36C25026C0025_1.pdf

PAGE 1 OF 1. REQUISITION NO.

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

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

TIME

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

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

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

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

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

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

SEE ADDENDUM

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

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

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

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

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

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

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

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

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

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

515-26-1-043-0001

515C60039

36C25026C0025

AWARDED:

EFFECTIVE: 12-13-2025

36C25026Q0121

Angela Higgins 615-225-4512

Department of Veterans Affairs Network Contracting Office (NCO) 10 260 E. University Avenue Cincinnati OH 45219

X 100

X

Y

561320

$34 Million

N/A

Department of Veteran Affairs Battle Creek Veteran Affairs Medical Center 5500 Armstrong Rd Battle Creek MI 49037

Network Contracting Office (NCO) 10 260 E. University Avenue Cincinnati OH 45219

1RCD7

SYGNETICS, INC

37054 COCHISE ST

CLINTON TWP MI 48036

989-348-2020 KDZBDHWDNVL9

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

See CONTINUATION Page

2.0 FTE Primary Care Physician Services for the Battle Creek

VA Medical Center, 5500 Armstrong Road, Battle Creek, MI 49037. Services to be provided at the Battle Creek VA Medical Center and the Lansing, Muskegon, Benton Harbor and Wyoming, Michigan Community Based Outpatient Clinic's (CBOCs).

Period of Performance December 13, 2025 to March 12, 2026

Contractor shall use purchase order (PO) #515C60039 on all invoices for the period of December 13, 2025 to March 12, 2026.

$214,201.13 See CONTINUATION Page

515-3660160-043-820100-2579 010020100

X X 1

Angela Higgins Contracting Officer

Tony Tarkowski President/CEO

12/04/2025

Table of Contents

SECTION A

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

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE SCHEDULE

B.3 PERFORMANCE WORK STATEMENT

B.4 IT CONTRACT SECURITY

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (NOV 2023)

ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

C.2 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.3 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.4 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED

SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESSES (JAN 2023)

(DEVIATION)

C.5 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.6 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.7 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.8 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.9 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.10 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.11 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (OCT 2025) (DEVIATION FEB 2025)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

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: Sygnetics, Inc Tony Tarkowski, CEO 248-537-1220 tony.tarkowski@sygnetics.com

b. GOVERNMENT: Angela Higgins, Contracting Officer

Network Contracting Office (NCO) 10 260 E. University Avenue Cincinnati OH 45219

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

[] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] 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.

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

AMENDMENT NO DATE

B.2 PRICE SCHEDULE

ITEM

NUMBER

DESCRIPTION OF

SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1,040.01 HR $192.980000 $200,701.13

2.0 Primary Care Physician Services; Board Certified/Board

Eligible Family Practice or Internal Medicine Physician Services for the Battle Creek VA Medical Center and the Lansing, Muskegon, Benton Harbor, and Wyoming CBOCs.

Contract Period: Base POP Begin: 12-13-2025 POP End: 03-12-2026 PRINCIPAL NAICS CODE: 621111 - Offices of Physicians (except Mental Health Specialists) PRODUCT/SERVICE CODE: Q509 - Family and Internal Medicine Services

3.00 MO $4,000.000000 $12,000.00

Lodging Expenses. For out-of-town physicians (defined as physicians not living within a 75-mile radius from the Battle Creek

VAMC).

Contract Period: Base POP Begin: 12-13-2025 POP End: 03-12-2026 PRINCIPAL NAICS CODE: 621111 - Offices of Physicians (except Mental Health Specialists) PRODUCT/SERVICE CODE: Q509 - Family and Internal Medicine Services

1.50 EA $1,000.000000 $1,500.00

Travel Costs. (Travel for out-of-town physicians), round trip airfare from residence to the contract place of performance Contract Period: Base POP Begin: 12-13-2025 POP End: 03-12-2026 PRINCIPAL NAICS CODE: 621111 - Offices of Physicians (except Mental Health Specialists) PRODUCT/SERVICE CODE: Q509 - Family and Internal Medicine Services

GRAND TOTAL $214,201.13

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL

1.1. Services Provided: The Contractor shall provide Primary Care Physician Services for the Battle

Creek VA Medical Center (BCVAMC), 5500 Armstrong Road, Battle Creek, Michigan 49037.

The 2.0 Full Time Equivalent (FTE) Primary Care Physicians shall be Board Certified or Board Eligible in Family Practice or Internal Medicine. Primary Care Physicians services shall be provided at the BCVAMC Primary Care Clinic and at the following Community Based Outpatient Clinic (CBOC) locations: Lansing CBOC, Muskegon CBOC, Benton Harbor CBOC, Wyoming CBOC. Hours of Operation, 8:00am to 4:30pm, Monday thru Friday, excluding federal holidays.

Every six weeks, the BCVAMC Primary Care Clinic and the Wyoming CBOC offer extended hours; Wednesday 8:00am to 6:30pm and Saturday 8:30am to 12:00pm. The Contractor shall provide Credentialed Contractor Physicians with the NACI background check completed.

1.2. Place of Performance – Contractor to provide Primary Care Physicians services at the BCVAMC Primary Care Clinic, 5500 Armstrong Road, Battle Creek, Michigan 49037 and at the following Community Based Outpatient Clinics (CBOC’s), Lansing CBOC; 2025 S. Washington Avenue, Lansing, MI 48910, Muskegon CBOC; 5000 Hakes Drive, Muskegon, MI 49441, Benton Harbor CBOC, 115-B West Main Street, Benton, Harbor, MI 49022, Wyoming CBOC; 5838 Metro Way, Wyoming, MI 49519.

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority.

1.4. Policy/Handbooks- the contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.4.1. VA Directive 1663: Health Care Resources Contracting - Buying https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.2. VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.3. VHA Directive 2010-018 “Facility Infrastructure”

www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2227

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

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

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

1.4.7. VHA Handbook 1100.19 Credentialing and Privileging -

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.8. VHA Handbook 1907.01 Health Information Management and Health Records:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.4.9. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.4.10. Bylaws and Rules of the Medical Staff, Battle Creek VA Medical Center – https://vaww.visn10.portal.va.gov/sites/Battle-https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2227 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm https://vaww.visn10.portal.va.gov/sites/Battle-Creek/Administration/ChiefOfStaff/Shared%20Documents/BYLAWS%2C%20PPEs%20AND%20PRIVILEGES/BYLAWS/BYLAWS%20and%20Rules%20and%20Regulations%20Final%20June%202017%20signed.pdf

Creek/Administration/ChiefOfStaff/Shared%20Documents/BYLAWS%2C%20PPEs%20AN D%20PRIVILEGES/BYLAWS/BYLAWS%20and%20Rules%20and%20Regulations%20Fin al%20June%202017%20signed.pdf

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

1.5.1. ABIM: American Board of Internal Medicine, https://www.abim.org/

1.5.2. ABFM: American Board of Family Medicine, https://www.theabfm.org/

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. AOD: Admitting Officer of the Day

1.5.5. BLS: Basic Life Support

1.5.6. CCNE:Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation

1.5.7. CDC: Centers for Disease Control and Prevention

1.5.8. CR: Contract Discrepancy Report

1.5.9. CEU: Certified Education Unit

1.5.10. CME: Continuing Medical Education

1.5.11. CMS: Centers for Medicare and Medicaid Services

1.5.12. Contracting Officer (CO) – The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.5.13. Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.14. COS: Chief of Staff

1.5.15. CPARS: Contractor Performance Assessment Reporting System

1.5.16. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.5.17. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.5.18. DEA: Drug Enforcement Agency

1.5.19. ED: Emergency Department

1.5.20. FSMB: Federation of State Medical Boards

https://vaww.visn10.portal.va.gov/sites/Battle-Creek/Administration/ChiefOfStaff/Shared%20Documents/BYLAWS%2C%20PPEs%20AND%20PRIVILEGES/BYLAWS/BYLAWS%20and%20Rules%20and%20Regulations%20Final%20June%202017%20signed.pdf https://vaww.visn10.portal.va.gov/sites/Battle-Creek/Administration/ChiefOfStaff/Shared%20Documents/BYLAWS%2C%20PPEs%20AND%20PRIVILEGES/BYLAWS/BYLAWS%20and%20Rules%20and%20Regulations%20Final%20June%202017%20signed.pdf https://vaww.visn10.portal.va.gov/sites/Battle-Creek/Administration/ChiefOfStaff/Shared%20Documents/BYLAWS%2C%20PPEs%20AND%20PRIVILEGES/BYLAWS/BYLAWS%20and%20Rules%20and%20Regulations%20Final%20June%202017%20signed.pdf https://www.abim.org/ https://www.theabfm.org/ http://www.aacn.nche.edu/accreditation

1.5.21. HHS: Department of Health and Human Services

1.5.22. HIPAA: Health Insurance Portability and Accountability Act

1.5.23. HR: Human Resources

1.5.24. ISO: Information Security Officer

1.5.25. Medical Emergency - a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.5.26. MOD: Medical Officer of the Day

1.5.27. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.5.28. NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

1.5.29. Non-Contract Provider - any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.5.30. NP: Nurse Practitioner

1.5.31. NPPES: National Plan and Provider Enumeration System

1.5.32. PA: Physician Assistant

1.5.33. PALS: Pediatric Advanced Life Support

1.5.34. POP: Period of Performance

1.5.35. PPD: Purified Protein Derivative

1.5.36. PWS: Performance Work Statement

1.5.37. Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for 8independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

1.5.38. QA/QI: Quality Assurance/Quality Improvement

1.5.39. QM/PI: Quality Management/Performance Improvement

1.5.40. QASP: Quality Assurance Surveillance Plan

1.5.41. Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

http://www.nlnac.org/

1.5.42. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers.

1.5.43. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

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

1.5.45. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean the Battle Creek VA Medical Center.

2. QUALIFICATIONS

2.1. The Primary Care Physicians are clinical representatives of the Medical Center Director and Chief of Staff and responsible for Primary Care outpatient clinical operations.

2.2. Contractor’s employee services to be performed include:

2.2.1. Outpatient/Primary Care. Evaluation of new and returning outpatients as assigned for the Battle Creek VA Medical Center and all sites to include Battle Creek, Lansing, Muskegon, Benton Harbor and Wyoming, MI. Patient care: approximately 8-15 outpatients – ½ hour allotted for follow-up and ½ hour/1 hour for new patients during regular work week schedule.

2.2.2. Patient medical history and physical exams appropriate to the care setting and documented in accordance with Battle Creek VA Medical Center Staff Bylaws. Contract physician shall complete appropriate evaluation and paperwork for special incidents such as medication errors, falls, injuries, adverse drug reactions.

2.2.3. Contract physician shall, at all times conduct themselves in a professional and ethical manner treating patients, visitors, and staff in a courteous manner. Sustained allegations of patient abuse, either verbally or physically shall result in immediate termination. Patient rights shall not be violated.

2.2.4. Preventive health and goal-oriented treatment.

2.2.5. Refers patient to other specialty care as required according to service agreements and current legislation.

2.2.6. Prescribing Medications: The contracted physicians shall be responsible for prescribing medications as needed and will be required to utilize the VA formulary. When the contract physician identities a need to prescribe non-formulary medication, the physician shall submit the appropriate non-formulary request with all required information. The contract physician will be required to have a DEA controlled substance registration certificate issued in their name only (not restricted for use at only one agency, institution or location) for prescribing Schedule II through Schedule V controlled substances. Medication reconciliation shall be completed during each patient encounter in the Clinic. Allergy assessment shall be documented when medication is prescribed.

2.2.7. Order labs, imaging and other pertinent tests.

2.2.8. Initial screening of patients to determine eligibility.

2.2.9. Documentation: Clinical records shall be completed and signed in a timely manner. The contract physician shall be trained on the proper use of various VA systems including Vista and CPRS. Contract physician are expected to comply with Medical Center requirements to use the Emergency Department Integration System (EDIS) when working in urgent care.

The performance metrics as outlined in the Emergency Medicine Management Tool (EMMTT) will be utilized in tracking compliance. Findings from an assessment or a 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 shall include all elements as explicitly outlined in the Battle Creek VA Medical Center Staff Bylaws and applicable policies. All required documentation shall be fully completed within Battle Creek VA Medical Center required timeframes.

2.2.10. When contract physician is the only practitioner involved in the care of the patient during stay he/she shall be responsible for completing all required medical record documentation, including the discharge summary and patient instructions.

2.2.11. Furnish technical and/or professional support for residents, physicians, nurse practitioners and physician assistants employed by the VA.

2.2.12. Responsible for coordination, evaluation, treatment, and overall medical management for eligible Veterans evaluated and treated within the clinic. Appropriate referral transfer of the Veteran shall be arranged by the Contractor for care that cannot be delivered in Battle Creek VA Medical Center clinical setting.

2.2.13. The contracted physician(s) ensures that medical record documentation contains the minimum information in congruence with the Health Care Financing Administration/ Medicare guidelines, supporting patient care.

2.2.14. When the Government directs, the Contractor shall remove from performance on the contract any physician who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the Battle Creek VA Medical Center and its population.

2.2.15. In addition, perform other work within the scope of their clinical privileges in the Battle

Creek VA Medical Center Clinic.

2.3. Emergency/Disaster Procedures: In case of fire or other Medical Center disaster, the contract Physician shall assist in the evacuation of patients. The contract physician shall ensure that he/she is familiar with fire and disaster instructions and will attend all fire and disaster drills conducted during his/her tour of duty.

