S02 36C24821R0017.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 ___________1____ 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 183

36C24821R0017 02-26-2021

Mechelle D. Reaser 813-972-2000 Ext. 7541 03-22-2021

3:00 PM EDT

36C248

Department of Veterans Affairs

Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy Suite 525

Tampa FL 33637

X 100

X

621498

$22 Million

N/A

Department of Veterans Affairs

VA Caribbean Healthcare System

10 Casia Street

Sam Juan,PR 00921

36C248

Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy

Tampa FL 33637

Financial Services Center

P.O. Box 149971

Austin TX 78714-9971

See CONTINUATION Page

The contractor shall provide Community Based Outpatient Clinic

(CBOC) in support of the Veterans Affairs Caribbean Healthcare

System (VACHS).

The CBOC shall be in St. Thomas, United Stated Virgin Islands

(USVIs).

The current wage determination listed on DOL’s website will be the applicable wage determination included in the resultant contract.

Wage Determinations (Service Contract Act and Davis Bacon Act) will be updated annually if the option year is exercised.

This procurement is set-aside based on an order of priority as established in 38 U.S.C 8127 utilizing Tiered Evaluations including Small Business concerns.

See CONTINUATION Page

Mechelle D. Reaser, Contracting Officer

36C24821R0017

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 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST (JUN 2020)

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTACTOR INFORMATION

SYSTEMS (JUN 2016)

C.4 52.216-18 ORDERING (AUG 2020)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.8 52.222-30 CONSTRUCTION WAGE RATE REQUIREMENTS—PRICE ADJUSTMENT

(NONE OR SEPARATELY SPECIFIED METHOD) (AUG 2018)

C.9 52.222-32 CONSTRUCTION WAGE RATE REQUIREMENTS—PRICE ADJUSTMENT

(ACTUAL METHOD) (AUG 2018)

C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)136

C.11 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.12 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

C.13 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.14 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.15 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (NOV 2020)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 SOL NOTICE OF TIERED EVALUATION

D.2 ORGANIZATIONAL CONFLICT OF INTEREST

D.3 CONTRACTOR RULES OF BEHAVIOR

D.4 PAST PERFORMANCE QUESTIONNAIRE

D.5 CONTRACTOR IMMIGRATION CERTIFICATION

D.6 WAGE DETERMINATION – SERVICE CONTRACT ACT

D.7 WAGE DETERMINATION – DAVIS BACON ACT

D.8 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.9 LIMITATIONS ON SUBCONTRACTING CERTIFICATION SOLICITATION VERSION

D.10 PRE -TREATMENT AND TRANSPORTATION OF SOILED CRITICAL AND SEMI-

CRITICAL REUSABLE MEDICAL EQUIPMENT

D.11 VHA DIRECTIVE PATIENT CENTERED MANAGEMENT MODULE FOR PRIMARY

CARE

D.12 VA Directive 5005 STAFFING

D.13 VHA HANDBOOK 1160.01, UNIFORM MENTAL HEALTH SERVICES N VA

MEDICAL CENTERS AND CLINICS

D.14 VA DIRECTIVE 1330.01 (4) HEALTH CARE SERVICES FOR WOMEN VETERANS

HEALTH CARE SERVICES FOR WOMEN VETERANS

D.15 VA DIRECTIVE 1120.02 (1) HEALTH PROMOTION AND DISEASE PREVENTION

CORE PROGRAM

D.16 VA DIRECTIVE 1120.02 (1) HEALTH PROMOTION AND DISEASE PREVENTION

CORE PROGRAM

D.17 VHA Directive 1306 QUERYING STATE PRESCRIPTION DRUG MONITORING

PROGRAMS

D.18 VHA Handbook 1100.19 VHA HANDBOOK CREDENTIALING AND PRIVILEGING

D.19 VHA Handbook 1100.18 REPORTING AND RESPONDNG TO STATE LICENSING

BOARDS

D.20 VHA Handbook 1106.01 PATHOLOGY AND LABAORATORY MEDICINE SERVICE

PROCEDURES

D.21 VA DIRECTIVE 1120.02 (1) VHA HANDBOOK 1106.01 PATHOLOGY AND

LABORATORY MEDICINE SERVICE PROCEDURES

D.22 VHA HANDBOOK 1105.03, MAMMOGRAPY PROGRAM PROCEDURES AND

STANDARDS

D.23 VHA Handbook 1101.10 PATIENT ALIGNED CARE TEAM (PACT)

D.24 VHA Handbook 1100.7, NATIONAL PRACTITIONER DATA BANK (NPDB)

REPORTS

D.25 VHA Handbook 1050.01 VHA NATIONAL PATIENT SAFETY IMPROVEMENT

D.26 VHA Handbook 1006 VHA SITE CLASSIFICATIONS AND DEFINITIONS

D.27 VHA HANDBOOK 1004.07 FINANCIAL RELATIONSHIP BETWEEN VHA HEALTH

CARE PROFESSIONAL AND INDUSTRY

D.28 VHA Directive 1003, VHA PATIENT ADVOCACY PROGRAM

D.29 VA HANDBOOK 0730, Security and Law Enforcement

D.30 VHA Dir 2012-026, SEXUAL ASSAULTS AND OTHER DEFINED PUBLIC SAFETY

INCIDENTS IN VHA

D.31 VHA Directive 1199 REPORTING CASES OF ABUSE AND NEGLECT

D.32 VHA Dir 2011-020, AUTOMATED SAFETY INCIDENT SURVEILLANE AND

TRACKING SYSTEM (ASSIST)

D.33 VHA Dir 2011-012, MEDICATION RECONCILIATIION

D.34 VHA Directive 2010-053, PATIENT RECORD FLAGS

D.35 VHA Directive 1230(3), OUTPATIENT SCHEDULING PROCESSESS AND

PROCEDURES

D.36 VHA Directive 1108, VHA FORMULARY MANAGEMENT PROCESS

D.37 VHA Directive 1108 COMMUNICATING TEST RESULTS TO PROVIDERS AND

PATIENTS

D.38 VHA DIRECTIVE 1033, ANTICOAGULATION THERAPY MANAGEMENT

D.39 VHA DIRETIVE 2010-033, MILITARY SEXUAL TRAUMA (MST) PROGRAMMING

D.40 VHA DIRECTIVE 2009-038, VHA NATIONAL DUAL CARE POLICY

D.41 VHA Directive 1088, Communicating Test Results to Providers and Patients

D.42 VHA Directive 2008-015, “Public Access to Automated External Defibrillators (AEDs)

Deployment, Training, and Policies for use in VHA Facilities”

D.43 VHA DIRECTIVE 2007-033, TELEPHONE SERVICE FOR CLINICAL CARE

D.44 VA DIRECTIVE 6371, DESTRUCTION OF TEMPORARY PAPER RECORDS

D.45 VA DIRECTIVE 1663 HEALTH CARE CONTRACTING - BUYING TTILE 38 U.S.C

D.46 VHA DIRECTIVE 2006-041, VETERANS HEALTH CARE STANDARDS

D.47 TITLE 21 C.F.R 900.12(c), “MAMMOGRAPHY QUALITY STANDARDS

D.48 VHA HANDBOOK 1101.11 COORDINATED CARE FOR TRAVELING VETERANS

D.49 VHA DIRECTIVE 1608 COMPREHENSIVE ENVIRONMENT OF CARE (CEOC)

D.50 MATERNITY HEALTH CARE AND COORDINATION VHA HANDBOOK 1330.03,

MATERNITY HEALTH CARE AND COORDIMATION

D.51 MEDICATION RECONCILIATION ACROSS THE CONTINUUM OF CARE, CENTER

MEMORANDUM 00-19-93

D.52 ANTICOAGULATION MANAGEMENT PROGRAM, SOP 119-20-18

D.53 ORDERING AND REPORTING OF TEST RESULTS AND DIAGNOSTIC

PROCEDURES, CENTER MEMORANDUM 11-19-07

D.54 SUICIDE PREVENTION POLICY, CENTER MEMORANDUM 116A-19-01

D.55 GUIDANCE ON THE MANAGEMENT OF FAILURE TO ATTEND MENTAL

HEALTH APPOINTMENT. CENTER MEMO 116-13-01

D.56 SUICIDE PREVENTION POLICY, CENTER MEMORANDUM 116A-19-01

SECTION E - SOLICITATION PROVISIONS

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

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) .. 160

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.11 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORARTED

BY REFERENCE (JAN 2008)

E. 12 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003)

E.13 52.212-2 EVALUATION - COMMERCIAL ITEMS (OCT 2014)

E.8 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (NOV 2020)

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:

Contract Administrator Name and Title: _________________________________________

Organization’s Name: ________________________________________________

Address: ___________________________________________________________

City/State/Zip Code: __________________________________________________

Telephone Number: ______________________________________________________

Facsimile Number: ______________________________________________________

E-mail: _______________________________________

Federal Taxpayer ID: ______________________

Dun and Bradstreet Number: _________________

b. GOVERNMENT: Contracting Office (36C248)

Mechelle D. Reaser, Contracting Officer

Department of Veterans Affairs

Network Contracting Office 8 (NCO 8)

8875 Hidden River PKWY, Suite 525

Tampa, FL 33637

Phone: 813-972-2000 Ext. 7541

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.

Invoicing shall use 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 .

5. CONFORMITY TO REGULATIONS: The Contractor and his/her operations shall conform to all regulations, Federal, State, and local governing the performance of contracted services.

6. MANDATORY WRITTEN DISCLOSURES: Mandatory written disclosure required by FAR clause 52.203-13to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at http://www.va.gov/oig/contracts/hotline.asp and clicking on http://www.fsc.va.gov/einvoice http://www.va.gov/oig/contracts/hotline.asp

“FAR clause 52.203-13 Reporting. If you experience difficulty accessing the website, call the Hotline at

1-800-488-8244 for further instructions.

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

AMENDMENT NO DATE

8. CAUTION: Late submissions, modification, and withdrawals: See Provisions 52.212-1.

9. POST AWARD ORIENTATION: The Contracting Officer will schedule a post award orientation conference for contract orientation purposes as required by https://www.va.gov/oal/library/vaam/vaamM842.asp#M84250270 .

END OF CONTRACT ADMINISTRATION DATA

https://www.va.gov/oal/library/vaam/vaamM842.asp#M84250270

B.2 SCHEDULE OF SERVICES

1. CONTRACT TYPE: Requirements

2. PERIOD OF PERFORMANCE: Base year period and four (4), one (1) year options periods.

3. TASK ORDER PROCEDURES: Should the government choose to exercise the option year, one

(1) task order will be issued for the year to cover billable veterans at the CBOC location. The task order will contain date of order, contract number and order number, line item number (LIN), description, quantity, unit price, performance schedule, place of performance, accounting and appropriations data, and method of payment.

4. Pricing Instructions: Offeror must fill out the cells in the following columns in the Schedule of

Services for each CLIN: Price Per Unit, Total Estimated Price, Estimated Total for Base Year, Option Year and the Estimated Sum Total for Base and Option Year One (1). For pricing and evaluating purposes. Throughout the life of the contract the VA will pay the awarded fixed rate. The

Offeror shall complete the Schedule of Services below for the performance locations needed. No

LINs should be left blank.

5. MINIMUM AND MAXIMUM GUARANTEED: This contract includes a guaranteed minimum of $250,000 of services for the base year of the contract. The maximum amount to be ordered for this contract for the base, and option period (s), if exercised by the government, is $12,000,000.00.

If the maximum aggregate amount of $12,000,000.00 is reached prior to the expiration date of the contract, no further task orders will be issued under the contract. The Government will issue a new solicitation if services are still required.

6. ESTIMATED QUATITIES: The quantities in the price schedule are estimated only and do no bind the government to utilize or pay for quantities above the minimum dollar amount of

$10,000.00.

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

*Pricing for COVID 19 related recurring charges will be reassessed on a monthly basis throughout the pandemic to determine if payment for charges are still required. Contractor shall provide supporting documentation for payment of actual costs incurred with the invoice on a monthly basis for recurring costs.

PERIOD OF PERFORMANCE: BASE YEAR PERIOD 05/24/2021 – 05/23/2022

LIN

No.

Services

Unit Estimated

Quantity

Price Per

Unit

Total

Estimated

Cost

0001 Primary Care

Services at capitation rates per member per month (PMPM)

PMPM 835

0002 Mental Health capitation rates per member per month (PMPM)

PMPM 167

Total for Base Year $________________________

PERIOD OF PERFORMACE: OPTION YEAR ONE (1) 05/24/2022 – 05/23/2023

LIN

No.

SUB

LIN

1001 None Primary Care capitation rates per member per month

(PMPM)

1002 None Mental Health capitation rates

PMPM

Total for Option Year One (1) $________________________

PERIOD OF PERFORMACE: OPTION YEAR TWO (2) 05/24/2023 – 05/23/2024

LIN

No.

SUB

LIN

2001 None Primary Care capitation rates per member per month

2002 None Mental Health capitation rates

Total for Option Year Two (2) $________________________

PERIOD OF PERFORMACE: OPTION YEAR THREE (3) 05/24/2024 – 05/23/2025

LIN

No.

SUB

LIN

3001 None Primary Care capitation rates per member per month

3002 None Mental Health capitation rates

Total for Option Year Three (3) $________________________

PERIOD OF PERFORMACE: OPTION YEAR FOUR (4) 05/24/2025 – 05/23/2026

LIN

No.

SUB

LIN

4001 None Primary Care capitation rates per member per month

4002 None Mental Health capitation rates

Total for Option Year Four (4) $________________________

TOTAL FOR BASE AND OPTION YEAR $___________________________

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. SERVICES REQUIRED: The Veterans Affairs Caribbean Healthcare System (VACHS), requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in the United States Virgin Islands (USVIs) of ST. Thomas and St.

John.

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 but may be available through referral or telehealth.

1.2. PLACE OF PERFORMANCE: The clinic locution must be centrally located in the USVIs of

St. Thomas with easy access to public transportation. The location should provide adequate parking and access to persons with disabilities.

1.3. AUTHORITY: In accordance with Title 38 United States Code (U.S.C), 8153 Health Care

Resources (HCR) Sharing Authority, FAR Part 12 Acquisition of Commercial Items in conjunction with FAR Part 15 Contracting by Negotiation to be furnished by the contractor on behalf the VA Caribbean Healthcare System, 10 Calle Casia, San Juan, Puerto Rico 00921.

1.4. POLICY AND REGULATIONS: The contractor is required to meet the 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.

1.4.1. Title 21 C.F.R 900.12(c), “Mammography Quality Standards” http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf

1.4.2. Title 21 CFR, “Food and Drugs” Section 1300-end”.

https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html

1.4.3. 38 USC. Section 7332, regarding a timely special consent for any medical treatment for drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus (HIV), or sickle cell anemia, to a Veteran with health insurance. A special consent from the Veteran is needed to allow VA to release bills and medical records associated with the treatment. http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-

2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html

1.4.4. 42 CFR Part 482, “Conditions of Participation” http://www.gpo.gov/fdsys/pkg/CFR-

2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf

1.4.5. 42 CFR 493.15(b), “Laboratories Performing Waived Tests” http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf http://www.va.gov/vhapublications/ http://www.va.gov/vapubs/ https://www.patientcare.va.gov/primarycare/Resources.asp http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf

1.4.6. Clinical Laboratory Improvement Amendments (CLIA):

http://cms.hhs.gov/Regulations-and-

Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp

1.4.7. VHA Directive 2006-041, “Veterans Health Care Service Standards” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.8. VA Directive 1663, “Health Care Resources Contracting – Buying” https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.9. VA Directive 6371, “Destruction of Temporary Paper Records” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2The

1.4.10. VHA Record Control Schedule 10-1 http://www1.va.gov/vhapublications/rcs10/rcs10-

1.pdf

1.4.11. "Patient Medical Records-VA" (24VA19). 24VA19 http://vaww.vhaco.va.gov/privacy/SystemofRecords.htm.

1.4.12. VHA Handbook 1101.11(3), “Coordinated Care for Traveling Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

1.4.13. VHA Directive 2007-033, "Telephone Service for Clinical Care," https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605

1.4.14. VHA Directive 2008-015, “Public Access to Automated External Defibrillators

(AEDs): Deployment, Training, and Policies for use in VHA Facilities” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1665

1.4.15. VHA Directive 1088, “Communicating Test Results to Providers and Patients” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.16. VHA Directive 2009-038 “VHA National Dual Care Policy” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058Tge

1.4.17. VHA Directive 1033, “Anticoagulation Therapy Management” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129

1.4.18. VHA Directive 1108.08, “VHA Formulary Management Process” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291

1.4.19. VHA Directive 1230 “Outpatient Scheduling Processes and Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

1.4.20. VHA Directive 2010-033, “Military Sexual Trauma (MST) Programming,” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2272

1.4.21. VHA Directive 2010-053, “Patient Record Flags”.

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341

1.4.22. VHA Directive 2011-012, “Medication Reconciliation”

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2390

1.4.23. VHA Directive 2011-020, “Automated Safety Incident Surveillance and Tracking

System (ASISTS)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407

1.4.24. VHA Directive 1199, “Reporting Cases of Abuse and Neglect”, https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5624

1.4.25. VHA Directive 2012-026, “Sexual Assaults and Other Defined Public Safety

Incidents in VHA” The directive specifically includes contracted sites of care and defines procedures specific to patient disruptive behavior.

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797

1.4.26. VA Handbook 0730, “Security and Law Enforcement”

https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=93&FType=2

1.4.27. VHA Handbook 1003.4, "VHA Patient Advocacy Program,"

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

1.4.28. VHA Handbook 1004.07, “Financial Relationships between Health Care

Professionals and Industry” http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2 http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf http://vaww.vhaco.va.gov/privacy/SystemofRecords.htm https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1665 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2272 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2390 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5624 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797 https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=93&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

1.4.29. VHA Handbook 1006.02, “VHA Site Classifications and Definitions” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970

1.4.30. VHA Handbook 1050.01, “VHA National Patient Safety Improvement Handbook” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389

1.4.31. VHA Handbook 1100.17, “National Practitioner Data Bank Reports”-https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.32. VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364The

1.4.33. Querying State Prescription Drug Monitoring Programs (PDMP) http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283

1.4.34. Amendment to VHA Handbook 1100.18, “” Reporting and Responding to State

Licensing Boards” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962The

1.4.35. VHA Handbook 1100.19, “Credentialing and Privileging” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.36. VHA Directive 1306, “Querying State Prescription Drug Monitoring Programs

(PDMP)”

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283

1.4.37. VHA Handbook 1101.10, “Patient Aligned Care Team (PACT)” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977

1.4.38. VHA Handbook 1105.0, “Mammography Program Procedures and Standards” http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2411

1.4.39. VHA Handbook 1106.01, “Pathology and Laboratory Medicine Service (P&LMS)

Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3169

1.4.40. VHA Handbook 1108.05, “Outpatient Pharmacy Services”

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209

1.4.41. VHA Directive 1120.02 Health Promotion and Disease Prevention Core Program

Requirements https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5965

1.4.42. VHA Handbook, “1330.01 Health Care Services for Women Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332

1.4.43. VHA Handbook 1160.01, “Uniform Mental Health Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762

1.4.44. VHA Handbook 5005, Part 2, Appendix G15, “Licensed Pharmacist Qualification

Standards” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2

1.4.45. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htmThe

1.4.46. Title 38 CFR §17.107, “VA Response to Disruptive Behavior of Patients” (2010) www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdfThe

1.4.47. Title 38 CFR § 1.203, “Information to be reported to VA Police” (2003) https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-

1.4.48. “Guidelines for Preventing Workplace Violence for Health Care and Social Service

Workers,” Occupational Safety and Health Administration (OSHA) OSHA 3148-

01R 2004) https://www.osha.gov/Publications/osha3148.pdf

1.4.49. “Violence: Occupational Hazards in Hospitals, National Institute for Occupational

Safety and Health” (NIOSH) NIOSH 2002-101, April 2002.

http://www.cdc.gov/niosh/docs/2002-101/default.html https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977 http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2411 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3169 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5965 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762 http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm http://www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdf https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203 https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203 https://www.osha.gov/Publications/osha3148.pdf http://www.cdc.gov/niosh/docs/2002-101/default.html

1.4.50. VA Assistant Secretary OSP Memo, Clarification of Policy for Sexual Assault

Reporting, June 2011.

http://www.diversity.va.gov/products/files/DAW/v10i05.docx

1.4.51. VHA Directive 1231 Outpatient Clinic Practice Management https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296

1.4.52. Access to VHA Clinical Programs for Veterans Participating in State-Approved

Marijuana Programs https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711The

1.4.53. VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary

Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

1.4.54. Provision of Medical Statements and Completion of Forms by VA Health Care

Providers https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300

1.4.55. Seasonal Influenza Prevention Program for VHA Health Care Personnel https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.56. Center Memorandum 116A-18-01 Management of Suicidal Behavior

1.4.57. VHA Directive 2008-052, Smoke-Free Policy for VA Health Care Facilities

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. ACOS: Associate Chief of Staff

1.5.5. ACPE: American Council on Pharmaceutical Education

1.5.6. ACO: Administrative Contracting Officer

1.5.7. ADE: Adverse Drug events

1.5.8. AED: Automatic External Defibrillators

1.5.9. AIS: Automated Information Security

1.5.10. ANA: American Nurses Association

1.5.11. AOA: American Osteopathic Association

1.5.12. ARRT: American Registry of Radiologic Technology

1.5.13. ASC: Ambulatory Surgery Clinic

1.5.14. 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.

1.5.15. BAA: Business Associate Agreement

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

1.5.17. BLS: Basic Life Support

1.5.18. BOS: Bureau of Osteopathic Specialists

1.5.19. CAHEA: Committee on Allied Health Education and Accreditation

1.5.20. CAP: College of American Pathologists

1.5.21. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.22. CBO: VA Central Billing Office

1.5.23. CDC: Centers for Disease Control and Prevention

1.5.24. CEU: Certified Education Unit

1.5.25. CLIA: Clinical Laboratory Improvement Amendments

1.5.26. CME: Continuing Medical Education

http://www.diversity.va.gov/products/files/DAW/v10i05.docx https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300 https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.5.27. CMS: Center for Medicare and Medicaid Services

1.5.28. CO: Contracting Officer

1.5.29. COPD: Chronic Obstructive Pulmonary Disease

1.5.30. COR: Contracting Officer’s Representative

1.5.31. COS: Chief of Staff

1.5.32. CPA: Collaborative Practice Agreement

1.5.33. CPS: Clinical Pharmacy Specialist

1.5.34. CPT: Current Procedural Terminology

1.5.35. CRNP: Certified Registered Nurse Practitioners

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

1.5.37. CPARS: Contractor Performance Assessment Reporting Systems

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

1.5.39. CVT: Clinical Video Telehealth

1.5.40. DICOM: Digital Image and Communications in Medicine

1.5.41. DIGMA: Drop-in Group Medical Appointment

1.5.42. DRG: Diagnostic Related Group

1.5.43. DSS: Decision Support System

1.5.44. ECC: Extended Care Center

1.5.45. 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.

1.5.46. EPRP: External Peer Review Program

1.5.47. FDA: Food and Drug Administration

1.5.48. FSMB: Federation of State Medical Boards

1.5.49. FTE: Fulltime Equivalent

1.5.50. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least five (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.

1.5.51. HHS: Department of Health and Human Services

1.5.52. HCFA: Healthcare Financing Administration

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

1.5.54. HT: Home Telehealth

1.5.55. HUD-VASH: Housing and Urban Development-VA supported housing.

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

1.5.57. ICD 10: International Classification Disease 10 Edition

1.5.58. iMED: Software used by VA for informed consent

1.5.59. INR: International Normalized Ratio

1.5.60. ISO: Information Security Officer

1.5.61. LIN: Line Item Number

1.5.62. LIP: Licensed Independent Practitioner

1.5.63. MCCR; Medical Care Cost Recovery

http://www.cswe.org/

1.5.64. 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.

1.5.65. VACHS: Veterans Administration Caribbean Healthcare System

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

1.5.66. MQSA: Mammography Quality Standards Act

1.5.67. MSN: Master of Science in Nursing

1.5.68. NCCPA: National Commission on Certification of Physician Assistant

1.5.69. NLN: National League for Nursing

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

Improvement in Cardiac Surgical Program

1.5.71. OTC: Over the Counter

1.5.72. PA: Physician Assistant

1.5.73. PACS: Picture Archiving and Communications System

1.5.74. 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.

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

1.5.76. PCMH: Patient-Centered Medical Home

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

Care Clinic Veteran rosters.

1.5.78. PCP: Primary Care Provider

1.5.79. Phar D.: Doctor of Pharmacy

1.5.80. POC: Point of Care Testing

1.5.81. 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.

1.5.82. PCMHI: Primary Care-Mental Health Integration

1.5.83. PWS: Performance Work Statement

1.5.84. QASP: Quality Assurance Surveillance Plan

1.5.85. RME: Reusable Medical Equipment

1.5.86. SOP (clinical): Scope of Practice

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

1.5.88. SFT: Store and Forward Telehealth

1.5.89. SMA: Shared Medical Appointment

1.5.90. SPD: Sterile Processing Division

1.5.91. SPE: Senior Procurement Executive

1.5.92. 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.

1.5.93. Support Staff: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of Registered Nurses (RNs) , license Practitioner Nurses

(LPNs) , Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.94. TJC: The Joint Commission

1.5.95. TIU: Text Integration Utility

1.5.96. TCT: Telehealth Clinical Technicians

1.5.97. VA: Veterans Affairs

1.5.98. VA EHR: VA electronic health record

1.5.99. VAMC: Veterans Affairs Medical Center

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

1.5.101.VHA: Veterans Health Administration

1.5.102.VVC: VA Video Connect

1.5.103.VISTA: Veterans Health Information Systems and Technology Architecture

1.5.104.WHEN: Weekend-Holiday-Every Night

2. STAFFING AND QUALIFICATONS

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS:

The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract, modeled after the Primary Care Medical Home. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio that meets the demand to meet VA standards. Panel size shall be determined by the

Contractor, based on available staffing, productivity, efficiency, access and clinical outcomes. The Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider The Contractor may use as reference the VA guidelines in accordance with PCMM Handbook

1101.02. The PACT model requires an assigned RN Care Coordinator, a Clinical Associate and a Clerical

Associate, for each PACT teamlet. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA, the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total

Estimated Patients enrolled/assigned to site 835.

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 and/or Family Practice. Contractor’s Physicians performing under this contract shall be board certified or board eligible by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff does not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar day. May also be credentialed and privileged as a PCP. (if so, authorization for prescriptive authority is required). Position Responsibilities: Serve as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care of this site.

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

2.3.1. TEAMLET MEMBER ONE (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.

2.3.1.1. Option one (1): Physician (MD) Qualification: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family

Practice Physicians performing under this contract shall be board certified or board eligible by the ABMS in Internal Medicine and/or Family Practice or the BOS in

Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. 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/viewPublication.asp?Pub_ID=1006&FType=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.

2.3.1.2. OPTION TWO (2): Certified Registered Nurse Practitioner (CRNP)

Qualifications: CRNP’s (including subcontractors) must have an Master of Science

(MSN) from a National League for Nursing (NLN) accredited nursing program and have a American Nurses Association (ANA) certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required. Three (3) 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 of the Outpatient Site of Care

(i.e. CBOC); Reference VA Handbook 5005, Appendix G6 located at https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=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.

2.3.1.3. OPTION THREE (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.

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2

PAs must be certified by the NCCPA. PA shall have current, full, active, and unrestricted license and registration in the…