36C24925R0056 0002.pdf

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

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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

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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.)

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(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)

1 16

MSO-2024-COM-0042

Department of Veterans Affairs Network Contracting Office 9 (90C)

NCO 9

1639 Medical Center Parkway, Suite 204 Murfreesboro TN 37129

90C

Network Contracting Office 9 Department of Veterans Affairs Network Contracting Office (90C) 1639 Medical Center Parkway Suite 204 Murfreesboro TN 37129

To all Offerors/Bidders

36C24925R0056

12-05-2025

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 01-14-2026 10AM CST

The purpose of this amendment is as follows:

1. Extend the solicitation close date to 1-14-2026 at 10:00AM Central Time.

2. Provide answers to vendor questions.

3. The PWS and Attachment D.6 were updated accordingly, additionally some references in D.6 were updated.

Carol Franklin Contracting Officer

Vendor questions and VA answers provided. Solicitation due date extended.

Vendor Questions VA Answers 1 Why was this solicitation not set aside for veteran-owned small businesses under the VA Rule of Two?

The solicitation strategy is considered source selection sensitive and cannot be disclosed, per FAR 3.104-4.

2 On what dates was the market research performed, and what were the findings?

Market research details are part of acquisition planning and not required to be disclosed, per FAR 10.002(b).

3 Does the current CBOC meet the government’s space requirements, and if not, will the location be ‘grandfathered in’ and available for rebid ‘as-is’?

The Offeror will need to make that determination.

The Government will not grandfather the current facility or issue any waivers if the current facility does not meet size or space requirements or design guidelines.

4 Please confirm the new CBOC must be designed with the On/Stage-Off/Stage concept as laid out in the PACT Design Guide.

Yes

5 Please provide the number of billable enrollees on the most current invoice.

PC: 1,716

MH: 502

6 Please list all VA staff that will be onsite at the clinic and the approximate number of days per week they will be there.

Staffing and Qualifications on page 17 discuss roles and FTE required.

7 Will the new contractor inherit the patients’ last vesting visit and be allowed to bill for one year from the date upon contract award?

Yes

8 Will the government be making site visits prior to the award? If so, how much advance notice will the contractor be given?

If site visits are performed this will be communicated appropriately, as needed.

9 How many Mission Act referrals for Primary Care were made in the past 12 months for enrolled veterans of the Dyersburg CBOC?

10 Please list the vaccines the contractor is responsible for purchasing and provide information on how many of each vaccine were used at the clinic in the past year.

Attachment D.15 Annual Vaccine and Medication History include usage for the past 12 months.

Routine prescriptions will be dispensed by the VA and mailed via VA Centralized Mail Out Pharmacy (CMOP). All other medications including vaccines that are to be administered to patients are to be provided by the contractor.

11 Will the government add price realism language to the current solicitation to prevent contractors from deliberately underbidding this contract?

No.

12 Will the VA provide the ThinPrep solution since contractors are unable to obtain it?

Yes.

13 How many female veterans are enrolled? 150 14 What is the current veteran population within the area required to be served under this contract?

Crocket: 647 Dyer: 1,774 Gibson: 3,058 Lake: 285 Lauderdale: 1,168 Obion: 1,749

36C24925R0056 0002 – Dyersburg CBOC Services

15 What was the rationale for the CLINs? The current enrollment numbers show significantly lower, and the trend shows enrollment has not been up to the presented level since 2019. Would the government consider adjusting the CLINs?

Here are the current enrollment numbers:

PC: 1,716

MH: 502

16 Is the PCMHI FTE included in the general MH staffing FTE or is the PCHMI FTE over and above the MH FTE staffing

PCMHI does not count towards the general/specialty mental health staffing requirements.

17 Does the VA require one or two sliding barn doors for each exam room?

One

18 The VA has asked for a 16,500 square foot minimum for the new clinic. Will the VA waive the 16,500 square foot minimum requirement if the offeror meets all room and hallway requirements? We believe the 16,500 square foot requirement is a significant and unnecessary cost driver.

There has to be enough space for the services requested.

19 Does the government require 1.22 FTE psychiatrist per 1,000 MH enrolled veterans or is the government requiring

0.05 FTE psychiatrist per clinic?

0.05 FTE is the minimum coverage for oversight but

if using a psychiatrist to meet staffing requirements, 1.22 FTE per 1000 patients is required.

20 Please verify CLIN, Total Estimated Patients enrolled/assigned to site: 2,442. ( pg. 17 bottom paragraph)

1,716; RFP updated to reflect this change

21 Will the Government provide historical Primary Care enrollment data to assist with validating projected capacity requirements? Specifically:

Request 1 – Monthly Count: Monthly active/billable Primary Care Veteran counts for the past 12 months (e.g., Dec 2024, Jan 2025, Feb 2025, etc.).

Request 2 – Annual Average: The annual average number of active/billable Primary Care Veterans for each of the last five years (2021–2025).

Oct 2025: 1,716 Sept 2025: 1,700 Aug 2025: 1,689 Jul 2025: 1,673 Jun 2025: 1,645 May 2025: 1,610 Apr 2025: 1,609 Mar 2025: 1,591 Feb 2025: 1,592 Jan 2025: 1,600 Dec 2024: 1,621 Nov 2024: 1,615

FY25: 1,700

FY24: 1,618

FY23: 1,627

FY22: 1,606

FY21: 1,700

22 Does the Government have historical telehealth encounter volumes available, and if so, will this information be provided to support calculating the required number of Telehealth Clinical Technicians (TCTs)?

Dyersburg completed 850 episodes of CVT, 142 Tele-eye, 0 Telederm

23 Will the Government provide the current number of enrolled female Veterans at the clinic to support planning

See answer to question 13.

for necessary supplies, equipment, and space requirements?

24 Is the Government willing to furnish Well Women’s Health Services supplies—including ThinPrep Pap Test materials, Pap smear collection kits, cytobrushes—as well as IFOBT kits? Industry experience indicates that these items are difficult for contractors to procure.

Yes

25 Is there an existing Mental Health billable roster?

If so, will the Government provide historical Mental Health enrollment data:

Request 1 – Monthly Count: Monthly active/billable Mental Health Veteran counts for the past 12 months (e.g., Dec 2024, Jan 2025, Feb 2025, etc.).

Request 2 – Annual Average: The annual average number of active/billable Mental Health Veterans for each of the last five years (2021–2025).

Oct 2025: 502 Sept 2025: 489 Aug 2025: 490 Jul 2025: 492 Jun 2025: 495 May 2025: 499 Apr 2025: 506 Mar 2025: 497 Feb 2025: 494 Jan 2025: 483 Dec 2024: 470 Nov 2024: 467

FY25: 489

FY24: 457

FY23: 336

FY22: 259

FY21: 288

26 Will the Government confirm that the parent facility is able and willing to support after-hours telephone care as required?

Yes, calls should be routed to the afterhours VISN 9 Call Center.

27 Will the Government confirm that it is acceptable for the contractor to provide required staff certifications upon contract award rather than at the time of proposal submission?

Amendment 0001 posted to address.

28 The attached WD (2015-5127) is applicable to Phillips County, Arkansas.

Will the Government confirm that offers should instead use WD 2015-4649 (rev 30) which includes Dyer County, Tennessee?

Amendment 0001 posted to address.

29 Attachment D.6 please confirm if the header on the attachment is a typo.

Yes, a typo. A corrected D.6 is included with this attachment.

30 The Past Performance narrative is listed as Evaluation Factor 1, however in the instructions on page 139, Factor 1 is not listed as being part of Volume I or Volume II. Could the Government confirm where they would like the Past Performance narrative to be listed within the Volumes?

For "Offeror shall submit at least three (3) references for current/prior Outpatient Clinic and Healthcare Management contracts that are similar in size and scope to this requirement, including any Federal, State, or local government, and commercial contracts." -- please add this information to Volume I, as Section 4.

31 Can the Government confirm the current Veteran enrollment as of the most recent reporting period for the clinic/service area?

PC: 1,716

MH: 502

32 Can the Government confirm whether the current clinic location meets the VA PACT Design Guide requirements?

Yes

33 For Item X003 (“Injectable Medications administered at the CBOC which are not listed in the contract”), the solicitation states reimbursement will be at 100% of actual cost. For proposal purposes, should offerors enter a plug figure for this line item, or leave it blank when calculating the total proposed price?

No plug number is needed, please leave as “100% of Actual Cost to Contractor”

34 2.6 General and Specialty Mental Health Staffing - Is the contractor required to provide a suicide prevention coordinator, and homeless outreach specialist since the enrollment does not meet the 10,000 enrollees?

No

35 2.7 Telehealth Services Clinical Staff - Please provide the contractor with the number of synchronous and asynchronous encounters in 2025.

Medication Management – Is the contractor responsible for providing quarterly and annual anticoagulation quality assurance summaries, if the VA in Memphis is managing the anticoagulant program?

Dyersburg completed 850 episodes of CVT, 142 Tele-eye, 0 Telederm

VA will provide AC services.

36 5.4 Ancillary support services - Will the Government supply the EKG 5500 at no cost to the contractor?

Contractor will be responsible for supplying the

EKG 5500.

37 10 Equipment, Office Supplies, and Technical Support - Please provide the number of copiers, faxes, or scanners that the Government will supply for the CBOC operation.

Since no contractor equipment will be connected to the VA network, will the Government be supplying a small desktop color printer for patient education materials?

3 insurance card scanners for MSA 4 printers Color printers are not supplied

38 Can the Government please provide the historical monthly and/or annual average of diagnostic radiographs and mammography services (screening mammography, diagnostic mammography and breast ultrasound) numbers by type, over prior contract years, to ensure we are quoting the necessary number of procedures needed at the Dyersburg VA Clinic? (5.4 Ancillary Support Services;

Radiology Services; 2.5.1 Diagnostic Radiologic Technologist)

FY24 46 exams 1 MRI, 5 U/S, 40 MAMMO FY 25 60 exams 1 MRI, 11 U/S, 48 MAMMO

39 The RFP specifies 16,500 NSF (Net Square Feet). Could the Government please confirm the required square footage for the CBOC expansion, and clarify if there have been any changes in the program requirements between the current contract and this follow-on contract? (12.Space Requirements)

No program changes have been made to the space requirements.

40 In the PWS Section 2.1 the Government states the "Total Estimated Patients enrolled/assigned to site: 2,442". In Schedule B CLIN 0001 the number of Patients for Primary

See answer to question 20.

Health Care Services is stated as 1911. Can the Government please confirm the enrollment numbers for Primary Care? (2.1. Minimum Patient Aligned Care Team (PACT) Staffing Requirements and B.2 Schedule B CLINs)

41 Will the Government accept a font size of no smaller than 8 pt font for tables, charts, graphics, and images?

(Instructions for the Preparation of Proposals)

Yes.

42 In order to accurately estimate FTE counts for TCT services the number of synchronous/asychronous telehealth encounters is required, will the Government provide the number of synchronous/asynchronous telehealth encounters over the last year or the expected number anticipated? (2.7 Telehealth Services Clinical Staff)

See answer to question 35.

43 In Section 2.3. Discipline Specific PACT Team Members (Required for all sites) for Discipline Specific 5: Primary Care Mental Health Integration (PC-MHI) the PWS provides a ratio of .67 FTE per PACT of a mix of stated Mental Health Disciplines. Later in Section 2.6. General and Specialty Mental Health Staffing, the PWS provides an FTE ratio performance standard of 9.0 FTEs (of a mix of stated MH disciplines and an administrative component) per 1000 Veterans seen in General Outpatient MH.

Can the Government please verify that these are two separate and distinct requirements? (Section 2.3. Discipline Specific PACT Team Members (Required for all sites) for Discipline Specific 5: Primary Care Mental Health Integration (PC-MHI))

This is in addition to the PCMHI staffing ratio. PCMHI does not count towards the general/specialty mental health staffing requirements.

44 Can the Government confirm which of the Attachment Documents require a signature at time of proposal submission? (Instructions Volume I)

Attachments D.1, D.2, D.3, and D.4 require signature. The Offeror should provide these signed along with any other required RFP documents requiring signature.

45 Will the VA provide the historical billed enrollment for primary care and mental health for the Dyersburg CBOC for the past five years?

PC MH

FY25: 1,700 489

FY24: 1,618 457

FY23: 1,627 336

FY22: 1,606 259

FY21: 1,700 288

46 Does the existing Dyersburg CBOC facility meet the requirements of this solicitation?

The requirements are provided in this solicitation, and it is up to the offeror to make any determinations about whether the current facility meets the specifications.

47 B.2 Schedule of Price and Services (p. 9-12) - The enrollment for primary care starts at 1911 in the base year and increases to 1985 in option year 9. However, in VSSC, the PCMM enrollment as of October 2025 is 1802.

Over the life of this contract, the VA anticipates a less than 1% increase year over year. Why is the starting enrollment

Current enrollment for Primary Care is 1,716.

1919 used in the base year, when the enrollment in PCMM as of October 2025 is only 1802 which is a 6% increase?

Will the VA adjust the enrollment numbers to more accurately reflect the actual enrollment?

48 B.2 Schedule of Price and Services (p. 9-12) - The enrollment for mental health has a base year enrollment of

573. However, in VSSC, the mental health enrollment is 280 as of October 2025.

What is the reasoning behind starting the MH enrollment at 595 when the enrollment in VSSC is only 280?

Current enrollment for Mental Health is 502.

49 1. General (p. 13) - The RFP states, services shall be performed by Contractor in Dyersburg (Dyer County), TN and within 10 miles of a local hospital providing emergency room services, on behalf of the Lt. Col. Luke Weathers, Jr.

VA Medical Center.

E.9 52.212-2 (p. 145) - The RFP states, proposed clinic site for Dyersburg CBOC must be physically located in the city of Dyersburg, Tennessee. Preference will be given to a single-level building structure, and preference will be given to a facility that is located within 10 miles of a hospital with emergency room facilities.

Is it a requirement or a preference that the CBOC facility be within 10 miles of a local hospital?

It is a requirement.

50 2. Staffing and Qualifications (p. 17) - Is a full-time Clinic Manager required and if so, would the VA prefer they be a Registered Nurse?

Yes.

51 2.5.2 Phlebotomist/ Laboratory Technician (p. 25) - The RFP states that the contractor will provide a phlebotomist/lab technician.

Is the bidder required to staff a 1.0 FTE phlebotomist/lab technician to cover all clinic hours?

Yes

52 2.6 General and Specialty Mental Health Staffing (p. 25) - The RFP states, General MH Staffing FTE ratio performance standard is 9 total FTE per 1,000 Veterans seen in general outpatient MH, which includes an interdisciplinary team of 8 clinical staff and 1 administrative support staff.

Is the PCMHI staffing ratio included in this total of 9 FTE per 1000 MH enrollees?

This is in addition to the PCMHI staffing ratio. PCMHI does not count towards the general/specialty mental health staffing requirements.

53 2.6 General and Specialty Mental Health Staffing (p. 25) - The RFP states, Required: Administrative Support Staff: FTE Ratio Performance Standard: Current minimum standard is

1.0 FTE administrative staff per 1,000 Veterans receiving

General and Specialty MH services.

This can be shared, but there needs to be administrative support available throughout the entire day (e.g. it cannot only be on Monday, Wednesday and Friday). Patients will need to be checked in/checked out/scheduled for follow-up, etc.

VHA Outpatient Mental health staffing policy currently requires 1.0 MH administrative support staff per 1,000 MH patients. With 573 patients in MH CLIN, is it appropriate for offerors to include 0.6 MH FTE administrative support staff instead of the 1.0 FTE outlined in the RFP?

54 2.7 Telehealth Services Clinical Staff (p. 28) - The RFP states the following telehealth staffing shall be provided by the Contractor. For CBOCs with fewer than 1050 synchronous and/or asynchronous encounters anticipated per year, one Telehealth Clinical Technician (TCT) FTE is required; for CBOCs with 1051-1479 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, 1.5-2 TCT FTE are required; for CBOCs with over 1480 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, greater than 2 TCT FTE are required. Each TCT shall have a trained back-up, e.g., another TCT or a member of the PACT Teamlet such as (PCP, RNCM, or clinical associate) who is able to perform all telehealth duties of the designated telehealth TCT.

In order to appropriately staff the TCTs, how many synchronous and asynchronous encounters does the Dyersburg CBOC anticipate per year?

See answer to question 35.

55 2.25.2 (p. 35) - The RFP states, evidence of past performance shall be submitted to the Contracting Officer directly prior to the close of the solicitation period.

(p. 139) - In the Instructions to Offerors, it states Proposals will consist of submitting two separate proposal volumes:

Volume I - Price and Volume II - Technical Capability, Business Operations, and Small Business Participation.

There is no mention of providing Past Performance information.

In Attachment D.6 Deliverables / Reports, it states, a minimum of three (3) past performance references, utilizing the Past Performance Questionnaire.

Attachment D.19 Past Performance Survey was provided.

There is no mention of Past Performance in the Instructions for the Preparation of Proposal. Given that Volume II can not contain any vendor (Offeror) specific information, rather the Vendor will obtain a code from the Contract Specialist, Laura Edelman, and that code shall be utilized in Volume II in place of Vendor's name, would the Past Performance references be located in Volume I Price?

Reference above answer to question 30 which states to include the Past Performance references and relevant information in Volume I, as Section 4.

There is no set format for Past Performance references. It is recommended to include an active point of contact. As a reminder, all Past Performance Surveys/Past Performance Questionnaires shall be submitted by the reference and not the offeror.

Is there any information or format the VA would like to see in the Past Performance references?

56 5.2 Women Veterans Health Care Services and Attachment D.15- Annual Vaccine and Medication History (p. 45) - Emergency Contraception: Contractor shall ensure emergency contraception (e.g., Levonorgestrel (Plan B) etc.) is available to all women patients in a timely manner (same day of their appointment) even if a provider has requested to opt out from providing emergency contraception to the patient because of a Rights of Conscience (ROC) Claim.

Plan B is not listed in Attachment D.15 Annual Vaccine and Medication History. Is the bidder responsible for the cost to provide Plan B? And what is the historical monthly and annual usage at the Dyersburg CBOC for the past 3 years?

Yes, contractor shall provide all medications, including any necessary vaccines that are to be administered to patients in the clinic. To date, Dyersburg clinic has not had to prescribe any.

57 5.3 Pharmacy Services (p. 46) - The RFP states, the Contractor will provide all medications that are to be administered to patients in the clinic (including vaccines in accordance with current and future Advisory Committee on Immunization Practices (ACIP)/CDC recommendations and guidance).

Will the VA provide a complete list of medications and vaccines to include all injectable medications that the contractor is expected to provide? And, will the VA provide historical monthly and annual usage at the Dyersburg CBOC for the past 3 years?

Contract clinics are expected to stock ANY medication or vaccine that is prescribed to be given to the Veteran in clinic.

58 5.3 Pharmacy Services (p. 47) - The RFP states, urgent/emergent medications needed will be filled via contracted local pharmacy for up to a 10 days.

Who pays for the cost of these contracted local pharmacy medications?

If the Veteran uses a non-VA pharmacy or out-of-contract pharmacy (ie, Heritage contract), then they (the Veteran) will incur all charges.

59 5.3 Pharmacy Services (p. 49, 50) - The RFP states, the Contractor shall meet all requirements for anticoagulation management and shall provide quarterly, and annual anticoagulation quality assurance summaries. The RFP also states, Clinical Pharmacy Services: Clinical Pharmacy Services shall be provided by the Memphis VAMC.

If the VA is providing the Clinical Pharmacy Services, wouldn't the VA be responsible for the anticoagulation management and providing anticoaguation quality assurance summaries?

Yes, VA provides the AC services listed.

60 5.3 Pharmacy Services (p. 50) - The RFP states, Clinical Pharmacy Services: Clinical Pharmacy Services shall be provided by the Memphis VAMC. The contractor shall provide space as detailed in space requirements, support staffing, and ancillary support to allow for the provision of

For the PACT CPP, we do not need ancillary support at the site (i.e. MSA, lab and occasionally nursing).

clinical pharmacy services. The support services shall be consistent for the CPS as with other prescribers for each Contractor’s scheduled clinic.

Is it acceptable for the PACT Team staff to provide support for the VA provided CPS?

61 5.4 Ancillary Support Services (p. 50) - The RFP states, the contractor shall provide by way of contract through a local accredited and certified facility at the contractor’s expense for general x-rays, diagnostic radiographs and mammography services (screening mammography, diagnostic mammography and breast ultrasound).

Does the VA have historical data on general x-rays, diagnostic radiographs and mammograms completed by the Dyersburg CBOC for the past 3 years?

FY24 46 exams 1 MRI, 5 U/S, 40 MAMMO FY 25 60 exams 1 MRI, 11 U/S, 48 MAMMO

62 Ancillary, Point of Care, and Waived Testing Services (p. 52)

- The RFP states, mandated POC testing includes:

Pregnancy testing, rapid flu test, and rapid strep test.

Does the VA require any other POC testing? For example, INR, Glucose, HbA1C and if so, will the VA provide the equipment for the same?

Covid testing

63 12. Space Requirements (p. 79) - The RFP states, there will be (1) room a minimum of 125 square feet with carpeted flooring, upper cabinetry with lower workstation on one wall, a desk that is a minimum of 3 feet wide, (3) chairs, and a total of (4) network access ports with port (1) located on each wall inside the room for the Memphis VAMC to utilize for a VA staff Audiologist during normal business hours. The room will have a lock on the door with keys only kept by the VA, office manager, and housekeeping. In order to avoid disruption of care, the room shall not be located beside an outside door or emergency door. The VA will provide and be responsible for the equipment needed for the ophthalmology and audiology clinics. The Contractor will be responsible for maintaining the rooms. The VAMC may utilize these two rooms for other specialty needs in place of or in between Audiology/Ophthalmology clinic operating days/hours. It is anticipated that both rooms will be utilized by the VA for the duration of the contract.

Does the VA want 1 or 2 additional rooms? Would the VA be willing to receive alternative proposals for bidders to provide these 2 clinic services instead of the VA?

VA doesn't currently need space for Audiology currently. Tele-audiology services will be provided by VA.

64 12. Space Requirements (p. 79) - Will pharmacy services be available at the Clinic? If so, will it be thru Tele-Pharmacy or clinical Pharmacist? If so will a Tele-Pharmacy room be needed or private office?

Pharmacy services will be provided through telepharmacy. It is anticipated the VA will utilize Telehealth Primary Care for up to 40 hours per week.

65 12. Space Requirements (p. 79) - Does the VA require a private office for the Dietician?

Yes

66 12. Space Requirements (p. 79) - Does the VA required a private office for the primary care LCSW?

Yes

67 12. Space Requirements (p. 79) - Does the VA require two separate offices for PCMHI?

Each PCMHI provider will need to be able to see patients privately. This can be accomplished in two ways. 1) Each PCMHI provider has a separate office. 2) If the PCMHI providers share an office or workspace, there must be adequate additional consult room space for them to use to see patients throughout the day.

68 12. Space Requirements (p. 79) - Does the VA require the two Tele-health TCTs to have offices or workstations?

The TCT can have a workstation, however they do test calls/VVC so this needs to be in a quiet area.

69 12. Space Requirements (p. 79) - Does the VA require a private office for the Podiatry Consultant?

No

70 12. Space Requirements (p. 79) - Does the VA require a private office for both the Retinal Camera room and Tele- Retinal room?

The retinal camera room and the Tele-Retinal room are the same room.

71 12. Space Requirements (p. 79) - Does the VA require a private office for both the Tele-Health Audiology and Tele- Retinal Ophthalmology?

Yes, the tele audiology and the tele-retinal require their own room. Tele Audiology needs to be in an area that provides quiet, the equipment is very sensitive and can pick up false noise. Away from a main hall, and areas where Veterans are constantly present is ideal. Typically, at the end of a hall is better.

72 12. Space Requirements (p. 79) - Does the VA require Tele- Mental Health rooms? If so, how many?

Yes, we are required to have Tele Mental health rooms for warm hand-off patients. This room would house a computer with a web cam or a Cas cart/ The Cas carts are pretty big.

73 12. Space Requirements (p. 79) - Does the VA require a Phone room in addition to the VA IT room?

No.

74 12. Space Requirements (p. 79) - How many Mental Health offices does the VA require?

Each mental health provider must have space to see patients privately throughout the day. This can be accomplished in two ways. 1) Each MH provider has a separate office. 2) If MH providers share an office or workspace, there must be adequate additional consult room space for them to use to see patients throughout the day.

75 12. Space Requirements (p. 79) - The RFP states, there must be (3) exam rooms per teamlet. There will be a total of two (2) consultation rooms to be shared by all teamlets.

Is one of the 3 exam rooms required to be a women's exam room and if so, does each PACT Team need to have a women's exam room?

Yes, one of the exam rooms can be a women's health room. We are required to have at least women's health providers at all times so at least 2 rooms are required.

76 13. Environment of Care (p. 85) - Contractor shall meet VHA standards regarding EOC and shall provide EOC management plans addressing safety, security, hazardous

It is acceptable to provide this information within 15 days after contract award.

materials, hazardous waste, emergency preparedness, life safety, medical equipment, infection control, and utility systems with the submission of their proposal and within 15 calendar days after contract award. However, nowhere in the In the Instructions to Offeror, does it mention providing EOC management plans.

Where in Volume II Technical Capabilities, Business Operations, Small Business Participation would the VA like to see the EOC management plans? Given that our EOC management plans are close to 100 pages long, is it acceptable to provide this as an attachment, or would it be acceptable to provide this information within 15 days after contract award?

77 20. Billing and Invoicing Procedures (p. 98) - Will the Contractor be provided a list of all primary care and mental health patients on the billable roster at the time when the Contractor begins performing clinical services and be able to bill for those patients on the billable roster in the following month’s invoice?

Yes, a list can be provided, and contractor will be able to bill for patients seen in the following month's invoice.

78 20. Billing and Invoicing Procedures (p. 98) - Will any reconciliation for CLIN 0003 be required?

Yes, itemized invoices will be required.

79 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO

OFFERORS— COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (p. 139) - The RFP states, offerors may submit alternative pricing or payment methods in their pricing proposal volume that address construction costs incurred during the build-out phase.

In addition to unique reimbursement models to account for construction cost recovery, is VA willing to consider pricing that includes specific value-based care payment model that lowers PMPM but allows for quarterly incentive payments for contractor performance in areas such as eQM, reduced emergency department visits and reduced hospitalizations?

Offerors may make the proposal but it is suggested to also submit an alternate proposal with standard PMPM pricing.

80 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO

OFFERORS— COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (p. 140) - The RFP states, the Offeror shall email the Contract Specialist, Laura Edelman, and obtain a code to be used on Offeror’s proposal in place of the Offeror’s name in all of Volume II. The Offeror is instructed to not include its name or any Offeror specific identifying information anywhere in Volume II of its proposal.

Will the VA please clarify what is considered "identifying information"? Does this include any names of organization leadership/management team members, using bidder's CBOC contract names or leaders in company's experience/ performance, email addresses that include company name in it and phone numbers for contact information, etc.?

Identifying information is considered the name of the Offeror, any logos, or email addresses. There should really not be any reason to include an email address or phone number in Volume II.

81 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO

OFFERORS— COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (p. 140) - In the Instructions for the Preparation of Proposal, it states to use font Times New Roman or Arial, with a font size no smaller than 11 point.

Will the VA permit tables, graphics, labels, footnote, org chart, etc. to have a font size smaller than 11 point? Is it acceptable to use other font types in graphics?

Yes, a font size no smaller than 8 may be used.

Times New Roman or Arial are to be used.

82 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO

OFFERORS— COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (p. 140) - Are there any email size restrictions when submitting the proposal electronically to the VA?

There may be a limit; however, please separate large proposal documents in multiple emails if you feel necessary, and please request confirmation for each email sent, to ensure entire proposal was received.

83 E.9 52.212-2 EVALUATION— COMMERCIAL PRODUCTS

ANDCOMMERCIAL SERVICES (NOV 2021) (p. 144) - In Evaluation Factor 1 - Past Performance, it states, Offeror shall submit at least three (3) references for current/prior Outpatient Clinic and Healthcare Management contracts that are similar in size and scope to this requirement, including any Federal, State, or local government, and commercial contracts. The Government will consider Offeror’s record for delivery, quality and past or present malpractice judgments, and proposed major subcontracts as it relates to the probability of successfully performing the solicitation requirements. Past performance evaluations will be conducted using information obtained from any sources deemed appropriate. While the Government may elect to consider data obtained from other sources, the burden of providing current and complete past performance information rests with the Offeror. The past performance information obtained will be used for both the responsibility determination and this evaluation factor. Offerors without a record of relevant past performance or from whom information on past performance is not available will not be evaluated favorably or unfavorably. Offeror shall also submit with proposal its overall turnover rate of professional personnel working under the same or similar contracts. (PWS Reference: 2.21).

Is the overall turnover rate that the VA is referencing in Evaluation Factor 1 - Past Performance, referring to the overall turnover rate for the reference contract provided by the bidder, or is it referring to the bidders overall company turnover rate for same or similar contracts? If it referring to the bidders overall company turnover rate, is it to be provided in the Past Performance section of the proposal or in the Management Plans/Quality Control section of the proposal?

It is the overall company turnover rate for same or similar contracts; you can include this information in Management Plans/Quality Control.

84 E.9 52.212-2 EVALUATION— COMMERCIAL PRODUCTS

ANDCOMMERCIAL SERVICES (NOV 2021) (p. 145) - In the Evaluation Sub-Factor B - Suitability and Accessibility of Facility, it states, within ten (10) days after award, 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 also 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.

If the bidder plans to buildout a new facility, is it acceptable if the bidder provides the state or local inspection of the facility upon completion of the construction?

Is the bidder to demonstrate that the proposed building will meet the codes for building, fire, and safety in our proposal or after contract award?

Yes, it is acceptable to provide the state or local inspection of the facility upon completion of construction; RFP updated.

85 E.9 52.212-2 EVALUATION— COMMERCIAL PRODUCTS

ANDCOMMERCIAL SERVICES (NOV 2021) (p. 146, 148) - In the Evaluation Sub-Factor C - Management Plans / Quality Control, it states to submit proposed back up staffing plan in the event a provider or staff member is absent for short or long periods of time. The plan should demonstrate the ability to provide appropriate staff on short notice with the intent of providing services with seamless or minimum disruption in services. In Sub-Factor E - Key Personnel, it states to describe contingency plan for covering enrolled patient's appointments due to scheduled or unscheduled vacancies to ensure that full patient grid of appointments is covered. The plan should demonstrate how Contractor shall provide seamless or minimal disruption in services.

Include identified locum and/or permanent staff that may be privileged in advance to cover routine and emergency vacancies.

Which section should the back up staffing plan for absences short or long term/ scheduled or unscheduled vacancies be located in the proposal, Sub-Factor C or Sub- Factor E?

The proposed backup staffing plan should be reflected in your response to Subfactor C. The contingency plan is a separate plan, that may reference some similarities from the backup staffing plan. The contingency plan should be located in response to Subfactor E.

86 E.9 52.212-2 EVALUATION— COMMERCIAL PRODUCTS

ANDCOMMERCIAL SERVICES (NOV 2021) (p. 146, 147) In Sub-Factor C - Management Plans / Quality Control in the Evaluation Factors, it states, demonstrate your recruitment and retention plans and policies to ensure stability of professional staff at the CBOC. (PWS Reference: 2.21). In Sub-Factor E - Key Personnel, it states: "Describe the mechanisms you will employ to recruit and retain key personnel.

Recruitment and Retention Plan should be reflected in your response to Subfactor E.

Would the VA like to see the Recruitment and Retention Plan in Sub-Factor C or Sub-Factor E?

87 In the Deliverables/Reports it states laboratory information / accreditation certificates are required with the proposal.

Given that we are not the incumbent contractor with an existing facility, we can't obtain a CLIA certificate until after contract award once we have credentialed the clinic physician director. Is it acceptable to the VA if the contractor provides the CLIA certificate after contract award and prior to providing patient care?

Yes, this is acceptable, and the solicitation will be updated to reflect this change. The Deliverables/Reports attachment is updated.

88 In the Deliverables/Reports it states time and attendance logs are required upon submission of invoices.

Given that this is a firm fixed price contract, why would time and attendance logs be required?

This deliverable is removed, and the Deliverables/Reports attachment is updated.

89 There is no mention of the Past Performance Survey in the instructions to offeror.

Is the bidder required to provide all their past performance references with the Past Performance Survey to complete and have them submit directly to the VA?

This is a determination made by the offeror.

Although any completed Past Performance Survey/Questionnaire shall be submitted by the reference and not the offeror. Past Performance Survey/Questionnaire are encouraged.

The following updates are incorporated via this amendment:

1. Add a Section for Past Performance in Volume I - RFP E.1.1 ADDENDUM to FAR 52.212-1

INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES –

INSTRUCTIONS FOR THE PREPARATION OF PROPOSAL. Changes are in red, bold italics.

FROM:

1) Email one (1) copy of Volume I. Volume I shall be separated into sections as follows:

• Section 1 – Signed 1449 and Signed Amendments; B.1 Contractor Administration Information

• Section 2 – Completed B.2 Schedule of Price and Services

• Section 3 – All RFP attachment documents requiring signatures

TO:

1) Email one (1) copy of Volume I. Volume I shall be separated into sections as follows:

• Section 1 – Signed 1449 and Signed Amendments; B.1 Contractor Administration Information

• Section 2 – Completed B.2 Schedule of Price and Services

• Section 3 – All RFP attachment documents requiring signatures

• Section 4 – Past Performance

2. E.9 52.212-2 EVALUATION— COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV

2021); SUB-FACTOR B; Bullet 5. Changes are in red, bold italics.

FROM: Within ten (10) days after award, 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 also 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. (PWS Reference: 12)

TO: Within ten (10) days after award or upon completion of construction, 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 also 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. (PWS Reference: 12)

3. PWS Section 2.1 is updated to reflect the current enrolled patients for primary care. Changes are in red, bold italics.

FROM: Total Estimated Patients enrolled/assigned to site: 2,442.

TO: Total Estimated Patients enrolled/assigned to site: 1,716.

See attached document: Attachment D.6 - Deliverables-Reports Table A0002.