36C25520Q0209-0001005.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) N/A 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth

KS

66048 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth

KS

66048 To all Offerors/Bidders

36C25520Q0209 04-02-2020

X X

X The purpose of this amendment is to provide an revised Statement of Work and to extend the due date to Thursday, April 16, 2020 10:00am CST.

POC: Denise Maynard, denise.maynard@va.gov

Denise Maynard Contracting Officer

ROBERT J DOLE VAMC

CARDIAC EVENT MONITORING SERVICE

1. Provide cardiac event monitoring services including all equipment, supplies and related services for designated beneficiaries of the VA Medical Center, Wichita Kansas, and remote CBOC's (Community Based Outpatient Clinic) under the control of the VA Medical Center, Wichita, KS. On the average fourteen (14) to Twenty (20) patients a month will require event monitoring under this contract. The Period of Performance will be for one year from contract award with four one-year options. Monitoring of cardiac arrhythmia will include multiple event looping, trans-telephonic capability and immediate notification of the on-call cardiology physician at the VA Medical Center, Wichita, KS. In most instances, services will be required on a 30-day per patient basis. This is always to include inventory of 10 monitors in stock at Robert J. Dole VAM&ROC, in addition to the monitors being used.

2. Information is to be shared across multiple sites, to include all Community Based Outpatient Clinics (CBOC) under the auspices of the Robert J. Dole VAM&ROC.

3. Contractor:

REQUIRED SERVICES: The Contractor will provide:

· Twenty-four hour, seven days per week, 52 weeks a year including leap year, cardiac arrhythmia monitoring for approximately 14 to 20 patients per month. All monitoring devices offered must have the capability to download stored information using any trans-telephonic receiver.

· The event monitoring device and all supplies for each patient. Both looping and non-looping devices will be provided and available for immediate use at the VAMC Wichita, KS. In the instances where all available devices are being utilized, additional equipment will be provided within twenty-four hours.

· In-service training for all VAMC, Wichita, KS Heart Station staff.

· Immediate notification of designated VAMC, Wichita, KS physician subsequent to a confirmed arrhythmia.

· Fax transmission of the ECG and its interpretation to the appropriate VAMC Wichita, KS Division.

· Maintenance and repair of devices provided as required in accordance with manufacturer's specifications.

· Generates patient reminder letters, daily schedules, and missed visits.

· Records trans-telephonic ECG transmissions.

· Records patient voice message as well as cardiac event.

4. Scheduling request for services:

Robert J. Dole VAMC will provide patient demographics. Requests for cardiac monitoring services will be telephoned to the Contractor by VA Cardiovascular Service.

Contractor must complete and provide the following information:

Contractor's Contact Person:

Telephone Number:

When patient calls the contractor, guidance will be given to patient, event will be transmitted, and assessment provided 24/7 by the on-call person and not by an answering machine. Contractor shall have a Board-Certified Cardiologist on staff and available at all times to perform ECG interpretations of an acute nature. Patients that are provided with the monitoring devices may make an unlimited number of symptomatic calls to Contractor. Cardiac technicians shall be available twenty-four hours per day seven days per week to discuss the patient's symptoms with him/her and then correlate the symptoms with the ECG findings.

· Contractor notifies Robert J. Dole VAMC upon receipt of transmission.

· After completion of test, Contractor will retrieve all data; finalize report, and forward report to Robert J. Dole VAMC. Written reports shall be furnished for each patient a minimum of 7 days after event is transmitted. Reports shall be submitted to: Robert J. Dole VAMC Cardiology Department, 5500 E. Kellogg, Wichita, KS 67218, Telephone 316-651-3653.

· Final reports will be faxed and mailed to Robert J. Dole VAMC Cardiology Department in a format, which can be scanned into the patient computerized record system. A copy of the actual ECG strip along with patient contact reports shall be included with all written reports.

· The Physician Notification Criteria, (see attachment) will be used to notify the provider. After hours, Emergency Department M.D. will be notified.

Arrhythmia Monitoring Service Physician Notification Criteria

EMERGENCY OFF HOUR

Physicians will be notified of each test that meets or exceeds these criteria as they are reported:

· Tachycardia 150 BPM or greater, sustained AV Blocks: Type II,2: 1, Advanced, Third for 60 seconds or more (age 10 and over)

· AV Blocks: Type II,2: 1, Advanced, Third Degree (Complete)

· Bradycardia less than 40 BPM, sustained for 30 seconds or more

· A Fibrillation/Flutter with a rate of 150 BPM or more

· Idioventricular rhythm, V Flutter, V Fibrillation, torsades de pointes

· SVT sustained for 30 seconds or more with a rate of 150 BPM or more

· Any suspected pacemaker failure

· 5 or more consecutive PVCs/Repetitive

· Asystole/Pauses of 2/5 seconds or greater

· Syncope/Unresponsiveness/Seizures

· Ineffective/Inappropriate or Multiple AICD discharges

· Severe chest pain, unrelieved for 15 minutes or more

· Chest pain with associated symptoms; marked shortness of breath; diaphoresis (sweating); radiating pain; extreme anxiety; nausea; vomiting; crushing, vice-like pain

EMERGENCY RESPONSE

Immediate physician notification:

· The patient will be kept on the line; repeat ECG transmissions will be attempted.

· If the event is sustained and the physician has not responded within 10 minutes, we will assist the patient in obtaining emergency medical assistance.

· Physicians will be notified of all action that is taken.

· ECG reports will be faxed within 15 minutes.

ROUTINE NOTIFICATION CRITERIA

Physicians will be notified daily of the following events, from 9 a.m. to 10p.m. (EST):

· Ectopy greater than 15 PVCs per minute

· First documented occurrence of A Fibrillation/Flutter

· SVT sustained for 30 seconds or more with a rate less than 150 BPM

· Effective/Single AICD discharges/any report of AICD discharge without ECG documentation

5. Once test is completed and report submitted, Contractor will submit invoice to Austin.

6. LOAN OF EOUIPMENT:

All event recorders will be loaned by the Contractor to the VA and must be state-of-the-art equipment, lightweight, and simple for patients to use. Equipment will be placed in inventory at the VA Cardiology ECG Departments upon award of contract. The contractor will reconcile inventory every 60 days.

Equipment levels will be maintained in sufficient quantities to handle, at a minimum, the average number of monitors generally utilized in a two week period of time. Contractor will be responsible for retrieving all monitoring equipment from patient. Contractor will also be responsible for any equipment lost or damaged. All equipment offered must be FDA approved.

7. Contractor will provide technical system training and technical services.

8. PRIVACY ACT NOTIFICATION

The Contractor will be required to design, develop, or operate a system of records on individuals to accomplish an agency function in accordance with the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Act may involve the imposition of criminal penalties.