36C24923R0047.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C24923R0047 08-03-2023

Angela Tucker, Contract Specialist No Phone Calls Accepted 09-14-2023

10:00AM CT

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

X

621498

$22.5 Million

N/A

Department of Veterans Affairs Lt. Col. Luke Weathers, Jr.

VA Medical Center 1030 Jefferson Avenue Memphis TN 38104

90C

Department of Veterans Affairs Network Contracting Office - 9 1639 Medical Center Parkway Suite 400 Murfreesboro TN 37129

90C

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

Setup 1-877-489-6135

Contractor shall provide Community Based Outpatient Clinic (CBOC) Services located in Helena, AR in accordance with the terms and conditions contained in herein, the PWS beginning on page 13, and in accordance with the Price Schedule beginning on page 8.

To be provided on individual orders issued.

X 1

Carol Franklin Contracting Officer

36C24923R0047 – Helena, AR CBOC

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF PRICE AND SERVICES

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL

1.1. SERVICES REQUIRED

1.2. PLACE OF PERFORMANCE

1.3. AUTHORITY:

1.4. POLICY AND REGULATIONS:

1.5. DEFINITIONS/ACRONYMS

2. STAFFING AND QUALIFICATIONS

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING

REQUIREMENTS

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES)

2.3. PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES) ..18

2.4. DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL

SITES)

2.5. SPECIALTY CARE STAFFING

2.9 LICENSE AND ACCREDITATION

2.10 CREDENTIALING AND PRIVILEGING

2.11 CME/CEU

2.12 TRAINING (ACLS/BLS/VA MANDATORY)

2.13 ACCESS TO PATIENT INFORMATION

2.14 RULES OF BEHAVIOR FOR AUTOMATED INFORMATION SYSTEMS

2.15 STANDARD INFECTION CONTROL MEASURES (PPD, IMMUNIZATIONS,

ETC.) 36

2.16 NATIONAL PROVIDER IDENTIFICATION (NPI)

2.17 PRESCRIPTION DRUG MONITORING PROGRAM

2.18 CONFLICT OF INTEREST

2.18.1 CITIZENSHIP RELATED REQUIREMENTS

2.19 ANNUAL OFFICE OF INSPECTOR GENERAL (OIG) STATEMENT

2.20 NON-PERSONAL SERVICES

2.21 CONTRACT PERSONNEL

2.22 INHERENTLY GOVERNMENTAL FUNCTIONS PROHIBITED

2.23 TORT

2.24 RYAN HAIGHT ACT

3. HOURS OF OPERATION

3.1

3.2 EVENING HOURS: N/A

3.3 WEEKEND HOURS

3.4 FEDERAL HOLIDAYS:

4. CONTRACTOR RESPONSIBILITIES

4.1 GENERAL

4.4 PATIENT HANDBOOK

4.5 STANDARDS OF PRACTICE

4.6 PATIENT CARE

4.6.2.1. PRIMARY CARE TASKS SUMMARY

4.6.3.3 Clinical Pharmacy Services

4.6.5.2. ELECTROCARDIOGRAM SERVICES:

4.6.5.3. LABORATORY SERVICES

4.6.5.4. ANCILLARY, POINT OF CARE, AND WAIVED TESTING SERVICES

4.6.5.5. COMMUNICATING TEST RESULTS TO PROVIDERS AND PATIENTS: .63

4.6.6.4. PRIMARY CARE-MENTAL HEALTH INTEGRATION (PC-MHI):

4.6.7. SPECIALTY CARE SERVICES:

4.6.7.1. PODIATRY SERVICES-

4.6.8. TELE HEALTH SUPPORT AND SERVICES

4.6.8.2. TELERETINAL SERVICES

4.6.8.3. TELEDERMATOLOGY SERVICES

4.6.8.5. TELEPHARMACY SERVICES

4.6.9. TELEPHONE ACCESS TO CLINICAL CARE

4.6.11. EMERGENCY RESPONSE REQUIREMENTS

4.6.12. NON-EMERGENCY TRANSPORT REQUESTS:

4.6.13. NON-EMERGENT SPECIALTY CONSULTATIONS, CARE, AND

DIAGNOSTIC TESTS PERFORMED AT VA:

