36C24920R0007 0003.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 07-27-2020 None Department of Veterans Affairs Network Contracting Office 9 (90C)

NCO 9

1639 Medical Center Parkway, Suite 400 Murfreesboro

TN

37129 90C Network Contracting Office 9 Department of Veterans Affairs Network Contracting Office (90C) 1639 Medical Center Parkway Suite 400 Murfreesboro

TN

37129 To all Offerors/Bidders

36C24920R0007 07-27-2020

X X X

The purpose of this amendment is to provide answers to the solicitation questions .

The response date to this solicitation is August 18, 2020 by 4:00 pm Central Time.

See attached pages for the questions and answers.

End of Amendment.

Darryl Scherer Contracting Officer

CONTINUATION PAGE

B.2.2. HOPKINSVILLE CBOC PRICE SCHEDULE

BASE PERIOD – May 1, 2021 through April 30, 2022

Total for Base Period $________________________

OPTION PERIOD 1 – May 1, 2022 through April 30, 2023

Total for Option Period 1 $________________________

OPTION PERIOD 2 – May 1, 2023 through April 30, 2024

Total for Option Period 2 $________________________

OPTION PERIOD 3 – May 1, 2024 through April 30, 2025

Total for Option Period 3 $________________________

OPTION PERIOD 4 – May 1, 2025 through April 30, 2026

Total for Option Period 4 $________________________

OPTION PERIOD 5 – May 1, 2026 through April 30, 2027

Total for Option Period 5 $________________________

OPTION PERIOD 6 – May 1, 2027 through April 30, 2028

Total for Option Period 6 $________________________

1. Upon award of the new contract, will the new contractor inherit the patient’s last Primary Care vesting visit and be allowed to bill for that patient up until their next anniversary date?

Yes

1. Do the current contracts have a separate CLIN for MH?

Yes

1. Upon award of the new contract, will the new contractor inherit the patient’s last Mental Health vesting visit and be allowed to bill for that patient up until their next anniversary date?

Yes

1. What mix of Specialty Mental Health Staffing, listed in Section 2.5.3 and Section 2.6.4, does the VA prefer for both the Dover and Hopkinsville clinics? Please list preferred position mix for both sites.

Require that all clinicians have simultaneous telemental health capability. This is fast becoming standard of care within the VA and will be expected at contract sites as well. Our clinicians are versatile and flexible in this regard and can tailor modality to patient need and context, whether that be face-to-face or via two-way audio/video encounters. This has become particularly important in the context of the COVID pandemic, where the majority of clinic visits have been converted to online clinical platforms which has allowed us to maintain gold-standard access to care.

See Amendment 2 removing Dover CBOC from the solicitation

1. Please list, by clinic, position, name and FTE, the PCMHI and Specialty MH positions that are currently staffed at the Dover and Hopkinsville CBOCs?

See Amendment 2 removing Dover CBOC from the solicitation Hopkinsville:

2FTE MD – Psychiatrist, 1 of these 2 FTE currently vacant (in hiring process now) 5 FTE - LCSWs

1.5 FTE MH RN

2 FTE MH NP (1 of these 2 FTE is in hiring process, start date 8/3/20)

0 PCMHI

1. How many TCTC/LPN staff will the Dover and Hopkinsville clinics need? The Solicitation does not identify how many telehealth encounters were originated at the Dover or Hopkinsville CBOC to support the calculation of 1 TCT/LPN per 1,000 encounters as stated in Section 2.6.5.

See Amendment 2 removing Dover CBOC from the solicitation Since based off of number of encounters, only 1 is required.

1. In Section 4.6.3.1 it states that that the contractor shall provide all medications need for administration at the Clinic, including necessary vaccines to ensure we have accurate information to price our proposal, please provide the number of Vaccines, by type as shown in the list below, that was provided to the Dover and Hopkinsville CBOC Enrolled Veterans in the last 12 months. Please list separately for each clinic.

6. Pneumovax 23

6. Prevnar 13

6. TDAP

6. TD

6. Zostavax

6. Shingrix

6. HPV

6. PPD

6. Twinrix (Hep A&B)

6. Hep A

6. Hep B

6. Depo This information was not included in solicitation 36C24920R0007. These are vaccines / medications that would be typically be provided by the contractor for our enrolled veterans.

See Amendment 2 removing Dover CBOC from the solicitation

1. Are there any additional Vaccines, other than those listed in question 7 above, that were provided to the Dover and Hopkinsville CBOCs enrolled Veterans in the last 12 months?

This information was not included in solicitation 36C24920R0007. These are vaccines/medications that would be typically be provided by the contractor for our enrolled veterans.

See Amendment 2 removing Dover CBOC from the solicitation

1. If there are additional vaccines identified pursuant to question 8, please provide the name and number of vaccines provided to Dover and Hopkinsville CBOCs Veterans in the last 12 months. Please list separately for each clinic.

