36C24518Q0073-001.pdf

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 84

540-18-1-022-0010

36C24518Q0073 01-17-2018

Ryan Mullins, ryan.mullins2@va.gov 304-623-3461 x 4177 01-31-2018

36C245

Department of Veterans Affairs

Louis A Johnson, VAMC

Contracting Office (90C)

1 Med Center DR

Clarksburg WV 26301-4199

X 100

X

Y

561320

$27.5 Million

N/A

Department of Veterans Affairs

Louis A. Johnson VAMC

Orthopedic Service

1 Med Center Drive

Louis A Johnson, VAMC

Contracting Office (90C)

1 Med Center DR

52XG5

825454957

Austin Payment Center

PO Box 149971

Austin TX 78714-8971

(877) 353-9791 (512) 460-5545

See CONTINUATION Page

Orthopedic Surgeon Services

Responses to the RFQ are to be submitted by email.

ryan.mullins2@va.gov

Questions are due by 01/24/2018 @ 1300 EDT.

Any questions submitted after the specified date and time shall not be addressed.

See sections B.3, B.4, D Att., E.1, E.2, E.9, and E.10 for details.

Incomplete submissions will be removed from consideration.

See CONTINUATION Page

X 1

Ryan Mullins

VA-VHA-SAOE-2017-5756D19E

36C24518Q0073

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PERFORMANCE WORK STATEMENT

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.216-18 ORDERING (OCT 1995)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.7 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE

POSTER (DEC 1992)

C.8 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

C.9 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED

SMALL BUSINESS SET-ASIDE (JUL 2016)(DEVIATION)

C.10 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2012)

C.11 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(JAN 2008)

C.12 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.13 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (NOV 2017)

C.14 IT CONTRACT SECURITY

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017)

E.2 SUPPLEMENTAL INSTRUCTIONS TO OFFERORS

E.3 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

E.5 52.216-1 TYPE OF CONTRACT (APR 1984)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION)

E.8 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(JAN 2008)

E.9 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998)

E.10 VAAR 852.273-73 EVALUATION - HEALTH-CARE RESOURCES (JAN 2003)

E.11 EVALUATION FACTORS FOR AWARD

E.12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (NOV 2017)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C245 Ryan Mullins

Department of Veterans Affairs

Louis A Johnson, VAMC

Contracting Office (90C)

1 Med Center DR

Clarksburg WV 26301-4199

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

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly

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.

Austin Payment Center

Department of Veterans Affairs

PO Box 149971

Austin TX 78714-8971

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered and dated as follows:

AMENDMENT NO DATE

V0002 revised 11 6 2014 Page 5 of 84

B.2 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. Services Provided: The Contractor shall provide Orthopedic Physician Services on site in accordance with the specifications contained herein to beneficiaries of the Department of

Veterans Affairs (VA) and the Louis A. Johnson VA Medical Center, Clarksburg, WV.

1.2. Place of Performance - Louis A. Johnson VA Medical Center, Clarksburg, WV.

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority.

1.4. Policy/Handbooks:

1.4.1. - VA Directive 1663: Health Care Resources Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

1.4.2. VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.3. - VHA Handbook 1100.17: National Practitioner Data Bank Reports -http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.4. - VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards -http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.5. - VHA Handbook 1100.19 Credentialing and Privileging -http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.6. VHA Handbook 1907.01 Health Information Management and Health Records:

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

1.4.7. - Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.5. Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.5.1. AAOS: American Academy of Orthopedic Surgery http://www.aaos.org/

1.5.2. ABOS: American Board of Orthopedic Surgery https://www.abos.org/

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. AOD: Admitting Officer of the Day

1.5.5. CCNE: Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation

1.5.6. CDC: Centers for Disease Control and Prevention

1.5.7. CDR: Contract Discrepancy Report

http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm http://www.aacn.nche.edu/accreditation

V0002 revised 11 6 2014 Page 6 of 84

1.5.8. CEU: Certified Education Unit

1.5.9. CME: Continuing Medical Education

1.5.10. CMS: Centers for Medicare and Medicaid Services

1.5.11. Contracting Officer (CO) – The person executing this contract on behalf of the

Government with the authority to enter into and administer contracts and make related determinations and findings.

1.5.12. Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The

COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.13. COS: Chief of Staff

1.5.14. CPARS: Contractor Performance Assessment Reporting System

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

1.5.16. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.5.17. DEA: Drug Enforcement Agency

1.5.18. ED: Emergency Department

1.5.19. FSMB: Federation of State Medical Boards

1.5.20. Full Time Equivalent (FTE): VA’s definition for full time- working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included.

1.5.21. HHS: Department of Health and Human Services

1.5.22. HIPAA: Health Insurance Portability and Accountability Act

1.5.23. HR: Human Resources

1.5.24. ISO: Information Security Officer

1.5.25. Medical Emergency - a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.5.26. MOD: Medical Officer of the Day

1.5.27. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.5.28. NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

1.5.29. Non-Contract Provider - any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors http://www.nlnac.org/

V0002 revised 11 6 2014 Page 7 of 84

1.5.30. NP: Nurse Practitioner

1.5.31. NPPES: National Plan and Provider Enumeration System

1.5.32. PA: Physician Assistant

1.5.33. PALS: Pediatric Advanced Life Support

1.5.34. POP: Period of Performance

1.5.35. PPD: Purified Protein Derivative

1.5.36. PWS: Performance Work Statement

1.5.37. Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure.

Clinical privileges must be facility-specific and provider-specific.

1.5.38. QASP: Quality Assurance Surveillance Plan

1.5.39. Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.5.40. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers in Michigan and Indiana.

1.5.41. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

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

1.5.43. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different

VA medical Center, for purposes of this contract, this term shall mean the Louis A.

Johnson VA Medical Center.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License - Contract physician(s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or

Commonwealth of the United States or the District of Columbia. (SPECIAL NOTE: For procurements that require a Drug Enforcement Agency (DEA) registration, contract providers must have a medical license and be individually registered with the DEA in the state where they will provide services under the contract). All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contract physician(s) who have current, full and unrestricted licenses in one or more states, but who

V0002 revised 11 6 2014 Page 8 of 84 have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2. Board Certification - Board certified or board eligible by the American Board of

Orthopedic Surgery http://www.abos.org/ is preferred.

2.1.3. Credentialing and Privileging –Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any contract physician(s) prior to obtaining approval by the (Louis A. Johnson VA Medical Center)

Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.3.1. If a contract physician(s) is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4. Technical Proficiency - Contract physician(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contract physician(s) and contract physician (s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements:

Contract physician (s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for contract physician(s).

2.1.6. Training (CPRS and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contract physician (s) as required by the VA.

2.1.7. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year.

2.1.7.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to

PPD testing for all contract physician (s). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually.

2.1.7.2. RUBELLA TESTING: Contractor shall provide proof of immunization for all contract physician (s) for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the COR.

2.1.7.3. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training http://www.abos.org/

V0002 revised 11 6 2014 Page 9 of 84 for all contract physician(s); provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998;

26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control.

Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.8. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and

Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.9. DEA (as required) - Contractor shall provide copy of current DEA certificate to the credentialing office

2.1.10. Conflict of Interest: The Contractor and all contract physician(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the

Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.11. Citizenship related Requirements:

2.1.11.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and

Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.1.11.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States.

Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.11.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

V0002 revised 11 6 2014 Page 10 of 84 discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the

U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.11.4. This certification concerns a matter within the jurisdiction of an agency of the United

States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.11.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFQ using the subject attachment in Section D of the solicitation document.

2.1.12. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the

Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services

(HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the

Medicare and Medicaid programs.

2.1.12.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract physician(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary

Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.12.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of

Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2. Clinical/Professional Direction: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center

Director as provided in VHA Handbook 1100.19. Clinical/Professional direction of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non Personal Healthcare Services: The parties agree that the Contractor and all contract physician(s) shall not be considered VA employees for any purpose.

2.4. Inherent Government Functions: Contractor and Contract physician (s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for

Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving http://oig.hhs.gov/exclusions/index.asp

V0002 revised 11 6 2014 Page 11 of 84 any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.5. No Employee status: The Contractor shall be responsible for protecting Contract physician (s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.5.1. Workers’ compensation

2.5.2. Professional liability insurance

2.5.3. Health examinations

2.5.4. Income tax withholding, and

2.5.5. Social security payments.

2.6. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract physician(s).

When a Contractor or contract physician(s) has been identified as a provider in a tort claim, the

Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.7. Key Personnel:

2.7.1. The VA Full Time Equivalency (FTE) for the services required is 1.0 VA FTE. FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays.

2.7.2. The number of Orthopedic physicians required to be on site on a daily basis is 1.0 as defined in paragraph Hours of Operation in this section.

2.8. Emergency Substitutions: During the first ninety (90) calendar days of performance, the

Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar days after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the

CO at least 15 calendar days prior to making any permanent substitutions.

2.8.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.8.2. For temporary substitutions where the key person shall not be reporting to work for three

(3) consecutive work days or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.8.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the

VA COS or designee show documented clinical problems or continual unprofessional

V0002 revised 11 6 2014 Page 12 of 84 behavior/actions with any contract physician (s), s/he may request, without cause, immediate replacement of said contract physician (s).

2.8.4. The CO and COR shall deal with issues raised concerning Contract physician (s) conduct.

The final arbiter on questions of acceptability is the CO.

2.9. Contingency Plan: Because continuity of care is an essential part of VAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if the contract physician (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. VA HOURS OF OPERATION/SCHEDULING

3.1. VA Business Hours: 8:00a.m. - 4:30 p.m.

3.2. Work Schedule:

3.2.1. The Orthopedic Surgeon shall work a Regular Tour of Duty: 7:30 a.m. to 4:00 p.m., Monday through Friday.

3.2.2. The Orthopedic Surgeon shall coordinate leave days (sick leave, vacation days) in advance with the Contractor and LAJVAMC administrative staff, to the maximum extent practicable, in an effort to minimize lapses in orthopedic coverage. Excessive absences may cause LAJVAMC to require the Contractor to provide an alternative Orthopedic

Surgeon for the duration of the task order.

3.2.3. Patients must be seen by a contract physician (s) on-site at the LAJVAMC in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

3.2.4. Contract Physicians shall be available and present in clinic during normal clinic hours, which will be established and may be revised, as deemed appropriate for patient care by the

Chief of Staff. Currently, normal clinic hours are 7:30 a.m. to 4:00 p.m.

3.2.5. Off-hours Coverage: Contractor must make the contract physician(s) available when on-call as scheduled, to include evenings, weekends and holidays.

3.2.5.1. On-call contract physicians must be available at all times for phone consultations with

VA residents and physicians.

3.2.5.2. The Orthopedic Surgeon may also be required to work any combination of the following:

3.2.5.2.1 Weeknight On-Call Coverage: 4:00 p.m. to 7:30 a.m., Monday through

Friday, on an as needed basis.

3.2.5.2.2. Weekend On-Call Coverage: on an as needed basis from Saturday 7:30 a.m.

- Sunday 7:30 a.m. and/or Sunday 7:30 a.m. - Monday 7:30.m.

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3.2.5.2.3. Overtime: Time outside of normal business hours or time worked while on-call. Contract provider is physically present at the medical center.

3.3. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

New Year’s Day

President’s Day

Martin Luther King’s Birthday

Memorial Day

Independence Day

Labor Day

Columbus Day

Veterans Day

Thanksgiving

Christmas

Any day specifically declared by the President of the United States to be a national holiday.

3.4 Cancellations: The Orthopedic Surgeon shall coordinate leave days (sick leave, vacation days), in advance, with the Contractor and LAJVAMC Chief of Surgery Service or designee, to the maximum extent practicable, in an effort to minimize lapses in orthopedic coverage. Excessive absences may cause the LAJVAMC to require the Contractor to provide an alternative Orthopedic Surgeon for the duration of the task order.

3.4.1 Unless a state of emergency has been declared, the Contractor shall be responsible for providing services.

4 CONTRACTOR RESPONSIBILITIES

4.4 Clinical Personnel Required: The Contractor shall provide contract physician (s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.4.1 Contract physician(s) shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices.

4.4.2 After task order award, the Contractor shall be responsible for notifying the Contracting Officer, immediately upon discovery, if the Orthopedic Surgeon provided by the Contractor can no longer perform the services of this task order, for any reason, and a substitute Orthopedic Surgeon will be required to complete task order performance. The Contractor may offer a substitute

Orthopedic Surgeon, provided:

a. The Contractor provides an explanation of the circumstances necessitating the substitution;

b. The proposed Orthopedic Surgeon substitute meets or exceeds the same requirements required by

B2.2. Qualifications: parts 1 through 8; and,

c. The proposed substitute Orthopedic Surgeon is approved by the Chief of Staff and the Chief of

Surgery.

4.5 Standards of Care: The contract physician (s)’ care shall cover the range of Orthopedic services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized TJC, VA and national standards as established by:

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4.5.1 American Academy of Orthopedic Guidelines: http://www.aaos.org/research/guidelines/guide.asp

4.5.2 VA Standards: VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

4.5.3 The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx

4.5.4 The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.5.5 The requirements contained in this PWS.

4.5.5.1 Attending Physician: Clinics/Orthopedic procedures shall not be conducted by residents in the absence of an attending physician. All procedures, inpatient admissions and consults shall be the responsibility of an attending physician.

4.6 MEDICAL RECORDS

4.6.1 Authorities: Contract physician (s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy

Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C.

5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45

C.F.R. Parts 160, 162, and 164 (HIPAA).

4.6.2 HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract.

Treatment and administrative patient records generated by this contract or provided to the

Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical

Records-VA’ (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense.

Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

4.6.3 Disclosure: Contract physician(s) may have access to patient medical records: however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management http://www.aaos.org/research/guidelines/guide.asp https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 http://www.jointcommission.org/standards_information/standards.aspx http://www.hpoe.org/resources?show=100&type=8 http://www.rms.oit.va.gov/SOR_Records/24VA19.asp http://www.rms.oit.va.gov/SOR_Records/24VA19.asp http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1469

V0002 revised 11 6 2014 Page 15 of 84 and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.6.4 Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA

Handbook 1907.01 Health Information Management and Health Records:

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VAMC.

4.6.5 Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of

Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use

VA Form 10-5345, Request for and Authorization to Release Medical Records or Health

Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Tonya Facemire, Privacy

Officer/FOIA Officer, Louis A. Johnson VA Medical Center, 1 Medical Center Drive, Mail Code

001C, Clarksburg, WV 26301. Phone (304) 623-3461, ext. 3292, Mobile: (304) 841-6458.

4.6.6. Direct Patient Care: 90% of the time involved in direct patient care.

4.6.7. Per the qualification section of this PWS, the Contractor shall provide the following staff:

4.6.7.1. Orthopedic Surgeon

The Orthopedic Surgeon will be providing services such as conducting comprehensive patient examinations, surgeries, record keeping (e.g. initial assessments, progress notes, surgery notes, etc.), and other tasks inherent to an Orthopedic Surgeon in collaboration with other VA staff in the Surgery Department

Scope of Care: Contract physician(s), as appropriate and within scope of practice/privileging, shall be responsible for providing Orthopedic care, including, but not limited to :

4.6.7.2. Clinic and Surgical Care: Contractor physician(s) shall provide clinical Orthopedic services. Contractor physician(s) shall be present on time for any scheduled clinics/surgeries as documented by physical presence in the clinic or operating room at the scheduled start time.

4.7.1.1.1. Approximate clinic case load is per clinic: 20-25 patients per day and patients may be any combination of scheduled or unscheduled, outpatient or inpatient.

# of procedures per surgical session: Two days per week, 3-7 patients per day, on average, depending on case size and complexity.

4.7.1.1.2. Operative Services: Contractor physician(s) shall provide comprehensive clinical

Orthopedic services. The approximate surgical case load is 3-7 patients per day, two (2) days per week. The number of cases scheduled depend upon the complexity of the procedures.

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1469 http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1423 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 http://www4.va.gov/vaforms/va/pdf/VA3288.pdf http://www4.va.gov/vaforms/va/pdf/VA3288.pdf http://www4.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf http://www4.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf

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4.7.1.1.3. Intraoperative Follow-up: the Contractor physician(s) shall be present in the operating suite for all orthopedic procedures.

4.7.1.1.4. Postoperative Follow-Up: Contractor Physician rounds shall be conducted on postoperative patients in the Intensive Care Unit (ICU) and on the wards. All complications will be discussed in morbidity and mortality conferences

4.7.1.1.5. Contractor physician(s) shall provide consultative services at the patient’s bedside if the patient is not ambulatory and in the clinic setting if the patient is able to report to the outpatient clinic. Procedures shall be scheduled for completion within 30 days of the date of the consult.

4.7.1.1.6. Medications: Contractor physician(s) shall follow all established medication policies and procedures. No sample medications shall be provided to patients.

4.7.1.1.7. Discharge education: Contractor physician(s) shall provide discharge education and follow up instructions that are coordinated with the next care setting for all orthopedic clinical or surgical patients.

4.7.2. ADMINISTRATIVE: 10% of time not involved in direct patient care. Responsible for completion of encounters and documentation at time of visit.

4.7.2.1. Quality Improvement Meetings: The contract physician(s) shall participate in continuous quality improvement activities and meetings with committee participation as required by the VAMC Chief of Service, Chief of Staff, or designee. This includes, but not limited to Operative & Invasive, M&M and

Grand Rounds, Quarterly Staff Meetings.

4.7.2.2. Staff Meetings: The contract physician (s) shall attend staff meetings as required by the VAMC Chief of Service, Chief of Staff, or designee. Contractor to communicate with COR on this requirement and report any conflicts that may interfere with compliance with this requirement.

4.7.2.3. QA/QI documentation: The contract physician (s) shall complete the appropriate

QM/PI documentation pertaining to all procedures, complications and outcome of examinations.

4.7.2.4. Patient Safety Compliance and Reporting: Contract physician (s) shall follow all established patient safety and infection control standards of care. Contract physician (s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care.

All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to the COR VA Safety Policy. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and submit to the COR the Patient Safety Report, following up with COR as required or requested.

4.8. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY

IMPROVEMENT(QI)

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4.8.1. Quality Management/Quality Assurance Surveillance: Contractor physician(s) shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, and Peer Reviews. Methods of Surveillance: Focused

Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE).

Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.8.1.1. The contractor’s physician(s) are expected to actively participate in the facility’s performance improvement activities as part of the contracted service time.

Performance Improvement Activities may include the following:

Surgical Case Review

Surgical Risk Assessment Program

External Peer/case Review Program Reporting

Infection Control

Blood Usage Review

Hospital Safety

Outpatient Qualitative and Quantitative Review

Medical Record Review

Drug Usage

Internal Peer Review

Patient Incident

Utilization

4.8.2. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.8.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The

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CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

4.8.4. Performance Standards:

4.8.4.1. Measure: Scope of Practice/Privileging

Performance Requirement: Contract physician(s) perform within their individual scopes of practice/privileging.

Standard: All (100%) contract physician (s) perform within their scope of practice/privileges 100% of the time.

Acceptable Quality Level: All (100%) contract physician (s) perform within their scope of practice/privileges 100% of the time. No deviations accepted.

Surveillance Method: Random Inspection of records.

Incentive: Favorable Contractor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contract physician(s) meet qualification standard.

4.8.4.2. Measure: Patient Access

Performance Requirement: The Contractor shall provide contract physician(s) in accordance with the operating hours and VA clinical schedule outlined in this PWS.

Standard: All contract physician (s) are on time and available to perform services 95% of the time.

Acceptable Quality Level: Contract physician(s) is on-time and available to perform services 95% of the time.

Surveillance Method: Periodic Sampling of Time and Attendance Sheets.

Incentive: Favorable Contractor performance evaluation.

Disincentive: Unfavorable contractor performance evaluation. Removal from contract until such time the contract physician(s) meet qualification standard.

4.8.4.3. Measure: Mandatory Training

Performance Requirement: Contractor shall complete all required training on time per

VAMC policy.

Standard: All (100%) of required training is complete on time by contract physician (s).

Acceptable Quality Level: 100% completions, no deviations.

Surveillance Method: Periodic Sampling.

Incentive: Favorable Contractor performance evaluation.

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Disincentive: Unfavorable contractor performance evaluation. Suspension or termination of all physical and/or electronic access privileges. Removal from contract until such time the contract physician(s) meet qualification standard.

4.8.4.4. Measure: Privacy, Confidentiality and HIPAA

Performance Requirement:

Standard: All (100%) contractor physician (s) comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA

Acceptable Quality Level: 100% compliance; no deviations.

Surveillance Method: Periodic Sampling…