36C24919R0003.docx

36C24919R0003 – Marshall County CBOC – Memphis VAMC

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

36C24919R0003 12-19-2018 Alyson Allman, Contract Specialist 615-225-3403 01-31-2019

3:00PM CT

90C Department of Veterans Affairs Network Contracting Office 9 1639 Medical Center Parkway Suite 400 Murfreesboro TN 37129 X 621498 $20.5 Million X N/A X Department of Veterans Affairs Memphis VAMC 1030 Jefferson Ave Memphis TN 38104 90C Department of Veterans Affairs Network Contracting Office - 9 1639 Medical Center Parkway Suite 400 Murfreesboro TN 37129

90C FSC e-Invoice Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 Invoice must be submitted electronically

Setup 1-877-489-6135 See CONTINUATION Page The contractor shall provide Community Based Outpatient Clinic services in Marshall County, MS in accordance with the Performance Work Statement, (pg. 10), and all other terms, Conditions, and requirements contained herein.

Pricing should be in accordance with the Schedule of Services in Section B.2, beginning on page 6.

See CONTINUATION Page X X Kimberly S. Carson Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1. CONTRACT ADMINISTRATION DATA

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

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

a. CONTRACTOR:

Company Name:

Contact Person:

Title:

Address:

City/State/Zip: (9-digit zip) Overnight Mailing Address (if different from above):

E-Mail:

Tax ID No.:

DUNS No.:

b. GOVERNMENT:

Kimberly S. Carson, Contracting Officer Alyson Allman, Contract Specialist Department of Veterans Affairs Network Contracting Office 9 - NCO 9 1639 Medical Center Parkway, Suite 400 Murfreesboro TN 37129 Overnight Mailing Address: Same as above Phone: Alyson (615) 225-3403; Kim (615) 225-6395; Fax: (615) 225-5432 E-Mail: Alyson.allman@va.gov or kimberly.carson@va.gov

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

AMENDMENT NO. DATE

[End of Contract Administration Data]

B.2 SCHEDULE OF SERVICES

PRICE SCHEDULE AND SERVICES

The following capitated rates are for continuous delivery of Contractor Operation Primary Care Services and Mental Health Care services located in Marshall County, Mississippi within approximately 20 miles of a local hospital in Holly Springs, MS providing emergency room services; and the facility shall have easy access to US-78W. This Marshall County Community Based Outpatient Clinic (CBOC) is for eligible Veterans residing within the coverage area for this CBOC of DeSoto, Benton, La Fayette, Tate, and Marshall County.

BASE YEAR – June 1, 2019 through May 31, 2020

Total Estimated Cost

Total for Base Year $________________________ OPTION YEAR 1 – June 1, 2020 through May 31, 2021

Total Estimated Cost

1,000

Total for Option Year 1 $________________________ OPTION YEAR 2 – June 1, 2021 through May 31, 2022

Total Estimated Cost

1,100

Total for Option Year 2 $________________________ OPTION YEAR 3 – June 1, 2022 through May 31, 2023

Total Estimated Cost

Total for Option Year 3 $________________________

OPTION YEAR 4 – June 1, 2023 through May 31, 2024

Total Estimated Cost

Total for Option Year 4 $________________________

TOTAL FOR BASE AND OPTION YEAR$___________________________

** Changes to the contract can only be made by a written modification which is formally executed by the contractor and the Contracting Officer.

Orders shall be issued only the Contracting Officer.

All unit prices shall be a firm-fixed price.

This contract is a fixed price Indefinite Delivery -Indefinite Quantity contract. The guaranteed contract minimum, including the base year and any option years exercised is 950 enrollees and the maximum contract amount, including the base year and any option years exercised shall not exceed 9,500 enrollees.

ORDERS: This is a Fixed Price (FP) Indefinite Delivery/Indefinite Quantity (IDIQ) contract (see FAR 52.216-22).

Task Order Procedures

a. This contract type allows the Veteran Affairs Network Contracting Office (NCO 9) contracting officers to place orders with the contractor on an as needed basis. In accordance with the Federal Acquisition Regulation (FAR) Clauses 52.216-18, Ordering. NCO 9 will obligate the funding and order the services by issuing a task order.

b. VA has the sole authority to assign Veterans treated by the contractor into the Primary Care Management Manual (PCMM) software program used to track primary care clinic veteran rosters. Specific billable processes for issuing task orders under the resultant contract includes: determining veteran eligibility, enrollment eligibility, and required Evaluation and Management Exams is further defined in 6.1.9.

c. The contractor shall initiate work when, so directed by a Task Order issued by the contracting officer. No work under any Task Order shall be performed unless specifically authorized by the contracting officer. Approval of a Task Order shall not constitute approval to exceed any item listed in the contract or general provisions of the contract. The contractor shall not exceed the estimated task order amount, or change the task order without prior written approval of the Contracting Officer.

d. In event the contractor is unable to fulfill the task order requirements for whatever reason; the government reserves the right to fulfill its need outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the task order is immediately required. The quantity of enrollees or PMPM ordered on the unfilled task order will be applied to the minimum quantity. The government’s right to fulfill its need outside this contract does not waive its right to the issuance of a cure notice nor does it waive its right to terminate for default.

Task Order Issuance Procedure. The terms that apply to the issuance of Task Orders under this contract are set forth below:

a. The estimated enrollees or PMPM for performance of each task shall be set forth in each task order. Each task order shall not exceed the enrollees or PMPM specified and total amount obligated for each task order. The total amount of all task orders shall not exceed overall Maximum Order Limitation (MOL) provided in FAR Clause 52.216-19 (b)(2).

Task Order Pricing

a. Task order prices shall be Fixed-Price (FP) as agreed to in the contractor’s schedule and individually funded. The Unit Price is an all-inclusive cost. If the contract Period of Performance (POP) is extended using FAR Clause 52.217-8, the specified rates under this clause will be those rates in effect under the contract each time an option is exercised under this clause.

Task Order Performance Period. Each task order shall have an established period of performance or delivery date. Individual Task order shall not exceed a 12-month period.

B.3 PERFORMANCE WORK STATEMENT

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

1. GENERAL:

1.1. SERVICES REQUIRED: The Veterans Affairs Medical Center, Memphis, TN requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in the following Mississippi counties: DeSoto, Benton, La Fayette, Tate, and Marshall Counties.

1.1.1. Primary Care CBOC: offer both medical (physically on site) and mental health care (either physically on site or 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. Sites that do not provide both primary care and mental health services are classified as Other Outpatient Services. Access to specialty care is not provided on site, but may be available through referral or telehealth. A Primary care CBOC often provides home-based primary care (HBPC) and home telehealth to the population it serves to meet the primary care and mental health needs of Veterans who have difficulty accessing clinic-based care. Primary care in VA includes both medical and mental health care services, as they are inseparable in providing personalized, proactive, patient-centered health care. Primary Care Requirements. A point of service is said to provide primary care services if the site registers more than 500 primary care encounters within the primary care stop class within a given fiscal year. Mental Health Requirements. A point of service is said to provide mental health services if the site registers more than 500 mental health encounters within a single mental health clinic stop class within a given fiscal year. Mental health services may be provided using telehealth, if the workload at the point of service would not otherwise justify the presence of mental health providers. Mental health services will be provided by the Contractor and by VA staff via telehealth.

1.2. PLACE OF PERFORMANCE: The Contractor shall provide a primary CBOC facility in Marshall County, MS AND within 20 miles of the local hospital in Holly Springs, MS providing emergency room services.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of VA Medical Center, Memphis, TN.

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, patient safety and performance, including, but not limited to, the following:

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

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 1003, “Customer Service Program” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=268

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

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

1.4.10. "Patient Medical Records-VA" 24VA10P12 https://www.oprm.va.gov/privacy/privacy_SOR.aspx

1.4.11. VHA Handbook 1101.11(2), “Coordinated Care for Traveling Veterans” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

1.4.12. VHA Directive 2007-033, "Telephone Service for Clinical Care," http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605

1.4.13. VHA Directive 1088, “Communicating Test Results to Providers and Patients” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.14. VHA Directive 2009-038 “VHA National Dual Care Policy” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058

1.4.15. VHA Directive 1033, “Anticoagulation Therapy Management”http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129

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

1.4.17. VHA Directive 1230 “Outpatient Scheduling Processes and Procedures” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

1.4.18. VHA Directive 1115, “Military Sexual Trauma (MST) Programming,” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6402

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

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

1.4.20. VHA Directive 2011-020, “Automated Safety Incident Surveillance and Tracking System (ASISTS)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407

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

1.4.22. 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://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797

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

http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=755&FType=2

1.4.24. VHA Handbook 1003.4, "VHA Patient Advocacy Program," https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

1.4.25. VHA Handbook 1004.07, “Financial Relationships between Health Care Professionals and Industry” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

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

1.4.27. VHA Handbook 1050.01, “VHA National Patient Safety Improvement Handbook” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389

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

1.4.29. VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.30. Amendment to VHA Handbook 1100.18, “”Reporting and Responding to State Licensing Boards” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962

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

1.4.32. VHA Directive 1306, “Querying State Prescription Drug Monitoring Programs (PDMP)” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283

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

1.4.34. VHA Handbook 1106.01, “Pathology and Laboratory Medicine Service (P&LMS) Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7477

1.4.35. VHA Handbook 1108.05, “Outpatient Pharmacy Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209

1.4.36. VHA Directive 1120.02 Health Promotion and Disease Prevention Core Program Requirements https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5965

1.4.37. VHA Handbook 1122, “Podiatric Medical and Surgical Services” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5959

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

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

1.4.40. VHA Handbook 5005, Part 2, Appendix G15, “Licensed Pharmacist Qualification Standards” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2

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

1.4.42. Title 38 CFR §17.107, “VA Response to Disruptive Behavior of Patients” (2010) https://www.gpo.gov/fdsys/pkg/CFR-2016-title38-vol1/pdf/CFR-2016-title38-vol1-sec17-107.pdf

1.4.43. 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-sec1-203

1.4.44. “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

1.4.45. “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

1.4.46. VA Assistant Secretary OSP Memo, Clarification of Policy for Sexual Assault Reporting, June 2011. http://www.diversity.va.gov/products/files/DAW/v10i05.docx

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

1.4.48. Access to VHA Clinical Programs for Veterans Participating in State-Approved Marijuana Programs https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711

1.4.49. VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

1.4.50. Provision of Medical Statements and Completion of Forms by VA Health Care Providers https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300

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

1.4.52 VISN 9 Directive 10N9-133-17 – Prescription Drug Monitoring Program Participation

1.4.53 VA Directive 1663: Health Care Resources Contracting - Buying https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.54 VHA Directive 2006-041 was rescinded July 2018, https://www.va.gov/vhapublications/ViewPublication.asp? the following directives/links replace this: VHA Directive 1003 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=268 ;

VHA Handbook 1003.1 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=422 VHA Handbook 1003.2 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=433 VHA Directive 1230 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3120

1.4.61 VA Directive 6008 Acquisition and Management of VA Information Technology Resources https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=891&FType=2

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6421

www.va.gov/vhapublications/viewpublication.asp?pub_id=2803

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=793&FType=2

1.4.76 VHA Directive 1005(1) Informed Consent for Long-Term Opioid Therapy for Pain https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3005

1.5. DEFINITIONS/ACRONYMS:

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. Assigned: A veteran is “assigned” to an outpatient clinic via PCMM (i.e. CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

1.5.14. BAA: Business Associate Agreement

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

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. CoP: Conditions of Participation in Virtual Care

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 System

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 Communication 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. FTC: Facility Telehealth Coorcinator

1.5.49. FSMB: Federation of State Medical Boards

1.5.50. HCC: Health Care Center A 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.

1.5.51. HEDIS: Healthcare Effectiveness Data and Information Set

1.5.52. HHS: Department of Health and Human Services

1.5.53. HCFA: HealthCare Financing Administration

1.5.54. 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.

1.5.55. HT: Home Telehealth

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

1.5.57. INR: International Normalized Ratio

1.5.58. ISO: Information Security Officer

1.5.59. LIP: licensed independent practitioner

1.5.60. MCCR: Medical Care Cost Recovery

1.5.61. 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.

1.5.62. MQSA: Mammography Quality Standards Act

1.5.63. MSN: Master of Science in Nursing

1.5.64. NCCPA: National Commission on Certification of Physician Assistants

1.5.65. NLN: National League for Nursing

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

1.5.67. OTC: Over the Counter

1.5.68. PA: Physician Assistant

1.5.69. PACS: Picture Archiving and Communications System

1.5.70. 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.

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

1.5.72. PCMH: Patient-Centered Medical Home

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

1.5.74. PCP: Primary Care Provider

1.5.75. Phar.D.: Doctor of Pharmacy

1.5.76. POC: Point of Care Testing

1.5.77. 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.

1.5.78. PCMHI: PRIMARY CARE-MENTAL HEALTH INTEGRATION:

1.5.79. PWS: Performance Work Statement

1.5.80. QAPI: Quality Assessment and Performance Improvement

1.5.81. QASP: Quality Assurance Surveillance Plan

1.5.82. RME: reusable medical equipment

1.5.83. SAIL: Strategic Analytics for Improvement and Learning

1.5.84. SF: Store and Forward telehealth

1.5.85. SOP (Clinical): Scope of Practice

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

1.5.87. SMA: Shared Medical Appointments

1.5.88. SPD: Sterile Processing Division

1.5.89. SPE: Senior Procurement Executive

1.5.90. 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.

1.5.91. 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.

1.5.92. TJC: The Joint Commission

1.5.93. TIU: Text Integration Utility

1.5.94. TCT: Telehealth Clinical Technicians

1.5.95. VA: Veterans Affairs

1.5.96. VAMC: Veterans Affairs Medical Center

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

1.5.98. VHA: Veterans Health Administration

1.5.99. VISTA: Veterans Health Information Systems and Technology Architecture

2. STAFFING AND QUALIFICATIONS

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS: PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Clerical 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 PCMM Handbook 1101.02. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent support staff for each full time equivalent Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: 1,400.

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

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

2.3.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician 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. At least one of the PCPs is to be a physician.

2.3.2.

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

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications: CRNPs (including subcontractors) must have a 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 of the Outpatient Site of Care (i.e. CBOC); Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&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 PCPs licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 3: Physician Assistant (PA):Qualifications: PAs (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 of the Outpatient Site of Care (i.e. CBOC); VA HANDBOOK 5005/78 PART II APPENDIX G8 PHYSICIAN ASSISTANT QUALIFICATION STANDARD http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=763&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 PCPs licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.3. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP.