36C24621R0068_2.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 178

36C24621R0068 07-29-2021

Wyona Davis, Administrative Contracting Officer 757-728-7013 08-30-2021

16:30 ESDT

Department of Veterans Affairs

Network Contracting Office 6

100 Emancipation Drive

Hampton, VA 23667-9900

X

Y

621498

$22 Million

N/A

Department of Veterans Affairs

Salem VA Medical Center

1970 Roanoke Boulevard

Salem, VA 24153-6404

Department of Veterans Affairs

Network Contracting Office 6

Hampton, VA 23667-9900

Tungsten Network https://authentication.tungsten-network.

com/login

Contract to provide Community Based Outpatient Clinic services in accordance with the Performance Work Statement

(PWS).

Schedule of Services begins on page 8

Performance Work Statement begins on page 13

X 1

MARIO L. SANTIAGO

36C24621R0068

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 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

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

2018)

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

C.3 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL

(JAN 2011)

C.4 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (JUN 2016)

C.5 52.216-18 ORDERING (AUG 2020)

C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.7 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.8 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

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

C.10 52.219-4 NOTICE OF PRICE EVALUATION PREFERENCE FOR HUBZONE SMALL

BUSINESS CONCERNS (MAR 2020) (JUN 2020) (DEVIATION)

C.11 52.219-14 LIMITATIONS ON SUBCONTRACTING (MAR 2020) (JUN 2020)

(DEVIATION)

C.12 52.222-5 CONSTRUCTION WAGE RATE REQUIREMENTS—SECONDARY SITE

OF THE WORK (MAY 2014)

C.13 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN 1997)

C.14 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.15 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.16 VAAR 852.237-72 CRIME CONTROL ACT—REPORTING OF CHILD ABUSE (OCT

2019)

C.17 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.18 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.19 VAAR 852.219-76 SUBCONTRACTING PLANS MONITORING AND COMPLIANCE

(JUL 2018)

C.20 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.21 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.22 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2021) (JUL 2020)

(DEVIATION)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 Quality Assurance Surveillance Plan - QASP

D.2 Past Performance Reference Questionnaire

D.3 VA Privacy Act, Information Security Awareness and Rules of Behavior

D.4 Conflicts of Interest

D.5 LAB Ward Instruction Manual 21st Edition 2019

D.6 Laboratory Computer Procedure Manual

D.7 MCP 658-11-34 Reporting Critical Results

D.8 MCM 658-11-75 Med Recon (2019)

D.9 MCM 658-116A-10 Telephone Calls - Suicide or Homicide

D.10 MCM 658-116A-21 Suicide Assessment, Intervention, and Documentation

D.11 MCM 658-136-33 Patient Rights and Responsibilities

D.12 MCP 658-119-28 Anticoagulation Management

D.13 Home Telehealth Operations Manual

D.14 Tele-Dermatology-Specialty Supplement

D.15 Tele-Eye Care Supplement

D.16 Asynchronous Telehealth Manual

D.17 2020 Rad Protocols

D.18 SOP for Cervical Cancer Screening at Salem VAMC

D.19 SOP for Mammography at Salem VAMC

D.20 SOP for Maternity Care at Salem VAMC

D.21 Ancillary Diagnostic Laboratory Testing Program (MCM658-113-02)

D.22 Electronic Clinical Performance Metrics

D.23 Code 10 Computer Downtime

D.24 Downtime procedures

D.25 CBOC Report Performance Measures

D.26 658-136-30 - Management of Electronic Health Records Document Scanning

D.27 Forms in Contingency Situation (Computer Downtime)

D.28 Service Contract Act of 1965

D.29 Wage Determinations

D.30 Demographic Information

D.31 Salem Save Lives Act SOP

D.32 COVID 19 Moderna Vaccine Redistribution to CBOC SOP

D.33 COVID 19 Janssen Vaccine Redistribution to CBOC SOP

D.34 Immigration Certification

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JUN 2020)

E.2 SPECIFIC INSTRUCTIONS TO OFFERORS REGARDING PROPOSAL PREPARATION

INSTRUCTIONS FOR PROPOSAL SUBMISSION

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

1998)

E.4 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

E.5 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) .. 158

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.9 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (FEB 2021) (JUL 2020) (DEVIATION)

E.10 52.212-3 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES

INCORPORATED BY REFERENCE (JAN 2008)

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: ______________________________________________

Address: ____________________________________________

City/State/Zip Code: ___________________________________

Tax ID Number: ______________________________________

DUNS Number: ______________________________________

Point of Contact/Title: _________________________________

Email: _____________________________________________

Phone: ____________________________________________

Fax Number: ________________________________________

b. GOVERNMENT:

Wyona Davis, Administrative Contracting Officer

Phone: 757-728-7013

Email: wyona.davis@va.gov

Department of Veterans Affairs

Network Contracting Office 6

Hampton VA 23667-9900

Mario L. Santiago, Contracting Officer

Phone: 757-251-4254

Email: mario.santiago@va.gov

Department of Veterans Affairs

Network Contracting Office 6

Hampton VA 23667-9900

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with accordance with 52.232-33, Payment by Electronic Funds Transfer –

Central Contractor Registration (OCT 2018).

3. INVOICES: Invoices shall be submitted monthly in arrears:

mailto:wyona.davis@va.gov mailto:mario.santiago@va.gov

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.

5. SECURE FAX: VA Handbook 6500 requires the following statement be included on all fax cover sheets: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

6. CONTRACT MODIFICATIONS: The Contractor is advised that only the Contracting Officer, acting within the scope of the contract and his/her duties and responsibilities and after advice and consultation with the Contracting Officer’s Representative (COR), has the authority to make changes that will affect contract prices, quantity, quality, delivery terms and conditions, or the term of the contract. In no event shall any understanding or agreement, modification, change order, or other matters in deviation from the terms of this contract between Contractor and a person other than the Contracting Officer be effective or binding upon the Government. All such actions must be formalized by the proper contractual document executed by the Contracting Officer.

7. SOLICITATION/CONTRACT: This solicitation and resulting contract adheres to the format defined in Federal Acquisition Regulation (FAR) Parts 12 and 15. The text of the FAR is available at https://www.acquisition.gov/.

8. CONTRACT PERFORMANCE: Contractor shall be required to begin treating patients under this contract no later than one hundred and twenty (120) calendar days after the date of award of this contract.

Offeror should thoroughly review the specifications and become familiar with areas of coverage prior to submitting a proposal. Failure to understand the contract requirements shall not relieve the successful offeror from performing in accordance within the strict meaning and intent of the specifications. Pricing shall include all facility, management, professionals, technical and labor necessary to perform specifications as outlined herein. The Government will not reimburse any costs not incorporated into the

Offeror price.

9. POST AWARD ORIENTATION (Awards over $1M): The Contracting Officer will schedule a post award orientation conference for contract orientation purposes as required by VA Acquisition

Manual, Part M842.502-70.

10. TECHNICAL INQUIRIES: Technical inquiries shall be made in writing via email to Wyona

Davis, Contract Specialist wyona.davis@va.gov. Inquires must be received a minimum of 10 business days before the closing date listed in block 8 of Standard Form 1449. If warranted, responses to inquiries will be incorporated into a written amendment posted to the Contract Opportunities website at https://www.sam.gov/.

http://www.fsc.va.gov/einvoice.asp https://www.acquisition.gov/ https://www.sam.gov/

11. PROPOSAL DELIVERY: Sealed Offers for furnishing the services in the schedule are to be sent electronically to wyona.davis@va.gov in PDF or Microsoft Word format and shall be assembled as instructed in Section E.2 SPECIFIC INSTRUCTIONS TO OFFERORS REGARDING PROPOSAL

PREPARATION INSTRUCTIONS FOR PROPOSAL SUBMISSION of this solicitation. Submissions may also be mailed, or hand carried to the address listed below:

DEPARTMENT OF VETERANS AFFAIRS

Network Contracting Office 6

100 Emancipation Drive

Hampton, VA 23664-9900

ATTN: Wyona Davis, Building 27

Late submissions, modifications and withdrawals will be handled as described in 52.212-1 “Instructions to Offerors – Commercial Items.” Faxed or offers will not be accepted.

Offeror shall address the evaluation factors listed in Section 52.212-2 - Evaluation – Commercial Items, to be considered for award. Contractor is responsible to ensure the offer includes both a Technical

Proposal and Price Proposal. There shall be no mention of pricing in the Technical Proposal.

12. CONTRACT COORDINATOR: The Contractor shall identify in writing to the CO their contact person(s) who shall serve as liaisons between the Contractor and VA and who shall ensure that services are performed in accordance with the contract specifications. The Contractor’s contact person(s) shall be available during VA regular administrative work hours, exclusive of national holidays.

