36C25025Q0517.docx

36C25025Q0517

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C25025Q0517 06- -2025 Kellie Konopinski 734-222-4330 07- -2025 4:30 pm

EDT

36C250 Department of Veterans Affairs Ann Arbor Healthcare System Network Contracting Office 10 2215 Fuller Road Ann Arbor MI 48105 X 339113 800 Employees N/A X Department of Veterans Affair

SEE SCHEDULE

36C250 Department of Veterans Affairs Ann Arbor Healthcare System Network Contracting Office 10 2215 Fuller Road Ann Arbor MI 48105

Department of Veterans Affairs Financial Management System PO Box 149971 Austin TX 78714-9971 877-353-9791 512-460-5540 X See CONTINUATION Page RFQ for VISN 10 Orthotics Appliances and Related Services Blanket Purchase Agreement (BPA) Questions due by:

/2025 at 4:30 pm This document along with the other required documents are to be emailed to Kellie.Konopinski@va.gov by 7/ /2025 at 4:30pm.

See CONTINUATION Page X Kellie Konopinski 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: _______________________

b. GOVERNMENT: Contracting Officer 36C250 Kellie Konopinski Kellie.Konopinski@va.gov 734-222-4330 Department of Veterans Affairs Ann Arbor Healthcare System Network Contracting Office 10 2215 Fuller Road Ann Arbor MI 48105

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

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.

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

36C25025Q0517

Page 1 of Page 1 of

B.2 STATEMENT OF WORK

1.0 Background

The Department of Veterans Affairs (VA) provides orthotic appliances and related services including: custom orthotics, braces, diabetic shoes, inserts, elastic supports for joints, stockings, compression garments, other new devices, and repairs to veterans who are eligible for VA healthcare services and have a medical need for such items and related services. This acquisition will supplement the VA in providing comprehensive orthotic appliances and related services to the veterans in need.

2.0 Scope

The vendor shall fabricate all orthotic appliances in strict conformance to the orthotic prescription provided by the VA Prosthetic Clinic. The VA will provide a list of approved A-Codes and/or L-Codes for work to be provided by the vendor for the specific prescription. The vendor shall not add or substitute components or alter the veteran’s prescription in any way without written authorization from a VA Clinic Prosthetic Representative or Contracting Officer’s Representative (COR). The solicitation only includes commercial items. Products not considered commercial items are considered experimental and purchase of experimental products shall not be authorized under this agreement.

2.1 Multiple Awards

It is the VA’s intent to solicit offers and establish multiple Blanket Purchase Agreements (BPAs) in multiple geographic locations throughout the Veterans Integrated Service Network 10 (VISN 10). The established BPAs resulting from this solicitation will cover all VISN 10 facilities and the associated Community Based Outpatient Centers (CBOC) in four states. The anticipated period of performance will include a 5-year ordering period.

Placement of delivery orders IS NOT GUARANTEED. The BPA is merely the framework for future delivery orders that create the contractual obligation when accepted by the BPA Holder. A contract is NOT created at the time the order is placed, the BPA Holder has neither the contractual obligation to perform, nor does the Government have the authority to enforce performance or any obligation to place delivery orders under the agreement.

2.2 Pricing

Pricing will be dependent upon the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System (CMS HCPCS) Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) A-Code and L-Code fee schedules. New and emerging Orthotics and Prosthetics (O&P) technology not yet formally recognized or coded by CMS, also known as Not Otherwise Classified code will be addressed in paragraph 2.2.1. Prices proposed should not exceed the established A-Code and/or L- Code fee schedule applicable to the geographic location at time of performance minus any discounts submitted by the BPA Holder at the time of accepting a delivery order. It should be noted that repair rates for 15-minute increments are now part of the L-Code fee schedule. Considering this, please apply the best percentage discount you offer against the A-Code and L-Code pricing baseline. Offerors are encouraged to give a discount on all A-Codes and L-Codes.

2.2.1 New & Emerging Orthotics & Prosthetics (O&P) Technology/Not Otherwise Classified code

New and emerging O&P technology also known as Not Otherwise Classified code is technology not yet formally recognized or coded by CMS A-Code and/or L-Code fee schedules. Pricing for new and emerging O&P technology, Not Otherwise Classified code will be determined using wholesale price plus overhead percentage, profit percentage and labor rates. The invoice from the manufacturer will be used to verify the wholesale price. Price plus fee will be negotiated prior to award. The labor rate will be determined using the current CMS fee schedule for the Prosthetics labor code L7520 applicable to the geographic location minus any discounts submitted by the BPA Holder at the time of accepting a delivery order.

Wholesale Price + Fee = Subtotal

Labor (geographic location minus any discounts) + Subtotal = Total Cost

3.0 Education and Training Requirements

3.1 General Education

The BPA Holder shall have a full-time American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) certified, or Board of Certification/Accreditation International (BOC) certified Orthotist(s) on staff in “good standing” at each of the proposed service locations throughout the BPA period. “Good standing” is defined as participating and achieving appropriate continuing education credits and paying dues as determined by Certifying Agency such as ABC or BOC.

VA reserves the right to verify Orthotists’ credentials anytime during the term of the established BPA. The BPA Holder shall provide current copies of certifications upon request of the COR. Failure to comply with this requirement may lead to adverse actions by the Government including BPA termination in accordance with the agreement clauses.

3.2 Special Education Requirements for certain Orthotics

The fitting and alignment of orthotic appliances and associated services shall be performed under the supervision of an orthotist who has met the applicable educational and training requirements covered under the manufacturing training program for that device. New technologies require proof of training and only those orthotists specifically trained or completing training for purposes of providing an item by the time of delivery of the item may provide the item and follow up services to a veteran. VA reserves the right to determine which technologies require specific training. VA will notify the BPA Holder when current technologies require specialized training from the manufacturer in order to provide to veterans.

4.0 Specific Requirements

4.1 Compliance with VA Prescription and Coding of Orthotic Appliances

The BPA holder shall not add or substitute components or alter the veteran’s orthotic prescription in any way without written authorization from a VA Clinic Prosthetic Representative. Any changes to the veteran’s prescription, components or codes requires review and approval by the VA Prosthetic Clinic Team and shall be authorized in writing by a VA Clinic Prosthetic Representative. Changes made to coding without VA approval may result in non-payment of those codes.

4.2 The Joint Commission and other Special Requirements

The BPA Holder shall perform the required work in accordance with the Joint Commission (TJC) and ABC and/or BOC standards. All BPA Holder employees shall continuously meet or exceed TJC and ABC and/or BOC standards. The BPA Holder shall develop and maintain a record for the following documents for each employee participating in the agreement: credentials and qualifications for the job; a current competence assessment checklist (an assessment of knowledge, skills, abilities and behaviors required to perform a job correctly and skillfully, and including knowledge and skills required to provide care for certain patient populations, as appropriate); a current performance evaluation supporting ability of the contractor employee to successfully perform the work required under this solicitation; and, listing of relevant continuing education for the last two years. The Offeror shall provide current copies of these records for each employee assigned to participant in the agreement at the time of award, annually on the date of award thereafter, and at any other time requested by the CO or COR.

The BPA Holder shall be responsible for ensuring employees participating in the agreement are fully trained and completely competent to perform the required work. When changes in personnel are approved in accordance with the “Key Personnel” clause of the BPA, the BPA Holder shall provide evidence of orientation, the current competence assessment, and current performance evaluation that supports the above.

4.3 Contractor Facility Locations

All Contractor facilities as well as other fabrication facilities such as commercial central fabrication facilities that will be utilized for this Contract shall be listed in the quote. All work required under this Contract shall be conducted at the facility locations included in the contract. The Contractor’s facilities shall be accredited either by the Facility Accreditation Program of the ABC or the Accredited Facilities Program of the BOC at the time of quote submission. VA reserves the right to conduct site visits of the facility and review accreditation and certification documents and standards at any time. The Contractor shall provide current copies of accreditation documents upon request of the COR. VA may conduct site visits as needed by the COR and other VA subject matter experts as determined by the COR.

Throughout the duration of this Contract, the Contractor shall notify VA of any facilities that are added, changed, or closed to the Contracting Officer (CO) and the COR within fifteen (15) calendar days of any change. Approval for added or changed facilities must be obtained before those facilities may be used for this contract. Accreditation and certification documents shall be submitted to the CO and COR at the time the Contractor seeks approval for added or changed facilities.

4.4 Warranty

The BPA Holder shall warrant orthotic appliances provided against defective material and/or workmanship for a minimum of 90 calendar days from the date of acceptance by VA. The minimum warranty period shall commence after final acceptance from the veteran, VA Prosthetic Representative or COR. Manufacturer’s warranties of orthotic appliances that extend beyond the minimum 90 calendar day period shall be in effect and be enforced. The BPA Holder shall furnish, without additional cost to the Government, all materials and labor necessary to correct defects detected during the warranty period.

These conditions do not apply to adjustments incidental to wearing of the orthotic, adjustments required by physical change of the wearer, or where there is evidence of deliberate misuse or alteration by anyone other than the BPA Holder.

The BPA Holder shall warrant and imply the items delivered hereunder are merchantable and fit for use for the particular purpose described in the agreement. The rights and remedies of the Government provided in this clause are in addition to, and do not limit any, rights afforded to the Government by any other clause of the established BPA.

4.5 Recalls

The BPA Holder shall immediately notify the CO and the COR in the event of an appliance recall, removal, required adjustment, or required modification that is suggested or mandated by the vendor, distributor, manufacturer, or any regulatory or Government agency. The following information shall be included in this notification:

a. A complete item description and identification;

b. Administrative identification data including BPA number, order numbers and order date;

c. Removal, adjustment, or modification reasons for recall; and

d. Instructions for appropriate corrective action.

4.6 Salvage

If a veteran beneficiary dies prior to delivery and acceptance, the VA shall pay the BPA Holder for the work performed up to the point they are notified to stop work. Prices paid should not exceed the established A-Code and L-Code fee schedule applicable to the geographic location minus any discounts submitted by the BPA Holder at the time of accepting a delivery order less the salvage value of unused orthotic appliances.

5.0 Special Contract Requirements

5.1 Key Personnel and Temporary Emergency Substitutions

The BPA Holder shall assign the following key personnel to the agreement: all individuals providing appliances and related services to veterans and for whom information about education and training is required to be submitted as a part of the response to this solicitation including, but not limited to, those individuals who must meet the training requirements set forth in the Education and Training Requirements in Section 3.0.

During the first ninety (90) calendar days of performance, the BPA Holder shall make no substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. The vendor shall notify the CO and COR, in writing, within fifteen (15) calendar days after the occurrence of any of these events and provide the following information:

a. Detailed explanation of the circumstances necessitating the proposed substitution;

b. Complete resume for the proposed substitute; and

c. Any additional information requested by the CO.

At least 30 days prior to the BPA Holder voluntarily diverting any of the specified individuals to other programs or contracts, the BPA Holder shall notify the CO and shall submit a justification for the diversion or replacement and a request to replace the individual. Proposed substitutes shall have comparable qualification to those of the persons being replaced. The CO will notify the BPA Holder within fifteen (15) calendar days after the receipt of all required information of the decision on the proposed substitutes. The agreement will be modified to reflect any approved changes of key personnel. In the case where the VA does not agree with the proposed substitutes and their qualifications, the VA may terminate the established agreement and/or pending delivery orders.

For temporary substitutions where the key person will not be reporting to work for three (3) consecutive business days or more, the BPA Holder shall provide a qualified replacement. This substitute shall have comparable qualifications to the key person being temporarily replaced. Any substitution exceeding a period of two weeks consecutively shall follow the key personnel replacement procedure as described in the paragraph above.

5.2 Confidentiality of Patient Records

The BPA Holder will assist in the provision of health care to patients seeking such care from or through VA. As such, the BPA Holder is considered as being part of the Department health care activity. The BPA Holder is considered to be a VA contractor for purposes of the Privacy Act, Title 5 U.S.C. 552a. Further, for the purpose of VA medical records access and patient confidentiality, BPA Holder is a VA contractor for the following provisions: Title 38 U.S.C. 5701, 5705, and 7362. Therefore, BPA Holders 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.

The records referred to above shall be and remain the property of VA and shall not be removed or transferred from VA except in accordance with U.S.C.552a (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 BPA Holder, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over the BPA Holder, may have access to VA records, at a VA place of business on request during normal business hours, to inspect and review and make copies of such records.

5.3 VA Sensitive Information

VA sensitive information is all Department data, on any storage media or in any form or format, which requires protection due to the risk of harm that could result from inadvertent or deliberate disclosure, alteration, or destruction of the information. The term includes information whose improper use or disclosure could adversely affect the ability of an agency to accomplish its mission, proprietary information, records about individuals requiring protection under various confidentiality provisions such as the Privacy Act and the HIPAA Privacy rule, and information that can be withheld under the Freedom of Information Act. Examples of VA sensitive information include the following: individually-identifiable medical, benefits, and personnel information; financial, budgetary, research, quality assurance; confidential commercial, critical infrastructure, investigatory, and law enforcement information; information that is confidential and privileged in litigation such as information protected by the deliberative process privilege, attorney work-product privilege, and the attorney client privilege; and other information which, if released, could result in violation of law or harm or unfairness to any individual or group, or could adversely affect the national interest or the conduct of federal programs.

6.0 Performance, Delivery, Inspection and Acceptance

6.1 Performance

The BPA Holder shall complete initial delivery of items ordered under this agreement no later than 30 calendars days after receipt of a delivery order. Initial delivery means an ordered item or service is complete and the item is provided to and accepted by the patient. In the event the BPA Holder is unable to deliver the required items or services in accordance with the Government’s required delivery date the BPA Holder shall provide written notification to the VA Prosthetic Representative or COR within 7 calendar days.

In the event the Government desires expedited delivery, the VA Prosthetic Representative or COR shall telephonically contact the BPA Holder and inquire into the feasibility of obtaining the appliance under this condition. The BPA Holder shall respond within 24 hours to such request and expedited delivery shall be mutually agreed upon. Expedited delivery terms and conditions, when required, shall be determined by the CO and the BPA Holder on a case-by-case basis and stated in the individual task or delivery order. Any additional costs incurred by the BPA Holder for meeting this requirement shall be negotiated in accordance with 48 U.S.C. 52.212-4, Contract Terms and Conditions – Commercial Items. The total cost for the expedited delivery shall not exceed 25% of the cost of the normal delivery for the same or similar item with any applicable discounts. Failure by the BPA Holder to deliver the ordered items on an expedited basis, or otherwise fulfill the agreed upon requirements shall constitute an event of default, and the CO shall undertake any action authorized pursuant to the established agreement, or otherwise in accordance with applicable statutes and regulations.

6.1.1 Solicitation of Beneficiaries

The BPA Holder agrees not too directly or indirectly through agents solicit eligible veteran beneficiaries. Solicitation includes, but is not limited to, utilizing any advertisements or mailing lists, contacting the veteran directly, VA clinics, etc. VA personnel shall not direct, guide, or prompt a veteran beneficiary to a specific BPA Holder except when a physician determines it is medically necessary. To assist in the selection of their Orthotist, all eligible veteran beneficiaries shall be given a current list of approved BPA Holders located within the Medical Center’s jurisdiction. The list of providers shall contain the following header statement in boldface type:

“YOU HAVE THE RIGHT TO SELECT THE ORTHOTIST OF YOUR CHOICE FROM ANY OF THE VA BPA HOLDERS. ANY ATTEMPT TO INFLUENCE YOUR DECISION OR TO DIRECT YOU TO ANY PARTICULAR BPA HOLDER SHOULD BE REPORTED TO THE MEDICAL CENTER DIRECTOR OF THIS FACILITY.”

6.2 Delivery

Typically, veteran beneficiaries who are experienced orthosis wearers will normally be measured, fitted, and accept delivery of their orthosis at the BPA Holder’s facility. Veteran beneficiaries who are not experienced orthosis wearers (first time orthotic user) will normally be measured, fitted, and accept delivery at the ordering VA Orthotic Clinic. The conditions of and point of measurement, fitting, delivery, inspection, and acceptance of orthotic appliances shall be at the discretion of the prescribing Orthotist, physician, VA Prosthetic Representative or COR and determined on a case-by-case basis.

The BPA Holder shall obtain a signature and date from the veteran at the time of delivery and acceptance of the orthotic appliance. This record shall be kept in the patient file. A copy of the signed and dated delivery and acceptance form shall accompany the invoice.

Example Patient Delivery and Acceptance Form

PATIENT NAME:

BPA HOLDER NAME:

In order to process prompt payment for the prescribed orthosis, you must provide the VA with the following:

1. Date of Initial Patient Visit:

2. Date of Final Delivery:

Final payment will be processed following delivery – with confirmation of the following information:

ACCEPTANCE RECEIPT:

DATE:

The articles and/or services listed herein have been rendered, received as ordered, or as shown by authorized changes indicated below, and are acceptable.

PATIENT

SIGNATURE:

6.3 Inspection and Acceptance of Appliance

BPA Holder performance shall be monitored using the following indicators:

a. Delivery time requirement

b. Appliance compliant with VA physician prescription

c. Workmanship free of defect

d. Patient education

e. Patient acceptance of the appliance in all aspects (cosmetically and functionally)

f. Payment shall be rendered for an orthotic appliance or service that satisfactorily meets all of the indicators. Payment shall be delayed for any appliance or service that does not meet one or more of the indicators. If the veteran feels the orthosis does not fit properly, and further adjustments are required, the BPA Holder will make these corrections/adjustments immediately. When further adjustments cannot be accomplished during the veteran’s visit, the BPA Holder will deliver the readjusted orthosis to the ordering facility for final acceptance and payment. The BPA Holder shall correct all deficiency of non-compliant appliance or service within fifteen (15) calendar days.

Initial delivery shall not be construed as final delivery or acceptance of an item or service by the Government and authorization for payment. No invoice shall be submitted until the Government accepts the item or service. Final acceptance and authorization for payment shall occur with the final delivery and acceptance by the veteran.

7.0 Invoice Procedures

Invoices submitted for payment shall include the BPA number, purchase/delivery order number, beneficiary’s name; detail of work accomplished, HCPCS Codes for each item, VA BPA discount and a copy of the signed and dated patient delivery and acceptance form. All invoices will be submitted in accordance with the addresses provided below. The preferred method of payment will be the Government Purchase/Visa Credit Card the BPA Holder must be capable of accepting it for payment. The BPA Holder should be able to process at Level II. If this involves additional machinery or computers, this will be at the BPA Holder’s expense. No advance payments shall be authorized. No charge shall be made until the orthosis is delivered to the veteran and he/she has signed and dated an acceptance form provided by the BPA Holder. Each invoice must be submitted to the ordering VA Orthotic Clinic within three calendar days of orthosis delivery to the veteran. Payment of invoices may be delayed if not completed and submitted as required.

BPA Holder invoices will be reviewed by a VA practitioner to ensure they meet the requirements of the VA prescription and have the proper assignment of HCPCS Codes. BPA Holders can anticipate contact from a VA practitioner seeking clarification and/or justification for specific items on invoices/quotes.