2.4. The good conduct of medical practice includes the proper and timely use of consultation.

Consultation shall be made when necessary with the VA medical backup physician, surgeon, psychiatrist and/or social worker.

2.5. All Physicians shall have current Basic Life Support (BLS) Certification.

2.6. Battle Creek VA Medical Center Staff will provide orientation and training to new contract physician staff members. Normally, the orientation 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 Battle Creek

VA Medical Center. Payment for orientation and training will be at regular hourly rate.

Maximum of 16 hours provided for training/orientation.

2.7. Documentation and clinical records shall be completed and signed in a timely manner. The

Contractor’s employees shall be trained on the proper use of various VA systems including VISTA and CPRS.

2.8. 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.

2.9. 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, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered. No services provided under this contract shall be performed outside of the United States.

2.9.1. License - The Contractor’s physician (s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia) when services are performed onsite on VA property.

All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician (s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.9.2. Board Certification - Contractor’s physician (s) shall be Board Certified or Board Eligible in Internal Medicine or Family Practice and be currently certified in Basic Life Support (BLS) or equivalency. All continuing education courses required for maintaining certification must be kept up to date at all times. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.9.3. Credentialing and Privileging –Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any Contractor’s physician(s) prior to obtaining approval by the Battle Creek VA Medical Center Professional Standards Board, Medical Executive Board and Medical Center Director.

2.9.3.1. If a Contractor’s physician(s)is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.9.4. Technical Proficiency - Contractor’s physician (s)shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all Contractor’s physician (s)and Contractor’s physician (s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.9.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements:

Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. Contractor’s physician (s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for Contractor’s physician (s).

2.9.6. Training BLS, CPRS and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor’s physician(s) as required by the VA.Other training may become required. VA will communicate any changes to the training requirement to the contractor.

Training (The following training is mandatory per VHACO for Contracted Physicians)

Frequency (once a year)

Annual Hours

Active Threat Training Annually 1.0 Government Ethics Annually 1.0 Prevention of Workplace Harassment/No Fear Act

Annually 1.0

VA Core Values Training (ICARE Recommitment)

Annually .25

VA Privacy and Information Security Awareness and Rules of Behavior

Annually 1.0

Privacy and HIPAA Training Annually 1.0 BLS BI-Annually 8 Prevention/Management of Disruptive Behavior/Violence Prevention

Annually 1.0

Suicide Prevention: Suicide Risk Management Training for Clinicians

Annually 1.0

CPRS As needed Stroke Basics Annually 1.0

2.9.7. Standard Personnel Testing: Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year.

2.9.7.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative Tuberculosis Skin Test (TST) or interferon-gamma release assays (IGRA) for all Contractor’s physician (s) {This is applicable to all health care workers}. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results. The TST or IGRA testing shall be repeated annually.

2.9.7.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.9.7.3. VARICELLA: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.9.7.4. ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor physicians {This is applicable to all health care workers}.

2.9.7.5. INFLUENZA: Contractors shall provide proof that all Contractor physicians have received the annual Influenza vaccine unless it is contraindicated. If the Contractor physician has a medical contraindication to the vaccine, they shall be required to wear a mask during the Influenza season. {This is applicable to all health care workers}.

2.9.7.6. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor’s physician

(s) {This is applicable to all health care workers}; provide their own Hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.9.7.7. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.9.8. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) and shall be provided to the Contracting Officer during the onboarding process.

2.9.9. DEA (as required) - Contractor shall provide copy of current DEA certificate.

2.9.10. Conflict of Interest: The Contractor and all Contractor’s physician (s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.9.11. Citizenship related Requirements:

2.9.11.1. The Contractor certifies that the Contractor 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 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.9.11.2. While performing services for the Department of Veterans Affairs, the Contractor 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 Contractor 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.

2.9.11.3. If the Contractor 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 Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.9.11.4. 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. 1001.

2.9.11.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.9.12. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) 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 may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.9.12.1. 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 physician (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.

2.9.12.2. By submitting their proposal, 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 offer/bid was signed.

2.10. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will http://oig.hhs.gov/exclusions/index.asp be provided by the VAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

All physicians will be evaluated through Focused Professional Practice Evaluations and Ongoing Professional Practice Evaluations and presented to the Executive Committee for Medical Staff for continued credentialing and privileging.

2.10.1. When the government directs, the contractor shall remove from performance under the task order any physician who is identified a potential threat to the health, safety, security, general well-being, or operation mission of the Battle Creek VA Medical Center and its population.

2.11. Non-Personal Healthcare Services: The parties agree that the Contractor and all Contractor’s physician (s) shall not be considered VA employees for any purpose.

2.12. Indemnification: The Contractor 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, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.13. Prohibition Against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s)

2.14. Inherent Government Functions: Contractor and Contractor’s physician (s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.15. No Employee status: The Contractor shall be responsible for protecting Contractor’s physician

(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.15.1. Workers’ compensation

2.15.2. Professional liability insurance

2.15.3. Health examinations

2.15.4. Income tax withholding, and

2.15.5. Social security payments.

2.16. Tort Liability: The Federal Tort Claims Act does not cover Contractor or Contractor’s physician (s). When a Contractor or Contractor’s physician (s)has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or Contractor’s physician (s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.17. Key Personnel:

2.17.1. The VA Full Time Equivalency (FTE) for the services required is 2.0 FTE (2,080 hours =

1.0 FTE; 2,080 hours x 2 physicians = 4,160 hours of service coverage annually).

2.17.2. The Contractor shall ask 60 days in advance for vacation or personal leave days.

2.17.3. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 2 calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 45 calendar days prior to making any permanent substitutions.

2.17.3.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 7 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.17.3.2. For temporary substitutions where the key person shall not be reporting to work for three consecutive work days or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.17.3.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s physician (s), s/he may request, without cause, immediate replacement of said Contractor’s physician (s). The CO and COR shall deal with issues raised concerning Contractor’s physician (s) conduct. The final arbiter on questions of acceptability is the CO.

2.17.3.4. Contingency Plan: Because continuity of care is an essential part of VAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor’s physician (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. HOURS OF OPERATION

3.1. VA Business Hours: Hours of Operation, 8:00am to 4:30pm, Monday through Friday, excluding federal holidays. Every six weeks, the BCVAMC Primary Care Clinic and the Wyoming CBOC offer extended hours, Wednesday 8:00am to 6:30pm and Saturday 8:30am to 12:00pm.

3.1.1. Patients must be seen by a Contractor’s physician (s) on-site at Battle Creek VA Medical

Center or CBOC in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

3.1.2. Contractor’s physician (s) s shall be available and present in clinic during normal hours at Battle Creek VA Medical Center or CBOC clinic hours, which will be established, and may be revised, as deemed appropriate for patient care by the Chief of Staff.

3.2. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

• New Year’s Day

• President’s Day

• Martin Luther King’s Birthday

• Memorial Day

• Juneteenth Day

• Independence Day

• Labor Day

• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any day specifically declared to be a national holiday.

• Any day where the federal agencies and departments are closed by executive order of the

President of the United States

3.3. Cancellations:

3.3.1. Unless a state of emergency has been declared, the Contractor shall be responsible for providing services.

4. CONTRACTOR RESPONSIBILITIES

4.1. 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.

4.1.1. 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.

4.1.2. The Contractor shall provide to the COR a completed schedule for the next month, showing assigned contractor physicians, no later than the 15th day of each month.

4.2. Standards of Care: The Contractor’s physician(s)’ care shall cover the range of Primary Care services as would be provided in a state-of-the-art health care facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1. ABIM: American Board of Internal Medicine Standards:

https://www.abim.org/certification/policies/combined-training/internal-medicine-medical-genetics-and-genomics/guidelines.aspx

4.2.2. ABFM: American Board of Family Medicine Standards:

https://www.theabfm.org/about/policies/guidelines-for-professionalism-licensure-and-personal-conduct

4.2.3. VA Standards: VHA Directive 2006-041 “Veterans’ Health Care Service Standards”

(expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

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

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

https://www.abim.org/certification/policies/combined-training/internal-medicine-medical-genetics-and-genomics/guidelines.aspx https://www.abim.org/certification/policies/combined-training/internal-medicine-medical-genetics-and-genomics/guidelines.aspx https://www.theabfm.org/about/policies/guidelines-for-professionalism-licensure-and-personal-conduct https://www.theabfm.org/about/policies/guidelines-for-professionalism-licensure-and-personal-conduct https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 http://www.jointcommission.org/standards_information/standards.aspx http://www.hpoe.org/resources?show=100&type=8

4.2.6. The requirements contained in this PWS.

4.3. MEDICAL RECORDS

4.3.1. Authorities: Contractor’s physician (s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 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), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to:

a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

4.3.3. Disclosure: Contractor’s physician(s) may have access to patient medical records:

however, Contractor shall obtain permission from the VA before disclosing any patient information. 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. The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines…