36C24920R0114 0001.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)

09-16-2020

N/A

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

36C24920R0114 09-03-2020

X

X X

October 16, 2020 3:00 PM CT

The purposes of this amendment are as follows: 1) Revise paragraphs in the PWS; 2) Provide Questions and Answers; and

3) Extend the proposal due date to October 16, 2020, 3:00PM CT.

Jackie L. Merriman Contracting Officer

CONTINUATION PAGE

The following paragraphs in the Performance Work Statement hereby replace the paragraphs contained in the original solicitation:

PWS Section 2, Paragraph 2.3.4 is hereby revised as follows:

2.3.4 TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations .Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff as well as the onsite VA-staffed audiology and ophthalmology clinics, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

PWS Section 4.5, Paragraphs 4.5.3.1.2.1, 4.5.3.1.2.2 and 4.5.3.1.2.3 are revised as follows:

4.5.3.1.2.1 All vaccines and medications administered by the provider shall be furnished by the Contractor and must be entered into CPRS by the provider. The contractor will bear the cost and must purchase and supply all vaccines including, but not limited to: flu, pneumococcal, tetanus/diphtheria toxoid, with and without pertussis (TD/TDaP), Herpes zoster, human papilloma virus, and PPD. All vaccines and administered shall be appropriately documented utilizing the clinical reminder package in the VA EHR. The manufacturer, lot number, expiration date, site of administration, and patient education information are required parts of the electronic documentation.

4.5.3.1.2.2 The contractor shall store eye drops to be used by the Memphis VAMC on-site VA-staffed ophthalmology clinic in a locked and secured location, separated from all other contractor provided pharmaceuticals. There will be no more than 8 eyedrop bottles requiring refrigeration at any given time that are no more than 5” in height. There will be no more than 6 eyedrop bottles that do not require refrigeration at any given time that are no more than 5” in height. The contractor is not required to provide or administer these medications.

4.5.3.1.2.3 The Contractor must keep all vaccines and medications in a secure and locked location, refrigerated and monitor temperatures of vaccines and other refrigerated drugs on a twice daily basis per TJC and CDC guidelines for vaccines. A record of refrigerator temperature monitoring must be maintained by the Contractor. If a temperature variation is identified by the Contractor, the Contractor should contact the VA immediately to determine the appropriate disposition for the refrigerated medications.

Provided below are the answers to all questions that have been submitted:

1. Section 2.11 on page 26 states, “ACLS certification is required for health care personnel that order, administer, monitor, or supervise moderate sedation, monitored anesthesia care, or general anesthesia, according to current VHA policy.” Since the CBOC providers do not administer, monitor or supervise moderate sedation, is ACLS required for the CBOC providers?

No

1. Is the contractor responsible for the cost of breast ultrasound and breast MRI’s? (Reference: 4.5.2.1.1 “Request for screening, and diagnostic mammograms, breast ultrasound and MRI must be initiated by Contractor…”) Yes, even though it is the cost of the contractor, it will still need to be documented in the veteran’s EHR that the veteran was sent to the contracted facility on the specific date and for what service.

1. Will the clinical pharmacy services provided by the VA be on site or via telehealth? If on site, what are the space requirements for the contractor?

Via telehealth from the Memphis VAMC

1. 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 door in the Tupelo CBOC? 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.

The Memphis VA does not have a preference on the use of sliding doors. This will be the contractor’s decision.

1. Regarding Volume 2, Section 1, Sub-section A – 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?

Yes, all documents may be provided after award.

1. Due to the fact that Psychiatrists are extremely scarce in Mississippi, would the Government allow for Mental Health Nurse Practitioners to be substituted for the Psychiatrists that are required by paragraph 2.6.1?

The VA will allow for mental health nurse practitioners, however, there must be a supervising psychiatrist.

1. Page 128 states, “Please ensure FAR 52.209-7 and 52.219-11 are completed and submitted with your proposal, otherwise your proposal will be found technically unacceptable.” Can the Government confirm which FAR clauses are required to be submitted? 52.219-11 does not appear to be applicable, and so we wonder if this is supposed to be 52.219-1.

Correct – this is a typo – FAR 52.209-7 and 52.219-1 ARE REQUIRED TO BE FILLED OUT AND SUBMITTED WITH THE PROPOSAL.

1. Would the VA consider allowing board eligible primary care physicians and/or psychiatrists?

Yes

1. Would the VA consider supplying the thin prep supplies for Pap Smears? The basis of the request is due to the fact that, when supplied by the contractor, the contractor must prepare for large quantities as the exact quantity needed will be unknown, and so of course this large quantity must be accounted for in the contractor’s price proposal.

Yes, The Memphis VA will supply.

1. PWS Section 2.1; 13 of 76; The solicitation states “Total Estimated Patients enrolled/assigned to site: 4350.” Please provide the most recent billing figures/members/enrollees for primary care and mental health services.

As of July 2020 – Primary Care: 4164; Mental Health: 892. The Memphis VA anticipates an increase in enrollment at the Tupelo CBOC due to the recent new addition of the VA-staffed ophthalmology clinic.

1. If Offerors plan on using the same Past Performance References as the original submission in June, can the original submitted PPQs be applied to this new solicitation to alleviate the administrative burden on our PP POCs?

Given that the first solicitation was completely cancelled, new PPQs using the questionnaire provided as an attachment to solicitation 36C24920R0114 will need to be submitted.

1. On pg 13 and at 2.2 and again on page 13 2.3.1, it states that: Contactor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Is a board eligible physician also acceptable?

Yes

1. On page 16 under 2.4.3.1 the rfp mentions: 1.0 FTE FLOATING ADMINISTRATIVE ASSOCIATE Is the government indicating the need for an additional 1.0 FTE to the clinic staffing, or is it a description of work that the 1.0 FTE per PACT doing?

The floating MSA has been removed from this solicitation.

1. On pg 19, under 2.6.1 it states the need for the psychiatrist Qualifications: Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC). Board certified physician in psychiatry. Is a board eligible psychiatrist acceptable?

Yes

1. On pg 23, under 2.7, the RFP calls for a TELEHEALTH SERVICES CLINICAL STAFF: The contractor is responsible for providing a Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services). For the purposes of this contract, is it acceptable for the back up TCT to be a part of a PACT team, or is the government wanting an additional 1.0 FTE TCT?

The backup can be part of a PACT

1. On pg. 34 under 4.5.2.11 it states that the contractor pays for mammography. Please give number of anticipated mammograms that will be needed in an average year In FY20 year to date (YTD), 55 exams were completed and sent to the Memphis VA. An additional 17 ordered and discontinued for a potential of 72 YTD. Of the completed 55 exams, 17 were screening exams and 15 were diagnostic. There are 52 overdue YTD. The Memphis VA can only query how many mammograms are sent as completed; therefore, if the contractor does not enter an order or send it to the Memphis VA, the data will not be documented and queried.

1. On pg 38 under 4.5.3.1 it states: PRESCRIPTION FULFILLMENT- The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic. Please provide a list of all medications, vaccinations and amounts to be administered in the clinic.

The contractor CBOC is responsible for procuring their own medications including vaccines, therefore this data is unable to be queried from the Memphis VA Pharmacy.

1. 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 The contractor will be responsible to purchase and administer medications and vaccines including those ordered by VAMC specialists and previously issued by the Memphis VA as ward stock. Medications that have been administered as ward stock at the Tupelo CBOC and the quantities from 1 October 2019 to date are as follows:

1. On pg 43 under 4.5.4.1 the rfp states: RADIOLOGY SERVICES –The contractor shall provide by way of contract for, diagnostic radiographs and mammography services (screening mammography, diagnostic mammography and breast ultrasound). Please provide the average number and types of diagnostic radiographs that the contractor will be responsible to provide in an average year Please see paragraph 4.5.4.1 as it has been revised on this solicitation for clarification and additional details. However, the data for diagnostic radiographs cannot be pulled since it is not ordered through the Memphis VA, but rather at the contractor’s expense. Images are uploaded into the veteran’s EHR.

1. How many veterans are on the latest on the billable roster?

As of July 2020 – Primary Care: 4164; Mental Health: 892. The Memphis VA anticipates an increase in enrollment at the Tupelo CBOC due to the recent new addition of the VA-staffed ophthalmology clinic.

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

Audiologist (1) – Every Friday Ophthalmic Technician – Monday through Friday Ophthalmologist Reader Clinician – Estimated 1-5 times per month Any potential additional VA staffed personnel for future specialty services will be discussed with the contractor for a mutual agreement prior to a final decision made by the Memphis VA.

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

Please refer to paragraph 4.8.1 as it discusses the space requirements for the Memphis VAMC staffed audiology and ophthalmology space.

1. Will the new contractor inherit the patients’ last vesting visit and be allowed to bill for one year from that date upon contact award?

Yes

1. Is the clinic manager required to be an RN?

The VA does not have a preference if the clinic manager is a RN or LPN

1. Thin-Prep PAP testing supplies are not available for purchase by contractor, will the VA supply?

Yes, the Memphis VA will supply

1. On page 55 4.5.5.5.12 it calls for an “Outreach specialist,” Who will provide this specialist the VA or contractor?

The contractor will provide the outreach specialist

1. page 57 4.5.6.2 requires contractor to perform Tele-Retinal services, who provides the equipment VA or contractor?

The VA will provide the equipment

1. Please confirm the contractor is responsible for providing discipline specific PACT team members: LCSW, Dietitian/Nutritionist and PC-MHI staff.

Yes, the contractor is responsible for providing the discipline specific members

1. Are the Mandated POC testing devices and kits, as identified in Section 4.5.4.4.1 to be provided by the VA at the cost of the VA as stated in Section 4.5.4.4.6?

The contractor is responsible for supplying the mandated POC testing devices and kits.

1. Please list, by position name and FTE the Specialty MH positions that are currently staffed at the Tupelo CBOC.

Psychiatrist: 1.8 FTE

MH NP: 1.6 FTE

MH RN: 1.0 FTE

MH LCSW: 3.0 FTE

1. Are pharmacy services provided by the VA on site or via telehealth?

Via telehealth

1. Does the VA have a preference for sliding or swinging doors on exam rooms?

The Memphis VA does not have a preference on the use of sliding doors. This will be the contractor’s decision.

1. Please confirm state and local inspection permits, and safety permits can be provided prior to clinic opening and not with the proposal since the building will need to be built out.

Yes, all requirements must be submitted and approved by the Memphis VA prior to the opening of the clinic.

1. Please confirm the government requires 1.0 FTE floating administrative assistant in addition to normal PACT staffing.

The floating MSA has been removed in this solicitation.

1. 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.

The contractor is responsible for procuring their own medications including vaccines, therefore this data is unable to be queried from the Memphis VA Pharmacy.

1. What is the required setback distance of the site to the bollards required for physical security? Will a 25-foot setback be required if the clinic is in a shopping center? If so, can bollards or planters be used to keep the minimum distance 8 feet away?

Physical security measures and location(s) must be submitted and approved by the Memphis VAMC Police Services prior to installation.

1. Please confirm the number of telehealth rooms required and their minimum square footage/size requirements.

Please refer to paragraph 4.8.1

1. Please confirm the number of Women’s Health exam rooms that the government requires for this CBOC.

(1) Women’s Health exam room per PACT

1. Please list all signature documents the government requires to be included in Volume 1 in addition to the SF 1449 and the SF-30(s). Does the government require the full documents to be included or just the signature pages?

Attachments 1, 21, 22, and 23. For the SF1449 and SF30’s, only the signature page needs to be included. For all other attachments, the full document shall be included.

1. Requirements call for proposals to be printed on front and back, will the government allow proposals to be submitted in single sided format?

No, please print on front and back.

1. Please extend proposal due date for at least 21 days from the date final questions are answered so that contractors can revise architectural floor plans.

Given the timeline and deadline for the new contract to be fully operational/in place, an extension until 16 October 2020 is given. No other extensions will be provided.