36C24920R0010 0002.docx

Maury County/McMinnville Questions:36C24920R0010

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

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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) 07-16-2020 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

36C24920R0010 07-16-2020

X X X

The purpose of amendment 2, is to provide answers and claifications to the 36C24920R0010 solicitation questions and provide an updated price schedule.

Proposals are due July 28, 2020 at 4:00p.m. CST.

See attached pages for the answers to the vendor questions and new price schedule.

Atachment 4 and 5 were published in the original RFP.

All other terms, conditions, and specifications remain the same and in effect.

End of amendment.

Darryl Scherer Contracting Officer

CONTINUATION PAGE

B.2.1. MAURY COUNTY CBOC PRICE SCHEDULE

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

Cost

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 $________________________

MAURY COUNTY CBOC TOTAL FOR BASE AND ALL OPTION YEARS $________________

B.2.2. MCMINNVILLE 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 Maury County and McMinnville 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.

1. What is the current PC-MHI and Specialty Mental Health staffing at each of the Maury County and McMinnville clinics? Please list position and the FTE.

Currently McMinnville and Maury County Clinics do not have dedicated PCMHI providers.

For McMinnville, the following regarding specialty mental health providers:

1 full time FTE (Psych NP) 1 full time FTE (LCSW) it is recommended that any new contracting groups be aware of this current guidance in anticipation of meeting these recommendations and we will work with current contracting groups to meet compliance with this metric.

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

Maury County had 658 in FY19 and to date has 377 for FY20. McMinnville had 385 for FY19 and to date has 160 for FY20

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 Maury County and McMinnville 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 36C24920R0010. These are vaccines / medications that would be typically be provided by the contractor for our enrolled veterans.

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

This information was not included in solicitation 36C24920R0010. These are vaccines/medications that would be typically be provided by the contractor for our enrolled veterans.

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

This information was not included in solicitation 36C24920R0010. These are vaccines/medications that would be typically be provided by the contractor for our enrolled veterans.

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 Maury County and McMinnville 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.

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?

Neither current facility meets the PACT Space Module Design. The Maury County facility is too small and cannot be expanded. Any new Maury County CBOC site will need to meet the PACT Space Module Design.

With regard to the McMinnville CBOC location, per the solicitation, “IF an offeror proposes to use the current space as a cost savings measure. However, IF used, the current space would need to be expanded, and the expanded area would need to follow the new Space Model Design Guide.” If an offeror proposes a different location than is currently being utilized, that new site will need to be built out in accordance with the PACT Space Module Design Guide.

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 Maury County and McMinnville 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.

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

See response to question 14.

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

See RFP Section 2.1.1, Maury county PC – 3628 McMinnville PC – 1914 These numbers represent the 12-month average per CBOC for Primary Care. (05/2019 – 04/2020

1. How many veterans using the Maury County and McMinnville CBOC are currently on the Mental Health billable roster? Please show number for each Clinic.

See RFP Section 2.1.1, Maury county MH – 622 McMinnville MH – 378 These numbers represent the 12-month average for Mental Health per CBOC (05/2019 – 04/2020)

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. Please list, by clinic, position, name and FTE, the PCMHI and Specialty MH positions that are currently staffed at the Maury County and McMinnville CBOCs?

The current contractors are staffing PHC and MHC at levels in accordance with current contract requirements. Current staffing levels may be different than what is required under this RFP and the offeror's focus should be on meeting the requirements of the current contract.

1. Are any of the current Maury County and McMinnville 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. Please confirm the estimated patients currently enrolled/assigned to each CBOC site as show at the end of Section 2.1. It appears the enrollment numbers are swapped with the other CBOC.

McMinnville PC – 1650, MH-450 Maury County PC – 3450, MH - 1450

B2 Schedule of Price and Services

1. Please provide the most recent billing figures/members/enrollees for primary care and mental health services at each clinic.

McMinnville

1. The solicitation shows that the contract maximum is $45M. Did the Government conduct an Independent Government Cost Estimate (IGCE) on this requirement? If so, what is the value associated with this estimate?

Yes, the government conducted an IGCE. The quantities listed in the Price Schedule are estimates only and are not to be considered a minimum or maximum. The Government will order the specified minimum contract value of services and may order up to and including the specified maximum contract value of services through task orders under this basic Indefinite Delivery Indefinite Quantity (IDIQ) contract during the duration of the contract inclusive of all option periods. The maximum amount under this contract is not guaranteed.

PWS Section B.4.6.3.1 Prescription Fulfillment

1. Can the VA please provide the list of medications and vaccines the contractor will be responsible for providing? Additionally, can the VA also provide estimated utilization numbers/quantity for each medication/vaccine required (or historical information)?

The most common medications that the contractor might supply for an emergency 10-day supply include the following:

See Attachment 18 – VISN 09 PBM CBOB Formulary See question 7 for a list of common vaccines that the contractor would be expected to supply.

PWS Section 6.2.1 Billable Roster

1. Please confirm that the new contractor will inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contract award?

Yes

PWS Section B.4.8

1. Are there any specific telehealth or tele-mental room requirements; including quantity, dimensions, lighting, etc.?

See section 4.8.6.2 and also new Space Module Design Guide.

1. Is there a minimum number of Women’s Health rooms being requested?

See Section 4.8.1 and also new Space Module Design Guide.

1. Are there any VA multi-use rooms being requested? If so, how many and do they have any specifications?

Conference rooms frequently have multiple uses, and some exam rooms can be used for regular visits or telehealth visits, as needed. We have found historically that it is best to have one large conference/group room, as well as a small conference/group room. Larger facilities may need to have more than one small group room based upon enrollment and need.

Phones that have conference call capability.

Internet access for computers and telehealth.

Also, some exam rooms may have telehealth equipment so the room can be used for either telehealth or for face-to-face care.

1. What are the Group Care room requirements, if any?

Phones that have conference call capability.

Internet access for computers and telehealth.

Any other requirements based on the Design Guide and contract requirements.

1. Attachments 4 & 5 appear to be missing from the solicitation package. Would the government kindly provide those for our reference?

Attachments 4 & 5 were included on original RFP and the system will not allow to resend them..

Past Performance Questionnaires

1. Due to the administrative burden on our contract POCs and the number of TVHS RFPs being released in succession, can Offerors attach our latest CPARs reports in lieu of Past Performance Questionnaires? Or can the contract POC submit one questionnaire for all clinics the Offerors are bidding on?

NO, Past Performance questionnaires are required and need to be submitted by the reference provider to the contract Specialist. One questionnaire is sufficient for all clinics being proposed by the contract POC rater. Date of receipt by the Contract Specialist is extended to 7/17/2020.

1. Please confirm total estimated patients represented in RFP (year 1 CLINs) as they seem to be incorrect when compared to the VA’s VSSC data:

Maury County, TN CBOC: 1,650 PHC 425 MHC McMinnville, TN CBOC: 3,450 PHC 1,450 MHC

McMinnville PC –2,632, MH-72 Maury County PC – 5,222, MH – 714 See also attached amended Price Schedule. Discrepancy in these numbers as well as on corrected price schedule

1. According to the CLINs, B.3 Schedule of Services, for Maury County, the VA is anticipating an increase of an additional 1,331 patients over the seven years of the contract. Given the historic enrollment at the Maury County CBOC, and that it has grown 205 patients from January 2018 to the present enrollment of 3,669, what is the VA’s rational or formula for arriving at this determination?

The rationale at arriving at the increased numbers was provided in a seven-year calculating tool that took the current enrollment numbers 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.

Also see updated CLIN Structure on the attached amended Price Schedule

1. For the McMinnville CBOC, the VA is anticipating an increase of 300 PC patients over the seven years of the contract. What is the VA’s rational or formula for arriving at this determination?

The rationale at arriving at the increased numbers was provided in a seven-year calculating tool that took the current enrollment numbers 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.

Also see updated CLIN Structure

1. What is the billable enrollment at each CBOC over each of the past three months?

McMinnville

1. If the current billable roster is higher than the starting CLINS, can the Government explain the discrepancy.

See updated CLIN structure for estimated quantities in amended Price Schedule attached.

1. Since its implementation, how many Mission Act referrals have been made at the Maury County CBOC? How many have been made at the McMinnville CBOC?

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

1. Please specify how many referrals were primary care at each CBOC.

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.

1. Please specify the types of specialty care referrals by number of patients at each CBOC.

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

1. Will the new Contractor inherit the patients’ last vesting visit and be allowed to bill for one year from that date upon contract award at each CBOC?

Yes

1. SECTION 4.3.1 states the Contractor is responsible for providing services to traveling veterans? How many are anticipated per year at each CBOC?

This data can not be tracked as this is random act.

1. SECTION 4.6.5.2.9, page 64, states: EXTENDED MH HOURS: 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.

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?

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.

What specific staff will be required to be on site to meet the requirement?

The Contractor shall make the determination on how to cover the requirement outlined in question 45.

If extended mental health hours are required, can this be accomplished via phone visit?

Unable to make determination, depends on patient needs and individual care required.

1. EVENING HOURS: Evening hours are optional until a CBOC enrollment exceeds 5,000 enrollees. Once a CBOC has 5,000 or more enrollees, evening hours are required.

Please specify how many evening hours would be required each week and what days of the week will they be required?

Per Solicitation Section 3.2 evenings are required, 3.3 weekends maybe required.

1. WEEKEND HOURS: Weekend hours are optional until a CBOC enrollment exceeds 5,000 enrollees. Once a CBOC has 5,000 or more enrollees, weekend hours may be required.

Please specify how many weekend hours would be required, and what days of the week will they be required?

Contractor is responsible to meet access to care metrics. Actual 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

48. SECTION 4.6.5.5.10.24, page 70: Pharmacotherapy with approved, appropriately-regulated opioid agonists (e.g. Buprenorphine or methadone) must be available to all patients diagnosed with opioid dependence for whom it is indicated and for whom there are no medical contraindications. It needs to be considered in developing treatment plans for all such patients. Pharmacotherapy, if prescribed, needs to be provided in addition to, and directly linked with, psychosocial treatment and support. When agonist treatment is contraindicated or not acceptable to the patient, antagonist medication (e.g., naltrexone) needs to be available and considered for use when needed. Opioid Agonist Treatment can be delivered in either or both following settings:

Will the CBOC providers be required to prescribe Buprenorphine, methadone, or pharmacotherapy for alcohol use? If so, how many veterans will require this treatment?

Physicians will be required to prescribe medications appropriate to treat Veteran patient needs. If a medication is listed on the VA Formulary, then physicians would be required to prescribe these medications when clinically indicated.

The VA does not track this information and therefore is unable to answer how many Veterans might require this medication(s).

49. Will the CBOC providers be required to have a “waivered” physician license?

All VA prescribing clinicians (psychiatrists only NPs are not allowed in the state of TN) are now X-waivered to provide Suboxone.

If a psychiatrist is going to be hired at contract sites, we want them to be already (or be willing to immediately get) X-waivered..

We can also help with resources for providing the training for this.

50. Is the Contractor required to provide x-ray through a sub-contracted community radiology group? Or, will all x-rays be referred to VAMC?

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

51. SECTION 2.6.5 TELEHEALTH SERVICES CLINICAL STAFF: Please provide the number of tele-health unique patients for each clinic for FY 2019.

FY19 FY20

McMinnville- MH-15; PC-5 MH-23; PC-18 Maury County- MH-73; PC-5 MH-93; PC- 89

52. SECTION 4.6.4.2 ELECTROCARDIOGRAM SERVICES: Please verify that VA will supply the EKG, MAC 5500 at no cost to the Contractor.

VA will provide

53. SECTION 4.6.4.4.3: Anticoagulation services will be the sole responsibility of the TVHS Anticoagulation Program. Please confirm that VATVHS will manage all patients requiring anticoagulation with VA Pharmacy staffed Pharmacist for both CBOCs? If so, will the VA provide the 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.

54. TELEPHONE ACCESS TO CLINICAL CARE: 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

SECTION 2.6.4.1, page 28: MH staffing FTE ratio performance standard is 7.72 total FTE per 1,000 Veterans seen in outpatient MH.

55. Do the primary care social workers required in Section 2.5.1 count as part of the 7.72 total FTE Mental health staff, or are they in addition to the mental health staff?

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.

56. Who will provide emergency contraceptive, Levnorgestrel, the Contractor or the VA?

Currently not offered on site. Must be received through Heritage Health formulary 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.

57. 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.

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

Contractor is responsible.

59. Please confirm that the Contractor is responsible for courier services.

YES

60. 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.

61. SECTION 4.6.2.4.7 requires Contractor to provide Women’s health equipment for comprehensive exam. Thin-Prep PAP testing supplies are not available for purchase by the Contractor. Will the VA supply?

No, contractor is responsible for purchasing of these supplies.

62. Is the Contractor required to offer in office/in CBOC buprenorphine treatment? If so, please provide the number our unique patients 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

63. How many FOB FIT kits, mailers. How many patients received the 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.

64. Will the contractor or the VA be responsible for paying for POC equipment, validation, and supplies?

VA will supply

65. Who is responsible for submitting and completing quarterly and annual anticoagulation reports to the Government, Contractor or VA?

The VA will be reporting this data.

66. Does the clinic need a DEA number?

The clinic does not need a DEA number, but all providers prescribing medications DO need a DEA number.

67. 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.”

68. Do the primary care social workers required in section 2.5.1 count as part of the 7.72 total FTE Mental health staff, or are they in addition to the mental health staff?

See questions 55

69. 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.

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

See question 13 and 47.

71. Do the primary care social workers required in section 2.5.1 count as part of the 7.72 total FTE Mental health staff, or are they in addition to the mental health staff?

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.

Space Requirements

72. Are sliding doors required on both sides of the exam room?

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

73. How many primary care consultation rooms are required?

Advise contractor to consult the design guide

74. How many procedures rooms does the contract require?

Advise contractor to consult the design guide

75. How many and small and how many large group rooms are required per clinic?

Advise contractor to consult the design guide

SECTION 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.

76. 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.

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

78. Due to the Covid-19 pandemic, our workplace and many others are in the process of implementing CDC social distancing and new company safety requirements that make it difficult to produce a hard-copy proposal at this time. Further, due to health challenges, some workers face potentially fatal consequences when exposing themselves to copy and shipping outlets and other tasks necessary to produce a hard-copy proposal. Will the Government accept the proposal for Solicitation 36C24920R0010 as an electronic submission?

No Proposal will not be accepted by electronic version. Please follow Instruction to Offerors found in the solicitation.

79. 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 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 Maury County CBOC.

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

80. 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 McMinnville CBOC. If an on-site Physician Director is staffed full time at the McMinnville 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 Primary Care Services. This FTE level would normally allow for up to 1,080 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

81. In paragraphs 2.1.1 and 2.1.2, the clinic names appear to be transposed (e.g. the enrollment numbers in paragraph 2.1.1 appear to be those for McMinnville (and not for Maury County) and those in 2.1.2 appear to be for Maury County (and not for McMinnville). Please clarify the current enrollment for each clinic.

Agree numbers appear to be switched and are hereby corrected accordingly as:

82. 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.

83. 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.

Regarding the space requirements in section 4.8:

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

Advise contractor to consult the design guide

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

See Section 4.8.1 and also new Space Module Design Guide.

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

See section 4.8.6.2 and also new Space Module Design Guide.

87. 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 CBOC 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.

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.

88. 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.

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

No, it has to be from a CBOC location.

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

Yes, based on the individual needs of the patient

91. Page 145 states, “Past performance questionnaires are to be forwarded directly to the Contracting Officer by June 12, 2020.” Can the Government clarify the due date for Past Performance questionnaires?

Anytime prior to July 21, 2020 @4:00p.m. CST.

92. 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 Maury County and McMinnville 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

93. 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.” Could the VA please confirm that hallways are not required to be six feet wide?

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

94. Paragraph 4.8.2.1 states, “It is estimated that the Maury County 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 requirement for additional space for future grown 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 Maury County 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.

97. Paragraph 4.8.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.

98. VHA Directive 1406 (which is referenced on pages 80 and 110 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 Maury County CBOC and/or McMinnville 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.

99. 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.

100. Paragraph E.5 of the Solicitation states, “The Government may elect to award a single delivery order contract or task order contract or to award multiple delivery order contracts or task order contracts for the same or similar supplies or services to two or more sources under this solicitation.” Is it acceptable for an offeror to submit a proposal for only one of the clinics being solicited (i.e. for only the McMinnville CBOC or only the Maury County CBOC)?

Agree, however a single award is preferred.

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. We also notice that Solicitation 36C24920R0048, for CBOC services Bowling Green, KY, expresses similar understanding that renovations of existing medical space may not be able to comply with all aspects of the PACT Module Design Guide, as that Solicitation states in Paragraph 4.8.2: “any offeror proposing to use the current site of care may not be required to fully remodel the current space into the new PACT Space Module Design to avoid a complete remodel of the current space; rather just the newly expanded space would be built to current PACT Space design and the currently utilized space only modified as necessary.” Accordingly, we submit the following two questions:

101. For the McMinnville CBOC, will the VA allow for a similarly flexible approach (as indicated in Solicitation 36C24920R0048) if the offer is renovating existing ADA-compliant medical facility space in response to the current Solicitation…