer

1.5.56. LIP: licensed independent practitioner

1.5.57. MCCR: Medical Care Cost Recovery

1.5.58. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions;

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psycho-education, family education, skills training, peer support, and Compensated Work Therapy (CWT) and supported employment;

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.59. MQSA: Mammography Quality Standards Act

1.5.60. MSN: Master of Science in Nursing

1.5.61. NCCPA: National Commission on Certification of Physician Assistants

1.5.62. NLN: National League for Nursing

1.5.63. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.5.64. OTC: Over the Counter

1.5.65. PA: Physician Assistant

1.5.66. PACS: Picture Archiving and Communications System

1.5.67. PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

1.5.68. Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.69. PCMH: Patient-Centered Medical Home

1.5.70. PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.5.71. PCP: Primary Care Provider

1.5.72. Phar.D.: Doctor of Pharmacy

1.5.73. POC: Point of Care Testing

1.5.74. PRIMARY CARE VISIT: an episode of care furnished in a clinic that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

1.5.75. PCMHI: PRIMARY CARE-MENTAL HEALTH INTEGRATION:

1.5.76. PWS: Performance Work Statement

1.5.77. QAPI: Quality Assessment and Performance Improvement

1.5.78. QASP: Quality Assurance Surveillance Plan

1.5.79. RME: reusable medical equipment

1.5.80. SOP (Clinical): Scope of Practice

1.5.81. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.82. SMA: Shared Medical Appointments

1.5.83. SPD: Sterile Processing Division

1.5.84. SPE: Senior Procurement Executive

1.5.85. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care and is only provided through a referral.” These services are generally divided into two sub-categories: medicine specialties and surgery specialties. The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology; emergency; employee health; endocrinology; gastroenterology; general medicine; hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology; amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

1.5.86. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.87. TJC: The Joint Commission

1.5.88. TIU: Text Integration Utility

1.5.89. TCT: Telehealth Clinical Technicians

1.5.90. VA: Veterans Affairs

1.5.91. VA EHR: VA electronic health record

1.5.92. VAMC: Veterans Affairs Medical Center

1.5.93. VetPro: a federal web-based credentialing program for healthcare providers.

1.5.94. VHA: Veterans Health Administration

1.5.95. VISTA: Veterans Health Information Systems and Technology Architecture

2. STAFFING AND QUALIFICATIONS

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS: PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI)staff). The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA, the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: 1145.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by Contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified (or board eligible) by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP. (If so, authorization for prescriptive authority is required). Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

2.3. PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor.

2.3.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size.

OPTION 1: Physician (MD): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified (or board eligible) by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2 Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e. CBOC). Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in CPRS for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life. CLINICAL ASSOCIATE [X] Mandatory for all sites

2.3.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. Requesting one LPN and one HCT for this location.

Licensed Practical Nurse (LPN): Qualifications: VA HANDBOOK 5005/3 PART II APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC) Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Staff member will receive training to serve as the telehealth back-up.

Health Care Technician (HCT) (as part of PACT teamlet not for other Tele health: Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. all sites

2.3.4. TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: Current standard is 1.0 FTE clerical associate per 1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.4. DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated.

2.4.1. DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) –PACT: FTE Ratio Performance Standard: 1.0 FTE per 3 PACTs. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center. Contractor to refer patients for services via consult.

2.4.2. DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-COAGULATION: FTE Ratio Performance Standard: 1.0 FTE per 5 PACTs. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center. Contractor to refer patients for services via consult.

2.4.3. DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER: FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center. Contractor to refer patients for services via consult.

2.4.4. DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST: FTE Ratio Performance Standard: 1 FTE per 5 PACTs. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center. Contractor to refer patients for services via consult.

2.4.5. DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH INTEGRATION (PC-MHI):

FTE Ratio Performance Standard - 0.67 FTE per PACT. PC-MHI staff provide services in collaboration with PCPs for mild to moderate MH needs. PC-MHI services include co-located collaborative care (usually provided face-to-face by options 2,4, and 5 below), disease-specific care management (usually provided via telephone by options 5 and 6 below) and medication/treatment consultation (usually provided via e-consult, telephone, or face-to-face by options 1 and 3 below) to PCPs who prescribe medications for mild to moderate MH needs. (See the Uniform Mental Health Services Handbook 1160.01 for PC-MHI requirements). A mix of the following disciplines shall be selected to meet the PC-MHI FTE ratio performance standard and PC-MHI service requirements. Staffing ratio outlined is “minimum” and may be adjusted by the VA to provide appropriate mental health care. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center. Contractor to refer patients for services via consult.

2.5. SPECIALTY CARE STAFFING:

2.5.1. PODIATRIST: FTE Ratio Performance Standard: 1.0 FTE per 950 active patients and only a single room available for services or 1 FTE per 1300 active patients with two rooms and clinical support (such as a nail technician). Staffing ratio may be adjusted upward locally to provide VA standard patient care average of 14 – 16 patients/8-hour period being seen. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center. Contractor to refer patients for services via consult.

2.5.2. DIAGNOSTIC OR THERAPEUTIC 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. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center. Contractor to refer patients for services via consult.

2.5.3. PHLEBOTOMIST/LABORATORY TECHNICIAN:

2.5.3.1. PHLEBOTOMIST/LABORATORY TECHNICIAN: Phlebotomist/Laboratory Technician FTE Ratio performance standard 1.0 FTE Phlebotomist/Laboratory Technician per estimated 5,000 patients at clinic, with a trained back-up (e.g., another Phlebotomist/Lab Technician or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic laboratory services). All staff providing Phlebotomy/Laboratory Technician related services (primary Phlebotomist/Lab Technician(s) and back-ups) must be trained in performing venipuncture, along with the proper collection procedures of specimens, patient identification, specimen handling/preparation and waived testing procedures, as applicable. Shall be provided by Contractor.

2.5.3.2. Qualifications: All contractor staff providing phlebotomy/laboratory technician related services must be working within permitted licensure and scope of practice.

2.5.3.3. Training: Contractor’s Phlebotomy/Laboratory staff will be required to complete mandatory laboratory training as assigned by the Laboratory and CBOC Managers.

2.5.3.4. Competency – Phlebotomists/Laboratory Technicians must demonstrate: proficiency in phlebotomy following proper procedures for drawing blood; knowledge of approved venipuncture specimen collection techniques; knowledge of laboratory test requirements necessary to select and use the appropriate equipment and materials; knowledge of applicable waived testing requirements; and knowledge of proper sample processing and shipping procedures. The Contractor staff will be required to complete initial competency assessment with the Erie VAMC laboratory preceptor and annual competency assessment with the CBOC preceptor at the McKean CBOC in order to be approved under the contract to draw labs on Veterans or perform testing procedures.

2.5.3.5. Phlebotomist/Laboratory Technician Position Responsibilities: The Phlebotomist/ Laboratory Technician performs phlebotomy and specimen processing duties. The majority of the duties include performing venipunctures on outpatients and specimen processing duties. The Phlebotomist/ Laboratory Technician performs duties primarily related to specimen collection, specimen receipt, preparation for testing and packaging and shipping, and will be required to proficiently collect blood samples on outpatients with a minimal number of failures, patient bruising, or required redraws. The Phlebotomist/Laboratory Technician will ensure the proper identification of the patient using two unique identifiers. They will ensure the proper identification of the specimens using two unique identifiers and labeling each specimen in the presence of the patient. They are responsible for reviewing test request orders prior to collecting specimens, determining whether the patient has been properly prepared for the test (fasting, special diet, medication, etc.), and will select the correct tube type that is required for the testing ordered. He/she will draw the blood using the correct order of draw for the tubes. The Phlebotomist/Laboratory Technician is responsible for all types of laboratory specimens during the entire pre-analytical phase which is the most critical phase and the most prone to error. The Phlebotomist/Laboratory Technician receives phlebotomy requests utilizing both manual and computerized logging methods. The Phlebotomist/Laboratory Technician patients on proper specimen collection techniques and provides patients with all necessary specimen collection equipment and containers. The Phlebotomist/Laboratory Technician will utilize VISTA, CPRS or HOWDY to look up patient’s orders and Accession the orders and prints patient labels. The Phlebotomist/Laboratory Technician will ensure that the labels have the correct patient name and unique number on them prior to using the labels. The Phlebotomist/Laboratory Technician will ensure all specimens are properly labeled and identified throughout the entire specimen procurement process to maintain specimen integrity. The Phlebotomist/Laboratory Technician is responsible for proper preparation of samples for testing in the various clinical laboratory sections, such as labeling, centrifugation, decanting, aliquoting, etc. Some specimens may need to be frozen or kept at room temperature during transportation. The Phlebotomist/Laboratory Technician provides information, guidance and technical advice to physicians and clinic personnel on specimen collection and submission. The Phlebotomist/Laboratory Technician will utilize all necessary personal protective equipment (PPE) as dictated by the position including safety goggles or working behind a safety shield when opening, aliquoting or pouring specimens. The Phlebotomist/Laboratory Technician ensures that specimen caps are secure so that specimens do not leak during transportation. The Phlebotomist/Laboratory Technician is responsible for preparation of samples for shipment to referral laboratories including all required paperwork; some may require the use of a highly technical computer system. The Phlebotomist/Laboratory Technician will package all specimens for shipment following all OSHA regulations. He/ she will ensure that the coolers/ bags utilized for transportation are properly labeled with the UN3373 symbol, biohazard symbol and the name, address and phone number from where the specimens are coming from and going to. He/She will complete required training for applicable waived testing to include sample preparation, result interpretation and reporting.

2.5.4. GENERAL AND SPECIALTY MENTAL HEALTH STAFFING:

2.5.4.1 MH staffing FTE ratio performance standard is 7.72 total FTE per 1000 Veterans seen in outpatient MH, which includes 1.22 psychiatrist FTE per 1000 outpatient MH and 0.67 PCMHI FTE per PC panel. A mix of the following disciplines may be selected to meet general and specialty MH FTE ratio performance standard and general and specialty MH service requirements. Staffing ratio outlined is “minimum” and may be adjusted by the VA to provide appropriate Mental Health Care. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center or via V-Tel. Contractor to refer patients for services via consult.

2.5.4.2. OTHER REQUIRED STAFF BASED ON SITE

2.5.4.2.1. Suicide Prevention Coordinator (SPC): The VA performance standard for sites with 10,000 patients or more is maintaining a Suicide Prevention Coordinator (SPC) with a full-time commitment to suicide prevention activities. In smaller sites serving less than 10,000, this may be a collateral assignment. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center or via V-Tel. Contractor to refer patients for services via consult.

2.5.4.2.2. Homeless Outreach Specialist: To ensure the availability of outreach and referral services to homeless veterans, all sites with 10,000 patients or more must designate at least one outreach specialist, usually a clinical social worker, to provide services to homeless veterans. NOTE: In smaller facilities, this may be a collateral assignment. Service provided by Erie VA Medical Center Staff located at the Erie VA Medical Center or via V-Tel. Contractor to refer patients for services via consult.

2.5.5. TELEHEALTH SERVICES SUPPORT STAFF: Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or PACT Teamlet LPN(s), depending on size of clinic/clinic workload/clinic telehealth services). All staff providing telehealth related services (primary TCT(s) and back-ups) must be trained in teleretinal imaging, teledermatology, teleaudiology, tele-mental health, etc. The qualifications, competencies, and position responsibilities noted below apply to primary TCT(s) and back-ups. Service provided by Erie VA Medical Center Staff.

2.5.6. TELEHEALTH SERVICES CLINICAL STAFF: Staff member will be…