36C25019R0093-001.docx

36C25019R0093

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.

DUNS:

DUNS+4:

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. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C25019R0093 12-06-2019 Lisa Bailey 317-988-1530 01-24-2020

15:00 ET

Department of Veterans Affairs Network Contracting Office 10 8888 Keystone Crossing Suite 1100 Indianapolis IN 46240

X

621498 $20.5 Million

N/A

Department of Veteran Affairs Northern Indiana Healthcare System

2121 Lake Avenue Fort Wayne IN 46805

Department of Veterans Affairs Network Contracting Office 10 8888 Keystone Crossing Suite 1100 Indianapolis IN 46240

Please submit invoices in accordance with VAAR Part 852.232-72

See CONTINUATION Page Contractor shall provide community-based outpatient clinic (CBOC) services in the southeast area of Goshen, Indiana (Elkhart County) or in the northeast area of Warsaw, Indiana (Kosciusko County) for eligible Veterans Northern Indiana Healthcare System (NIHCS).

See CONTINUATION Page

WILL BE FUNDED BY INDIVIDUAL ANNUAL TASK ORDERS

One

Lisa Bailey Contracting Officer

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: _____________________________

DUNS# _____________________

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: 52.23233, Payment by Electronic Funds Transfer – System for Award Management

3. INVOICES: Invoices shall be submitted in arrears: Monthly

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.

All invoices shall include the following:

· Invoice Number

· Invoice Date

· Purchase Order Number (will always begin with 610)

5. CHANGES/MODIFICATIONS TO THE CONTRACT: The Contracting Officer will be the only person authorized to approve changes or modify any of the requirements under this resultant contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer will be authorized to make commitments or issue changes that affect price, quantity, delivery or quality of performance of this resultant contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered unauthorized by the local VAMC and no adjustment will be made in the contract price to cover any increase in cost incurred as a result thereof.

6. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

7. SECURE FAX: In accordance with VA Handbook 6500, the following statement is required on all fax cover sheets; if it is determined the ordering process will include a fax: “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.”

8. POST-AWARD ORIENTATION (Contract Awards Exceeding $1M): The Contracting Officer will schedule a post-award orientation conference for contract orientation purposes as required by Procurement Policy Memorandum (PPM) 2019-01.

9. System for Award Management: Federal Acquisition Regulation requires contractor registration in the System for Award Management (SAM) database prior to the award of a contract. Offerors and Contractors may obtain information on registration and annual confirmation requirements via the internet at https://www.sam.gov/portal/public/SAM/.

B.2 SCHEDULE OF SERVICES

Contractor shall provide community-based outpatient clinic (CBOC) services in the southeast area of Goshen, Indiana (Elkhart County) or the northeast area of Warsaw, Indiana (Kosciusko County) for eligible Veterans of the Department of Veterans Affairs (VA), Northern Indiana Healthcare System (NIHCS), 2121 Lake Avenue, Fort Wayne, IN 46805. The services are for a 12-month base year with nine (9) 12-month option year renewals, which may be exercised at the discretion of the Government.

The guaranteed minimum only applies to the Federal Government Fiscal Year in which the contract is awarded. The total minimum amount, or guaranteed minimum of this contract is $950,000.00. The minimum guaranteed amount shall be expended in the initial fiscal year in which this contract is awarded. The maximum total value of the contract, inclusive of the base year and all options exercised, shall not exceed $40,000,000.00. Individual task orders shall be funded annually. The Contracting Officer is the only authorized individual that can place annual task orders against this contract for the estimated amount of services for the specific timeframe, and the task orders shall be issued to the contractor. Offerors shall offer pricing for the entire estimated quantity for each CLIN.

Note: PMPM includes cost of unassigned patient visits, contractor shall not bill separately or propose an additional CLIN or bill separately for these costs.

BASE YEAR: 4/1/2020 to 3/31/2021

Total Estimated Cost

Total for Base Year: $________________________

OPTION YEAR 1: 4/1/2021 to 3/31/2022

Total Estimated Cost

Total for Option Year 1: $________________________

OPTION YEAR 2: 4/1/2022 to 3/31/2023

Total Estimated Cost

Total for Option Year 2: $________________________ OPTION YEAR 3: 4/1/2023 to 3/31/2024

Total Estimated Cost

Total for Option Year 3: $________________________

OPTION YEAR 4: 4/1/2024 to 3/31/2025

Total Estimated Cost

Total for Option Year 4: $________________________

OPTION YEAR 5: 4/1/2025 to 3/31/2026

Total Estimated Cost

Total for Option Year 5: $________________________

OPTION YEAR 6: 4/1/2026 to 3/31/2027

Total Estimated Cost

Total for Option Year 6: $________________________

OPTION YEAR 7: 4/1/2027 to 3/31/2028

Total Estimated Cost

Total for Option Year 7: $________________________

OPTION YEAR 8: 4/1/2028 to 3/31/2029

Total Estimated Cost

Total for Option Year 8: $________________________

OPTION YEAR 9: 4/1/2029 to 3/31/2030

Total Estimated Cost

Total for Option Year 9: $________________________

GRAND TOTAL FOR BASE YEAR AND ALL OPTION YEARS 1-9: $________________________

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. SERVICES REQUIRED: Contractor shall provide community-based outpatient clinic (CBOC) services in the southeast area of Goshen, Indiana (Elkhart County) or in the northeast area of Warsaw, Indiana (Kosciusko County) for eligible Veterans at the Department of Veterans Affairs (VA), Northern Indiana Healthcare System (NIHCS), 2121 Lake Avenue, Fort Wayne, IN 46805. The services are to be provided in a private hospital, office, or clinic environment to Veterans primarily residing in the Elkhart County but shall also serve Veterans residing in Kosciusko, Lagrange, and Noble Counties.

1.1.1. [X] Primary Care CBOC: offer both medical (physically on site) and mental health care (either physically on site or 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 shall be provided by the NIHCS Mental Health staff on-site, and, when appropriate or needed, by NIHCS Mental Health staff at other locations via telehealth.

1.2. PLACE OF PERFORMANCE: The contractor shall establish one location in the Goshen, Indiana area (Elkhart or Kosciusko Counties).

1.3. AUTHORITY: In accordance with FAR Parts 12, 15, and Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of NIHCS

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. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, patient safety and performance, including, but not limited to, the following:

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. BAA: Business Associate Agreement

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

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: chronic obstructive pulmonary disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

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

1.5.36. CPARS: Contractor Performance Assessment Reporting System

1.5.37. CVT: Clinical Video Telehealth

1.5.38. DICOM: Digital Image and Communication in Medicine

1.5.39. DIGMA: Drop in Group Medical Appointment

1.5.40. DRG: Diagnostic Related Group

1.5.41. DSS: Decision Support System

1.5.42. ECC Extended Care Center

1.5.43. 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.

1.5.44. EPRP: External Peer Review Program

1.5.45. FDA: Food and Drug Administration

1.5.46. FSMB: Federation of State Medical Boards

1.5.47. HCC: Health Care Center an 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.

1.5.48. HHS: Department of Health and Human Services

1.5.49. HCFA: HealthCare Financing Administration

1.5.50. 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.

1.5.51. HT: Home Telehealth

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

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

1.5.54. iMED: Software VA uses for Electronic Informed Consent

1.5.55. INR: International Normalized Ratio

1.5.56. ISO: Information Security Officer

1.5.57. LIP: licensed independent practitioner

1.5.58. MCCR: Medical Care Cost Recovery

1.5.59. MENTAL HEALTH (MH) 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:

· Diagnostic and treatment planning evaluations for the full range of mental health problems;

· Treatment services using evidence-based pharmacotherapy, or primary evidence-based

· psychotherapy for patients with mental health conditions and substance use disorders;

· Patient education;

· Family education when it is associated with benefits to the Veterans;

· Referrals as needed to inpatient and residential care programs; and

· Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST)

Specialty Mental Health Services Include:

· Consultation and treatment services for the full range of mental health conditions;

· Evidence-based psychotherapy;

· Mental Health Intensive Case Management (MHICM);

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

· PTSD teams or specialists;

· MST special clinics;

· Homeless programs; and

· Specialty substance abuse treatment services

1.5.60. MQSA: Mammography Quality Standards Act

1.5.61. MSN: Master of Science in Nursing

1.5.62. NCCPA: National Commission on Certification of Physician Assistants

1.5.63. NLN: National League for Nursing

1.5.64. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.5.65. OTC: Over the Counter

1.5.66. PA: Physician Assistant

1.5.67. PACS: Picture Archiving and Communications System

1.5.68. 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.

1.5.69. PARENT FACILITY: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.70. PCMH: Patient-Centered Medical Home

1.5.71. PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.5.72. PCP: Primary Care Provider

1.5.73. Phar.D.: Doctor of Pharmacy

1.5.74. POC: Point of Care Testing

1.5.75. 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.

1.5.76. PCMHI: Primary Care-Mental Health Integration

1.5.77. PWS: Performance Work Statement

1.5.78. QAPI: Quality Assessment and Performance Improvement

1.5.79. QASP: Quality Assurance Surveillance Plan

1.5.80. RME: reusable medical equipment

1.5.81. SOP (Clinical): Scope of Practice

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

1.5.83. SFT: Store and Forward Telehealth

1.5.84. SMA: Shared Medical Appointments

1.5.85. SMI: Serious Mental Illness

1.5.86. SPD: Sterile Processing Division

1.5.87. SPE: Senior Procurement Executive

1.5.88. 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.

1.5.89. SUD: Substance Abuse Disorders

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. TJC: The Joint Commission

1.5.92. TIU: Text Integration Utility

1.5.93. TCT: Telehealth Clinical Technicians

1.5.94. VA: Veterans Affairs

1.5.95. VA EHR: VA Electronic Health Record

1.5.96. VAMC: Veterans Affairs Medical Center

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

1.5.98. VHA: Veterans Health Administration

1.5.99. WHEN: Weekend Holiday Evenings Nights (a call center system)

1.5.100. WH-PCP: Women’s Health Primary Care Provider

2. STAFFING AND QUALIFICATIONS

2.1. MINIMUM 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 1200 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. Total Estimated Patients enrolled/assigned to this site: 3,300.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES):

2.2.1. FTE Ratio Performance Standard per PACT: 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/or board eligible by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Physicians shall be licensed in the state of Indiana, where the Outpatient Site of Care (i.e. CBOC) is located. 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).

Position Responsibilities: Serves as Medical Director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site and shall assume the leadership role for improvement activities in the clinic.

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

All primary care teamlet staffing shall be provided by the contractor. The selection of teamlet and specialty team staffing mix is the responsibility of contractor.

2.3.1. TEAMLET MEMBER 1: PCP

FTE Ratio Performance Standard: Current standards are twelve hundred (1200) active patients per full time physician and nine hundred (900) active patients per full time mid-level 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 (1) PCP shall be a Physician.

2.3.1.1. OPTION 1: Physician (MD):

Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine (IM) or Family Practice (FP). Physicians performing under this contract shall be board certified/or board eligible by the ABMS in IM and/or FP or the BOS in IM and/or FP. Authorization for prescriptive authority is required. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days.

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 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.

2.3.1.2. OPTION 2: Certified Registered Nurse Practitioner (CRNP):

Qualifications: CRNP’s (including subcontractors) shall have an MSN from an NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health (AH) or FP. Authorization for prescriptive authority is required. Three (3) 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 FM or IM environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e. CBOC); Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2 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 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.

2.3.1.3. OPTION 3: Physician Assistant (PA):

Qualifications: PA’s (including subcontractors) shall 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 shall total at least five (5) years. Authorization for prescriptive authority is required. PAs shall be certified by the NCCPA. PA shall have current, full, active, and unrestricted license and registration in the state of the Outpatient Site of Care (i.e. CBOC); VA HANDBOOK 5005/78 PART II APPENDIX G8 PHYSICIAN ASSISTANT QUALIFICATION STANDARD http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=763&FType=2.

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 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: RN Care Manager

FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2 Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and 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 of the Outpatient Site of Care (i.e. CBOC).

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 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.

for all sites

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 Associate from the options below.

2.3.3.1. OPTION 1: Licensed Practical Nurse (LPN):

Qualifications: VA Directive 5005/3 PART II APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC).

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.

2.3.3.2. OPTION 2: 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.

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 ability 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.

for all sites

2.3.4. TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE

FTE Ratio Performance Standard: Current standard is 1.0 FTE clerical associate per 1.0 FTE PCP per 1200 patients.

Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.4. DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated.

2.4.1. DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS)

Responsible Party: NIHCS to provide on-site CPS PACT: FTE Ratio Performance Standard: 1.0 FTE per 3 PACTs Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. CPS who is a licensed pharmacist who is a graduate of an Accreditation Council for Pharmacy Education (ACPE) accredited College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or a Doctor of Pharmacy (Phar.D.) degree and has at least 1 year of pharmacy equivalent experience at the next lower level at time of employment. In addition to the requirements listed above, the CPS must meet licensed qualification standards to include a graduate of a degree program in pharmacy from an approved college or university and have post-graduate experience performing chronic disease state and medication management services (e.g., post-graduate residency, direct patient care under collaborative practice agreement or similar equivalent experience). The CPS has duties and responsibilities as defined in VA Handbook 5005, Part 2, Appendix G15, Licensed Pharmacist Qualification Standards at https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC). Authorization for a VA scope of practice is required, in accordance with VHA Handbook 1108.11 or subsequent policy release and must adhere to pharmacy practice acts within that state. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care. Clinical Pharmacy Specialists shall be scheduled to sufficiently provide the needs of enrolled patients functioning in the capacity of a mid-level provider (under SOP or collaborative practice agreement) as their primary duty is to assist providers with comprehensive medication management (chronic primary care disease management)..

2.4.2. DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-COAGULATION:

Responsible Party: NIHCS to provide on-site CPS FTE Ratio Performance Standard: 1.0 FTE per 5 PACTs.

Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. CPS who is a licensed pharmacist who is a graduate of an Accreditation Council for Pharmacy Education (ACPE) accredited College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or a Doctor of Pharmacy (Phar.D.) degree and has at least 1 year of pharmacy equivalent experience at the next lower level at the time of employment. In addition to the requirements listed above, the CPS. Pharmacists must meet licensed qualification standards to include a graduate of a degree program in pharmacy from an approved college or university and have post-graduate experience performing chronic disease state and medication management services (e.g., post-graduate residency, direct patient care under collaborative practice agreement or similar equivalent experience). The degree program must have been approved by the ACPE. Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC). The CPS has duties and responsibilities as defined in VA Handbook 5005, Part 2, Appendix G15, Licensed Pharmacist Qualification Standards https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. Authorization for a VA scope of practice is required, in accordance with VHA Directives 2008-043 and 2009-014 or subsequent policy release and must adhere to pharmacy practice acts within that state. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care. Clinical Pharmacy Specialists shall be scheduled to sufficiently provide the needs of enrolled patients functioning in the capacity of an advanced practice provider (under scope of practice or collaborative practice agreement) as their primary duty is to assist providers with comprehensive medication management (i.e. anticoagulation therapy management).

2.4.3. DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER

Responsible Party: NIHCS to provide on-site FTE Ratio Performance Standard: 1 FTE per 2 PACTs Qualifications: Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC).