36C25618R0078-00004000.docx

Amendment 4 for Houma CBOC

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 ITE M 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 r eference 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

BY

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) 00004 05-10-2018 Department of Veterans Affairs for SL Veterans Health Care System Network Contracting Office 16 400 Veterans Avenue Biloxi MS 39531 Department of Veterans Affairs Network Contracting Office 16 400 Veterans Avenue Biloxi MS 39531 To all Offerors/Bidders

36C25618R0078 05-10-2018

X X X

1600 CT 5/24/18

X Solicitation is hereby amended to include more responses toquestions received and are included herein.

Extension of offers is provided in block 11 above.

Attachment D8 has been revised and attached.

Melanie Hawley Contract Specialist

NCO1616L3-0035

1) P2 - Q6 - "There will be at least one Physician MD/DO in addition to the Physician Director." Is this to be 1.0 FTE? The VA answered "Yes." However, on P9 - Q3, the answer states "One primary care physician will perform the medical director duties in addition to seeing primary care patients. The other PCP will be full-time patient care providers." Can the VA please clarify if one full-time physician and three mid-levels would be permitted in this contract?

Answer: Per the solicitation (Section 2.2) regarding a Physician Director, there is to be 0.05 FTEE Physician Director per PACT. This Per the solicitation (Section 2.3.1) regarding Teamlet members, ‘There will be at least one Physician MD/DO in addition to the Physician Director’.

(Please note, that veteran input was solicited via numerous VHA ‘townhalls’ with the majority expressing preferences for MD/DO’s over NP/PA’s.)

2) P3 - Q9 - " These calculations are from the PACT model that is included in the link in the solicitation. It is based on provider panels and workload. The numbers are based on 1000 veterans per each FTE. The 7.72 is correct for Mental Health. Actual panel sizes can be determined by the VA by PCMM Handbook 1101.02" PCMM Handbook 1101.02 has been rescinded and replaced by VHA Directive 1406. We have reviewed this directive and do not see any mention of this ratio or how to calculate mental health ratios based on PACT team ratios. PHA has reviewed hundreds of CBOC RFPs and has never seen this staffing requirement for mental health in any RFP let alone a clinic this size. We are calculating a total of 9.64 total mental health FTEs for this solicitation. We respectfully request the VA to explain its approach and some of the objectives it is attempting to accomplish with the increase of mental health staff.

Answer: These staffing standards are provided by the Office of Mental Health and Suicide Prevention. The 7.72 FTE ratio per 1000 Veterans seen in outpatient MH includes .67 PCMHI FTE per PC panel (or PACT) and 1.22 psychiatrist FTE per 1000 Veterans seen in outpatient MH.

These services can be provided by a variety of disciplines, but certain services need to be provided by a licensed independent provider (a LIP such as a psychologist) for full assessment and disposition services and a prescribing provider (such as a psychiatrist or APRN) for medication consultation/prescribing and supervision, so important to include a mix of disciplines in providing MH services.

A CBOC similar in the size of the present clinic has the following staffing:

Slidell is similar in size with 4 PACTs. Our staffing is (1 psychologist/2 psychiatrists/2 MH RNs/1 LCSW/1 VASH-HUD LCSW, 1 MSA). This CBOC has 4 PACTs.

3) P3 - Q9 "GENERAL AND SPECIALTY MENTAL HEALTH STAFFING (not PC-MHI) (emphasis added). MH staffing performance standard is 7.72 total FTE per 1000 Veterans seen in outpatient MH, which includes 1.22 psychiatrist FTE per 1000 outpatient MH and 0.67 PCMHI (emphasis added) FTE per PC panel." The beginning of this sentence includes "(not PC-MHI)" in parentheses, suggesting that the ratio is not meant to include PCMHI staffing, and yet the end of the sentence includes "and .67 PCMHI". We find this statement ambiguous with the inconsistent references to inclusion or exclusion of PCMHI staff and ask that this is clarified.

4) Answer: These staffing standards are provided by the Office of Mental Health and Suicide Prevention. The 7.72 FTE ratio per 1000 Veterans seen in outpatient MH includes .67 PCMHI FTE per PC panel (or PACT) and 1.22 psychiatrist FTE per 1000 Veterans seen in outpatient MH.

The inclusion of “not PCMHI” after GENERAL AND SPECIALTY MENTAL HEALTH STAFFING was meant to clarify that GENERAL AND SPECIALTY MENTAL HEALTH STAFFING is in addition to PCMHI staffing.

Including the below clarification in addition to above question:

Confirmed via MH PCMHI includes co-located collaborative care and care management services (see VHA Handbook 1160.01, Uniform Mental Health Services). These services can be provided by a variety of disciplines, but certain services need to be provided by a licensed independent provider (a LIP such as a psychologist) for full assessment and disposition services and a prescribing provider (such as a psychiatrist or APRN), for medication consultation and supervision so important to include an appropriate mix of disciplines to provide all PCMHI services.

5) P4 - Q14 - "The Contractor covers the costs of the ‘bridge’ medications for patients that can’t wait until they receive them in the mail. The Capitated Rate is to be all-inclusive (including medications)." Please see contract award o/a 3/27/18: GS-23F-0047U 36C25618F0824 from Department of Veterans Affairs, VISN 16, Southeast Louisiana Veterans Health Care System (SLVHCS) Medical Center for Emergent Prescription Filling Services in support of Veteran care at New Orleans’ Medical Center and associated Community Based Outpatient Clinics (CBOCs)." Please clarify this inconsistency.

Answer: This contract is a new award (4/12/2018) and does indeed cover Houma CBOC; however, the term of the contract may expire prior to this CBOC contract expiring; therefore, if the contract 36C25618F0824 with Heritage Health Solutions, Inc expires, then the contractor shall bear the cost(s) of the urgent and Emergent (bridge) medications. Contract was awarded by Leslie Robinson (504)507-2000 x74160

6) P4 - Q15 - "Providers get credit for telephone visits as well as face to face visits. Yes" - What type of credit? Does this mean the contractor can perform visits that allow enrollees to be added or updated on the billable roster?

Answer: If evaluation and management occurs and the phone call warrants a CPT billing code, it will count as if it were a face to face clinic visit.

7) P9 - Q7 Embedded attachment: Clinic Stops and Persons: This chart shows a total of 3,454 cumulative individual MH encounters and 490 cumulative MH group encounters. Does this mean there were 3454 individual MH encounters for over the year (FY17)? Do the 490 cumulative group encounters mean 490 group sessions with at least two participants /session in FY17? Is this the encounter volume that VA wants a contractor to supply close to 10 MH FTEs for? Does VA want 10 MH FTEs for only 3,454 individual encounters per year?

Answer: The MH staffing performance standard is 7.72 FTEE per 1000 MH patients but the PWS allows for some flexibility with the staff mix.

A CBOC similar in the size of the present clinic has the following staffing:

Slidell is similar in size with 4 PACTs. Our staffing is (1 psychologist/2 psychiatrists/2 MH RNs/1 LCSW/1 VASH-HUD LCSW, 1 MSA). This CBOC has 4 PACTs.

8) P11 - Q21 - Answer indicates that the New Orleans VAMC will pay for the lab courier. P12 - Q35 indicates the contractor is responsible for the cost. Can the VA please clarify who is responsible for providing the lab courier?

Answer: The lab courier cost will be borne by the contractor as specified in 4.6.

9) P12 - Q38 - "Services for PCMHI, MH, compensation, and pension as needed." - If the contractor is responsible for providing PCMHI and mental health, in what circumstances would the VA provide these services via telehealth? - Would it be acceptable for the VA to use the telehealth room for teleretinal and telederm as well?

Answer: Page 23 section 2.4.5 indicates Contractor is to provide PCMHI staff to provide services on-site.

The contractor will connect to the VA via Telehealth as needed for services including Clinical Video Telehealth (CVT). TCT (Telehealth Clinical Technician) coordinates CVT. The TCT is usually a LPN and physically conducts the entire visit with instruction from Dermatology via tele-dermatology.

There will be no VA staffing stationed at the CBOC.

Teleretinal and Tele-Derm are standalone procedures that are completed at the clinic and the resultant images are transmitted to VA.

There is no expectation for compensation and pension examinations at the CBOC.

10) P13 - Q44 - "Yes, armed. Refer to PWS 4.7.5 and 4.7.9." - PWS section 4.7.5 refers to Privacy Standards. 4.7.9 refers to Equipment, Office Supplies, and Technical Support. After reviewing the solicitation, we see no mention of requiring on-site physical security in the form of a guard or one requiring an armed security guard. Is this a new requirement not stated in the original PWS?

Answer: A security guard is not mandated, and retract the previous answer of an armed one.

11) P13 - Q50 - "Two rooms per provider is a minimum requirement." - VHA Directive 140 on page E-2 states, " VHA Dir 1406, Patient-Centered Management Module (PCMM) for Primary Care Levels of 2.5 examination rooms per 1.0 FTE provider have been recommended as a minimum for VHA." The PWS states in section 4.7.1 "to include a minimum of 3 exam rooms per teamlet and 1 consultation room per teamlet" We ask the VA to clarify.

Answer: PWS language should be changed to the following:

4.7.1 Contractors shall provide space that meets the standards outlined in the PACT Space Module Design Guide (see link above) and for the purposes of this solicitation the following minimum space requirements are:

Provide patient reception and transition zone (a.k.a waiting room), patient corridors, patient care rooms (to include a minimum of 3 exam rooms and 1 consultation room per PACT), a procedure/treatment room, group care rooms for shared medical appointments and for mental health groups, a teamwork support zone, and adequate core supply storage areas. At least two of the exam rooms need to have attached bathroom for women’s health services. Space/offices need to be included for non-primary care staff (mental health staff, dietitian, social worker, and CPS) and for x-ray, phlebotomy, and telehealth services.

12) P13 - Q52 - “At a minimum, one” We do not see any language requiring a procedure room in the solicitation. Can the VA please specify which types of procedures will need to be performed in this room as well as the required equipment?

Answer: The procedure/treatment room is used for non-invasive procedures that require more space than a common examination room. Usage is based on the discretion of provider, patient and case. Typically, the rooms are used for EKG’s, IND’s, dressing changes, and even Telehealth services as needed if equipped. The procedure/treatment room is also used for bed-ridden patients who arrive via gurney for examinations. At times, the room can be utilized as a staging area for patients who require transfer to another facility as to not occupy a teamlets room during clinic while waiting for Acadian Ambulance transport. (Podiatry section was removed from PWS)

13) Notwithstanding the clarifications provided in Amendment 0002, there still remains a fair amount of uncertainty about staffing requirements in general, as evidenced by the need for yet further clarification, in particular, for mental health staffing. Since the VA has indicated specific enrollment for both PC and MH, we ask that VA specify minimum staffing associated for this number and mix of enrollees. This will enable all prospective offerors to have a clear understanding of exactly what this minimum is (with the exception of specifying those mental health positions that can be satisfied by different categories of professionals); otherwise, VA is likely to get bids based on different assumptions of minimum requirements.

Answer: The MH staffing performance standard is 7.72 FTEE per 1000 MH patients but the PWS allows for some flexibility with the staff mix.

Providing more clarification on a previous question in relation to above:

2.5.4.6;

2.5.4.7;

2.5.4.9;

2.5.4.10 What are the FTE Ratio Performance Standards for each of these positions?

The Specialty Mental Health Options 1-5 (2.5.4.3 to 2.4.5.7) is contingent on the makeup of staffing that is offered and satisfies the requirement in the solicitation. Clinical performance standards are addressed in the QASP and other aspects of the PWS/RFP.

2.5.4.9 and 2.5.4.10 can be collateral duties therefore performance standards cannot be determined. The VA staffing has a primary SPC for all CBOC as well as an Outreach Coordinator.

MH staffing FTE ratio performance standard is 7.72 total FTE per 1000 Veterans seen in outpatient MH, which includes 1.22 psychiatrist FTE per 1000 outpatient MH and 0.67 PCMHI FTE per PC panel. A mix of disciplines (see RFP for options) may be selected to meet general and specialty MH FTE ratio performance standard and general and specialty MH service requirements. Staffing ratio outlined is “minimum” and may be adjusted by the VA to provide appropriate Mental Health Care. See the Uniform Mental Health Services Handbook 1160.01 for General and Specialty Mental Health requirements.

Another answer clarified in relation to above question:

This link is to VA CPGs, but we are unable to locate the current performance measures. Please provide a copy of the current performance measures, or an accessible link to them.

Strategic Analytics for Improvement and Learning (SAIL). https://www.va.gov/QUALITYOFCARE/measure-up/Strategic_Analytics_for_Improvement_and_Learning_SAIL.asp Additional measures can be found through EPRP - https://www.va.gov/HEALTHPOLICYPLANNING/VISION/5CHAP4.pdf and SHEP. The CPG’s are currently being updated. Access will be available to awardee. Refer to PWS 4.8.9. Contractor will be held to the standards as outlined in PWS 4.9 and to the QASP Attachment D5.

Current performance measures can be found here: http://vaww.car.rtp.med.va.gov/programs/pm/performance.aspx

13.) Would you please confirm the number of printed copies and CD copies of the Houma Proposal that you require for submission?

Answer: As provided in the Addendum to instructions in Section E Provisions:

One copy of Technical/Past Performance to be sent to Dr. Buth per 2.4.1 and follow 2.5. Clarification on Past Performance: This should only be your references (Attachment D15) and may include a copy of email where you’ve requested your reference to provide the CO with a copy of Attachment D8. A revised Attachment D8 has been attached to this amendment with the new due date of 5/24/2018. D8/Survey is to be provided to the CO directly. CO will provide a courtesy email that it has been received. Surveys are to be anonymous.

One copy of Price, Subcontracting Plan and Veteran Participation as instructed in 2.4.2 to be sent to CO and follow 2.6. 2.6.4 contains the instruction to include a CD containing a copy of the full Technical/past performance.

See attached document: ATT D8 PAST PERF QUESTIONNAIRE-rev AM 4.

End of Document