Name: ____________________________________

Phone Number: _____________________________

Email: _____________________________________

13. AUTHORIZED NEGOTIATORS: The offeror represents that the following persons are authorized to negotiate on its behalf with the Government in connection with this Request for Proposals:

Name/Title: ________________________________

Telephone Number: _________________________

Email Address: _____________________________

Name/Title: ________________________________

Telephone Number: _________________________

Email Address: _____________________________

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

Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 SCHEDULE OF SERVICES

The Contractor shall provide Primary Care (PC) and Mental Health (MH) services in accordance with the terms, conditions, and provisions stated herein at the prices specified in the Schedule of Services.

Proposed Contractor facility must be physically located within the county of Tazewell and be located within the Salem VAMC primary care catchment area. Veterans to be serviced under this contract reside primarily in the counties of Bland, Tazewell, Wythe, and Giles, however; residency is not restricted to these counties. The Parent Facility for this CBOC is the Salem VA Medical Center, 1970 Roanoke, Salem, VA. Payment for primary care and Mental Health services shall be based on a monthly capitated rate, as further explained within this solicitation.

Contract Minimum $10,000.00 Contract Maximum $19,179,303.44

*PMPM includes cost of unassigned patient visits, contractor shall not bill separately or propose an additional line item or bill separately for these costs.

BASE YEAR 1 – [10-01-2021] through [09-30-2022]

LIN

No.

SLIN

Services

Unit Estimated

Quantity

Price Per

Unit

Total

Estimated

Cost

0001 None

Primary Care

Services at capitation rates per member per month (PMPM)

PMPM

0002 None

Mental Health

Services at capitation rates per member per month (PMPM)

Estimated Total for Base Year 1 $__________________________

BASE YEAR 2 – [10-01-2022] through [09-30-2023]

SLIN

Quantity Price Per

Unit

Total

Cost

1001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 826 $_____ $_____

1002 None

Mental Health

Services at capitation rates

Estimated Total for Base Year 2 $__________________________

BASE YEAR 3 – [10-01-2023] through [09-30-2024]

SLIN

Quantity

Price Per

Unit

Total

Estimated

Cost

2001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 842 $_____ $_____

2002 None

Mental Health

Services at capitation rates

PMPM 280 $_____ $_____

Estimated Total for Base Year $__________________________

BASE YEAR 4 – [10-01-2024] through [09-30-2025]

SLIN

Quantity

Price Per

Unit

Total

Estimated

Cost

3001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 859 $_____ $_____

3002 None

Mental Health

Services at capitation rates

Estimated Total for Base Year 4 $__________________________

BASE YEAR 5 – [10-01-2025] through [09-30-2026]

SLIN

Quantity

Price Per

Unit

Total

Estimated

Cost

4001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 876 $_____ $_____

4002 None

Mental Health

Services at capitation rates

Estimated Total for Base Year 5 $__________________________

OPTION 1 YEAR 6 – [10-01-2026] through [09-30-2027]

Quantity Price Per

Unit

Total

Estimated Cost

Primary Care Services at capitation rates per member per month (PMPM)

PMPM 894 $_____ $_____

Mental Health Services at capitation rates per member per month (PMPM)

PMPM 298 $_____ $_____

Estimated Total for Option 1 Year 6 $__________________________

OPTION 2 YEAR 7 – [10-01-2027] through [09-30-2028]

SLIN

Quantity Price Per

Unit

Total

6001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 912 $_____ $_____

6002 None

Mental Health

Services at capitation rates

PMPM 304 $_____ $_____

Estimated Total for Option 2 Year 7 $__________________________

OPTION 3 YEAR 8 – [10-01-2028] through [09-30-2029]

SLIN

Quantity

Price Per

Unit

Total

7001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 930 $_____ $_____

7002 None

Mental Health

Services at capitation rates

PMPM 310 $_____ $_____

Estimated Total for Option 3 Year 8 $__________________________

OPTION 4 YEAR 9 – [10-01-2029] through [09-30-2030]

SLIN

Quantity

Price Per

Unit

Total

Estimated

Cost

8001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 949 $_____ $_____

8002 None

Mental Health

Services at capitation rates

PMPM 316 $_____ $_____

Estimated Total for Option 4 Year 9 $__________________________

OPTION 5 YEAR 10 – [10-01-2030] through [09-30-2031]

SLIN

Quantity

Price Per

Unit

Total

Estimated

Cost

9001 None

Primary Care

Services at capitation rates per member per month

(PMPM)

PMPM 968 $_____ $_____

9002 None

Mental Health

Services at capitation rates

PMPM 322 $_____ $_____

Estimated Total for Option 5 Year 10 $__________________________

ESTIMATED TOTAL FOR ALL BASE AND OPTION YEAR $__________________________

ESTIMATED QUANTITIES: All quantities listed herein are estimated annual quantities. The

Government is not obligated to purchase any specified amount of services under this contract beyond the contract minimum, however, will be obligated to make payment for all services requested and received in the quantities and of the quality requested.

ORDERING PROCEDURES: VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management Model (PCMM) software program used to track primary care clinic

Veteran rosters. Specific billable processes for issuing task orders under the resultant contract include determining Veteran eligibility, enrollment eligibility, and at least one qualifying encounter by the

Contractor’s primary care provider (PCP) within the previous 12 months.

The Contractor will be provided a list of all enrolled patients at the beginning of the contract and will be able to bill for these patients immediately. In order to remain enrolled in the clinic, patients must have a qualifying encounter within 12 months of their last visit. Qualifying encounters are further defined in

PWS Section 6.2.1. Please review in detail to ensure compliance for issuance of subsequent task orders and payment processing.

Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from date of award through contract expiration. Orders may be issued by facsimile or by electronic commerce methods.

AWARD BASED ON INITIAL OFFERS: Offerors are advised of the possibility that award may be made without discussion. Accordingly, offerors are cautioned to submit their initial offers based on their most favorable terms, pricing and technical factors.

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. SERVICES REQUIRED: The Salem VA Medical Center requires the following services to be provided in a private hospital, office or clinic environment to Veterans, primarily residing in the

Tazewell, Virginia area and must be able to provide cover for the following geographical locations: the counties of Bland, Tazewell, Wythe and Giles, and surrounding cities within those counties. The proposed Contractor facility must be physically located within the county of

Tazewell and be within the Salem VAMC primary care catchment 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 on-site by the contractor.

1.2. PLACE OF PERFORMANCE: The proposed Contractor facility must be physically located within the county of Tazewell and must be able to provide coverage for the following geographical locations: counties of Bland, Tazewell, Wythe and Giles, and surrounding cities within those counties and be located within the Salem VAMC primary care catchment area. The facility shall be complete with primary care physicians and personnel required for primary care, routine primary care services, and mental health services.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 and FAR Parts 12 &

15 to be furnished by the contractor on behalf of Salem VA Medical Center, 1970 Roanoke

Boulevard, Salem, VA.

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

http://www.va.gov/vhapublications/ http://www.va.gov/vapubs/ https://www.patientcare.va.gov/primarycare/Resources.asp

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. CVT: Clinical Video Telehealth

1.5.38. DICOM: Digital Image and Communication in Medicine

1.5.39. DIGMA: Drop in Group Medical Appointment

1.5.40. DRG: Diagnostic Related Group

1.5.41. DSS: Decision Support System

1.5.42. ECC Extended Care Center

1.5.43. 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.

1.5.44. EPRP: External Peer Review Program

1.5.45. FDA: Food and Drug Administration

1.5.46. FSMB: Federation of State Medical Boards

1.5.47. 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.

1.5.48. HHS: Department of Health and Human Services

1.5.49. HCFA: HealthCare Financing Administration

1.5.50. 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 http://www.cswe.org/ infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

1.5.51. HT: Home Telehealth

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

1.5.53. ICD 10: International Classification of Diseases 10th edition

1.5.54. iMED: software used by VA for informed consent

1.5.55. INR: International Normalized Ratio

1.5.56. ISO: Information Security Officer

1.5.57. LIP: licensed independent practitioner

1.5.58. MCCR: Medical Care Cost Recovery

1.5.59. 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.

1.5.60. MQSA: Mammography Quality Standards Act

1.5.61. MSN: Master of Science in Nursing

1.5.62. NCCPA: National Commission on Certification of Physician Assistants

1.5.63. NLN: National League for Nursing

1.5.64. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing

Improvement in Cardiac Surgical Program

1.5.65. OTC: Over the Counter

1.5.66. PA: Physician Assistant

1.5.67. PACS: Picture Archiving and Communications System

1.5.68. 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.

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

1.5.70. PCMH: Patient-Centered Medical Home

1.5.71. PCMM: Primary Care Management Module- a software program used to track Primary

Care Clinic Veteran rosters.

1.5.72. PCP: Primary Care Provider

1.5.73. Phar.D.: Doctor of Pharmacy

1.5.74. POC: Point of Care Testing

1.5.75. 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.

1.5.76. PCMHI: Primary Care-Mental Health Integration

1.5.77. PWS: Performance Work Statement

1.5.78. QAPI: Quality Assessment and Performance Improvement

1.5.79. QASP: Quality Assurance Surveillance Plan

1.5.80. RME: reusable medical equipment

1.5.81. SOP (Clinical): Scope of Practice

1.5.82. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care.

Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.83. SFT: Store and Forward Telehealth

1.5.84. SMA: Shared Medical Appointments

1.5.85. SPD: Sterile Processing Division

1.5.86. SPE: Senior Procurement Executive

1.5.87. 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.

1.5.88. 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.

1.5.89. TJC: The Joint Commission

1.5.90. TIU: Text Integration Utility

1.5.91. TCT: Telehealth Clinical Technicians

1.5.92. VA: Veterans Affairs

1.5.93. VA EHR: VA electronic health record

1.5.94. VAMC: Veterans Affairs Medical Center

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

1.5.96. VHA: Veterans Health Administration

1.5.97. VVC: VA Video Connect

1.5.98. WHEN: Weekend- Holiday- Every Night

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. A minimum of 1 physician is required and the remaining number of PACT providers can be either nurse practitioners or physician assistants. 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: 805.

Sufficient support staff to conduct daily business, including such functions as patient registration, financial assessments, and medical record documentation in VISTA and CPRS. Support staff will also be responsible for appointment scheduling within the VA system as well as facilitating consult scheduling in the community as needed. The contractor shall provide personnel, either through direct hire or through subcontracting in numbers and qualifications capable of fulfilling the requires of the resultant contract.

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 eligible by the ABMS in Internal Medicine and/or Family Practice or the

BOS in Internal Medicine and/or Family Practice. 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). Physicians shall be licensed in the state in which the

Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook

5005, Appendix G2 located at: https://www.va.gov/vapubs/search_action.cfm?dType=2.

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.

The Commonwealth of Virginia requires a Practice Agreement be developed by the supervising

Physician and Physician Assistant, kept on file or by both parties. This Practice Agreement should be available to the Virginia Board of Health Professions at all times.

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 and 900 active patients per full time midlevel provider. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. A minimum of one physician and up to one mid-level provider (NP or

PA) are required.

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 eligible in Internal Medicine and/or Family

Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the Outpatient Site of

Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G2 located at: https://www.va.gov/vapubs/search_action.cfm?dType=2.

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, telehealth, 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.

https://www.va.gov/vapubs/search_action.cfm?dType=2

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications:

CRNP’s (including subcontractors) must have an MSN from a NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health or

Family Practice. Authorization for prescriptive authority is required. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family

Medicine or Internal Medicine environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6 located at:

https://www.va.gov/vapubs/search_action.cfm?dType=2. 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, telehealth, 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.

OPTION 3: Physician Assistant (PA):Qualifications: PA’s (including subcontractors) must meet one of the three following educational criteria: a) A bachelor’s degree from a

PA training program which is certified by the CAHEA; or b) Graduation from a PA training program of at least twelve (12) months duration, which is certified by the

CAHEA and a bachelor’s degree in a health care occupation or health related science; or

c) graduation from a PA training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician. The duration of approved academic training and health care experience must total at least five (5) years.

Authorization for prescriptive authority is required. PAs must be certified by the

NCCPA. PA shall have current, full, active, and unrestricted license and registration in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G8 PHYSICIAN

ASSISTANT QUALIFICATION STANDARD located at:

https://www.va.gov/vapubs/search_action.cfm?dType=2. 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, telehealth, 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

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 in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6 located at:

https://www.va.gov/vapubs/search_action.cfm?dType=2. 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 the VA EHR 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.

PRIMARY CARE STAFFING –SSOCIATE [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. Contractor to propose the mix of Clinical Associates from the options below.

OPTION 1: Licensed Practical Nurse (LPN): Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G13

LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION

STANDARD located at: https://www.va.gov/vapubs/search_action.cfm?dType=2.

(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 may receive training as back-up for telehealth services (e.g. S&F, CVT).

OPTION 2: Medical Support Assistant (MSA):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…