36C25021Q0183.docx

36C25021Q0183

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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

36C25021Q0183 12-23-2020 Karen Williams 614-257-5220 01-11-2021 2:00

EST

36C250 Department of Veterans Affairs Network Contracting Office (NCO) 10 Chalmers P. Wylie Ambulatory Care Center 420 North James Road Columbus OH 43219-1834 X X 621111 $30 Million N/A X 36C610 Department of Veterans Affairs Northern Indiana Health Care System 1700 E. 38th Street Marion IN 46953-4568 36C250 Department of Veterans Affairs Network Contracting Office (NCO) 10 Chalmers P. Wylie Outpatient Clinic 420 North James Road Columbus OH 43219-1834

36C250 Department of Veterans Affairs Financial Services Center Invoices to be Submitted Electronically www.ob10.com/us/en/veterans-affairs// e-Invoice Setup Info Phone 877-489-6135 877-353-9791 512-460-5429 See CONTINUATION Page Contractor to provide 3.3 FTE Board Certified Medical Officer of the Day (MOD) Physician Services for the VA Northern Indiana Health Care System (VANIHCS) in Marion, IN.

The period of performance for this solicitation and resultant contract is for one year.

See the Price Schedule and Performance Work Statement See CONTINUATION Page X X Karen Williams 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’S NAME/ADDRESS/CITY/STATE-ZIP (Please print or type):

Point of Contact/Title: ____________________________ ____________

Telephone: _______________________________

Facsimile #: _______________________________

E-mail: __________________________________

DUNS NO: ________________________________

b. GOVERNMENT:

Karen Williams, Contract Specialist Department of Veterans Affairs Network Contracting Office (NCO) 10

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: 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 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.

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

5. 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.

6. 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 to the contract price to cover any increase in cost incurred as a result thereof.

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

8. POST AWARD ORIENTATION: The Contracting Officer may schedule a post-award orientation conference in accordance with FAR 42.503 or via post award letter in accordance with FAR 42.504.

9. The Contracting Officer’s Representative (COR) will be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority.

36C25021Q0183

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B.2 PRICE SCHEDULE

The Contractor shall provide 3.3 FTE, Medical Officer of the Day (MOD)/Urgent Care physicians in accordance with specifications contained herein to beneficiaries of the Department of Veterans Affairs Northern Indiana Health Care System (VANIHCS) located at 1700 E. 38th Street, Marion, IN 46953.

The contractor shall propose a sufficient number of key personnel to be credentialed and be available for scheduling to meet the FTE requirements.

The contract line item number (CLIN) is all inclusive of services, travel, housing, airfare, etc., and shall be priced as such.

Period of Performance: March 25, 2021 through March 24, 2022

(3.3 FTE)

B.3 PERFORMANCE WORK STATEMENT

Medical Officer of the Day (MOD)/ Urgent Care Physician Services

1. DESCRIPTION OF SERVICES

1.1. The contractor shall provide Medical Officer of the Day (MOD)/Urgent Care physician coverage at the VA Northern Indiana Health Care System (VANIHCS), 1700 E. 38th Street, Marion, IN, 46953. The physician designation of MOD delineates the responsibility of a sole provider on duty during the prescribed hours of coverage, to service the Urgent Care department and provide medical back-up and assistance to the Community Living Center (CLC), Mental Health (MH), Substance Abuse Residential Recovery Treatment Program (SARRTP) services. Hours of coverage shall be from 4:30pm through 8:00am Monday through Friday; 4:30pm Friday through 8:00am Monday; (entire weekend); and ten (10) Federal Holidays. Physicians shall not work longer than 24 consecutive hours. The minimum qualifications shall meet 621-001 Physician, Internal Medicine or Family Practice.

1.2. The contractor shall provide with advance notice of a minimum fourteen (14) business days coverage 4:30pm-8:00am at the Marion NIHCS campus.

1.3. The Contractor shall provide additional coverage for the day tour, 8:00am through 4:30pm for the urgent care to cover vacations and/or emergency leave situations of VANIHCS Staff. The VA will give a minimum of seven (7) business days' notice of any such needed coverage.

1.4. All physicians performing services for the Contractor under this contract shall be credentialed and privileged by the VANIHCS, and shall abide by the most current VANIHCS Medical Staff Bylaws (included in attachments) and all other facility policies, including the health information management policy. The Contractor shall be responsible for meeting all performance improvement quality standards set forth in the most current The Joint Commission (TJC) Accreditation Manual for Hospitals, current fiscal year VHA Performance Measurement System Technical Manual, and all applicable VHA/VA policies, procedures, and directives.

1.5. Upon award of the contract, the Contractor shall provide a staff roster of all physicians intending to perform under this contract. The VA shall receive notification of proposed changes to this list at least 30 days prior to a new physician performing services. A schedule indicating which physicians shall perform for the first 30 days of the contract shall be provided immediately after award. Schedules for the remainder of the contract period are to be provided monthly, at least 15 days prior to the start of the scheduled month. The VA will have complete discretion on approval/disapproval of physicians performing services under this contract. When the Government directs, the Contractor shall remove from performance on the contract any person who is identified as a potential threat to the health, safety, security, general wellbeing, or operational mission of the VANIHCS and its population.

1.6. VANIHCS provides ancillary and administrative support staff as well as Police/Security on site 24 hours a day, seven (7) days a week.

1.6.1. VHA Handbook 1100.17: National Practitioner Data Bank Reports https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.6.2. VHA Handbook 1100.18: Reporting and Responding to State Licensing Boards https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.6.3. VHA Handbook 1100.19: Credentialing and Privileging https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.6.4. VHA Directive 1192: Seasonal Influenza Prevention Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.6.5. VHA Directive 1220: Facility Procedure Complexity Designation Requirements to Perform Invasive Procedures In Any Clinical Setting https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8365

1.6.6. VA Directive 1663: Health Care Resources Contracting - Buying https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.6.7. VHA Handbook 1907.01 Health Information Management and Health Records https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.6.8. Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.6.9. VHA Handbook 1103.03: Organ, Tissue, and Eye Donation Process - http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3072

1.6.10. VHA Handbook 1106.01: Pathology and Laboratory Medicine Service (P&LMS) Procedures - http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3169

1.7. Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of conflict in language between the definitions and other sections of this contract, the language in this section shall govern.

1.7.1. AOD- Administrative Officer of the day

1.7.2. Contracting Officer (CO)- The representative of the VANIHCS who has the authority to enter into, administer, terminate, modify, approve changes, or otherwise represent and bind the VANIHCS in all matters under or relating to this contract.

1.7.3. Contracting Officer Representative (COR)- Individual(s) who furnishes technical guidance and advice or generally supervisees the work performed under the contract. Designations will be in writing and will define the scope and limitation of the representative’s authority.

1.7.4. CPRS—Computerized Patient Record System. A computer software systems used by the VA for the electronic patient record and to track patient use of services.

1.7.5. DHCP—Decentralized Hospital Computer Program. The MUMPS-based computer software system used by the VA for electronically tracking of workload, procedures, cases, progress notes and time.

1.7.6. EDIS- Emergency Department Integration Software

1.7.7. HCFA/CMS – Health Care Financing Administration; renamed Centers for Medicare and Medicaid Services. CMS, formerly known as HCFA, is a division of the Department of Health and Human Services that administers the Medicare and Medicaid programs at the federal level. It is the contracting agency for HMO’s seeking direct contractor/provider status for the provision of Medicare benefits package.

1.7.8. M&M—Morbidity and Mortality

1.7.9. MCM—Medical Center Memorandum

1.7.10. MOD- Medical Officer of the Day

1.7.11. NOD- Nurse Officer of the day

1.7.12. NVCC- Non-VA Care Coordination

1.7.13. PI—Performance Improvement or Peer Review

1.7.14. PIV- Personal Identity Verification

1.7.15. Quality Management/Quality Assurance/Quality Improvement (QM/QA/QI)—The ongoing process of assuring that the delivery of the health care is appropriate, timely, accessible, available, medically necessary, and in keeping with established guidelines and standards and reflective of the current state of medical knowledge.

1.7.16. TJC- The Joint Commission

1.7.17. VA NIHCS— Veterans Administration Northern Indiana Healthcare System

1.7.18. VetPro—Veterans Health Administration credentialing software.

1.7.19. VHA—Veterans Health Administration

1.7.20. VISN—Veterans Integrated Health Administration

1.7.21. VISTA—Veterans Health Information System. VISTA is built on a client-server architecture, which ties together workstations and personal computers with graphical user interfaces at Veterans Health Administration (VHA) facilities, as well as software developed by local medical facility staff.

2. RESPONSIBILITIES

2.1. The Medical Officer of the Day (MOD)/Urgent Care physician Marion is the clinical representative of the Medical Center Director and the Chief of Staff, advising hospital clinical operations in their absence. The Urgent Care MOD shall not leave the medical center grounds during the tour of duty unless relieved by another physician, and the Administrative Officer of The Day (AOD) shall be notified. The Urgent Care MOD physician shall carry a pager at all times during the assigned tour of duty and will readily available to the Urgent Care and all unit nursing staff when called upon. The Urgent Care MOD shall be available at all times for consultation and direct patient care by nursing with any and all inpatients on the following units: Community Living Center (CLC), Mental Health (MH), Substance Abuse Residential Recovery Treatment Program (SARRTP) services, Long Term Care, Acute and Chronic Psychiatry. The Urgent Care MOD is also responsible for attending and leading emergency codes during their tours of duty.

2.1.1. Telephone Contacts: Information should be obtained and action should be taken under the following conditions:

2.1.1.1 In the event an outside physician recommends admission.

2.1.1.2. If ambulance transportation is necessary and requested by said physician.

2.1.1.3. When a caller is not a physician, i.e., service officer, guardian, responsible relative, the MOD must ascertain if an outside physician has recommended (a) and (b) of the above.

2.1.1.4. The Urgent Care MOD may authorize ambulance travel when medically indicated upon patient presentation.

2.1.2. Admission and ambulance transportation will be authorized if a responsible nursing home official requests the immediate return of a Veteran still under VA contract for an emergency medical condition. This applies to those Veterans under contract from other VA medical centers as well.

2.1.3. Triage and/or treat all patients presenting to the urgent care, including those with intoxication, substance abuse, psychiatric problems or those Veteran referred by other local hospitals.

2.1.4. Patient medical history and physical exams appropriate to the care setting shall be performed by the physician and documented in accordance with VANIHCS Bylaws/Rules/Regulations (included in attachments), guiding Medical Center policies, and as clinically indicated by patients signs, and symptoms (History and Physical Examinations for Inpatients and Outpatients MCM, 11-21, see). Patient medical records, notes, and encounters must be signed before the end of each shift. In order to obtain appropriate reimbursement, the contract physician must ensure that all elements within their medical documentation is signed, checked-out, and 100% completed.

2.1.5. Attend to patients who are judged to be potential threats to themselves or others, or who are incapable of comprehending risks. These patients may require initiation of a 24-hour hold or appropriate, least restrictive restraints (documented with a specific length of duration) in accordance with facility policies to permit complete evaluation. Physicians must follow all medical center policies for patients placed in restraints as require continued timely documentation.

2.1.6. Prescribing Medications: The contracted personnel shall be responsible for prescribing medications as needed, and shall be required to utilize the VA’s formulary. The formulary shall be provided to the Contractor upon contract award. Medication reconciliation shall be completed during each patient encounter in the Urgent care, and upon patient admission and discharge.

2.1.7. Document the findings from assessment and reassessment shall be clearly documented in the medical record, which is used by all members of the interdisciplinary care team in care planning and treatment. Assessment for invasive procedures will include all elements as explicitly outlined in the VANIHCS Bylaws and applicable policies. All required documentation shall be fully completed within VANIHCS- required timeframes.

2.1.8. While providing care, the physician(s) will be responsible for the coordination evaluation, treatment, and overall medical management for eligible Veterans evaluated and treated within the Urgent Care. Appropriate referral transfer of the Veteran shall be arranged by the physician for care that cannot be delivered in VANIHCS clinical setting. Referrals to other VAMCs will be performed in accordance with VANIHCS policies and procedures.

2.1.9. The contracted physician(s) will ensure medical record documentation contains at a minimum or exceeds Health Care Financing Administration/ Medicare guidelines, which supports patient care and the VANIHCS medical cost care recovery initiatives.

2.1.10. A physician’s employee shall be actually performing the required services for the period specified in the contract or the contract cost shall be decreased accordingly during each billing cycle. The payments for any leave, including sick leave, holidays, or vacation time shall be the responsibility of the Contractor.

2.1.11. All physicians shall have current ACLS certification and shall maintain certification during length of contract in accordance with VANIHCS policies and procedures.

2.1.12. The physician(s) shall be responsible for using the EDIS program as required in directive for each Veteran seen. This is a requirement for both the Urgent Care under directive VHA 2011- 029. EDIS entries will be entered by the contract physician timely during each patient encounter. EDIS must be documented in accordance with Urgent Care/ Emergency Medicine VHA Directive.

2.2. Community-Based Veterans: During weekend and holiday hours, the Urgent Care MOD may obtain updates on the conditions/treatment plans of all Veterans being provided care under a Fee for Service arrangement. When clinically appropriate the provider will facilitate their transfer to VANIHCS or another VA Facility.

2.3. Emergency/Disaster Procedures: In case of fire or other medical center disaster, Urgent Care MOD shall immediately take charge of the evacuation of patients in accordance with published regulations. He/she shall also notify the Director of the nature of the emergency or disaster and report what action has been taken. All physicians providing services under this contract shall ensure that he/she is familiar with fire and disaster instructions and shall participate in all fire and disaster drills conducted during his/her tours of duty.

2.4. Consultation: The good conduct of medical practice includes the proper and timely use of consultation. Consultation may be made when necessary with the VA medical backup physician, surgeon on call, psychiatrist on call, specialty physician, social worker on call, etc.

2.5. Cardiopulmonary Resuscitation Team: All physicians shall have both current Basic Life Support (BLS) & Advanced Cardiovascular Life Support (ACLS) Certification. Urgent Care MOD’s shall respond to codes occurring during their tour of duty including mock codes, will lead the code team, stay until completed, and participate in the post-Code Blue critique process in accordance with VANIHCS policy.

2.6. Emergency Surgical Procedures: When a patient in the medical center or a newly admitted patient is suspected of having a surgical condition warranting early attention, the surgeon on-call shall be called for a consultation. Based on the consultation, if the patient needs to be transferred to another VA or a private facility, the contracted physician(s), in coordination with the on-call surgeon, shall arrange the transfer.

2.7. Blood Transfusions: All physicians providing services under this contract shall be fully familiar with the procedure governing the administration of blood (Policy No. 113-03). When the blood is requested from the Red Cross Blood Bank and delivery cannot be made promptly, the physicians shall request the police officer on duty to pick up the blood. The laboratory technician shall coordinate the blood pickup. If the requested blood is not available from the Red Cross Blood Bank, community hospitals should be canvassed to see if the blood might be obtained from them.

2.8. Restraints/Seclusion: All physicians providing services shall review Policy No. 116-01, Use of Restraint for Behavioral Health Reasons, and Policy No. 111A-13. Medical Care Restraints, and comply with the requirements therein, contained within the attachments.

2.9. Observation Status: When patients meet Interqual criteria for observation status, they shall be admitted to the respective unit under this status.

2.10. Inter facility transfers: When patients are transferred to another facility from the Urgent Care, the physician shall ensure the patient is stable for transfer and is accepted by another physician. An inter-facility transfer note shall be completed to accompany the patient.

2.11. Release of Information: Any requests from the Police Department or any request for release of information concerning a Veteran beneficiary shall be referred to the Administrator on Duty (AOD).

2.12. Death: In case of death of a patient during irregular tours of duty, the physicians shall review autopsy guidelines and policy, VHA Handbook 1106.01 (see directive link above) on organ donation.

2.13. Reporting: The Inpatient provider shall provide written and verbal hand-off at the end of their tour in the following manner. At 7:45am Monday through Friday the Urgent Care MOD shall hand off verbally to the oncoming Urgent Care physician each weekday and weekend, every shift to review current patient status, relevant medical history, treatment course, and anticipated disposition.

2.14. Orientation: All physicians shall be oriented to the appropriate policies and procedures by the facility Education Coordinator and service chiefs. Orientation is provided on a bi-weekly basis and shall be accomplished at the earliest possible date, prior to the first day of scheduled duty. All contracted providers must complete applicable TMS modules, training and orientation prior to providing any services at VANIHCS.

2.15. Administrative Officer of the Day Functions: The AOD relieves the Urgent Care MOD provider (if applicable) of all administrative functions not requiring medical decisions. The duties consist of receiving admission calls, making and receiving telephone contacts with other VA facilities and private hospitals, arranging conference calls between physicians and other hospitals, determining legal eligibility of applicants, assisting next-of-kin with funeral arrangements, and any other duties as assigned. Questions regarding going on diversion will be addressed according to VANIHCS Policy No. 11-48 (included in attachments). Diversion of Patients, and at a minimum, a physical count of patients and beds will occur with the NOD of the affected unit(s).

2.16. Documentation/Communication: Documentation and clinical records shall be complete, timely, and reported in compliance with VANIHCS policies and procedures, Medical Staff Bylaws, TJC standards, VA regulations, Health Care Financial Administration (HCFA) and the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The Contractors’ employees shall be trained on the proper use of various VA systems including Veterans Health Information Systems and Technology Architecture VistA and CPRS. Contractor’s employees shall submit a report of the patient treatment activity of the previous tours to the Associate Chief of Staff, Medical Service, at a specified time and area. Documentation must also occur in the Emergency Department Integration Software System (EDIS) for every patient seen in the Urgent Care.

2.17. Badges: Contractor shall be required to wear the Government furnished picture ID badge during the entire time he/she is on VA grounds. The ID badge shall be returned to VA at contract completion. All contracted physicians shall be required to maintain current PIV badges at all times.

3. CERTIFICATIONS AND QUALIFICATIONS

3.1. Personnel assigned by the Contractor to perform the services covered by this contract shall be licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia. The qualifications of such personnel shall also be reviewed by the VANIHCS Professional Standards Board and concurred by Clinical Executive Board and approved by the VANIHCS Director prior to being authorized to provide patient care services. The licensee shall have an active, current, full and unrestricted license to practice his/her profession. Physicians shall be board certified and/or board eligible in Internal Medicine or family practice. All qualified physicians shall be BLS & ACLS certified and trained. Internal medicine is preferred over family practice physicians.

3.2. All contractor personnel must have general Liability and Malpractice Insurance.

3.3. The VA may request the personnel records of nay employee providing services under this contract for competency review. The VA reserves the right to request copies of current certifications and/or licenses at any time during the duration of this contract.

4. HOURS OF OPERATION

4.1. VA Business Hours: VA business hours/hours of operation are Monday through Friday 8:00 am – 4:30 pm. The urgent care is open 24 hours a day, seven (7) day a week.

4.2. Work Schedule: Shall be from 4:30pm through 8:00am Monday through Friday; 4:30pm Friday through 8:00am Monday; (entire weekend); and ten (10) Federal Holidays.

4.3. The Urgent Care Physician (MOD) is required for 6896 hours per year on a Monday-Sunday, twelve – twenty-four hour shift basis to support the 24/7 UC operations and to service as the onsite medical officer of the day (MOD) within the Urgent Care and medical center, Marion IN

4.4. Federal Holidays: The 10 Federal holidays observed by the Federal Government are: New Year’s Day, President’s Day, Martin Luther King’s Birthday; Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day, and Christmas Day. Any other day specifically declared by the President of the United States to be a national holiday or administrative closure is also covered by this contract.

5. REIMBURSEMENT AND MONITORING

5.1. Monitoring of time shall be demonstrated through time and attendance logs. The contractor physician(s) shall be required to sign an attendance log upon reporting for duty and upon departure at the end of the shift. The AOD shall be the point of contact for the time and attendance logs. The Contracting Officer’s Representative (COR) is responsible for monitoring the contractor’s time.

6. PERSONNEL POLICY

6.1. The physician(s) shall be responsible for protecting the personnel furnishing services under this contract. To carry out this responsibility, the Contractor shall provide the following benefits for personnel:

6.1.1. Worker’s Compensation Insurance

6.1.2. Professional Liability Insurance

6.1.3. Health Examinations

6.1.4. Income Tax Withholding

6.1.5. Social Security Payments

6.2. The parties agree that such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor.

7. PERFORMANCE IMPROVEMENT

7.1. Contractor personnel shall actively participate in the VANIHCS Performance Improvement (PI) activities. As defined in the Medical Staff Bylaws, policies and procedures. The PI process utilizes pre-established, measurable indicators to document the effectiveness of health care delivery.

8. MEETING ATTENDANCE

8.1. The VANIHCS Medical Staff regularly meets in accordance with the Medical Staff Bylaws. The minutes of the Medical Staff meetings are available in the Inpatient MOD suite and shall be reviewed by each physician providing service under this contract, on a monthly basis.

9. SECURITY REQUIREMENTS FOR CONTRACTOR EMPLOYEES

9.1. Contractor(s) shall ensure the confidentiality of all patient and employee information and shall be held liable in the event of breach of confidentiality according to federal regulations contained in HIPAA. Any person, who knowingly or willingly discloses confidential information from the VA Medical Center, may be subject to fines of up to $50,000.00 and may be subjected to civil litigation from the patient.

9.2. Background Investigations: Contractor(s) personnel performing work under this contract shall satisfy all requirements for appropriate security eligibility in dealing with access to sensitive information systems belonging to or being used on behalf of the Department of Veterans Affairs. To satisfy the requirements of the Department of Veterans Affairs a Minimum Background Investigation (low level risk) shall be conducted prior to performing work under this contract. The level of access and the individual’s capability to perform work under this contract shall be the determining factor in deciding if a higher investigative requirement is needed. The Contractor(s) shall ensure that those requirements are fully satisfied within 30 days of initiation of such investigations.

9.3. Contractor Responsibilities: Contractors shall sign a Rules of Behavior document to be granted remote access if applicable. Additionally, access requests documentation shall be required by the Information Security Officer (ISO) to gain VPN access. All contractors, regardless of whether remote access is required, shall complete Cyber Security Training, VHA Privacy Policy Training and sign a Statement of Commitment ANNUALLY. Failure to comply with the Contractor personnel security requirements may result in termination of the contract for default.

9.4. The Contractor shall bear the expense of obtaining background investigations. If the Office of Personnel Management (OPM) conducts the investigation, the Contractor shall reimburse VA within 30 days.

9.5. The Contractor shall prescreen all personnel requiring access to the computer systems to ensure they maintain a U.S. citizenship and are able to read, write, speak and understand the English language.

9.6. The Contractor shall submit or have their employees submit the following required forms to the Contracting Officer within 30 days of receipt: Standard Form 85, Questionnaire for Non-Sensitive Positions; Optional Form 306, Declaration for Federal Employment; SF87 (Rev 4-84), U.S. Office of Personnel Management Fingerprint Chart; VA Form 0710, Authority for Release of Information Form.

9.7. The Contractor shall prepare and forward a listing of all Contractor personnel that shall be performing services under the contract that shall have access to VA computer systems. The contractor shall inform the contract employee that when filling out Standard Form 85, that there should be no gaps in employment history. Any gaps in employment history on Standard Form 85 may result in OPM rejecting the document for investigation.

9.8. Government Responsibilities: The VA Contracting Officer or COR will provide the necessary forms to the Contractor or to the Contractor’s employees after receiving a list of names and addresses.

9.9. Upon receipt, the VA Contracting Officer will review the completed forms for accuracy and forward the forms to VHA Service Center (VSC) to conduct the background investigation.

9.10. The VA facility will pay for investigations conducted by the Office of Personnel Management (OPM) in advance. In these instances, the Contractor shall reimburse the VA facility within 30 days. A bill of collection will be prepared by the VA and forwarded to the Contractor for payment. The estimated cost for a Low Risk Level (NACI) Background Investigation is $200.

9.11. The VA Contracting Officer will forward the completed background investigation packages to VSC. VSC will notify the Contracting Officer and Contractor after adjudicating the results of the background investigations received from OPM/ Contracting Officer.

9.12. The Contracting Officer will ensure that the Contractor provides evidence that investigations have been completed or are in the process of being requested.

9.13. The Contractor may utilize a private investigating agency if such agency possesses an OPM and Defense Security Service certification. A Cage Code number shall be provided to the VA Office of Security and Law Enforcement, which shall verify the information and advise the Contracting Officer whether Contractor’s access to the computer systems can be authorized.

9.14. The investigative history for Contractor(s) personnel working under this contract shall be maintained in the databases of either with OPM or the Defense Industrial Security Clearance Organization (DISCO). Should the Contractor(s) use another vendor other than OPM or Defense Security Service (DSS) to conduct the investigation, the investigative company shall be certified by OPM/DSS to conduct Contractor(s) investigations.

9.15. The Contractor shall be expected to maintain a Drug-free Work Place in accordance with Federal regulations. The Contractor shall establish and maintain a drug-free workplace program. The administration of this program shall be the responsibility of the contractor, as well as, the establishment of disciplinary actions.

9.16. All costs associated with obtaining clearances for Contractor(s) provided personnel shall be the responsibility of the Contractor(s). Further, the Contractor(s) shall be responsible for the actions of those individuals they provide to perform work for the VA under this contract. In the event that damages arise from work performed by Contractor(s) provided personnel, under the auspices of this contract, the Contractor(s) shall be responsible for all resources necessary to remedy the incident.

10. INFORMATION MANAGEMENT

10.1. System of Records: The Veterans Affairs system(s) “Patient Medical Records – VA (24VA136). https://vaww.visn11.portal.va.gov/sites/northern-indiana/nihcspolicies/nihcs policies3/11-06.docx.

10.2. System Security: The Contractor(s) shall provide VHA with the full assurance that security measures have been implemented that are consistent with OMB Circular A-130 and VA Departmental Standards. https://vaww.visn11.portal.va.gov/sites/northern-indiana/nihcspolicies/nihcs policies3/oit-03.doc

10.3. Confidentiality of Patient Records: The Contractor shall be a VA contractor and shall assist in the provision of health care to patients seeking such care from or through VA. As such, the Contractor shall be considered as being part of the Department health care activity. Contractor shall be considered a VA contractor for purposes of the Privacy Act, Title 5 U.S.C. 552a. Further, for the purpose of VA records access and patient confidentiality, Contractor shall be considered a VA contractor for the following provisions: Title 38 U.S.C. 5701, 5705, and 7362. Therefore, Contractor may have access, as would other appropriate components of VA, to patient medical records including patient treatment records pertaining to drug and alcohol abuse, HIV, and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. However, like other components of the Department, and notwithstanding any other provisions of the contract, the Contractor shall be restricted from making disclosures of VA records, or information contained in such records, to which it may have access, except to the extent that explicit disclosure authority from VA has been received. The Contractor shall be subject to the same penalties and liabilities for unauthorized disclosures of such records as VA. The records referred to above will be and remain the property of VA and shall not be removed or transferred from VA except in accordance with U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records) and federal laws, rules and regulations. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. In addition, the following policies and laws are applicable to the services to be provided under this contract:

10.3.1. Computer Security Act of 1987, PL 100-235

10.3.2. Privacy Act of 1974, 5 U.S.C. 552a

10.3.3. Healthcare Insurance Portability and Accountability Act of 1996 (HIPAA)

10.3.4. Fraud and Related Activity in Connection with Access Devices and Computers, 18 U.S.C. 1029-1030

10.3.5. Electronic Communications Privacy Act of 1986, PL 99-508

10.3.6. U.S.C. 3301, Confidential Nature of Claims

10.3.7. U.S.C. 3305, Confidentiality of Medical Quality Assurance Records

10.3.8. U.S.C. 4132, Confidentiality of Certain Medical Records

10.4. The Contractor shall comply with VANIHCS computer and end user security requirements:

10.4.1. Access only data for which the contractor has authorized privileges.

10.4.2. Maintain confidentiality of sensitive data or information.

10.4.3. Protect any assigned user ID’s, passwords, electronic signatures, and other access keys from disclosure.

10.4.4. Secure sensitive printed information in approved storage containers when not in use.

10.4.5. Practice good housekeeping with equipment and work areas.

10.4.6. Log off systems before leaving a computer unattended.

10.4.7. Refrain from the illegal reproduction or use of copyrighted and licensed software.

10.4.8. Utilize the data only to the need necessary to perform the requirements of this contract.

10.5. The Contractor shall understand and agree that the medical records of a patient generated are strictly confidential. Each person assigned to this contract shall be required to sign a confidentiality statement. Each person allowed access to the VISTA system shall sign an automated information security agreement annually.

10.6. Health Insurance Portability and Accountability Act (HIPAA): In accordance with 45 CFR 164.502(e), the Privacy Rule includes exceptions to the Business Associate standard. This contract and its requirements meet the following exception and it does not require a Business Associate Agreement (BAA) for Covered Entity to disclose Protected Health Information (PHI) to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. https://vaww.visn11.portal.va.gov/sites/Northern-Indiana/iso/Shared Documents/Contract Security/contract_memo.docx

10.7. The contractor shall maintain an “Errors and Omissions” liability insurance policy which insures against a negligent act, error or omission and the oral or written publication of material that violates a person’s rights of privacy. The Contractor shall also maintain a Commercial General Liability Policy. Evidence of coverage shall be provided to the VANIHCS credentialing department upon request.

10.8. In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities on the OIG List of Excluded Individuals/Entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

10.9. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contractor’s physicians (s)are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

10.10. By submitting their quote, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the quote was signed.

10.11. All patient images/documents transmitted from a VAMC to the Contractor are the sole property of the VHA and shall be transmitted for healthcare purposes only. Transmitted images/documents shall not be archived, printed, stored, re-transmitted or used for any purpose other than interpretation. Images shall be purged from hard drives at the termination of the contract.

11. GOVERNMENT FURNISHED SERVICES

11.1. PHYSICAL SITE: The Government will be responsible for providing the appropriate facilities, property, equipment, technical support staff and supplies required for the Contractor’s performance at VANIHCS under the terms of this contract. The VA will establish accounts and authorize privileges for the use by contractor.

11.2. CREDENTIALING AND PRIVILEGING: VANIHCS will be responsible for credentialing doctors to work in a timely fashion. An application package shall be provided by the VA to be completed by the candidate. This includes: Curriculum Vitae, current copies of certification(s), license(s), documentation of experience and documentation of education and training, competency check list(s), brief description of the provider’s experience including three (3) current references regarding related work with point of contact, signed release of information from candidate, and statement that candidate does not have any physical or mental health condition that would adversely affect his/her ability to carry out assigned duties, and additional credentialing and privileging forms. Candidate shall also be required to make application through the VET-PRO Internet process. Candidate shall need to be enrolled in VET-PRO by the VA Credentialing and Privileging Coordinator. The website address is: http://fcp.vetpro.org/.

11.3. GUIDELINES: The Contractor shall perform the functions required under this contract in accordance with the rules of medical ethics, Federal, State and local laws, rules and regulations, TJC standards, and American College of Medicine. The Contractor shall not participate nor be a party to any activities, which are in conflict with Federal and/or State guidelines. In the event the Contractor encounters said conflicting situations, the Contractor shall notify the COR or the Contracting Officer to resolve such issues. The Contracting Officer will document and be responsible for resolution of any such situations. Neither the VA nor the Contractor will be responsible for any delays or failures to perform due to causes beyond each party's control. The VA and the Contractor may upon mutual consent, modify the timing and schedule of services.

12. GENERAL INFORMATION

12.1. SERVICES: The services specified herein of this Performance Work Statement (PWS) may be changed by written modification to this contract. The modification will be prepared by the VA Contracting Officer. The services to be performed by the contractor shall be performed in accordance with VA policies and procedures and the regulations of the Medical staff by-laws of the VA facility (copy available upon request). Contractor shall provide the same professional level of care to VAMC patients and/or beneficiaries as to any other patient under his/her care. Contractor shall provide all services specified in this contract for any person deemed eligible by the Chief of Staff or his/her designee, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered.

12.2. RESPONSIBILITY OF THE CONTRACTOR: The Contractor shall obtain authorization from the Contracting Officer for any services required outside the scope of work provided herein.

12.2.1. Clinical Personnel Required: The Contractor shall provide contractor’s physician (s)who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

12.2.2. Contractor’s physician (s)shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices.

12.3. Standards of Care: The Contractor’s physician MOD(s)’ shall provide primary services to the Urgent Care department and medical back-up and assistance to the Community Living Center (CLC), Mental Health (MH), Substance Abuse Residential Recovery Treatment Program (SARRTP) services. Standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by the Joint Commission and Long Term Care Institute.

12.3.1. American College of Internal Medicine Guidelines: https://www.acponline.org/clinical-information/guidelines

12.3.2. American College of Emergency Physician Guidelines: https://www.acep.org/

12.3.3. The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx

12.3.4. The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8…