36C25621R0001 0005.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 NUMBERE

D 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 amendmen t, 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) 08-03-2021 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

36C25621R0001 05-18-2021

X x x

Due 08/12/2021 at 3:00 PM CST x 1 (one)

The purpose of this amendment is to post Questions and Answers (Q & A).

A. See attached Q & A on page 2.

B. The hour and date specified for receipt of Offers must be received by 08/12/2021 at 3:00 PM CST.

C. This amendment will need to be signed and returned with proposal submission to be eligible for award.

Christopher D. Vu Contracting Officer

VA-VHA-SAOC-2018-E8E15CC2

Amendment: 0005 Solicitation: 36C25621R0001 Greenville CBOC

Questions and Answers #1

The Network Contracting Office (NCO) 16 received questions in response to Request for Proposal (RFP) 36C25621R0001.

Please see below for the Contractor’s questions and NCO 16’s respective answers accordingly.

Contractor’s question: Is the Contractor to provide 1 MH LCSW and 1 PC LCSW plus 0.67 per PACT Mental Health LCSW?

VA’s response: Yes Contractor’s question: Or does the Contractor provide 1 MH LCSW per PACT Team plus 0.67 PC-MHI per PACT Team?

VA’ s response: 1.67 LCSW FTE per PACT Team Contractor’s question: Does one LCSW provide PCMHI and General Mental Health Services?

VA’s response: Yes Contractor’ s question: If so, per how many PACT Teams or enrolled and non-enrolled Veterans? Or is there another scenario?

VA response: 1.67 LCSW FTE per PACT Team.

“Contractor shall ensure that Dietitians electronically complete an Event Capture System form for all direct patient care, whether individual visits, group visits or team meetings that discuss individual patients.” If the parent VAMC is providing the Registered Dietitian/Nutritionist, wouldn’t the VAMC ensure that the Dietitians electronically complete the Event Capture System form and not the Contractor?

Yes, VA personnel will need to track reports to ensure no gaps in request are pending at the CBOC.

VA’s response: Yes Contractor’s question: With an enrollment of approximately 2250 in the first year, is it acceptable to hire a 0.5 FTE TCT or is the Contractor required to have a full time TCT available Monday through Friday, 8:00 AM to 4:30 PM?

VA’s response: No, 1.0 Full time FTE is required and shall be available Monday through Friday.

a. Please clarify how patients will be added to the Mental Health billable roster since the VA is providing specialty mental health services and not the contractor.

b. Please confirm that 0.67 FTE per PACT the appropriate staffing level to account for both the PCMHI and general mental health services to be provided by the Contractor’s LCSW that is required by paragraph 2.4.5.

The Contract LCSW will provide both General Mental Health and PCMHI Services. Certain Mental Health services are not provided by the CBOC contractor may be provided by the Medical Center by VVC when appropriate.

Contractor’s question: Please clarify how patients will be added to the Mental Health billable roster since the VA is providing specialty mental health services and not the contractor.

VA’s response: We project a 10% increase in additional Mental Health roster billing due to specialty Mental Health from the VA.

Contractor’s question: Please confirm that 0.67 FTE per PACT the appropriate staffing level to account for both the PCMHI and general mental health services to be provided by the Contractor’s LCSW that is required by paragraph 2.4.5.

VA’s response: 1.67 LCSW FTE per PACT Team

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

Greenville Primary Care estimate monthly at 2082 and Mental Health at 271.

Does the Government require both a phlebotomist and medical laboratory technician (MLT) for this facility? Will the VA accept an MLT whose duties include phlebotomy?

A Medical Laboratory Technician is required but can also perform Phlebotomy if workload allow and great customer service is maintained.

Please confirm that the PCMHI Licensed Clinical Social Worker (LCSW) can cover both PCMHI and Mental Health team roles.

Yes, one can do both if demand volume allows and customer service is great.

The solicitation mentions a separate space for telepsychiatry, are any additional telehealth rooms required? If so, how many?

Three rooms total are needed for telehealth and they can be multipurpose rooms.

How many Women’s Health exam rooms are required? Would each PACT team need their own Women’s Health exam room?

One per PACT team.

Does each PACT Team require a consultation room?

Each PACT team does not require a consultation room as long as the rooms are available for use.

How many discipline specific offices will be required for VA staff?

None

2.8 TELEHEALTH SERVICES CLINICAL STAFF: Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services).

Does the government anticipate needing 1.0 FTE TCT?

Is the government preferring a 1.0 FTE TCT to be available full-time for Telehealth visits, or does the government prefer us to staff to the anticipated patient volume?

Yes 1.0 FTE is required.

Full time is required.

2.3.1 TEAMLET MEMBER 1: Primary Care Provider (PCP)

OPTION 1: Physician (MD): Qualifications Will the government accept either Board Certified or Board Eligible at the time of proposal submission?

Yes, either Board Certified or Board Eligible is acceptable.

Specialty Mental Health Services will be provided by the parent facility via consult through telehealth (CVT, VVC, Telephone).

Suicide Prevention Coordinator (SPC): The parent facility will provide Suicide Prevention Coordinator services via telehealth.

Homeless Outreach Specialist: The parent facility will provide Suicide Prevention Coordinator services via telehealth.

1. Will the government please specify the disciplines of specialty MH services that are provided by VA?

1. As there is a separate PMPM for MH services under this contract?

1. Is the MH LCSW permitted to vest patient visits?

Contractor’s question: Will the government please specify the disciplines of specialty MH services that are provided by VA?

VA’s response: The contract LCSW will provide PCMHI and General Mental Health to all enrolled Veterans at the designated CBOC.

Contractor’s question: As there is a separate PMPM for MH services under this contract?

VA’s response: None at this time. Certain Mental Health services that are not provided by the CBOC contractor may be provided by the Medical Center by VVC when appropriate. These MH services have not been determined but are in the planning stage.

Contractor’s question: Is the MH LCSW permitted to vest patient visits?

VA’s response: No

Will the government please provide historical enrollment for the last 5 years?

The historical enrollment has been about 2,100 Veterans in Primary Care and 275 Veterans in Mental Health for the last 5 years.

PWS Section 4.6.2.4.7 Contractor shall provide all equipment necessary to provide comprehensive women’s health services. Examination rooms shall be set up in accordance with current VA standards to afford women with privacy (placement of examination tables in the room, privacy curtains, etc. See Space Requirements section for more details). Equipment such as privacy curtains, exam tables with stirrups and lights, bathrooms adjacent to where pelvic exams are performed, speculums, supplies, and equipment to perform Pap smears and point of care pregnancy testing should be on hand in the clinic area.

The RFP states contractor will provide supplies for PAP testing; however, the Contractor is not able to purchase Thin Prep. Will the Government please confirm that the VA will supply Thin Prep?

If this is confirmed that the contractor cannot purchase required supplies the Medical Center will facilitate providing the needed supplies when appropriate.

PWS Section 4.9.1 Contractors shall provide space that meets the standards outlined in the PACT Space Module Design Guide Will the Government please confirm if VA will provide the phone circuit and physical phones?

VA will not provide telephones or telephone service to the CBOCs.

PWS Section 4.8.21 Closed Circuit Television (CCTV):

Could the government please confirm if there is any preference in using Dome and Bullet cameras versus Fisheye or 360 cameras?

There is not a preference for the camera type but should provide high resolution for CCTV review.

PWS Section 4.11 EQUIPMENT, OFFICE SUPPLIES AND TECHNICAL SUPPORT The contractor is unable to network contractor owned equipment to VA network if it is not owned and operated by VA. Will the Government please provide a list of the equipment the VA will supply the contractor, such as copiers, fax, printers, scanners, or other peripheral office equipment or lab label printers.

The VA will provide certain printers, scanners or other peripheral that is approved to meet OIT standards for this location on the OIT network only.

PWS Section 4.11.1.1 CAT 6 wiring Will the Government please confirm if CAT 6 wiring is preferred and not CAT 6A?

Cat 6A is required. Wiring standards need to meet the VA wiring standards as described in the engineering documents. VA OIT is not responsible for infrastructure wiring.

PWS Section 4.11.1 The Contractor shall be responsible for:

4.11.1.5 the procurement, installation and maintenance of all printers, copiers, scanners, fax machines*, shredders, or other peripheral office equipment and all related and ongoing supplies (paper, toner, ink cartridges) required to operate the equipment in support of the facility under the specifications of this contract.*

6.3.5.6 VA prohibits the installation and use of personally-owned or contractor/subcontractor-owned equipment or software on VA’s network.

The contractor is unable to network contractor owned equipment to VA network if it is not owned and operated by VA, yet 4.11.1.5 states the contractor shall provide installation and maintenance of all printers, copiers, scanners, fax machines*, shredders, or other peripheral office equipment and all related and ongoing supplies (paper, toner, ink cartridges) required to operate the equipment in support of the facility under the specifications of this contract.

Will the government please provide a list of the equipment the VA will supply the contractor, such as copiers, fax, printers, scanners, or other peripheral office equipment or lab label printers that can be connected to the network?

The VA will provide certain printers, scanners or other peripheral that is approved to meet OIT standards for this location on the OIT network only.

PWS Section 4.11.1.8 One small desktop color printer for printing patient education information.

Will the Government please confirm that VA will supply small desktop color printer for patient education documents since contractor owned equipment is not permitted on VA network?

The VA will provide network printers as appropriate.

PWS Section 4.10.2.5 Power Requirements four (4) L6-20 receptacles one (1) L6-30 receptacle in the closet Could the government please confirm the Power Requirements and if two 20-amp dedicated receptacles are acceptable?

Yes, this should be adequate, but is dependent and the size and scope of the Clinic.

PWS Section 4.10.2.6.6 Racks - both racks will have 2 shelves on the bottom installed to hold IT computers Could the government please confirm if shelves are required?

The configuration of the shelves can be variable if they are setup to all the proper functioning of the equipment and ability to clean the area when appropriate.

Section 5.1.3 Contract Administration Will the government please confirm the how many VA staffed personnel will be providing services at the CBOC? Please list by job title and number of days per month.

Zero. None.

PWS Section 6.2.1 Billable Roster Will the government please provide the number of veterans currently on the billable roster?

Primary care at 2082 and Mental Health 271 average monthly with a projected stable volume.

Section 1. Evaluation Factors and criteria 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:

a)Transcript(s) from an Accredited Nurse Practitioner Program b)Graduation Certificate from an Accredited Nurse Practitioner Program Due to Privacy Act considerations and information that may need to be redacted on transcripts, will the government accept transcripts and graduation certificates at the time of credentialing rather than at the time of proposal submission?

Primary source verification is required by VA Policy. Redacted information can be submitted but independent primary source is required at time of VA credentialing/privileging.

2.6.1 MEDICAL LABORATORY TECHNICIAN AND PHLEBOTOMIST

Contractor shall provide (1) FTE Medical Laboratory Technician (MLT) or Medical Laboratory Technologist (MT) Could the government please confirm if the VA wants 1.0 FTE for both positions? Contractor is not used to seeing this level of staffing at clinics with less than 2000 enrollees.

The government will require a total of one (1.0) FTE. This could be either a Medical Laboratory Technician (MLT) or Medical Laboratory Technologist (MT).

6.1. CONTRACT START-UP REQUIREMENTS:

6.1.2 Performance shall begin no later than 90 days after effective date of contract award.

The RFP states the VA will provide the primary telecommunications lines. Our experience with previous CBOC start-ups has shown that installation of such lines is taking 180 days and beyond. Will contractors be permitted to submit a contract modification if an extended delay has a negative impact on start-up costs?

The government will adjust the performance start period to begin 180 days after contract award, therefore there will be no negative impact on start-up costs.

4.6.3.1 PRESCRIPTION FULFILLMENT- the parent facility will provide all medications, including any necessary vaccines, and pyxis equipment to the contractor clinic…. Urgent/emergent medications needed will be filled via contracted local pharmacy for up to 10 days.

Will the government please confirm if the VA will incur the cost of meds dispensed from contracted pharmacy?

Yes VA will incur the cost of meds dispensed from contracted pharmacy.

Yes.

Can the VA please provide the list of medications and vaccines the contractor will be responsible for providing? Additionally, can the VA also provide estimated utilization numbers/quantity for each medication/vaccine required (or historical information)?

All preventative care immunizations that are recommended by the CDC.

Medications will vary with the level of Primary Care complexity, case mix and staff privileges for MD or NP Primary Care providers but comparable to what is seen in the private sector for Primary Care.

The historical Vaccine rates for Veterans are approximately 40% for this catchment area.

Will provide via email upon request. Please send an email request to stephanie.keo@va.gov

Same responses above.

In regard to Addendum to FAR 52.212-1 Instructions to offerors the following clarification to the submission Volumes is outlined below.

Volume 1

· Price

Volume II

· Completion of SF1449, Signed Amendments, Clauses/Provision fill-in and attachments

Volume III

· Volume III - Technical Capability, Geographic Location/Accessibility, Past Performance, Veteran Participation and Subcontracting

III and includes Sections: 1 Technical Capability, 2 Geographic Location/Accessibility, 3 Past Performance and 4 Veteran Participation. However, on pages 143-144 it states the following will be included and legible in each of the respective sections of Volume III and includes: Section 1 Technical – Offeror Capability which include Offeror’s Capability/Experience; Quality Staffing; Coordination and Continuity of Care; Key Personnel, including salary range worksheet and other supporting documents; and Implementation Plan. It also includes Section 2 Geographic Location/Accessibility, Section 3 Past Performance, Section 4 Veteran Participation, and Section 5 Subcontracting. And on page 149 in the Evaluation Factors the Technical Capabilities lists: a) Offeror’s Capability/Experience, b) Quality Staffing and c) Implementation Plan, but does not mention anything about Coordination and Continuity of Care or Key Personnel including salary range worksheets, etc. Is the Coordination and Continuity of Care and Key Personnel part of the evaluation factors, should it be added to the proposal, and if so, what should be addressed in these two sections?

And secondly, over the past 20+ years submitting CBOC proposals, we have never been required to provide salaries to the VA. Given that the Solicitation Schedule of Services is Per Member Per Month (PMPM) and the bidders are required to meet the service contract labor standards, why would a salary range worksheet and other supporting documents be required?

In regard to FAR 52.212-2 Evaluation Commercial Item the following clarification to the technical capability criteria is outlined below.

· (a) Capability/Experience

· (b) Quality Staffing/Key Personal (includes salary range worksheet)

· (c) Implementation Plan

In response to the inclusion of “Salary Worksheets” this will assist the Contracting Officer in determining the PMPM rates are fair and reasonable as well as assist the Contracting Officer in determining fair and reasonable pricing to any future Contract Modification requesting additional staff.

PWS, 2.1 MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS

The CLINS reflects base year of 1850 primary care patients; the final sentence of section 2.1 states the Total Estimated patients enrolled are 1700. Will the government please clarify, including any adjustment to the year-over-year anticipated growth?

The VA will keep the numbers as to account for additional enrollment as this is just an estimated quantity.

The government will be responsible for all cost related to the VA provided radiology services.

We are required in solicitations where build-out may result, to identify the applicable Davis-Bacon wages. However, build-out costs and associated functions in this solicitation/requirement will be the responsibility of the contractor. It is at the discretion of the contractor on what they would like to submit for their PMPM rate as one line item in accordance with the solicitation requirements.

Yes

The government will adjust the performance start period to begin 180 days after contract award.

(End of Amendment 0005)