Michigan

Ohio

Louis Stokes VA Medical Center 10701 East Boulevard Cleveland, OH 44106

Indiana

VA Northern Indiana Health Care System – Fort Wayne 2121 Lake Avenue Fort Wayne, IN 46805

7.1 Vendor Remittance Address

All payment by the Government to the BPA Holder will be made in accordance with Federal Acquisition Regulation (FAR) Clause 52.232-34, Payment by Electronic Funds Transfer— Other than Central Contractor Registration (31 U.S.C. 3332):

CONTRACTOR: Company Name:

Name:

Address:

City, State, Zip:

Telephone Number:

E-mail:

8.0 VA Orthotic Clinic Attendance

8.1 Who may attend Clinic

a. Only Certified Orthotists or Certified Prosthetists and Board Eligible Residents and NCOPE Preceptorship students may attend the VA clinic.

b. Only Certified Orthotists or Certified Prosthetists may serve as the senior “hands on” or Lead Orthotic or Prosthetic Practitioner in the VA Clinic.

c. BPA providers who see veterans shall be ABC or BOC- certified and the facilities shall be ABC or BOC-certified.

d. Approved VA Residents may also attend the VA Clinic as part of their training.

e. In the absence at a given site of a VA Certified Orthotist or Certified Prosthetist – prior to clinic and by invitation only – the Prosthetics Representative or COR will identify a non-VA Certified Orthotist or Certified Prosthetist to coordinate with the VA Physician/Clinician chairing the clinic in addressing the veteran’s needs. Alternatively, as determined by the Prosthetics Representative or COR, the veteran can attend the VA Clinic with a non-VA Certified Orthotist or Certified Prosthetist that has been treating the veteran.

8.2 Prior to Clinic Attendance

a. BPA providers should inform the Prosthetics Representative or COR they will be attending clinic that day either with a veteran or as the subject-matter expert.

b. All clinic attendees must wear a VA badge issued by the VA Police and Security Office or a “Contractor” or “Visitor” badge as approved by the Prosthetics Representative or COR where the VA Clinic is being administered. Per VA security guidelines, designated personnel will be identified in the agreement and will vary per site location.

8.3 Orthotic Clinic Process and Conduct

a. It is the responsibility of the VA Orthotist/Lab Manager, and/or the Prosthetics Representative to ensure the clinic is managed efficiently and conducted appropriately.

b. It is the responsibility of the non-VA attendees to comply with the VA facility policies and procedures, as well as the clinic operating procedures.

c. BPA providers may attend clinic as subject matter experts when authorized by a VA Orthotist, Prosthetics Representative, or the COR if they have a veteran scheduled for the clinic.

d. The VA Orthotist, Laboratory Manager, Prosthetics Representative or COR will determine the number of providers who can be present at the clinic at one time. A rotating schedule may be developed, if necessary.

e. The Physician/Clinician chairing the clinic is directly responsible for assessing the patient’s needs through direct communication and physical evaluation, which may also be accomplished in assistance with a VA Orthotist, Prosthetist, Pedorthist, or Laboratory Manager if in attendance.

f. The VA Orthotist, Laboratory Manager, Prosthetics Representative or COR should ensure patients flow efficiently through clinic. They will communicate with each patient after evaluation to ensure the veteran clearly understands the next step in his/her orthotic treatment.

g. If the veteran is not already receiving care from an outside provider a Prosthetics Representative or COR will obtain the veteran’s signature indicating their BPA provider of choice. If possible, the list of current BPA providers will be sent to the veteran prior to their scheduled visit. This will allow the clinic to arrange for the BPA provider of choice to be present during the Orthotic Clinic visit.

h. BPA providers are not allowed to directly address the veteran or to establish a rapport with the veteran, unless directed by the Physician, Clinic Chairperson, VA Orthotist, Laboratory Manager or Prosthetics Representative. BPA providers are not allowed to solicit veterans in any way, including, but not limited to, passing out business cards or asking personal questions at the VA facility, in the waiting area and/or during the clinic evaluation.

i. Concerns about the clinic process or a BPA provider’s conduct will be discussed outside of the clinic setting, unless it is so egregious that immediate action is needed by the VA Orthotist, Laboratory Manager, Prosthetics Representative or COR. In any event, the Contracting Officer should be immediately notified of the conduct and action taken.

j. As determined by the Contracting Officer – in association with the VA Orthotist, Laboratory Manager, Prosthetics Representative or COR, any such action by a BPA provider deemed inappropriate may result in exclusion from clinic attendance for a period of time or indefinitely. If any VA staff person or veteran is aware of this behavior, it is to be reported to the facility VA Orthotist, Laboratory Manager, Prosthetics Representative or COR and to the Contracting Officer.

k. No patient lists shall be distributed to a BPA provider attending with his/her patient prior to or during clinic. No patient information will be allowed to leave the clinic unless it’s required by the treating BPA provider. Patient information released for treatment will be limited to that of which will allow for adequate treatment of the veteran.

8.4 BPA Holder Personnel

a. Are required to wear ID Badges during the entire time they are on the VA grounds. ID Badges must have an identification picture and shall state in English the name of the individual and the company represented.

b. Are required to check into the facility Police and Security Office at each visit to pick up a “Contractor” or “Visitor” badge prior to contacting the Prosthetics Representative or COR.

c. The BPA Holder should not employ persons to participate in the agreement if such employee is a potential threat to the health, safety, security, general well-being or operational mission of the installation and its population.

1. Personnel are required to observe the rules and regulations of the VA facility.

2. Parking is permitted in areas designated as Visitor Parking Lots by the facility, or otherwise designated by the Police and Security Office staff.

8.5 Days and Hours of Clinic Operations

The VA VAMC/VISN 10 Medical Centers operate during normal business hours - Monday through Friday, 8:00am – 4:30pm. Clinic sessions will be established at each VA Facility by the VA Orthotist, Laboratory Manager, Prosthetics Representative or COR, in association with the Physician/Clinician. An Orthotic clinic BPA provider rotation schedule may be implemented depending upon the number of BPA Holders selected for the BPA.

8.6 Federal Holiday

The eleven holidays observed by the Federal Government are:

New Year’s Day – January 1st Martin Luther King’s Birthday – 3rd Monday of January Presidents’ Day – 3rd Monday of February Memorial Day – Last Monday of May Juneteenth – June 19th Independence Day – July 4th Labor Day – 1st Monday of September Columbus Day – 2nd Monday of October Veterans Day – November 11th Thanksgiving Day – 4th Thursday of November Christmas Day – December 25th

When a Federal Holiday falls on a Sunday, the following Monday shall be observed as a Federal Holiday. When a Federal Holiday falls on a Saturday, the preceding Friday is observed as a Federal Holiday. Also included – any other day specifically declared by the President of the United States of America to be a Federal Holiday.

9.0 Blanket Purchase Agreement (BPA) Administrative Information

The Contracting Officer (CO) is the only person authorized to approve changes or modify any of the requirements under this BPA. The BPA Holder shall communicate with the CO on all matters pertaining to BPA administration. Only the CO is authorized to make commitments or issue changes, which will affect price, quantity, or quality of performance of the agreement. In the event the BPA Holder effects any such change at the direction of any person other than the CO, the change shall be considered to have been made without authority and no adjustment will be made to the agreement price to cover any increase in costs incurred as a result thereof.

9.1 Other Indemnification

The BPA Holder shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, resulting from the fault, negligence, or wrongful act or omission of the BPA Holder, its agents, or employees.

9.2 BPA Holder Certification

The BPA Holder certifies the BPA Holder shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under the agreement for the BPA Holder while providing services to Department of Veterans Affairs patient referrals. While performing services for the Department of Veterans Affairs, the BPA Holder shall not knowingly employ, contract, or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the BPA Holder is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

If the BPA Holder fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the BPA Holder’s place of business that services Department of Veterans Affairs patient referrals; or other place where the BPA Holder provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of the agreement for breach.

The BPA Holder agrees to obtain a similar certification from its subcontractors.

Signature:

Date:

Typed Name and Title:

Company Name:

This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 100.

9.3 Abbreviations

A-CODE – Medicare Code for Orthotic Shoes, Inserts & Orthotic Supplements AAOP- American Academy of Orthotics & Prosthetics ABC – American Board for Certification in Orthotics & Prosthetics AFO/KAFO – Ankle Foot Orthosis/Knee Ankle Foot Orthosis AOPA – American Orthotic & Prosthetic Association BOC – Board for Orthotist-Prosthetist Certification (Accredited Facilities Program) CAD/CAM – Computer Aided Design/Computer Aided Manufacturer CMS – Centers for Medicare & Medicaid Services CO – Contracting Officer COR – Contracting Officer’s Representative HCPCS – Healthcare Common Procedure Coding System IAOP – International Association of Orthotics & Prosthetics L-CODE – Medicare Code for Artificial Limbs & Orthotic Appliances/Services NAAOP – National Association for the Advancement of Orthotics & Prosthetics NCOPE - National Commission on Orthotic and Prosthetic Education RGO – Reciprocation Gait Orthosis VAQP – VA Qualified Orthotist VAMC – Veteran Affairs Medical Center VISN - Veterans Integrated Service Network

B.3 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

1. Purpose

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the Blanket Purchase Agreement (BPA). The QASP does not detail how the Contractor accomplishes the work or monitors the quality of its work. Rather, the QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the BPA. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the Contractor. Copies of the original QASP and revisions shall be provided to the Contractor and Government officials implementing surveillance activities.

2. Government Roles and Responsibilities

The following personnel shall oversee and coordinate surveillance activities in accordance with the QASP.

a. Contracting Officer (CO) – The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the BPA terms and shall safeguard the interests of the United States in the agreement relationship. The CO shall also assure that the Contractor receives impartial, fair, and equitable treatment under this BPA. The CO is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

b. Contracting Officer’s Representative (COR) – The COR is responsible for technical administration of the BPA and shall assure proper Government surveillance of the Contractor’s performance. The COR shall maintain a quality assurance file. The COR is not empowered to make any commitments or to authorize any changes on the Government’s behalf. Any changes that the Contractor deems may affect contract price, terms or conditions shall be referred to the CO for action.

3. Performance Standards

All deliverables shall meet the following QASP performance standards to the acceptable quality level. The Government shall perform surveillance to determine if the Contractor meets or does not meet these standards.

B.4 VA INFORMATION AND INFORMATION SYSTEM SECURITY AND PRIVACY LANGUAGE FOR INCLUSION IN CONTRACTS

1. GENERAL. This entire section applies to all acquisitions requiring any Information Security and Privacy language. Contractors, contractor personnel, subcontractors and subcontractor personnel will be subject to the same federal laws, regulations, standards, VA directives and handbooks, as VA personnel regarding information and information system security and privacy.

2. VA INFORMATION CUSTODIAL LANGUAGE. This entire section applies to all acquisitions requiring any Information Security and Privacy language.

a. The Government shall receive unlimited rights to data/intellectual property first produced and delivered in the performance of this contract or order (hereinafter “contract”) unless expressly stated otherwise in this contract. This includes all rights to source code and all documentation created in support thereof. The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General. The primary clause used to define computer software license (not data/intellectual property first produced under this contractor or order) is FAR 52.227-19, Commercial Computer Software License.

b. Information made available to the contractor by VA for the performance or administration of this contract will be used only for the purposes specified in the service agreement, SOW, PWS, PD, and/or contract. The contractor shall not use VA information in any other manner without prior written approval from a VA Contracting Officer (CO). The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General.

c. VA…