36C25226Q0036.docx

36C25226Q0036

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

36C25226Q0036 10-06-2025 Becky Cincotta 414-844-4822 10-27-2025 13:00

CDT

36C252 Department of Veterans Affairs Great Lakes Acquisition Center 115 South 84th Street, Suite 101 Milwaukee WI 53214-1476 X X 621512 $19 Million N/A X 36C556 Captain James A. Lovell Federal Health Care Center 3001 N. Green Bay Road North Chicago IL 60064-3048 36C252 Department of Veterans Affairs Great Lakes Acquisition Center 115 South 84th Street, Suite 101 Milwaukee WI 53214-1476

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 Contractor to provide Teleradiology Services to the Captain James A. Lovell Federal Health Care Center in accordance with the specifications, terms, and conditions contained herein.

This procurement is 100% set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB). All vendors must be listed as a certified SDVOSB through the Small Business Administration's small business search website at:

https://search.certifications.sba.gov/.

Schedule of Services and Price begins on Page 7.

Performance Work Statement begins on Page 25.

38 U.S.C. 8153 X X

BECKY CINCOTTA

Contracting Officer Table of Contents

D.1 ATTACHMENT A - QASP TELERADIOLOGY

D.2 ATTACHMENT B - IMMIGRATION AND NATIONALITY ACT CONTRACTOR

CERTIFICATION

D.3 ATTACHMENT C - VA NOTICE OF LIMITATIONS ON SUBCONTRACTING

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. CONTRACT ADMINISTRATION MATTERS WILL BE HANDLED BY:

a. Contractor: Name/Address/City/State/Zip (Print or Type Information) Point of Contact/Title: __________________________________ Telephone Number: ______________________________ Fax Number: ______________________________ Email: __________________________________ UEI Number: ___________________________ Federal Taxpayer Identification Number: ___________________________

b. Contractor Past Performance Point of Contact:

Name & Title: __________________________________ Email: __________________________________

c. Government:

Department of Veterans Affairs Great Lakes Acquisition Center (GLAC/36C252) 115 South 84th Street, Suite 101 Milwaukee, WI 53214-1476

Becky Cincotta, Contracting Officer Telephone: (414) 844-4822 Email: becky.cincotta@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with Federal Acquisition Regulation (FAR) Clause 52.232-33, Payment by Electronic Funds Transfer-- System for Award Management (31 U.S.C. 3332).

3. POST AWARD ORIENTATION: The Contracting Officer may schedule a post award conference call/meeting for contract orientation purposes. Contractor is required to participate.

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

5. SECURE FAX: VA Handbook 6500 requires the following statement on all fax cover sheets be included: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribute on, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

[End of Contract Administration Data]

B.2 SCHEDULE OF SERVICES AND PRICE

The Contractor shall furnish all space, supplies, equipment, management, and key personnel to include board certified/board eligible radiologists to perform off-site Teleradiology Services in accordance with the specifications contained herein, on an on-demand, as needed basis for the Captain James A. Lovell Federal Health Care Center (FHCC) located at 3001 Green Bay Road, North Chicago, IL, 60064-3048.

The FHCC Radiology Service follows the standards & guidelines set forth by American College of Radiology (ACR). A contractor providing Teleradiology Services shall provide services that meet or exceed the American College of Radiology Guidelines found at Practice Parameters and Technical Standards | American College of Radiology (acr.org).

Contract Term: This contract shall consist of a five-year ordering period. The anticipated period of performance is January 1, 2026, through December 31, 2030.

Contract Type: The resultant contract type will be a Fixed Price, Indefinite Delivery, Indefinite Quantity (FP-IDIQ) contract. The quantities provided in the Price Schedule are estimates. Contractor shall be paid only for actual services performed.

Orders: Orders shall be placed against this contract as needed during the term of the contract. Task Orders shall specify the estimated quantities of services for the period of performance and shall comply with FAR 52.216-18 and 52.216-19.

Ordering Procedures: The FHCC’s Radiology personnel are the only individuals authorized to order services under this contract. An order for Teleradiology Services is placed upon delivery of the images to the contractor through the FHCC electronic imaging system or, if that is not possible, through a secure fax.

Ordering Officers (OOs) may be authorized to place orders against this contract. If used, the Contracting Officer (CO) will furnish the Contractor With the names of individuals authorized as OOs, by a separate memorandum. When OOs are added after award, the CO Will furnish the Contractor With the names of individuals authorized as OOs, by memorandum upon OO appointment. OOs are responsible for issuing and administering orders placed under this contract. OOs have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the CO responsible for this contract. The Contractor shall accept orders against this contract only from the CO and/or authorized OOs. Fulfilling orders from persons other than the CO or OO may result in loss or delay in payment for services provided under such orders.

Guaranteed Minimum and Maximum Ceiling Amount: The guaranteed minimum for the initial fiscal year in which this contract is awarded is $20,000.00. The maximum total value of the contract, inclusive of each ordering year and all options exercised, shall not exceed $3,600,000.00. The VA does not guarantee that it shall place any orders under this contract more than the guaranteed minimum award amount.

Pricing Instructions:

For pricing and evaluation purposes, the current Centers for Medicare and Medicaid (CMS) Medicare Physician Fee Schedule rates found at www.cms.gov shall be used in completing each LINs 1001-1147 for Year 1. Offerors must fill out the cells in the Proposed Unit Cost, CMS Unit Cost, % of CMS rate unit costs represents, and estimated total annual cost columns in the Price Schedule for each Line Item Number (LIN).The same unit costs and % of CMS rate must be entered for Years 2-5.

Throughout the life of the contract the FHCC will pay the awarded firm fixed percentage of the CMS Medicare rate effective at the time of contract award and at each year anniversary. A contract modification will be executed to incorporate CMS Current Procedural Terminology (CPT) rate changes to the Price Schedule.

The contractor is not entitled to retroactive payment rate adjustments prior to implementation of the change(s) in Medicare rates by the Contracting Officer. “Piecemeal” changes to Medicare rates, such as only seeking per-procedure rate adjustments for select codes or a select group of codes, shall not be permitted under any circumstance.

This basis of the Offeror’s proposed firm fixed percentage of the CMS Medicare rate will be used by the Government for future pricing of additional codes/procedures and for reimbursement under the contract. The basis of estimate used for the fixed price, i.e. the way that the price is calculated, shall remain the same throughout the life of the contract and may be validated by post award audits.

The Offeror shall complete the Price Schedule below based on CMS Medicare non-Facility rates for locality code 0610215 for Suburban Chicago with a modifier of 26 (professional component). No LINS or codes should be left blank. If for some reason a code on the schedule has expired or is for any other reason unusable, offeror shall annotate the Proposed Unit Cost block with “N/A” or otherwise notate the replacement CPT code. The Offeror shall base pricing on the application of Medicare reimbursement rules.

“STAT” pricing will include the preliminary report and the final report that is entered and verified in the FHCC computer system within 24 hours. “ROUTINE” pricing will be based on the final report that is entered and verified in the FHCC computer system within 24 hours.

PRICE SCHEDULE

Year 1: January 1, 2026 to December 31, 2026

Qty.

Annual Cost

STAT

ROUTINE

Estimated Total Year 1

Year 2: January 1, 2027 to December 31, 2027

Qty.

STAT

ROUTINE

Estimated Total Year 2

Year 3: January 1, 2028 to December 31, 2028

Qty.

STAT

ROUTINE

Estimated Total Year 3

Year 4: January 1, 2029 to December 31, 2029

Qty.

STAT

ROUTINE

Estimated Total Year 4

Year 5: January 1, 2030 to December 31, 2030

Qty.

STAT

ROUTINE

Estimated Total Year 5

Total Estimated Contract Value: $____________

KEY PERSONNEL: The contract physicians listed below are identified as Key Personnel who are authorized to provide services under this contract upon successful completion of the credentialing and privileging requirements and initiation or existing favorable adjudication of an Access National Agency Check with Written Inquiries (ANACI) background investigation.

[End of Schedule of Services & Price]

B.3 PERFORMANCE WORK STATEMENT - TELERADIOLOGY SERVICES

1. GENERAL:

1.1. Services Provided: The Contractor shall furnish all space, supplies, equipment, management, and key personnel to include board certified/board eligible radiologists to perform off-site Teleradiology Services in accordance with the specifications contained herein, on an on-demand, as needed basis for the Captain James A. Lovell Federal Health Care Center (FHCC).

The FHCC Radiology Service follows the standards & guidelines set forth by American College of Radiology (ACR). A contractor providing Teleradiology Services shall provide services that meet or exceed the American College of Radiology Guidelines found at Practice Parameters and Technical Standards | American College of Radiology (acr.org).

1.2. Place of Performance: All work performed under this contract will be at the Contractor’s place(s) of performance. The contractor’s total Teleradiology operations shall be confined to within the borders of the United States of America, District of Columbia and/or Puerto Rico. The Contractor shall not access any FHCC data/information (for example, by remote computer access) from locations that are outside the above-stated borders. Furthermore, the Contractor shall not send, transfer, mail or otherwise transmit any FHCC data/information to locations outside the above-stated borders.

1.3. Authority: Title 38 USC 8153 – Sharing of Health Care Resources Authority in accordance with a combination of Federal Acquisition Regulation FAR 12 – Acquisition of Commercial Items and VAAR 873 – Simplified Acquisition Procedures for Health Care Resources.

1.4. Policy/Directives/Handbooks. The contractor shall be subject to the following policies, including any subsequent updates during the period of performance. The policies listed below can be accessed electronically at the following sites: VA Publications and VHA Publications.

Security Program

1.

1.4.

1.4.3.

1.4.4.

1.4.5.

1.4.6. VHA Directive 1065: Productivity and Staffing Guidance for Specialty Provider Group Practice

1.4.7. VHA Directive 1088(1): Communicating Test Results to Providers and Patients

1.4.8. VHA Directive 1100.18: Reporting and Responding to State Licensing Boards

1.4.9. VHA Directive 1100.20: Credentialing of Health Care Providers

1.4.10. VHA Directive 1100.21: Privileging

1.4.11. VHA Directive 1605.01: Privacy and Release of Information

1.4.12. VHA Directive 1907.01: VHA Health Information Management and Health Records

1.4.13. VHA Handbook 1100.17: National Practitioner Data Bank (NPDB) Reports

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

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

1.4.15. 42 Code of Federal Regulations (CFR) Part 482 Conditions of Participating Hospitals:

https://www.ecfr.gov/cgi-bin/text-idx?node=pt42.5.482&rgn=div5

1.5 Acronyms/Definitions: 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. ACGME: Accreditation Council for Graduate Medical Education 1.

1.5.

1.6.

1.7.

1.5.2 BAA: Business Associate Agreement

1.5.3 CDC: Centers for Disease Control and Prevention

1.5.4 CEU: Certified Education Unit

1.5.5 Clinical Privileging: Clinical Privileging is the process by which a practitioner, licensed for independent 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, and within available resources.

1.5.6 CME: Continuing Medical Education

1.5.7 CMS: Centers for Medicare and Medicaid Services

1.5.8 CO: Contracting Officer: 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.

1.5.9 COR: Contracting Officer’s Representative: 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.

1.5.10 COS: Chief of Staff

1.5.11 CPARS: Contractor Performance Assessment Reporting System

1.5.12 Credentialing: Credentialing is the process of obtaining, verifying, and assessing the qualifications of a health care provider to provide care or services in or for the VA/FHCC health care system. Credentials are documented evidence of licensure, education, training, experience or other qualifications.

1.5.13 EHR: Electronic Health Record -…