4.7. ADMINISTRATIVE:

4.7.3. MY HEALTHEVET PROMOTION

4.7.4. MEDICAL RECORDS/COMPUTERIZED RECORD SYSTEMS/

DISCLOSURE/ RECORD RETENTION

4.7.7. WORK RELATED INCIDENT TREATMENT

4.7.8. PATIENT RIGHTS, SAFETY, COMPLAINTS, GRIEVANCE SYSTEM

PROCESSES

4.9. SPACE REQUIREMENTS

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (DEC 2022)

C.2 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (JAN 2011)

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.4 52.216-18 ORDERING (AUG 2020)

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

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

C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) . 143

C.10 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.11 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.12 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.13 VAAR 852.211-72 TECHNICAL INDUSTRY STANDARDS (NOV 2018)

C.14 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) 145

C.15 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.16 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAR 2023)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

Attachment D.1 – Quality Assurance Surveillance Plan Attachment D.2 – Contractor Organizational Conflict of Interest Attachment D.3 – Contractor Certification of Immigration Attachment D.4 – Contractor Rules of Behavior Attachment D.5 – IB10-441 Enrollment Priority Groups Attachment D.6 – Deliverables-Reports Table Attachment D.7 – BI Security Package Instructions and Documents Attachment D.8 – CFM-CBOC Prototype Design Attachment D.8a – OIT-Infrastructure Standard Telecom Spaces Attachment D.8b – OIT Design Guide Attachment D.9 – Wage Determinations Attachment D.10 – Reserved Attachment D.11 – SB Goals Attachment D.12 – VA National Formulary Attachment D.13 – PACT Space Module Design Guide Attachment D.14 – Past Performance Survey

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAR 2023)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

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

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

E.6 52.222-5 CONSTRUCTION WAGE RATE REQUIREMENTS—SECONDARY SITE

OF THE WORK (MAY 2014)

E.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)

E.9 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.10 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.11 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (DEC 2022)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

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

a. CONTRACTOR:

Company Name:

Contact Person:

Title:

Address:

City/State/Zip:

Phone No.:

E-Mail:

Tax ID No.:

UEID No.:

b. GOVERNMENT:

Angela Tucker, Contract Specialist U.S. Department of Veterans Affairs Network Contract Activity (NCO) 9 1639 Medical Center Parkway, Suite 400 Murfreesboro TN 37129 Overnight Mailing Address: Same as above E-Mail: angela.tucker2@va.gov

2. Contractor Remittance Address: All payments by the Government to the contractor will be made in accordance with FAR 52.232-33, Payment by Electronic Funds Transfer-System for Award Management

3. Invoices: Refer to the Performance Work Statement Section 6.2 Billing

4. Government Invoice Address: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. Invoicing shall be in accordance with the requirements of the Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp

5. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered and dated as follows:

AMENDMENT NO. DATE

6. Place of Performance: Services shall be provided on-site at Contractor’s clinic facility to be located in Helena, Arkansas.

7. Post Award Orientation: The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by VA Acquisition Manual, Part M842.502-70.

8. Secure Fax: VA Handbook 6500 requires the following statement on all fax cover sheets be included:

“This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

9. Mandatory Written Disclosures: Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at http://www.va.gov/oig/contacts/hotline.asp and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488- 8244 for further instructions.

B.2 SCHEDULE OF PRICE AND SERVICES

Under the authority of Public Law 104-262 and 38 U.S.C. 8153 the Contractor agrees to provide Primary Care and Mental Health services in accordance with the terms, conditions, and provisions stated herein at the prices specified in the Schedule of Services. Proposed Contractor facility for Helena CBOC must be physically located in Helena, Arkansas. Veterans to be serviced under this contract reside primarily in the cities surrounding and/or in Helena, Arkansas; however, residency is not restricted to this county. The Parent Facility is the Lt. Col. Luke Weathers, Jr. VA Medical Center. Payment for Primary Care and Mental Health services shall be based on a monthly capitated rate, as further explained within this solicitation.

The quantities listed in the Price Schedule below are estimates only and are not to be considered a minimum or maximum. The Government will order the below specified minimum contract value of services and may order up to and including the below 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.

The guaranteed minimum contract award amount for the contract is $500,000.00 The maximum aggregate value of all orders placed under this contract shall not exceed $30,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum contract award amount.

Ordering Procedures: VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management Manual (PCMM) software program used to track primary care clinic Veteran rosters. Specific billable processes for issuing task orders under the resultant contract include:

determining Veteran eligibility, enrollment eligibility, and at least one qualifying encounter by the Contractor’s primary care provider (PCP) within the previous 12 months.

The Contractor will be provided a list of all enrolled patients at the beginning of the contract and will be able to bill for these patients immediately. In order to remain enrolled in the clinic, patients must have a qualifying visit within 12 months of their last visit. Qualifying encounters are further defined in PWS Section 6.2.1. Please review in detail to ensure compliance for issuance of subsequent task orders and payment processing.

Any services to be furnished under this contract shall be ordered by issuance of task orders by the Contracting Officer or Administrative Contracting Officer. Orders may be issued by electronic commerce methods.

Per FAR 16.504(a)(4)(ii) reference the min/max.

Contract Minimum $500,000.00 Contract Maximum $30,000,000.00

PRICE SCHEDULE

BASE PERIOD – 01-01-2024 through 12-31-2024

CLIN

No.

Services

Unit Estimated Quantity

Price Per Unit

Total Estimated Cost

0001 Primary Care Services at capitation rates per member per month (PMPM)

PMPM 966

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

PMPM 290

Total for Base Period $

OPTION PERIOD 1 – 01-01-2025 through 12-31-2025

CLIN

Price Per Unit

Total

1001 Primary Care Services at capitation rates per member per month (PMPM)

PMPM 953

1002 Mental Health Services at capitation rates PMPM

PMPM 286

Total for Option Period 1 $

OPTION PERIOD 2 – 01-01-2026 through 12-31-2026

CLIN

No.

Services Unit Estimated Quantity

Price Per Unit

Total

2001 Primary Care Services at capitation rates per member per month

(PMPM)

PMPM 941

2002 Mental Health Services at capitation rates PMPM

PMPM 282

Total for Option Period 2 $

OPTION PERIOD 3 – 01-01-2027 through 12-31-2027

CLIN

Price Per Unit

Total

3001 Primary Care Services at capitation rates per member per month (PMPM)

PMPM 928

3002 Mental Health Services at capitation

PMPM 278

Total for Option Period 3 $

OPTION PERIOD 4 – 01-01-2028 through 12-31-2028

CLIN

Price Per Unit

Total

4001 Primary Care Services at capitation

PMPM 916

4002 Mental Health Services at capitation

PMPM 275

Total for Option Period 4 $

OPTION PERIOD 5 – 01-01-2029 through 12-31-2029

CLIN

Price Per Unit

Total

5001 Primary Care Services at capitation

PMPM 903

5002 Mental Health Services at capitation

PMPM 271

Total for Option Period 5 $

OPTION PERIOD 6 – 01-01-2030 through 12-31-2030

CLIN

Price Per Unit

Total

6001 Primary Care Services at capitation

PMPM 891

6002 Mental Health Services at capitation

PMPM 267

Total for Option Period 6 $

OPTION PERIOD 7 – 01-01-2031 through 12-31-2031

CLIN

Price Per Unit

Total

7001 Primary Care Services at capitation

PMPM 891

7002 Mental Health Services at capitation

Total for Option Period 7 $

OPTION PERIOD 8 – 01-01-2032 through 12-31-2032

CLIN

Price Per Unit

Total

8001 Primary Care Services at capitation

PMPM 891

8002 Mental Health Services at capitation

Total for Option Period 8 $

OPTION PERIOD 9 – 01-01-2033 through 12-31-2033

CLIN

Price Per Unit

Total

9001 Primary Care Services at capitation

PMPM 891

9002 Mental Health Services at capitation

Total for Option Period 9 $

TOTAL FOR BASE AND ALL OPTION PERIODS $

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. SERVICES REQUIRED: The Department of Veteran Affairs, Lt. Col. Luke Weathers, Jr.

VA Medical Center, Memphis, TN (Memphis VAMC) requires the following services to be provided in a private hospital, office or clinic environment to Veterans, primarily residing in the following Arkansas and Mississippi counties: St. Francis, Lee, and Phillips counties in AR; and Bolivar, Coahoma, and Tunica counties in MS.

1.1.1. Primary Care CBOC: offers both medical and mental health care (physically on site and by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care CBOCs are required to provide both primary care and mental health services. Mental Health services will be provided by the Contractor.

1.2. PLACE OF PERFORMANCE: The contractor shall provide a primary CBOC facility in

Helena (Phillips County), AR and within 10 miles of a local hospital providing emergency room services.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 in conjunction with FAR Parts 12 and 15, to be furnished by the Contractor on behalf of the Memphis VAMC, Memphis, TN.

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index and clinical guidelines.

Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the Contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vhapublications/ or at http://www.va.gov/vapubs/. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/Resources.asp.

1.5. DEFINITIONS/ACRONYMS:

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

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

1.5.14. ASYNCHRONOUS CARE: Care provided outside of bookable time and includes but is not limited to the following activities: refilling prescriptions, reviewing outside records, huddles and case management, team meetings, processing view alerts, secure messaging and training.

1.5.15. BAA: Business Associate Agreement

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

1.5.17. BLS: Basic Life Support

1.5.18. BOS: Bureau of Osteopathic Specialists

1.5.19. CAHEA: Committee on Allied Health Education and Accreditation

1.5.20. CAP: College of American Pathologists

1.5.21. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.22. CBO: VA Central Billing Office.

1.5.23. CDC: Centers for Disease Control and Prevention

1.5.24. CEU: Certified Education Unit

1.5.25. CLIA: Clinical Laboratory Improvement Amendments

1.5.26. CME: Continuing Medical Education

1.5.27. CMS: Center for Medicare and Medicaid Services

1.5.28. CO: Contracting Officer

1.5.29. COPD: chronic obstructive pulmonary disease

1.5.30. COR: Contracting Officer’s Representative

1.5.31. COS: Chief of Staff

1.5.32. CPA: Collaborative Practice Agreement

1.5.33. CPS: Clinical Pharmacy Specialist

1.5.34. CPT: Current Procedural Terminology

1.5.35. CRNP: Certified Registered Nurse Practitioners

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

1.5.37. CPARS: Contractor Performance Assessment Reporting System

1.5.38. CVT: Clinical Video Telehealth

1.5.39. DICOM: Digital Image and Communication in Medicine

1.5.40. DIGMA: Drop-in Group Medical Appointment

1.5.41. DRG: Diagnostic Related Group

1.5.42. DSS: Decision Support System

1.5.43. ECC Extended Care Center

1.5.44. Enrollment: The process of establishing eligibility for VA’s “Medical Benefits

Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

1.5.45. EPRP: External Peer Review Program

1.5.46. FDA: Food and Drug Administration

1.5.47. FSMB: Federation of State Medical Boards

1.5.48. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

1.5.49. HHS: Department of Health and Human Services

1.5.50. HCFA: HealthCare Financing Administration

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

1.5.52. HT: Home Telehealth

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

1.5.54. ICD 10: International Classification of Diseases 10th edition

1.5.55. iMED: software used by VA for informed consent

1.5.56. INR: International Normalized Ratio

1.5.57. ISO: Information Security Officer

1.5.58. LIP: licensed independent practitioner

1.5.59. MCCR: Medical Care Cost Recovery

1.5.60. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the Veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress

Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions;

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psycho-education, family education, skills training, peer support, and Compensated Work Therapy (CWT) and supported employment;

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.61. MQSA: Mammography Quality Standards Act

1.5.62. MSN: Master of Science in Nursing

1.5.63. NCCPA: National Commission on Certification of Physician Assistants

1.5.64. NSF: Net Square Footage

1.5.65. NLN: National League for Nursing

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

Improvement in Cardiac Surgical Program

1.5.67. OTC: Over the Counter

1.5.68. PA: Physician Assistant

1.5.69. PACS: Picture Archiving and Communications System

1.5.70. PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team-based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

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

1.5.72. PCMH: Patient-Centered Medical Home

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

Primary Care Clinic Veteran rosters.

1.5.74. PCP: Primary Care Provider

1.5.75. Phar.D.: Doctor of Pharmacy

1.5.76. POC: Point of Care Testing

1.5.77. PRIMARY CARE VISIT: an episode of care furnished in a clinic that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.

Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

1.5.78. PCMHI: Primary Care-Mental Health Integration

1.5.79. PWS: Performance Work Statement

1.5.80. QAPI: Quality Assessment and Performance Improvement

1.5.81. QASP: Quality Assurance Surveillance Plan

1.5.82. RME: reusable medical equipment

1.5.83. SOP (Clinical): Scope of Practice

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

1.5.85. SFT: Store and Forward Telehealth

1.5.86. SMA: Shared Medical Appointments

1.5.87. SPD: Sterile Processing Division

1.5.88. SPE: Senior Procurement Executive

1.5.89. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care, and is only provided through a referral.” These services are generally divided into two sub-categories:

medicine specialties and surgery specialties. The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy;

cardiology; dermatology; emergency; employee health; endocrinology;

gastroenterology; general medicine; hematology or oncology; infectious disease;

nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology;

amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery; orthopedics;

plastic surgery; urology; or vascular clinic stops.

1.5.90. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.91. SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two-way conversation.

1.5.92. TJC: The Joint Commission

1.5.93. TIU: Text Integration Utility

1.5.94. TCT: Telehealth Clinical Technicians

1.5.95. VA: Veterans Affairs

1.5.96. VA EHR: VA electronic health record

1.5.97. VAMC: Veterans Affairs Medical Center

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

1.5.99. VHA: Veterans Health Administration

1.5.100. VVC: VA Video Connect

1.5.101. WHEN: Weekend – Holiday – Every Night

2. STAFFING AND QUALIFICATIONS:

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

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff). The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1,200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Current Total Estimated Patients enrolled/assigned to site: 996.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance

Standard: 0.05* FTE per PACT Responsible Party: Shall be provided by Contractor.

Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP. (If so, authorization for prescriptive authority is required). Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G2. *NOTE: Physician Director shall be on site at the CBOC a minimum of 4 hours every other week per PACT. Position Responsibilities:

Serves as Physician Director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

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

2.3.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance

Standard: Current standards are 1,200 active patients per full time physician and 900 active patients per full time midlevel provider. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. At least one of the PCPs is to be a 1 FTE physician.

2.3.1.1. FTE Ratio Performance Standard: 1 FTE per PACT Responsible Party: Shall be provided by Contractor.

2.3.1.2. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family

Practice. Contactor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP. (If so, authorization for prescriptive authority is required).

Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G2.

Option 1: Physician (MD/DO): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005.

Position Responsibilities: Serves as Physician Director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site. Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face, telehealth, and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications:

CRNP’s (including subcontractors) must possess a master’s degree from a program accredited by the NLNAC or CCNE and maintain full and current certification as a nurse practitioner from the American Nurses Association or another nationally recognized certifying body as a Nurse Practitioner in either Adult Health or Family Practice.

. Authorization for prescriptive authority is required. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face, telehealth, and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 3: Physician Assistant (PA): Qualifications: PAs (including subcontractors) must meet one of the three following educational criteria: a) A bachelor’s degree from a PA training program which is certified by the CAHEA;

or b) Graduation from a PA training program of at least twelve (12) months duration, which is certified by the CAHEA and a bachelor’s degree in a health care occupation or health related science; or c) graduation from a PA training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician. The duration of approved academic training and health care experience must total at least five (5) years.

Authorization for prescriptive authority is required. PA shall have current, full, active, and unrestricted license and registration in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G8. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face, telehealth, and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life. Serves as clinic manager to oversee the administrative operation of the clinic.

2.3.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP.

Contractor to propose the mix of Clinical Associates from the options below.

OPTION 1: Licensed Practical Nurse (LPN): Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e.

CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G13. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment.

Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. This staff member will be required to receive training as back-up for telehealth services.

OPTION 2: Licensed Vocational Nurse (LVN):Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G13. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment.

Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. This staff member will be required to receive training as back-up for telehealth services.

OPTION 3: Medical Assistant (MA): Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination.Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. This staff member will be required to receive training as back-up for telehealth services.

OPTION 4: Health Care Technician (HCT) (as part of PACT teamlet, not primary telehealth technician): Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination.