36C25621R0090.docx

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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.

DUNS:

DUNS+4:

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. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C25621R0090 05-17-2021 Corey Labbe 713-770-2766 06-25-2021 3:00 pm

CST

36C256 Department of Veterans Affairs Network Contracting Office 16 Michael E. DeBakey VA Medical Center 2002 Holcombe Boulevard Houston TX 77030 4298 X 621498 $22 Million N/A X 36C586 Department of Veterans Affairs G.V. (Sonny) Montgomery VAMC 1500 E Woodrow Wilson Avenue Jackson MS 39216 36C256 Department of Veterans Affairs Network Contracting Office 16 Michael E. DeBakey VA Medical Center 2002 Holcombe Boulevard Houston TX 77030 4298

FSC e-Invoice Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 nvoice must be submitted electronically Setup 1-877-489-6135 512-460-5429 See CONTINUATION Page Contractor to provide Community Based Outpatient Clinic Services for Lowdnes County, MS.

Reference schedule of services and performance work statement on page 6 through 129 for details Addendum to 52.212-1 is attached and provides instructions to contractor on page 159 through 163.

This is a single award solicitation in accordance with Federal Acquisition Regulation (FAR) 12,15, and 16.504.

$0.00 See CONTINUATION Page X x one(1) Corey Labbe

VA-VHA-2020-FC38F64E

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

b. GOVERNMENT: Corey Labbe, Contracting Officer 36C256 Department of Veterans Affairs Network Contracting Office (NCO) 16 2002 Holcombe Boulevard (90C) Houston, TX 77030 Phone: 713-770-2766 Email: corey.labbe@va.gov

Miles Musgrove, Contracting Officer Representative Department of Veterans Affairs G.V. (Sonny) Montgomery VAMC 1500 E Woodrow Wilson Avenue Jackson, MS 39216 Phone: 601-362-4471 ext 1332 Email: miles.musgrove@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp

5. MANDATORY WRITTEN DICLOSURES: Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at http://www.va.gov/oig/contacts/hotline.asp and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instruction.

6. SECURE FAX: Please review VA Handbook 6500 that 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, distribution, 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.”

7. POAT AWARD ORIENTATION: The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by VA Acquisition Manual, Part M842.502-70.

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

B.2 SCHEDULE OF SERVICES

The G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi, requires the provision of Primary Care and Mental Health services (General and PCMHI) via a community based outpatient clinic (CBOC) solely dedicated to Veteran beneficiaries located in Lowndes County, MS. The contractor shall furnish professional medical staff, diagnostic testing and treatment capability, medical facilities, equipment and supplies, and administrative functions to fulfill the support of enrolled patients.

Contract Minimum $500,000.00 Contract Maximum $10,000.000.00

The following capitated rates utilizing a Per Member Per Month (PMPM) rate structure are for provision of Primary Health Care and Mental Health Care services.

* All unit prices shall be a Fixed-Price (FP) and all inclusive. Any build out cost incurred shall be the responsibility of the contractor. The government will only pay for services identified in PMPM rate. PMPM includes cost of unassigned patient visits, contractor shall not bill separately or propose an additional Line Item or bill separately for these costs.

Pricing Instructions:

The contractor is instructed to provide pricing for all line items.

The contractor must complete and return all information designated under Addendum FAR 52.212-1-Instruction to Offerors - Commercial.

Note: Period of Performance for base and each option year is based on a twelve (12) month period, effective date and end date may change depending on when award will be made, but will be based on a twelve (12) month period.

BASE YEAR: October 1, 2021 through September 30, 2022

Total Estimated Cost

PMPM

1,850

Total for Base Year $________________________

OPTION YEAR 1: October 1, 2022 through September 30, 2023

Total Estimated Cost

Primary Care Services at capitation rates per member per month (PMPM)

1,950

Total for Option Year 1 $________________________

OPTION YEAR 2: October 1, 2023 through September 30, 2024

2,100

Total for Option Year 2 $________________________

OPTION YEAR 3: October 1, 2024 through September 30, 2025

Total Estimated Cost

2,150

Total for Option Year 3 $________________________

OPTION YEAR 4: October 1, 2025 through September 30, 2026

Total Estimated Cost

2,200

Total for Option Year 4 $________________________

Base Year:

Option Year 1:

Option Year 2:

Option Year 3:

Option Year 4:

TOTAL FOR BASE AND OPTION YEAR $___________________________

NOTE: The rates in effect under the contract each time an option is exercised in accordance with FAR Clause 52.217-8 Option to Extend Services will be the rates that apply to the option period being exercised.

For the purposes of the award of this contract, the Government intends to evaluate the option to extend services under FAR 52.217-8 as follows: The evaluation will consider the possibility that the option can be exercised at any time, and can be exercised in increments of one to six months, but not for more than a total of six months during the life of the contract. The evaluation will assume that the prices for any option exercised under FAR 52.217-8 will be at the same rates as those in effect under the contract at the time the option is exercised. The evaluation will therefore assume that the addition of the price or prices of any possible extension or extensions under FAR 52.217-8 to the total price for the basic requirement and the total price for the priced options has the same effect on the total price of all proposals relative to each other, and will not affect the ranking of proposals based on price, unless, after reviewing the proposals, the Government determines that there is a basis for finding otherwise. This evaluation will not obligate the Government to exercise any option under FAR 52.217-8.

ORDERING PROCEDURES

a. This contract type allows the Department of Veteran Affairs Network Contracting Office 16 (NCO 16) contracting officers to place orders with the contractor on an as needed basis, in accordance with the FAR Clauses 52.216-18, Ordering. NCO 16 will obligate the funding and order the services by issuing a task order. The estimated enrollees or PMPM for performance of each task order shall be set forth in each task order.

b. VA has the sole authority to assign Veterans treated by the contractor into the Primary Care Management Manual (PCMM) software program used to track primary care clinic veteran rosters. Reference PWS Section 6.2.1 for specific billable processes for issuing task orders.

c. The contractor shall initiate work when, so directed by a Task Order. No work under any Task Order shall be performed unless specifically authorized by the contracting officer.

Approval of a Task Order shall not constitute approval to exceed any item listed in the contract or general provisions of the contract. The contractor shall not exceed the task order amount or change the task order without prior written approval of the contracting officer.

d. Task orders within scope of the IDIQ contract will be issued unilaterally in accordance with the IDIQ Contract terms and conditions and bilaterally when change in terms and conditions is negotiated in accordance with contract clauses FAR 52.212-4 (c), FAR 52.216-18, FAR 52.216-19 and FAR 52.216-22.

e. Task order pricing for services will be based on IDIQ prices based on negotiated priced contract line items as outlined in B.2 Schedule of Services section in this single award IDIQ contract.

f. Contractor is required to deliver services in accordance with the task order terms and conditions during the task order specified period of performance.

g. The NCO 16 Contracting Officer is the only authorized official to issue task orders under this IDIQ Contract.

h. Task order prices shall be Fixed-Price (FP) as agreed to in the contractor’s schedule and individually funded.

i. Each task order shall have an established period of performance or delivery date. Individual Task order shall not exceed a 12-month period.

36C25621R0090

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B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. SERVICES REQUIRED: The G.V. (Sonny) Montgomery VA Medical Center located at 1500 East Woodrow Wilson Avenue, Jackson Mississippi (MS), 39216 , also known as the “parent facility”, requires the following services to be provided in a private hospital, office, or clinic environment to Veterans primarily residing in the limits of Lowndes County MS, but may include the counties of: Monroe County MS, Oktibbeha County MS, Clay County MS, and Noxubee County MS.

1.1.1. Primary Care CBOC: offers both medical and mental health care (physically on site and by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care CBOCs are required to provide both primary care and mental health services. Mental Health services will be provided by contractor staff and VA staff virtually (via VVC, Telephone, CVT, and other telehealth modalities.

1.

1.1.

1.2. PLACE OF PERFORMANCE: Columbus, Lowndes County Mississippi, located 150 miles from the parent facility.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 in conjunction with Federal Acquisition Regulation (FAR) 15 to be furnished by the contractor on behalf of the G.V. (Sonny) Montgomery VA Medical Center.

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index, and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the Contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vhapublications/ or at http://www.va.gov/vapubs/. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/Resources.asp.

1.5. DEFINITIONS/ACRONYMS:

1.

1.1.

1.2.

1.3.

1.4.

1.5.

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e. CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

1.5.14. BAA: Business Associate Agreement

1.5.15. BI-RADS: Breast Imaging-Reporting and Data System; a quality assurance tool designed to standardize mammography reporting

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: chronic obstructive pulmonary disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

1.5.35. CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org/ .

1.5.36. CPARS: Contractor Performance Assessment Reporting System

1.5.37. CVT: Clinical Video Telehealth

1.5.38. DICOM: Digital Image and Communication in Medicine

1.5.39. DIGMA: Drop in Group Medical Appointment

1.5.40. DRG: Diagnostic Related Group

1.5.41. DSS: Decision Support System

1.5.42. ECC Extended Care Center

1.5.43. Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

1.5.44. EPRP: External Peer Review Program

1.5.45. FDA: Food and Drug Administration

1.5.46. FSMB: Federation of State Medical Boards

1.5.47. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

1.5.48. HHS: Department of Health and Human Services

1.5.49. HCFA: HealthCare Financing Administration

1.5.50. HICPAC: Healthcare Infection Control Practices Advisory Committee- a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

1.5.51. HT: Home Telehealth

1.5.52. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.53. ICD 10: International Classification of Diseases 10th edition

1.5.54. iMED: software used by VA for informed consent

1.5.55. INR: International Normalized Ratio

1.5.56. ISO: Information Security Officer

1.5.57. LIP: licensed independent practitioner

1.5.58. MCCR: Medical Care Cost Recovery

1.5.59. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

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 primary 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 Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

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

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

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

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.60. MQSA: Mammography Quality Standards Act

1.5.61. MSN: Master of Science in Nursing

1.5.62. NCCPA: National Commission on Certification of Physician Assistants

1.5.63. NLN: National League for Nursing

1.5.64. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.5.65. OTC: Over the Counter

1.5.66. PA: Physician Assistant

1.5.67. PACS: Picture Archiving and Communications System

1.5.68. PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

1.5.69. Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.70. PCMH: Patient-Centered Medical Home

1.5.71. PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.5.72. PCP: Primary Care Provider

1.5.73. Phar.D.: Doctor of Pharmacy

1.5.74. POC: Point of Care Testing

1.5.75. PRIMARY CARE VISIT: an episode of care furnished in a clinic that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

1.5.76. PCMHI: Primary Care-Mental Health Integration

1.5.77. PWS: Performance Work Statement

1.5.78. QAPI: Quality Assessment and Performance Improvement

1.5.79. QASP: Quality Assurance Surveillance Plan

1.5.80. RME: reusable medical equipment

1.5.81. SOP (Clinical): Scope of Practice

1.5.82. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.83. SFT: Store and Forward Telehealth

1.5.84. SMA: Shared Medical Appointments

1.5.85. SPD: Sterile Processing Division

1.5.86. SPE: Senior Procurement Executive

1.5.87. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care, and is only provided through a referral.” These services are generally divided into two sub-categories: medicine specialties and surgery specialties. The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology; emergency; employee health; endocrinology; gastroenterology; general medicine; hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology; amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

1.5.88. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.89. TJC: The Joint Commission

1.5.90. TIU: Text Integration Utility

1.5.91. TCT: Telehealth Clinical Technicians

1.5.92. VA: Veterans Affairs

1.5.93. VA EHR: VA electronic health record

1.5.94. VAMC: Veterans Affairs Medical Center

1.5.95. VetPro: a federal web-based credentialing program for healthcare providers.

1.5.96. VHA: Veterans Health Administration

1.5.97. VVC: VA Video Connect

1.5.98. WHEN: Weekend- Holiday- Every Night

2. STAFFING AND QUALIFICATIONS Subcontracted staff shall be comprised of less than 25% of total CBOC staff.

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS:

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff. The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide 1 FTE Clinic Administrator per 5000 patients enrolled/assigned. If the contractor services more than 5000 enrolled/assigned Patients, the contractor will provide an additional 1 FTE Assistant Clinic Administrator or RN Nurse Manager every 5000 patients enrolled/assigned thereafter. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: _1700__.

2.2 PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by Contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required and United States Drug Enforcement Administration (DEA) prescriptive authority is required for controlled substances. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP (If so, authorization for prescriptive authority is required). Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G2 located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2.

Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

2.3 PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor. The Contractor shall provide 1 FTE Clinic Administrator per 5000 patients enrolled/assigned. If the contractor services more than 5000 enrolled/assigned Patients, the contractor will provide an additional 1 FTE Assistant Clinic Administrator or RN Nurse Manager every 5000 patients enrolled/assigned thereafter

2.3.1 TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. A Physician collaborator is needed for CRNP’s.

OPTION 1: Physician (MD): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required and United States DEA prescriptive authority is required for controlled substances. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located otherwise qualifications as per VA Handbook 5005, Appendix G2 located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face, telephone, and VA video connect care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications: CRNP’s (including subcontractors) must have a MSN from a NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required and United States DEA prescriptive authority is required for controlled substances. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e. CBOC)is located; otherwise qualifications as per VA Handbook 5005, Appendix G6 located at : https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face, telephone, and VA video connect care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.2 TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP.

Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6 located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, VA video connect visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

PRIMARY CARE STAFFING – CLINICAL ASSOCIATE [X] Mandatory for all sites

2.3.3 TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. Contractor to propose the mix of Clinical Associates from the options below.

OPTION 1: Licensed Practical Nurse (LPN): Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. CVT training shall be required for this position.

OPTION 2: Licensed Vocational Nurse (LVN):Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 .

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. CVT training shall be required for this position.

PRIMARY CARE STAFFING – CLERICAL ASSOC

2.3.4 TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT. A two week training located at the parent facility shall be required for this teamlet member.

2.4 DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated.

2.4.1 DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) –

Clinical Pharmacy Services will be provided by the parent facility. The parent facility will provide a Clinical Pharmacy Specialist via virtual coverage (VVC & telephone visits).

2.4.2 DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-COAGULATION: Services will be provided by the parent facility. The parent facility will provide a Clinical Pharmacy Specialist for Anti-coagulation via virtual coverage (VVC & telephone visits).

2.4.3 DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER (this position provides general/medical social work services): Contractor shall provide Licensed Clinical Social Worker. FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Qualifications: Social Workers providing general social work 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). Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005/120 PART II APPENDIX G39 SOCIAL WORKER QUALIFCATION STANDARD GS-0185 located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned Veterans presenting for care. Covered services would include, but are not be limited to, conducting bio-psychosocial assessments to determine needs of Veterans, Veteran’s family members and caregivers. Provide a full range of clinical social work services within established standards of social work practice which includes treatment planning, individual, family and group counseling, VA and community-based resource referrals, case management and other services as appropriate. Providing tailored interventions for a wide range of psychosocial issues to include, housing/homelessness, food, finances, family/caregiver support, home care/placements, legal, education, employment, disability, mental health/addiction, medical and reporting of abuse/neglect. Participate in treatment planning with interprofessional teams, members and other programs. Assist with long term care placement, discharge planning, hand off communication and transitions between levels of care and arranging for in home services to ensure care is timely and appropriate.

2.4.4 DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST: Services will be provided by the parent VAMC via telehealth (by referral), individual instruction and group classes, and/or telephone clinic.

2.4.5 DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH INTEGRATION (PC-MHI):

Contractor to provide a 0.67 FTE per PACT Mental Health Licensed Clinical Social Worker. Qualifications: 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). Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005/120 PART II APPENDIX G39 SOCIAL WORKER QUALIFCATION STANDARD GS-0185 located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2.

Position…