This information was not included in solicitation 36C24920R0007. These are vaccines/medications that would be typically be provided by the contractor for our enrolled veterans.

See Amendment 2 removing Dover CBOC from the solicitation

1. Pursuant to the Prescription Fulfillment Section 4.6.3.1, please provide a list of Medications, with the quantities, provided to the Veterans enrolled in the Dover and Hopkinsville CBOCs in the last 12 months that the government expects the contractor to administer at the Clinic.

This data in unavailable to TVHS as the current contractor provides the medications. See Attachment 18 VA formulary for the list of medications that are able to be prescribed. Medications are filled by VA pharmacy and do not have specific data on individuals or individual CBOC locations.

See Amendment 2 removing Dover CBOC from the solicitation

1. Do the current CBOC facilities meet the new contract PACT Space Module Design Guide requirements as stated in the Space Requirements Section 4.8 of the solicitation?

Space requirements have changed and some of the current sites do not meet the new PACT requirements.

See Amendment 2 removing Dover CBOC from the solicitation

1. The Solicitation does not contain FAR 52.222-6 (Construction Wage Rate Requirements) or related applicable Davis Bacon Act construction Federal Acquisition Regulation (FAR) clauses set forth in FAR 22.407. However, according to [Section 4.8 of the Solicitation], an offeror must provide substantial construction work in accordance with detailed specifications that appears to be physically and functionally segregable from service work set forth in the Statement of Work and [the agency] will pay, directly or indirectly, for this construction work. As such, please confirm that FAR 52.222-6 applies to any of that work set forth in the Solicitation and that Davis Bacon Act wages should be used for pricing work under Section 4.9. Please also expressly identify the portion of the work for which the requirements of FAR 52.222-6 applies, when FAR 52.222-6 will be incorporated into the Solicitation, and which wage determination(s) will be incorporated into the Solicitation so offerors can have the a common basis for pricing the portion of work subject to FAR 52.222-6.

The construction and build out takes place before the performance of this contract begins therefore construction clauses and Davis Bacon Act Wages do not apply to this requirement.

1. Is the VA supplying the phones and phone system for the CBOCs or is the contractor to provide?

The Contractor is required to provide phones and phone system. Per the solicitation

1. How many VA staffed personnel will be providing services at the Dover and Hopkinsville CBOCs? Please list by clinic, job title and number of days per month.

No VA staff will be working at the CBOCs on a daily basis. Mental Health Care may have a VA staff member visit approximately once a month, and this VA Staff member may need use of an office during this visit.

See Amendment 2 removing Dover CBOC from the solicitation

1. How many offices will be needed at the Dover and Hopkinsville CBOC for the VA provided staff (by position/function) identified in question 14?

See response to question 14.

See Amendment 2 removing Dover CBOC from the solicitation

1. How many veterans using the Dover and Hopkinsville CBOCs are currently on the Primary Care billable roster? Please show number for each Clinic.

See RFP Section 2.1.1, Hopkinsville PC – 3654 These numbers represent the 12-month average per CBOC for Primary Care. (05/2019 – 04/2020) See Amendment 2 removing Dover CBOC from the solicitation

1. How many veterans using the Dover and Hopkinsville CBOC are currently on the Mental Health billable roster? Please show number for each Clinic See RFP Section 2.1.1, Hopkinsville MH – 1739 These numbers represent the 12-month average for Mental Health per CBOC (05/2019 – 04/2020) See Amendment 2 removing Dover CBOC from the solicitation

1. Is the current number of veterans on the Primary Care and Mental Health billable roster an accurate reflection of what the starting billable roster will be under the new contract?

Yes, this is as accurate as possible given the current enrollment numbers, however these change from month-to-month.

1. Is the vesting period for the current contract the same as the 12-month vesting period under the new contract?

yes

1. If the vesting period for the current contract is different from the 12-month vesting period of the new contract, what is the current contracts vesting period?

See question 19

1. How many times per year does the VA anticipate that the Contractor staff will be required to travel to and attend VA mandated meetings on-site at the VAMC or other VA Facility?

See PWS Section 2.10 page 34.

1. Are any of the current Dover and Hopkinsville staff shared with other CBOCs in the TVHS? If Yes which CBOCs, which positions and how many hours a week?

This is a decision of the current CBOC provider and not the VA. Contractors are certainly allowed to share staff if they are awarded multiple contracts. Frequently, sharing staff between a large CBOC and a smaller CBOC can assist in keeping stable staffing at the smaller CBOC location. Sharing of staff just cannot have a negative impact on any one location. Sharing of staff should be only for short term contingencies (no more than 90 days) and should not be a normal practice. Performance of the PACT should not be affected, and all measures are still required to be met as per required by contract. Additionally, staff members need to be privileged at each site they work

1. What is the maximum number of Extenders (Nurse Practitioners or Physician Assistants), located at a single CBOC, that the TVHS will allow a Physician to oversee (as the Collaborating provider)?

Per TN state guidance, a physician can only monitor 3 physician extenders. We abide by this guidance, since their licenses are under the state board of nursing and medical examiners.

1. Please verify the Mental Health CLIN volume for Hopkinsville. The numbers in the MH CLIN volume are 45% of the Primary Care CLIN volume. Is this correct?

Yes.

1. With reference to E.14 52,212-2 Evaluation – Commercial Items Sub-Factor B Suitability and Accessibility of Facility, 5th bullet, page 150: Offeror shall provide a copy of the latest State or local inspection of each facility that substantiates appropriate codes for building, fire and safety are met. The Offeror shall demonstrate that each proposed building meets the codes for building, fire and safety to ensure the VA that veteran patients are in a safe environment. Question: Due to the often lengthy process of obtaining these certificates, will the Government allow the certifications to be submitted post-award?

The original construction would have required a building permit and certificate of occupancy. Any renovations would require additional building permits…ask for these documents.

If Offeror is unable to obtain from State or Local entity, and the Landlord is unable to provide copies, the Offeror would need to provide a statement with Landlord concurrence. Offeror would need to affirmatively agree that if, after award, the specified site does not meet State and Local requirements for safety and otherwise, that Offeror would secure another suitable site that meets contract requirements at no additional cost to the VA.

1. With reference to Instructions to Offerors, 4.c (page 144): Electronic Copies. One (1) copy of the complete proposal shall be submitted in an electronic format.

0. Question: As Volume II is a blind (redacted) submission, does Government want the electronic copies of these volumes submitted on separate discs to maintain anonymity or should all volumes be included on one disc?

See Instruction to Offerors 4.c.iii. (page 145) All proposal documents and price information must be placed on the CD/DVD

0. Question: In 4.c.ii it is stated The CD/DVD shall be marked with the Offeror’s name, the RFP number, and RFP name. The CD/DVD shall also be marked “Confidential Proposal Documents.” As Volume II is redacted, does Government want the Offeror’s name to be replaced with the submission code on the disc label and on the file name?

The CD/DVD shall be marked with the Offeror’s name, the RFP number, and RFP name. The CD/DVD shall also be marked “Confidential Proposal Documents,” and include proposal Code as a reference.

1. Paragraph 2.2 states the Physician Director is to be staffed at “0.5 FTE per PACT.” We are wondering if this is a typo, as recent VA Solicitations for CBOC services have required this position to be staffed at 0.05 FTE per PACT. We respectfully note that the requirement as written would necessitate approximately two full-time Physician Directors for the Hopkinsville CBOC.

FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party, and the solicitation is corrected accordingly

1. If the Physician Director staffing requirement is amended to be 0.05 FTE per PACT, we have an additional question applicable to the Physician Director for the Dover CBOC. If an on-site Physician Director is staffed full time at the Dover CBOC as the Physician Director and as a Primary Care Physician, would the VA consider allowing this Primary Care Provider to have a panel of more than 900 patients? As this is a two PACT clinic, the Physician Director would need to be staffed at 0.10 FTE (based on 0.05 FTE per PACT), leaving 0.90 FTE available for clinical (as opposed to physician director/administrative) Primary Care Services. This FTE level providing clinical services allow for up to 1080 patients, and so capping this panel at 900 would create potential unnecessary inefficiencies for a clinic of this size.

Yes, panel can increase up to 1,080 See Amendment 2 removing Dover CBOC from the solicitation

1. Option 1 under paragraph 2.6.4.1 states that Psychiatrists shall be “Board certified physician in psychiatry.” Is a board eligible physician also acceptable?

These are considered on a case by case basis. We are open to working with contractors to accept highly qualified candidates who have good reasons for not having had the opportunity to sit for boards, and who express the full intention to do so at their first opportunity. However, board eligible providers who fail to secure board certification as outlined during the credentialing and privileging process are subject to not being re-credentialed if board certification is not obtained as outlined.

1. Regarding Sub-factor B – Suitability and Accessibility of Facility, “Offeror shall provide a copy of the latest State or local inspection of the facility that substantiates appropriate codes for building, fire and safety are met. The Offeror shall demonstrate that the proposed building meets the codes for building, fire and safety to ensure the VA that veteran patients are in a safe environment.” Due to the fact that the proposed clinic will likely need be built out into a new medical facility, such documents may not available at the time of proposal submission and prior to clinic build out. Would the VA consider revising this requirement so that it can be provided after award?

No, The original construction would have required a building permit and certificate of occupancy. Any renovations would require additional building permits If Offeror is unable to obtain from State or Local entity, and the Landlord is unable to provide copies, the Offeror would need to provide a statement with Landlord concurrence. Offeror would need to affirmatively agree that if, after award, the specified site does not meet State and Local requirements for safety and otherwise, that Offeror would secure another suitable site that meets contract requirements at no additional cost to the VA.

31. Regarding the space requirements in section 4.8:

a. Is there a particular number of exam rooms required for either clinic location?

See Page 36 and 39 PACT Space Module Design Guide

b. Is there a particular number of Women’s Health exam rooms required for either clinic location?

Every PACT exam room can be considered women’s health as long as the exam table has foot rests, a privacy curtain, a light source, locking door, feminine hygiene products and adjacent bathroom (so a toilet in close proximity), where the Veteran can use a restroom without walking in a public space in a gown. Women’s Exam rooms do not have to be exclusive for women only. “ Also see page 39.

c. Is there a particular number of tele-health rooms required for either clinic location?

See Page 36 and 39 PACT Space Module Design Guide

d. Is the Contractor required to provide any space for VA staff? If so, please indicate what space(s) must be provided for VA staff.

No VA staff will be working at the CBOCs on a daily basis. Mental Health Care may have a VA staff member visit approximately once a month, and this VA Staff member may need use of an office during this visit.

32. Paragraph 2.4 states that the Clinical Pharmacy Specialist (CPS) “can be provided through VA Video Connect.” Please clarify the following related to this provision.

1. Is it acceptable for a CPS to provide patient care from an alternate CBOC location?

Yes, if good faith effort in recruitment and can not cross state lines.

b. Is it acceptable for CPS to provide patient care from an alternation location that is not a CBOC?

No, it has to be from a CBOC location.

c. May the patient receive care remotely through VA Video Connect?

Yes, based on the individual needs of the patient

33. Page 143 states, “Past performance questionnaires are to be forwarded directly to the Contracting Officer by June 19, 2020.” Can the Government clarify the due date for Past Performance questionnaires?

Anytime prior to August 4, 2020 @4:00p.m. CST.

34. The PACT Space Module Design Guide identifies the possible use of sliding doors but does not require them. Does the VA have a preference for the use of sliding doors in the Hopkinsville and Dover CBOCs? If so, please clarify if sliding doors are preferred on the patient side of each exam room or on both sides of each exam room.

Please refer to design guide specifications See Amendment 2 removing Dover CBOC from the solicitation

35. The VA Barrier Free Design Standard referenced in paragraph 4.8 of the Solicitation provides the following recommendation in note 3 on page 5: “It takes a minimum of 1500 mm (5’-0”) for two wheelchairs to pass. Wheelchairs have increased in size in recent years, so 1800 mm (6’-0”) is recommended for Patient Care Delivery Areas where wheelchair usage is commonplace.”

We also note that the PACT Module Design Guide referenced in paragraph 4.8 acknowledges that renovations of existing facilities may require more flexibility in their design (Section 4.5 Approach to Renovation) than newly built facilities. Could the VA please confirm that hallways in a proposed existing medical facility are not required to be six feet wide?

Contractor is required to follow ADA guidelines and design guide as advised in solicitation

36. Paragraph 4.8.2.1 states, “It is estimated that the Hopkinsville facility will need to include at least 15,000 square feet; and the facility is required to include some additional space for future growth.” Is there a requirement for additional space for future growth above and beyond the requirement for 15,000 square feet? In other words, if a clinic of 15,000 square feet is able to provide enough space for the required services and future expansion space, would this this be acceptable for the Hopkinsville CBOC?

Please refer to requirements as outlined in the solicitation. It is expected that 15,000 sq. ft. should allow some room for future growth, however Offeror should consult the design guide and make an independent determination on how to best meet solicitation requirements.

37. Paragraph 4.8.1 states “The TVHS Women Veterans Program Manager (TVHS WVPM) shall act as the consultant representing Veterans in planning of new, renovation and improvement projects.” Could the VA provide more information as to how and when the communication from the TVHS Women Veterans Program Manager related to clinic design will occur with the Contractor?

After award the TVHS Women’s Veteran Manager will be included in all post award meetings with an emphasis on Women’s Health design specifications.

38. VHA Directive 1406 (which is referenced on pages 79 and 108 of the Solicitation), Appendix E indicates that provider panel sizes can be adjusted upward by 5% when there are more than 2.5 primary care exam rooms per primary care provider. If the contractor is providing more than 2.5 primary care exam rooms per primary care provider at the Hopkinsville CBOC and/or Dover CBOC, will the VA approve the adjustment of the maximum panel sizes by 5% for primary care providers at the applicable clinic in accord with VHA Directive 1406?

NO. The Solicitation specifically prohibits this type of adjustment. Any such requested adjustment must be made through consultation with TVHS AFTER award

39. If a full-time physician is furnished at one clinic for both Medical Director services in accord with paragraph 2.2 and Primary Care Provider services in accord with paragraph 2.3.1., we understand that paragraph 2.2 requires this provider’s patient panel to be capped at 900. Does the VA consider that, based on this panel size, such a full-time Medical Director/ Primary Care Provider would be providing 25% administrative services and 75% clinical services?

No, Based on CBOC pact size fulltime clinician/medical can increase pact roster up to 1,080 with commiserate split in administrative and clinical time.

40. Regarding the Dover CBOC facility and paragraph 4.8.2.2, will elements of the design guide be waived so that the space at 1406 Donelson Parkway is deemed acceptable in its existing floor plan?

See Amendment 2 removing Dover CBOC from the solicitation

41. Paragraph 4.6.1.3 states, “…extended hours for a CBOC of such size is not applicable to this contract.” However, paragraph 4.6.5.2.9 states, “Mental Health services will be provided at least one evening per week to those who need them. This requirement can also be met through offering services during weekend hours to meet the needs of the patient population.” Please clarify the following:

a. Please confirm if extended hours are required for Mental Health services at both the Dover CBOC and the Hopkinsville CBOC.

See Amendment 2 removing Dover CBOC from the solicitation It’s 10,000 or more enrolled uniques to meet this requirement. Neither Dover or Hopkinsville meet that.

b. Is the contractor allowed to provide extended hours for Primary Care services?

See Amendment 2 removing Dover CBOC from the solicitation “It is VHA policy that VA medical facilities and Community Based Outpatient Clinics (CBOC) treating 10,000 or more Primary Care enrolled unique Veterans per fiscal year (FY), must provide access to a minimum of 4 Extended Hours (EH) per week in both a Primary Care clinic and Mental Health clinic.”

CLINs/Enrollment

43. Question: How many veterans are currently on the billable roster?

Average billable rooster over a 12-month period.

See Amendment 2 removing Dover CBOC from the solicitation

44. Question: What is the billable roster for the past three months?

See Amendment 2 removing Dover CBOC from the solicitation

45. Question: Since its implementation, how many Mission Act referrals have been made at the CBOC?

There is no way to actively track community care referrals (Mission Act referrals).

46. Question: Please specify how many referrals were for primary care.

Community care referrals are made based on patient distance to the clinic, nor are they based on insufficient staffing at the CBOC resulting in the CBOC not meeting access to care metrics. There is no way to track these referrals.

47. Question: Please specify the types of specialty care referrals by number of patients.

This question is not relevant to the solicitation. Specialty referrals do not impact CBOC enrollment, and thus would not impact staffing.

48. Question: Will the new Contractor inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contact award?

Yes

49. Question: Is the Contractor responsible for providing services to traveling veterans? How many are anticipated per year?

Yes, but his data can not be tracked as this is considered a random act

2.6.2 DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: Not Required

50. Question: Please confirm if Contractor is responsible to set up, and pay for radiology services in the local community?

Yes, the contractor will need to sub-contract for the radiology services.

2.6.5 TELEHEALTH SERVICES CLINICAL STAFF: Telehealth Clinical Technician (TCT) and/or License Practical Nurse (LPN), FTE Ratio performance standard 1.0 FTE TCT/LPN per estimated 1,000 encounters at the clinic, with a trained back-up (e.g., another TCT/LPN or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services).

51. Question: Please confirm the number of telehealth encounters in the past year at Hopkinsville, and Dover CBOCs?

See Amendment 2 removing Dover CBOC from the solicitation

4.6.4.2 ELECTROCARDIOGRAM SERVICES

52. Question: Please verify that VA will supply the EKG, MAC 5500 at no cost to the Contractor?

VA will provide.

Medications

4.6.4.4.3 Anticoagulation services will be the sole responsibility of the TVHS Anticoagulation Program

53. Question: Please confirm that VATVHS will manage all patients requiring anticoagulation with VA Pharmacy staffed Pharmacist? If so, will the VA provide point of care finger-stick anticoagulation Accu-check machine?

Contractor will be required to offer point of care finger stick or blood draw, and TVHS will provide the machine and Anticoagulation management services.

4.6.5.5.10.24.2 Office Based Buprenorphine Treatment

54. Question: Is the Contractor required to offer in office/in CBOC buprenorphine treatment? If so, please provide the number of unique patients that received this treatment?

Access to medication treatment for OUD is required per VA SUD guidance. Access to office-based buprenorphine for veterans receiving care at contract CBOCs should be required whether directly in the CBOC or via telehealth services. TVHS has the ability to observe, in real time, a clinician’s capacity of patients receiving buprenorphine/naloxone by means of data resource, VHA Academic Detailing Buprenorphine Dashboard..

Reference attached re: removing buprenorphine barriers and telehealth guidance below http://vaww.telehealth.va.gov/current/ryanhaight.asp

55. Question: Will the Contractor be responsible to purchase and administer medication or vaccinations ordered by VAMC specialists? If so, please list the medication or vaccinations that the Contractor will be responsible to provide at the Contractor’s cost.

ALL medications administered in the clinic prescribed by Contractor’s physicians will be the responsibility of the Contractor.

See question 7 for a list of frequently used medications.

Medications prescribed by other physicians (not employed by Contractor) shall be addressed by TVHS and the specialist and are not the responsibility of the contractor.

56. Question: How many patients received FOB FIT kits in the past year?

The current contractor orders these and set their own par level. There is not a way of tracking this information per site as all collections received are entered into the lab software as either Nashville or York, depending upon which site received the sample.

57. Question: Will the Contractor or the VA be responsible for paying for POC equipment, validation, and supplies?

The VA will supply

4.6.2.4.7 Thin Prep: RFP states Contractor will provide supplies for PAP testing, but Contractor is not able to purchase Thin Prep.

Contractor shall provide all equipment necessary to provide comprehensive women’s health services. Examination rooms shall be set up in accordance with current VA standards to afford women with privacy (placement of examination tables in the room, privacy curtains, etc. See Space Requirements section for more details). Equipment such as privacy curtains, exam tables with stirrups and lights, bathrooms adjacent to where pelvic exams are performed, speculums, supplies, and equipment to perform Pap smears and point of care pregnancy testing should be on hand in the clinic area. Each designated women’s health provider shall have an appropriate exam table to conduct the annual women’s health exam.

58. Question: Will the VA supply Thin Prep?

No, contractor is responsible for purchasing of these supplies

59. Question: Please list all Mental Health Medications required to be given in clinic, at Contractor cost.

BUPRENORPHINE/NALOXONE TAB 2 MG-0.5 MG

BUPRENORPHINE/NALOXONE TAB 8 MG-2 MG

LORAZEPAM TAB 0.5 MG

Attached is a list of the most used medications, this is not an all-inclusive list.

60. Question: Who will provide emergency contraceptive, Levnorgestrel, the Contractor or the VA?

Currently not offered on site. Must be procured and is considered to be a part of the 10-day emergency medication covered by the CBOC.

Emergency contraception (e.g. Levonorgestrel (Plan B) etc.) must be available to all women Veteran patients in a timely manner (meaning same day of their appointment). A process must be implemented at the local or VISN level to ensure availability of emergency contraception to patients in a timely manner (same visit) even if a provider has requested to opt out from providing emergency contraception to the patient because of a Rights of Conscience (ROC) Claim. Contractor shall have a provider available who is able to prescribe this emergency contraception without exception.

61. Question: Will the VA provide Naxolone for veterans who require it as a precaution? If not, how many times was it administered at the CBOC in the past 12 months?

VA does provide Naloxone IN to Veterans for Veteran self-administration. All medications administered in the clinic are the responsibility of the CBOC contractor.

TVHS VAMC does not have a way to independently track this administration of this medication.

62. Question: Will the VA or the Contractor be financially responsible for the cost of 10-day bridge medications?

Contractor is responsible.

63. 4.6.4.2.1: Please confirm that the Contractor is responsible for courier services Yes, contractor is responsible.

4.6.8 TELEPHONE ACCESS TO CLINICAL CARE

64. Question: Please confirm that VA will provide the telephone system for the CBOCs?

The Contractor is required to provide phones and phone system. Per the solicitation

4.10.1.5: The procurement, installation and maintenance of all printers, copiers, scanners, fax machines*, shredders, or other peripheral office equipment and all related and ongoing supplies…

65. Question: The Contractor is unable to network Contractor owned equipment to VA network if it is not owned and operated by VA. Please provide a list of the equipment the VA will supply the Contractor, such as copiers, fax, printers, scanners, or other peripheral office equipment or lab label printers?

Please refer to the solicitation. Contractor is responsible to furnish any office equipment for their own use in operating and managing the CBOC.VA will provide Multifunction Device (includes fax, copier, printer) lab testing equipment, label maker

4.10.1.9: One small desktop color printer for printing patient education information.

66. Question: Please confirm that VA will supply small desktop color printer for patient education documents since Contractor owned equipment is not permitted on VA network?

Please refer to the solicitation. See above Multifunction Device

CBOC Hours

4.6.1.3 EXTENDED HOURS states: This CBOC enrollment is not expected to exceed 10,000 PHC Veterans and therefore extended hours for a CBOC of such size is not applicable to this contract. While Section 3.2 on page 41 states: Evening hours are optional until the CBOC enrollment exceeds 5,000 enrollees. Once a CBOC has 5,000 or more enrollees, evening hours are required.

67. Question: Will the Government require extended or weekend hours? If so, would extended hours be required at 10,000 or 5,000 enrollment? Please clarify.

VA Policy states that once a clinic’s enrolled Veterans reach 10,000, extended and weekend hours will be required. PCMHI implementation is required once total enrollment reaches 5,000

68. Question: If the Contractor has adequate access, and enrollment exceeds 5,000 enrollees, does the Contractor have to offer extended weekday and weekend hours?

VA Policy states that once a clinic’s enrolled Veterans reach 10,000, extended and weekend hours will be required. PCMHI implementation is required once total enrollment reaches 5,000.

69. Question: If extended weekday and weekend hours are required, what staff members, specifically will be required to work the extended hours?

Contractor is responsible to meet access to care metrics. Extended hours would be at the discretion of the Contractor in response to ensuring that metrics for access to care are met. Contractor will work with TVHS to ensure sufficient hours are offered, so that access to care metrics are met

70. Question: If extended weekday and weekend hours are required, exactly how many additional hours will be required?

Contractor is responsible to meet access to care metrics. Extended hours would be at the discretion of the Contractor in response to ensuring that metrics for access to care are met. Contractor will work with TVHS to ensure sufficient hours are offered, so that access to care metrics are met

71. Question: If extended weekday and weekend hours are required, what are the additional staff specifically who will need to be hired and credentialed to cover? Will the extended hour providers have their own panel?

Contractor is responsible to meet access to care metrics. Extended hours would be at the discretion of the Contractor in response to ensuring that metrics for access to care are met. The whole point for extended and weekend hours is to improve access for Veterans who work, and cannot come during regular business hours. It does not mean that a new panel just to cover extended hours or weekends is required. It is allowable, but staggered schedules is also allowed.

4.6.5.2.9 EXTENDED MH HOURS states: The Contractor shall meet the following requirements for Extended Hour Clinics: Mental Health services will be provided at least one evening per week to those who need them. This requirement can also be met through offering services during weekend hours to meet the needs of the patient population.

However, section 4.6.5.2.9.1 states: It is VHA policy that VA medical facilities and CBOCs treating 10,000 or more Primary Care enrolled unique Veterans per fiscal year (FY), must provide access to a minimum of 4 Extended Hours (EH) per week in both a Primary Care clinic and Mental Health clinic.

72. Question: Please clarify. Will the Government require extended hours for mental health? If so, specifically at what point of enrollment will the extended mental health hours be required? What specific staff will be required to be on site to meet the requirement? If extended mental health hours are required, can this be accomplished via phone visit?

Yes, Contractors are responsible to meet access to care metrics and will be required to offer extended hours of at least one night a week and/or weekend access depending on the identified needs of the patient population. The Contractor shall make the determination on how to cover the requirement of question. Unable to make determination, depends on patient needs and care required.

Staffing

1.1 PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES):

FTE Ratio Performance Standard: 0.5 FTE per PACT Responsible Party: Shall be provided by Contractor.

73. Question: Please clarify if 0.5 FTE is required for Physician Director per PACT or it is 0.05 FTE per PACT?

FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party, and the solicitation has been corrected accordingly

0. Hopkinsville, KY CBOC: 3,500 PHC 1,400 MHC

74. Question: This does not match CLIN numbers please clarify.

The rationale at arriving at the increased numbers was provided in a seven-year calculating tool that took the current enrollment numbers at the time when this spreadsheet was created along with several other factors and the tool produced the projected enrollment numbers in a seven-year period. The government will only pay for the number of enrollments at that time.

Use the updated CLIN numbers for pricing.

75. Question: Does the VA require the Tele-health Tech to be a Medical Assistant or LPN?

Per solicitation: The Tele-presenter can be any clinically trained person assisting the provider in the presentation of the Veteran using video-conferencing. Depending on the skills needed for the encounter, the Tele-presenter can be a licensed independent provider (LIP), Registered Nurse (RN), LPN, or TCT. Tele-presenters can also serve as TCT/LPN back-ups. The number and discipline of Contractor’s staff trained to function as a TCT/LPN back-up or Tele-presenter will be based on the volume and type of telehealth services provided. Qualifications: All staff providing telehealth related services into the clinic shall be appropriately credentialed and; where necessary, privileged. The PACT/Telehealth LPNs shall be assigned only to Telehealth duties. The PACT Telehealth nurses are to be in constant communication with the Facility Telehealth Coordinator for duties, equipment issues or any other issues related to Telehealth services. The PACT Telehealth Nurses are to ensure all equipment is cleaned and kept in working condition, if a problem occurs they would contact the Facility Telehealth Coordinator or designee. All Contractor staff who support and manage telehealth services must be working within permitted licensure and scope of practice. Where non-licensed staff is supporting telehealth services the Contractor’s licensed staff must provide appropriate clinical supervision.

The RFP requires the Contractor to provide CPS 1.0FTE/3 PACT teams, yet 4.6.7.5.1 asks Contractor to provide space for VA Telepharmacy support services.

76. Question: Will the VA be staffing a CPS either in clinic or by Tele visit?

The VA does not staff in clinic pharmacist, the contractor is expected to provide this onsite. The telehealth space is for those clinics that do not have the population for a pharmacist. The questioned sentence reads: “The Contractor shall provide space for clinical pharmacy telehealth services at the Contractor’s location as appropriate.

77. The RFP requires the Contractor to provide CPS 1.0FTE/3 PACT teams, yet 4.6.7.5.1 asks Contractor to provide space for VA Telepharmacy support services, will the VA be staffing a CPS either in clinic or by Tele visit?

The VA does not staff in clinic pharmacist, the contractor is expected to provide this onsite. The telehealth space is for those clinics that do not have the population for a pharmacist. The questioned sentence reads: “The Contractor shall provide space for clinical pharmacy telehealth services at the Contractor’s location as appropriate.

78. How many VA staffed personnel will be providing services at the CBOC? Please list job title and number of days per month.

No VA staff will be working at the CBOC on a daily basis. Mental Health Care may have a VA staff member visit approximately once a month, and this staff member may need use of an office during this visit.

79. Will the VA provided staff require an office at the CBOC? If yes, what type and size?

No VA staff will be working at the CBOC on a daily basis. Mental Health Care may have a VA staff member visit approximately once a month, and this staff member may need use of an office during this visit.

80. Will the VA require a clinic manager?

Yes

81. Will the Mental Health 7.72/1000 FTE include the primary care social workers?

No, primary care SWs do not count in the ratio of mental health staff. We do not utilize MH SWs in our primary care clinics. If mental health clinics are staffed appropriately, based on known parameters around high need for psychotherapy modalities in veteran patient populations, these clinicians should be utilized to provide psychotherapeutic care and not be utilized in primary health care social work duties.

2.5.1 DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER (this position provides general/medical social work services): FTE Ratio Performance Standard: 1 FTE per 2 PACTs 82.Question: Can the Social Worker performing general primary care social work services be a Licensed Medical Social Worker for this position?

PACT position MH SW needs Advance Licensure LCSW in that state, Kentucky.

Space Requirements

4.8.2.1 It is estimated that the Dover facility will need to include at least 20,000 square feet; and the facility is required to include some additional space for future growth. A copy of the PACT Space Module Design Guide is also attached in Section D.

83. Question: Clearly, following PACT guidelines the clinic does not require 20,000 square feet. Please indicate the amount of expansion space required. Because the Government has said “estimated, ”please confirm there is no minimum square footage as long as PACT guidelines are met and there is expansion space available.

See Amendment 2 removing Dover CBOC from the solicitation

84. Question: Will the VA-provided staff require an office at the CBOC? If yes, what type and size?

No VA staff will be working at the CBOCs on a daily basis. Mental Health Care may have a VA staff member visit approximately once a month, and this VA Staff member may need use of an office during this visit.

85. Question: Does the VA prefer sliding doors? If yes, on both sides and patient side only or will swing doors on the provider side be adequate?

Please refer to the New Pact Space Module Design Guide, that does specify Sliding door on entry.

Typically, the RFP Space Requirements state:“Setback distance from the face of the Building's exterior to the protected/defended perimeter (i.e., any potential point of explosion). This means the distance from the Building to the curb or other boundary protected by bollards, planters, or other street furniture. Such potential points of explosion may be, but are not limited to, such areas that could be accessible by any motorized vehicle (i.e., street, alley, sidewalk, driveway, parking lot).”

86. Question: What is the setback distance of the site to the bollards required for physical security? Typically, it is 25 feet, but most clinics in shopping center etc. … do not have spaces that conform to this requirement?

This setback is determined by the security standards that were used in the solicitation. We no longer have to follow the Physical Security Design Manual for VA Facilities. Physical security features shall comply with requirements of the Interagency Security Committee Standards in accordance with Facility Security Level II specifications, Department of VA Handbook 0730/4 and “Life Safety Protected” occupancies as enumerated in VA Physical Security Design Manual. HTTP://WWW.CFM.VA.GOV/TIL/PHYSICALSECURITY/DMPHYSECLS.PDF

The PACT Design Guidelines require three exam rooms per PACT, one consult room and two exam rooms.

87. Question: Can the Woman’s Health Exam rooms be part of the PACT set up? For example, if there are five PACT teams, then 15 exam rooms would be provided that include the five consult rooms, two Woman’s Health Rooms and then eight more exam rooms for a total of 15. Is this correct?

Every PACT exam room can be considered women’s health as long as the exam table has foot rests, a privacy curtain, a light source, locking door, feminine hygiene products and adjacent bathroom (so a toilet in close proximity), where the Veteran can use a restroom without walking in a public space in a gown. Women’s Exam rooms do not have to be exclusive for women only. “

88. Question: How many Behavior Health Rooms will be required and list the names of each type of office.

See Page 36 and 39 PACT Space Module Design Guide PACT Space Module Design Guidelines require two small group rooms for the amount of Behavior Health rooms.

89. Question: Is a large conference group room required as well to…