36C25619R0150-0002000.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

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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

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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 __1________ 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)

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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.

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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)

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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) 10-24-2019 36C256 Department of Veterans Affairs Network Contracting Office 16 Michael E. DeBakey VA Medical Center 2002 Holcombe Boulevard Houston TX 77030 4298 36C256 Department of Veterans Affairs Network Contracting Office 16 Michael E. DeBakey VA Medical Center 2002 Holcombe Boulevard Houston TX 77030 4298 To all Offerors/Bidders

36C25619R0150 9-23-2019

X x x x See Continuation Page

Christopher D. Vu

VA-VHA-SAOC-2018-E8E15CC2

CONTINUATION PAGE

The request for proposal due date is Thursday, 31 October 2019 4:00 PM CST.

Questions (Q) and Answers (A) are as follows:

Q1: On page 6 of the RFP states the CLIN 0002 Mental Health Services has an estimated quantity of 300. As the incumbent CBOC Contractor, it should be noted that the billable enrollment in the Kosciusko CBOC for Mental Health is actually 154 enrollees as of August 2019, which is approximately 50% lower than the stated enrollment. Will the VA adjust the estimated quantity to reflect the actual billable enrollment for the base and option years in order to ensure all bidders are pricing to the actual enrollment?

A1: Price proposals shall be in accordance with the schedule of services as described in section B of the solicitation. This request for proposal is for a Firm-Fixed-Price Indefinite Delivery/Indefinite Quantity contract where quantities represent a not to exceed amount. All price proposals will be equally evaluated in accordance with the instructions and evaluation criteria in the solicitation. Quantities will be specified on issued task orders under the resulting contract aligned with current needs of the VA which may differ from contract CLIN quantities.

Q2: On page 18 paragraph 2.4.5 of the RFP states, “DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH INTEGRATION (PC-MHI): Contractor to provide a Mental Health Licensed Clinical Social Worker. Qualifications: Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC) Social Workers providing services under this contract must have a Master’s degree in Social Work (MSW) from a school accredited by Council on Social Work Education (CSWE). VA HANDBOOK 5005/23 PART II APPENDIX G39 SOCIAL WORKER QUALIFICATION STANDARD GS-185 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=481&FType=2 Position Responsibilities: Responsible for collaboration with PACT team for the provision of mental health services to enrolled and unassigned patients presenting for care per VHA Handbook 1160.01 and the requirements of this contract.” With this section, will the government provide specifics as to what MHI encompasses and what constitutes MH Specialty or General so the CBOC staff have a clear definition of the LCSW's responsibilities?

A2: All new patients requesting or referred for mental health services must receive an initial evaluation within 24 hours, and a more comprehensive diagnostic and treatment planning evaluation within 30 days.

(1) The primary goal of the initial 24-hour evaluation is to identify patients with urgent care needs, and to trigger hospitalization or the immediate initiation of outpatient care when needed.

(2) The initial 24 hour evaluation can be conducted by primary care, other referring licensed independent providers, or by licensed independent mental health providers.

b. Waiting times for all services for established patients must be less than 30 days from the desired date of appointment.

c. Telemental Health services require a qualified professional at the facility and support staff at the distal end who can arrange appropriate time and space for the veteran, and staff who can provide technical support as needed.

(1) Use of Telemental Health to support the delivery of services is allowed and encouraged as a mechanism for meeting requirements throughout this document. Nevertheless, it is important to recognize that there may be limits to the services that can be provided using this technology. These may include certain highly interactive and “high-touch” evaluations or interventions.

(2) Sufficient band width is required for satisfactory communication. The Mental Health Service needs to consult with the medical center and VISN Information Technology Offices to determine specific requirements to have satisfactory clinical video conferencing capabilities.

d. Psychotherapy groups can be closed or cohort-based, or they can continually be open to new members. There are a number of arguments in favor of closed groups. However, waiting for the formation of a new group can lead to delays in the institution of treatment. Accordingly, closed or cohort-based groups are allowable in VHA facilities only when the facility’s care system ensures that they do not lead to the denial of care for any veteran, and that waiting for the start of a new psychotherapy group does not lead to delays in the implementation of care

(1) Whenever veterans have an urgent need for mental health care, appropriate mental health services must be provided.

(2) Patients awaiting the start of a therapy group must be monitored on an ongoing basis. Their care needs must be evaluated, and alternative treatments must be implemented when needed, for example:

(a) When patients are a danger to themselves or others,

(b) When they are experiencing increasing degrees of impairment, or

(c) When they are suffering from severe symptoms.

(3) Waiting periods need to be utilized to provide pre-group preparation to enhance the experience and benefits of group treatment. Whenever patients need to wait for the start of a group, they must be offered an appropriate form of interim treatment.

e. VA medical centers must provide general and specialty mental health services when those receiving care from the medical centers need them.

(1) General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including PTSD and MST.

(2) Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions;

(b) Evidence-based psychotherapy;

(c) MHICM;

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psycho-education, family education, skills training, peer support, and CWT and supported employment;

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

f. Clinics in medical centers must offer a full range of services during evening hours at least 1 day per week. Additional evening, early morning, or weekend hours need to be offered when they are required to meet the needs of the facility's patient population.

(1) Like medical centers, very large CBOCs, those seeing more than 10,000 unique veterans each year, must provide mental health services to those who need them during evening hours at least 1 day per week. Like medical centers, they must offer services during additional evening, early morning, or weekend hours when they are required to meet the needs of the facility's patient population.

(2) Other CBOCs are strongly encouraged to provide mental health services to those who need them evenings and weekends.

g. Facilities must offer options for needed mental health services to veterans living in rural areas from which medical centers or clinics offering relevant services are geographically inaccessible.

(1) This may be through providing care in a MH RRTP when this is clinically necessary.

(2) It can include provision of telemental health services with secure access available near the veteran’s home, or

(3) It can also include making services available by using a sharing agreement, contract, or non-VA fee basis to the extent that the veteran is eligible from appropriate community-based providers, when available.

(4) When veterans decline these options because they prefer to receive care from VA providers, this must be documented.

h. Very large CBOCs, those serving 10,000 or more unique veterans each year, are encouraged to provide MHICM teams, PRRCs, intensive outpatient programs for SUD, and Grant and Per Diem programs for homeless veterans. They are required to provide the other ambulatory care services listed in paragraph 13 when these are needed.

i. Large CBOCs, those serving 5,000 or more unique veterans annually, must provide the general and specialty mental health services required (see subpar. 13e) for those who need them, using telemental health as needed to meet this requirement. They must provide a substantial component of the mental health services required by their patients on-site or by telemental health, but they may supplement these services by referrals to geographically-accessible VA medical centers, or through sharing agreements, contracts or non-VA fee-basis mechanisms to the extent that the veteran is eligible.

j. Mid-sized CBOCs, those serving between 1,500 and 5,000 unique veterans annually, must provide general mental health services as required by their patients, using telemental health as needed. Other services must be available to those who need them by using:

(1) On-site or telemental health;

(b) Referral to a VA MH RRTP when this type of care is needed;

(c) Referral to mental health services at a geographically-accessible VA medical center; or

(d) A sharing agreement, contract, or non-VA fee basis to the extent that the veteran is eligible .

k. Smaller CBOCs with less than 1,500 unique veterans are:

(1) To provide access to the full range of general and specialty mental health services to those who need them through on-site services, telemental health, referral to a VA MH RRTP when this type of care is needed, by referral to mental health services at a geographically accessible VA medical center, or through either contracts or non-VA fee-basis to the extent the veteran is eligible with local providers or organizations.

(2) Strongly encouraged to provide evaluation and treatment-planning services, as well as general mental health services on-site or by telemental health.

Q3: On page 19 paragraph 2.8 of the RFP states, “TCT FTE Ratio performance standard 1.0 FTE TCT per estimated 5,000 patients at clinic, with a trained back-up….” Currently the VA has required that the TCT be a full time position with no collateral duties. Is the VA requiring the TCT remain a full time position with no other collateral duties under the new contract?

A3: The VHA requires that the TCT remains a full-time position with no other collateral duties. This position will also require collaboration with the facility telehealth coordinator and continued education to new equipment and processes as technology changes and upgrades.

Q4: On page 22 paragraph 2.12 of the RFP states, “Contractor staff shall complete VA mandatory training as requested and complete ACLS/BLS training and keep ACLS/BLS certifications current throughout the life of the contract.” Will providers be expected to keep a current ACLS certification even if the CBOC does not have a crash cart? If the CBOC has AED equipment, will BLS certification be sufficient.

A4: BLS certification will be sufficient.

Q5: On page 27 paragraph 4.2.1.1 of the RFP states, “CONTRACTOR RESPONSIBILITY: All veterans applying for care at the Contractor’s Outpatient Site of Care shall have an application processed in VA EHR by the Contractor to determine priority enrollment category for benefits. The Contractor shall process all applications for veterans requesting to be followed at the Contractor’s site. The Contractor shall use a number of processes in making priority group determinations including discharge documentation, Hospital Inquiry (HINQ), and communications (written and telephonic) with the VA Regional Office and Records Management Center in St. Louis. The Contractor shall contact the VA Supervisor, Patient Registration for any unusual or complicated enrollment issues/questions. The Contractor shall adhere to the processes and guidelines established by the Supervisor, Patient Registration in regard to all issues concerning patient enrollment and registration. All applications shall be registered and enrolled into VA EHR by the Contractor using the "Register a Patient" option in the VA EHR Registration package. All registrations shall then be "Dispositioned" in VA EHR by using the "Disposition an Application" option before close of business each day.” Currently the incumbent CBOC contractor does not process applications. Is the VA requiring the Contractor to process applications and enroll patients under the new contract instead of the VA office of Eligibility and Enrollment Specialists?

A5: Under the resulting contract, the contractor shall be required to process Veterans applications for enrollment.

Q6: On page 38 paragraph 4.6.2.4.8 of the RFP states, “Women Veterans must have women-only or unisex toilet rooms and bathing/shower facilities.” Is the VA requiring a bathing/shower in the women’s restroom?

A6: The VA will not require a bath or shower in the women’s restroom.

Q7: On page 44 paragraph 4.6.4.2 of the RFP states, “ELECTROCARDIOGRAM SERVICES: MUSE-compatible EKGs shall be used which are interfaced with the VA EHR Imaging. (This will be supplied by VA at cost to the contractor. EKGs are done by the Outpatient Site of Care and documentation will be sent electronically from the GE 5500 EKG machine directly into the VA EHR Imaging.” Currently in the Kosciusko CBOC, EKGs are completed in the clinic and read by the providers. With the new contract, will all EKGs be transmitted to the VA and read by VA cardiology service?

A7: EKG’s should be initially read by the primary provider then, transmitted to the VA and read by the Cardiology service.

Q8: On page 44 paragraph 4.6.4.3 of the RFP states the Contractor is responsible for entering lab orders; sending specimens to the VA Core Lab twice daily; and paying any costs of all lab work, except for lab work sent to the VA or emergency lab work sent to another site which has been authorized by the VA Communications Center and paying any costs associated with transportation of specimens to the VA and for arranging such transportation in a proper secure method. Currently the Kosciusko CBOC sends specimens once daily to the VA. With the volume of specimens to be delivered to the VA and the 2-hour distance from Kosciusko to the VA Medical Center, would the VA consider having specimens sent to the VA Core Lab once daily?

A8: The VA will allow specimens to be sent to the VA Core Lab once daily.

Q9:On page 45 paragraph 4.6.4.4.1 of the RFP states, “Outpatient Site of Care must have point of care or stat pregnancy testing at the same site of care.” Currently the VA does not allow any point of care testing in any of the Mississippi CBOCs. Is the VA now requiring pregnancy testing?

A9: Point of care pregnancy testing is required.

Q10: On page 90 paragraph 4.10 of the RFP states, “Contractor must meet Joint Commission and VHA standards regarding EOC and shall provide the following Safety and Health EOC documents, as required by Joint Commission, with the submission of their proposal/within 15 calendar days after contract award.” Is the Contractor required to submit Safety and Health EOC documents with the submission of the proposal OR within 15 calendar days after contract award? Which would the VA prefer?

A10: The contractor may submit Safety and Health EOC documents with the submission of the proposal or within 15 days after contract award.

Q11: On page 98 paragraph 4.13 states, "The Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming services per FAR 52.212-4(a)." What methods will the VA use to calculate an equitable price reduction or adequate consideration? What process exists for the contractor to dispute the VA's calculation of an equitable price reduction or adequate consideration? In what percentage of contracts does the VA exercise its rights under FAR 52.212-4(a)?

A11: The VA will use the performance standards and surveillance measures as a method to calculate an equitable price reduction or consideration based on the nature of the nonconformance services. Contractor may dispute any VAs calculation of equitable price reduction or consideration under FAR 52.212-4 (d) and FAR 52.233-1.

Q12: On page 161 under paragraph 2. Special Instruction it states, “(d) Offeror shall submit pages that require fill-ins to include.” However, it does not clearly state which Volume these documents should be placed. In which volume do you want the following sections?

o Section D.1: Acknowledged and Sign the QASP o Section D.2: Signed Organization Conflict of Interest o Section D.18: If applicable, sign the Small Business Subcontracting Plan/Certification o Section D.19 If applicable fill Subcontracting Plan Model In addition, the Subcontracting Plan Model in Section D.19 is dated February 2012. Will the VA accept our approved Subcontracting Plan which utilizes the August 2018 template?

A12: Submit information other than Past Performance as attachments on Volume 1, for Past Performance information, submit as attachments on Volume III. Submit requested information on templates, ONLY on attached templates.

Q13: On page 175 paragraph 3) states “Factor 3 – Past Performance. Limited to no more than 2 pages per contract listed. Only references for same or similar type contract desired.” It also states, “Provide any information currently available (letters, metrics, customer surveys, independent surveys, etc.) which demonstrates customer satisfaction with overall job performance and quality for same or similar type contracts.” With no more than 2 page limitation per contract listed, can the requested letters, metrics, customer surveys, independent surveys, etc. be provided as an attachment and not be counted as part of the 2 page limitation?

A13: Yes

Q14: Will the new contractor inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contract award?

A14: Yes

Q15: Please provide the most recent billing figures/members/enrollees for primary care and mental health services.

A15: Price proposals should be in accordance with the schedule of services as described in section B of the solicitation. This request for proposal is for a Firm-Fixed-Price Indefinite Delivery/Indefinite Quantity contract where quantities represent a not to exceed amount. All price proposals will be equally evaluated in accordance with the instructions and evaluation criteria in the solicitation. Specific quantities will be specified on issued task orders under the resulting contract aligned with current needs of the VA based on actual billing numbers.

Q16: The RFP states “The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic.” Can the VA provide the list of medications, including vaccines the contractor be responsible for providing? Additionally, can the VA also provide estimated utilization numbers for each medication/vaccine required (or historical information)?

A16: ALBUTEROL 3/IPRATROP 0.5MG/3ML INHL 0.5 mg/3 mL (3 mL) INHL ALBUTEROL SO4 0.083% INHL (3 mL) INHL ASPIRIN 325 mg TAB CEFTRIAXONE SODIUM 1 g VIAL CLONIDINE HCL 0.1 mg TAB CYANOCOBALAMIN 1000 mcg/1 mL (1 mL) VIAL DEXAMETHASONE NA PHOS 4 mg/1 mL (1 mL) VIAL DIPHENHYDRAMINE HCL 25 mg CAP DIPHENHYDRAMINE HCL 50 mg/1 mL VIAL DIPHTH/PERTUSS/TET (Tdap)(ADACEL)SYR EA

DIPHTHERIA TOXID/TETANUS TOXOID VIAL

EPI-PEN 0.3MG/0.3ML (0.3 mL) INJECTOR

GLUCAGON 1MG/VIL EMERGENCY KIT

HEPATITIS A/B (720/20) VACCINE (1 mL) VIAL HEPATITIS-B VACC,RECOMB 20MCG/ML (1 mL) VIAL INFLUENZA VACCINE,QUADVAL (PF) SYR 0.5ML (0.5 mL) SYRINGE KETOROLAC 30 mg/1 mL (1 mL) VIAL KETOROLAC 60 mg/2 mL (2 mL) VIAL LEVONORGESTREL (PLAN B) 1.5 mg TAB LIDOCAINE 1% (10 mL) VIAL

LIDOCAINE 1% (SMALL VIAL) EA

MEDROXYPROGESTERONE SUSP 150 mg/1 mL (1 mL) VIAL METHYLPREDNISOLONE ACETATE (DEPO-MEDROL) 80 mg/1 mL (1 mL) VIAL NALOXONE (EQV-NARCAN) 0.4 mg/1 mL (1 mL) AMP NITROGLYCERIN (NITROSTAT) SL (NITROSTAT) 0.4 mg TAB PENICILLIN G BENZATHINE 1.2 MIL UNT/2ML 1.2 MIL UNT/2 mL (2 mL) EA

PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE EA

PNEUMOCOCCAL 23-VALENT POLYSACC VACCINE (0.5 mL) VIAL POTASSIUM CL SA (DISPERSIBLE) (DISPERSIBLE) 20 mEq TAB STERILE WATER VIAL (10 mL) VIAL TUBERCULIN PPD 5 UNIT/0.1ML 50 TEST/VI (5 mL) VIAL

ZOSTER VACCINE, RECOMBINANT (SHINGRIX) VIAL

Q17: How many Choice/Mission Act referrals occurred in the past 12 months for enrolled veterans at the Kosciusko CBOC?

A17: Mission act requirements have not been implemented for more than 12 months on current services, for purposes of this request for proposal, Offerors will assume 200 Mission Act referrals per year.

Q18: Will the VA require a clinic manager?

A18: Proposed personnel other than what is required in the Performance Work Statement is at the discretion of the Offeror. Evaluation of proposals will be executed in accordance with the solicitation instructions and evaluation criteria.

Q19: Can an NP see patients in the CBOC if they are supervised remotely by CBOC Physician from another location?

A19: No, there is a 75-mile radius. See https://www.sos.ms.gov/ACProposed/00021862b.pdf.

Q20: The RFP calls for a TCT at 1.0FTE/5000, will the VA accept this ratio, or will a 1.0 FTE TCT be required?

A20: The acceptable TCT ration is 1.0FTE/5000.

Q21: Does the VA require the Tele-health tech to be a Medical Assistant or LPN?

A21: The VA requirement is LPN; TCT’s are required to have assessment skill sets.

Q22: Sub-factor (b), page 173 of RFP states:

Offerors shall provide copies of the following on any nurse practitioner(s) to be assigned to perform services under the contract, including any nurse practitioner(s) to provide coverage relief:

1. Transcript(s) from an Accredited Nurse Practitioner Program

1. Graduation Certificate from an Accredited Nurse Practitioner Program

1. Active, current, unrestricted license Can the Contractor submit the proposal with an NP’s current, unrestricted license and CV information and then provide transcripts and graduation certificates prior to clinic opening? We have found that these items can take 4-6 weeks to receive from candidates.

A22: The contractor may submit the proposal with an NP’s current, unrestricted license and CV information and then provide transcripts and graduation certificates prior to clinic opening.

Q23: How many referrals were for PC patients? How many for MH patients?

A23: Price proposals should be in accordance with the schedule of services as described in section B of the solicitation which includes a not to exceed number of PC and MH patients. This request for proposal is for a Firm-Fixed-Price Indefinite Delivery/Indefinite Quantity contract where quantities represent a not to exceed amount. All price proposals will be equally evaluated in accordance with the instructions and evaluation criteria in the solicitation. Quantities will be specified on issued task orders under the resulting contract aligned with current needs of the VA which will include actual PC and MH encounters.

Q24:How many VA staffed personnel will be providing services at the CBOC? Please list job title and number of days per month.

A24: Offerors SHALL ignore any solicitation references to VA health providers collocated at the CBOC. Any VA health provider’s space will be negotiated via a separate contract action or other mechanism.

Q25:Will the VA provided staff require an office at the CBOC in addition to the MH Office required in Section 4.9.1? If yes, what type and size?

A25: Offerors SHALL ignore any solicitation references to VA health providers collocated at the CBOC. Any VA health provider’s space will be negotiated via a separate contract action or other mechanism.

Q26:Is industrial-strength refrigeration required in the lab?

A26: No, but the temperature must be able to be monitored.

Q27:Space Requirements: Section 4.9.1. In the table telepsychiatry section, please complete the following sentence “The Contractor’s non- medical MH LCSW will …” A27: Performance Work Statement Paragraph 4.9.1. is revised as follows. See correction in red.

From “Telepsychiatry: The Contractor shall provide space for telepsychiatry equipment to be placed within the facility by the VA. This space should provide privacy for patients to meet confidentially in an individual or group setting with providers at the VA via electronic transmissions. The space shall be large enough for a desk, chair, computer, and TV and videoconferencing equipment (provided by VA). The VA will maintain the VA-provided telepsychiatry equipment. VA will also provide the networking capability to support the telepsychiatry equipment. The Contractor’s non-medical MH LCSW will” To:

Telepsychiatry: The Contractor shall provide space for telepsychiatry equipment to be placed within the facility by the VA. This space should provide privacy for patients to meet confidentially in an individual or group setting with providers at the VA via electronic transmissions. The space shall be large enough for a desk, chair, computer, and TV and videoconferencing equipment (provided by VA). The VA will maintain the VA-provided telepsychiatry equipment. VA will also provide the networking capability to support the telepsychiatry equipment. The Contractor’s non-medical MH LCSW will facilitate use of the equipment for the veterans. Contractor will provide clerical support, including scheduling, for VA telepsychiatry CRNP.

Q28:Section 4.9.1: Is the intention to use the private group room for the telepsychiatry equipment /sessions or to use the VA Mental Health Provider Work Space for telepsychiatry?

A28: The designated room for telepsychiatry equipment/sessions will be for telepsychiatry equipment/sessions. VA mental health provider is NOT a requirement under this Performance Work Statement. Offerors SHALL ignore any solicitation references to VA health providers collocated at the CBOC. Any VA health provider’s space will be negotiated via a separate contract action or other mechanism.

Q29:List all medications and vaccines administered in the CBOC that the Contractor will be responsible for.

A29: See answer 16.

Q30:Section 4.6.2.4.6: Who pays for emergency contraception (E.g. Levonorgestrel (Plan B), etc.), Contractor or VA?

A30: Contractor.

Q31:Thin-Prep PAP testing supplies are available for purchase by the Contractor. Will the VA supply?

A31: The VA Medical Center Lab service will supply thin-prep testing supplies to the contractor.

Q32:List all medications provided in the past 12 months A32: See answer 16

Q33 List all vaccines provided in the past 12 months.

A33: See answer 16

Q34 Section 4.6.4.2: Regarding EKGs, what does VA-provided at Contractor’s cost mean?

A34: Performance Work Statement paragraph 4.6.4.2 Sentence is revised from “(This will be supplied by VA at cost to the contractor.” To (This will be supplied by the VA).

Q35 Section 4.11.2.7.4.4: Will the VA provide the telephones for the clinic?

A35: Yes, all communication equipment will be provided and maintained by the VA.

Q36 Will the Contractor be responsible for all data lines installed in the CBOC?

A3: The contractor will be responsible for data line installed at the CBOC. Data lines will be activated by the VA onto existing communications infrastructure provided by the contractor.

Q37 Telehealth Support Services: Section 4.6.7: Please clarify what telehealth equipment the Contractor will be responsible for providing and maintaining.

A37: All telehealth equipment will be provided and maintained by the VA.

Q38 How many exam rooms are required per provider?

A38: Refer to the Performance Work Statement paragraph 4.9 Space requirements for acceptable exam room designs.

Q39 Is a consultation room needed for each provider?

A39: Refer to the Performance Work Statement paragraph 4.9 Space requirements for acceptable consultation room designs.

Q40 How many procedure rooms does the contract require?

A40: Refer to the Performance Work Statement paragraph 4.9 Space requirements for acceptable procedure room designs.

Q41 In total, how many group rooms are required for this facility and what are the size requirements?

A41: Refer to the Performance Work Statement paragraph 4.9 Space requirements for number of rooms and clinic acceptable designs.

Q42 Will the Government conduct site visits prior to award? If so, how much advance notice will the Contractor be given?

A42: If determined necessary by the Government, The Government will conduct a site visit prior to award and will provide seven days advance notice.

Q43 The Contractor shall meet all requirements for anticoagulation management outlined in VHA Directive 1033 Anticoagulation Therapy Management (or subsequent revisions thereto) as well as local policy related to the management of patients on anticoagulation. Local policy is included in the attachments section?

A43: Yes, local policy is included as Attachment D.22. Anticoagulation Therapy Monitoring.

Q44 The RFP requires performance period to start 90 days after award, is the VA able to provide Primary telecommunications connectivity within 90 days as outlined in the in the RFP?

A44: The VA will provide communications connectivity within 90 days on network infrastructure provided by the contractor.

Q45: Will the VA consider extending the start-up period to 120 days?

A45: The Government requires start-up requirements in accordance with the Performance Work Statement paragraph 6.1.2.

Q46: How many exam rooms and how many consult rooms would the VA prefer per provider?

A46: Refer to the Performance Work Statement paragraph 4.9 Space requirements for number of consult rooms and acceptable clinic designs.

Q47: What is the current PM/PM rate at the existing clinic?

A47: The current PMPM rate is not available for disclosure. Offerors are encouraged, at their discretion, to submit their best pricing proposal for a competitive evaluation in accordance with the solicitation instructions and evaluation criteria.

Q48 Are the current employees under a collective bargaining agreement?

A48: No

Q49: Does the VA require a refrigerated centrifuge?

A49: No

Q50: Does the VA require or prefer swinging doors or sliding doors on Primary Care Exam Rooms? Is a sliding door required on offstage side of the exam room?

A50: Refer to the Performance Work Statement paragraph 4.9 Space requirements for clinic designs which include acceptable door types.

End of Amendment