Clarification Questions 36C25622R0128 10_27_2022.docx

VISN 16 Home O2 Services 36C25622R0128 Offer Due Date (NCO

· Q: May the Government please consider extending the due date of the proposals being submitted, based on the receipt of clarification questions and answers being provided?

Due Date extended to 10-27-2022

2.2 Veterans Served

· “The five (5) stations within VISN 16 currently serves an estimated 4,600 oxygen-using Patients and 75 ventilator patients per month.”

· It is observed, there are 3 VISN 16 facilities that were not included as part of the solicitation, including, Fayetteville, AR, Little Rock, AR and Jackson, MS.

· Q: Will these facilities be added as part of this solicitation, or is it anticipated they will be released at a later time?

Released at a separate time (separate solicitation)

2.4 Home Visits

· “B. Initial setup(s) for Home Oxygen Patients and Ventilator Patients shall be performed by a certified respiratory therapist (CRT) or registered respiratory therapist (RRT), that is licensed in accordance with the governing standards of where the services are to be provided.”

· “5 LPM Concentrator with Backup System Fee: This shall include- Initial home environment assessment, delivery and set-up, by a Technician…”

· Q: Please confirm an initial oxygen setup may be completed by a Technician, as noted in the price schedule.

Clarification-

· Home Oxygen Patients are to be set-up by a trained qualified Technician.

· Ventilator Patients are to be set-up by a Respiratory Therapist.

3.3 Equipment

· 2.6 Emergency Service/Maintenance Management Protocol - “G. The backup system for ventilator patients shall consist of two (2) ventilators on hand.”

· J. Ventilator

· 2. The Contractor shall provide a back-up ventilator in the home for all patients being ventilated via invasive ventilation.

· 3. The Contractor shall have back-up ventilator available for exchange within one hour of notification of ventilator failure for all patients being ventilated via non-invasive ventilation.

· Q: May the Government please confirm the contractor will only provide a primary and backup ventilator in the home, to each patient prescribed a ventilator invasively?

Yes, contractor will only provide a primary and backup ventilator in the home, to each patient prescribed a ventilator invasively

· 4. Contractor shall provide a self-inflating resuscitation bag with mask to all patients using a ventilator.

· Q: May the Government consider phrasing this requirement as follow: “Contractor shall provide a self-inflating resuscitation bag with mask to all invasive patients using a ventilator” as the ambu bags are for invasive patients, Section 3.3 Equipment, item J. Ventilator, #4 is revised to read “Contractor shall provide a self-inflating resuscitation bag with mask to all invasive patients using a ventilator.”

· 6. … and a CRT/RRT follow-up shall be completed, not to exceed 48 hours, after initial set-up to assess equipment compliance,

· Q: May the Government consider adding a CLIN for the follow-up visit after initial setup.

The government is not seeking any clinical services. For this reason, a clinical CLIN for CRT/RRT Services will not be added.

Price Schedule

· 0008 - Cylinder - Size B/C/D/E/M6 Monthly Refill

· Q1: May the Government please clarify if the intent of this line item is for the contractor to bill on a per cylinder basis?

Monthly refill is not a “flat fee” per month. Each refill will be billed according to the size & number of tanks being refilled during the month.

· Q2: It is the intent of the Government for the contractor to bill a monthly fee for the use of a portable gaseous system, with a allotted quantity of cylinders per month?

Please previous response (0008-Q1).

· Q2.a: If the intent is for the contractor to bill on a monthly basis for the use of a portable gaseous system, please consider reviewing the quantities listed for all 5 facilities.

· Biloxi – 4785

· Alexandria – 33000

· Shreveport – 8095

· Houston – 17050

· New Orleans - 1375

Please previous response (0008 Q1).

· 0015 – Portable Concentrator “four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered”

· Q: May the Government please clarify if each POC patient will be provided with 4 portable cylinders for the use of backup only?

The 4 cylinder tanks are for back-up to the portable concentrator. However, the cylinders are not to replace the Emergency Back-up supply required in the event of a natural disaster or power outage.

· 0025 – Thermal Fuses Cannulas w/Connector

· Q: May the Government please review the quantities listed for the Thermal Fuses, as it currently reflects an estimated 1000 thermal fuses will be provided monthly throughout the facilities.

Monthly quantities of 1,000 are correct for this line item per facility, not all facilities. Please see calculation table below:

· 0035 – 12 LPM Concentrator with Backup System Fee

· Q: Currently, there are no concentrator units available for home use that will meet 12 LPM requirement. May the Government please clarify what equipment is required for this CLIN?

LIN 00035, 02035, 07035, 08035, and 09035 are removed from the price schedule.

E.2 Addendum to Instructions to Offerors

· Basis for Award

· Q: May the Government please clarify if it intends to award the contract to a single awardee, or are multiple awards anticipated?

Single Award.

· Q: May the Government please clarify if an interested vendor may submit an offer for individual VA facility or must the interested vendor include all 5 facilities listed in the solicitation?

This solicitation is all-inclusive of the named Medical Centers. Individual bids are not being accepted for this solicitation.

1.2 Locations/Place of Performance

· The contractor shall service any patients that are treated at any of these facilities and all associated Community Based Outpatient Clinic (CBOC), Contractors shall have a facility or resources physically located in the geographic area in which they shall provide service.

· Q: Is it the Government’s intent for the contractor to have facilities throughout the U.S. to provide services to patients who are outside of the geographical areas stipulated within the PWS?

The PWS states “resources”. Resources could mean other contractor rental relationships in the geographical area where the patient needs services. However, for servicing of the Main locations, there should be facilities within the local geographical area of the Medical Center being served.

· Q:May the Government please clarify the process for patients who reside outside of the geographical areas stipulated within the PWS, but prefer to be seen at a specific VAMC facility, and the contracted vendor not having a location within the area?

There are Veterans that live within VISN 16 or bordering states that choose to go to a closer or specific location. If treated within VISN 16, the contractor should have a means to assist with services. See PWS Section 2.11 Patient Travel.

4.8 DEMURRAGE CHARGES

· “The VA shall not pay for the Contractor’s lost or damaged equipment provided under this contract except for contractor equipment unless circumstances as reviewed by the Contracting Officer are concluded to be the results of willful negligence on behalf of Patients or VA employees.”

· Clarification Question:

· Q: May the Government please clarify the process to be followed, when a patient/caregiver loses or damages the contractor’s equipment, may the contractor bill the VA for the loss/damage of the equipment?

· Q: In a case where the patient/caregiver refuses to return the contractor owned equipment, may the contractor bill the VA?

· Q: Should the VA not approve to pay for the equipment not returned, may the contractor bill the patient directly?

Cases of loss or damage must be brought to the attention of the Contracting Officer to discuss, negotiate, and determine appropriate resolution on a case-by-case basis. In addition, see PWS Section 4.12 Payment and Invoicing Information item M, “Contractor shall bear all costs associated with recovering contractor-owned equipment from a patient that is no longer needed by the patient.”

Certification, page 71

· Q: May the Government clarify if Contractor is to fill in the Certification form identified on page 71 and submit with the proposal, or will the Government be releasing a separate amendment acknowledging the limitations on Subcontracting?

Per the Addendum to Instructions to Offerors, Offer Submittal Instructions, “3) Offeror shall complete C.11 VAAR 852.219-77 VA Notice of Limitations on Subcontracting—Certificate of Compliance for Services and Construction (SEP 2021) (DEVIATION)”

2.8 Manuals

· Contractor shall provide to the Government, one (1) copy of the Operation and Service manual for each type of equipment with any proposals regarding this contract.

· Q.: May the Government consider increasing the page limit if the manual is to be included with the proposal?

PWS Section 2.8 sentence 3 is revised to read:

Contractor shall provide to the Government, one (1) copy of the Operation and Service manual for each type of equipment upon request following award regarding this contract.

· Q:Or is it the intent for the Contractor to provide a copy if awarded the contract?

See previous response.

· 2.3 Ordering Officers

· Ordering officers (OOs) will be authorized to place orders under this contract

· Q: May the Government clarify orders submitted will be compliant with JC standards and signed by an authorized prescribing entity?

Yes, orders submitted will be compliant with JC standards and signed by an authorized prescribing entity.

VISN 16 Home Oxygen 36C25622R0128

1. CLIN 0015 states that “This shall include- Initial home environment assessment, delivery and set-up by a Technician of the oxygen concentrator, back-up system completes with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, Filter(s), batteries (min 2 based on patient requirements), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of Portable Concentrator.”

Question: Is this correct in stating that Portable Oxygen Concentrators will be issued as the primary oxygen concentrator source, or are they being provided as a supplement to the stationary 5lpm or 10lpm concentrators?

VA provides one (1) concentrator (stationary or portable) as the primary source. Although Portable Oxygen Concentrators are generally not issued as the primary oxygen concentrator source, there are occasion where POC maybe issued as a primary source due to patient’s oxygen requirement, frequent long-distance travel, or significant mobility issues.

2. CLIN 0035 refers to a 12 lpm concentrator. At this time, Eagle is unaware of any home stationary concentrators capable of providing this liter flow. Can the Government provide examples of such machines?

LIN 00035, 02035, 07035, 08035, and 09035 are removed from the price schedule.

3. Is CLIN 0019 referring to a portable liquid system, such as the Helios brand, or a part of the Homefill station setup?

CLIN 0019 is for the portable unit that works with the Homefill Station

4. Is CLIN 0019 describing the same equipment as CLIN0012 but Helios brand specific?

No. CLIN 0012 is for the portable liquid oxygen system

5. In addition to the 4 portable cylinders required by CLIN 0001, does the delivery of additional oxygen cylinders require prior approval from the COR and/or a Rx change from the ordering physician?

CLIN 0002 includes the resupply. No additional approval is required.

1. Section 2.4 Home Visits (B)- Initial setup(s) for Home Oxygen Patients and Ventilator Patients shall be performed by a certified respiratory therapist (CRT) or registered respiratory therapist (RRT), that is licensed in accordance with the governing standards of where the services are to be provided. Can a technician that is supervised by a Therapist do the initial oxygen set-up, or could a Technician do the set-up and have a therapist do a follow-up with-in 7 business days?

Clarification-

· Home Oxygen Patients are to be set-up by a trained qualified Technician.

· Ventilator Patients are to be set-up by a Respiratory Therapist.

1. In the price table CLIN 00008 A-E Cylinder – size B/C/D/E/ M6 refills- The yearly estimated quantity is 4785. This would average to less than 400 tanks per month. This average seems very low for 1040 patients. Can you please verify tank fills used monthly and provide a breakdown of the sizes and quantities used?

Monthly tank fills and a breakdown of the sizes and quantities used cannot be obtained within an appropriate time frame based on the due date of proposals and the procurement’s necessary lead time. The estimated total quantity is validated as correct.

1. In the price table, CLIN 00011 A-E (liquid System) and CLIN 00012 (Liquid pounds used) seem to be not coincide with each other. Can you please verify the amount of liquid patients for the Biloxi, MS VAMC and the amount of liquid oxygen pounds used each month?

LINs 0011 and 0012 for Biloxi have been updated.

1. In the price table CLIN 00016 A-E (Portable Oxygen Concentrator Monthly Rental) has a quantity of 7560 per year (630/mo.). This estimated quantity is at a much higher percentage rate than the other VAMCs in the VISN. Can you please verify there are currently roughly 630 patients using Portable Oxygen Concentrators at the Biloxi VAMC?

Yes, the numbers listed for Biloxi are correct. Currently, they have several patients using POC for daily portability. However, patients are clinically reviewed annually to determine the possibility of using portable tanks. This review may result in reduced use of POC, in some cases.

1. In the price table CLIN 00035 A-E is for a 12 LPM Concentrator with Backup System fee. There is not a 12 LPM concentrator on the market. Would this be for the set-up of a high flow patient that would need two 10LPM concentrators connected together?

LIN 00035, 02035, 07035, 08035, and 09035 are removed from the price schedule.

1. In the price table CLIN 00036 A-E is for the monthly rental 12 LPM Concentrator with Backup System fee. There is not a 12 LPM concentrator on the market. Would this be for the rental of two 10LPM concentrators that could be used together for patients above 10 LPM?

LIN 00036, 02036, 07036, 08036, and 09036 are removed from the price schedule.

1. NAICS code 621610.

Question: Since this is a Home Oxygen Contract where the contractor owns the equipment and rents to the VA, the appropriate NAICS code is 532283 (Home Medical Equipment Rental with a size definition of $35M). NAICS code 621610 (Home Health Care Services, with a size definition of $16M) is used when the VA owns the equipment, and the contractor simply provides the servicing of the equipment and patients. Consider revising the NAICS code to 532283.

NAICS 621610 was determined appropriate during the acquisition planning with the program office, as the major portion of the requirement is the home health services rather than the equipment rental. The NAICS was concurred with by OSDBU and was utilized in the market research and sources sought notice, with no inquiries to the chosen NAICS.

2. 2.4 HOME VISITS:

B. Initial setup(s) for Home Oxygen Patients and Ventilator Patients shall be performed by a certified respiratory therapist (CRT) or registered respiratory therapist (RRT), that is licensed in accordance with the governing standards of where the services are to be provided.

Question: Can a qualified technician perform an initial set-up for a Home Oxygen Patient as long as a certified respiratory therapist (CRT) or registered respiratory therapist (RRT) follows up within 7 days? The Line-Item descriptions on the Price Schedule suggest so.

Clarification-

· Home Oxygen Patients are to be set-up by a trained qualified Technician.

· Ventilator Patients are to be set-up by a Respiratory Therapist.

3. 2.4 HOME VISITS:

J. The contractor shall provide initial set-up for discharged patients on the same day regardless of what time the order was received.

Not all Patient’s receiving Home Oxygen are being “Discharged” from the Hospital.

This paragraph is for patients that were “inpatient” and are now being discharged home.

K. The Contractor shall provide the initial set-up the same day when the prescription is received by 3:00 PM Central Time to include weekends and holidays; this shall also apply to service calls.

This paragraph addresses normal/daily prescription orders (different than “discharged” patients from Inpatient care). When an order is received prior to 3pm CST. The set-up should occur the “same” day.

L. The Contractor shall be required to provide initial setup within 24 hours when prescription is received after 3:00 PM Central Time to include weekends and holidays; this shall also apply to service calls.

This paragraph addresses normal/daily prescription orders (different than “discharged” patients from Inpatient care). When an order is received after to 3pm CST. The set-up should occur the “with 24 hours” of receipt of prescription.

Question: These 3 paragraphs seem to be contradicting themselves. Please clarify (Responses above).

4. 2.7 PREVENTIVE MAINTENANCE: The Contractor shall perform equipment routine maintenance semi-annually (every six (6) months) for all oxygen patients, and per manufacture’s guidelines, with documentation of these checks on file.

Question: Did you mean to say and/or? Or are we to perform equipment routine maintenance semi-annually (every six (6) months) for all oxygen patients, and in addition to per manufacture’s guidelines?

Both

5. 3.1 MATERIALS: The Contractor shall provide the Operation and Service manual to the patient and/or caregiver upon delivering any equipment. The manual shall contain information on operation, maintenance, and troubleshooting for clinicians, users, caregivers, and service technicians. Contractor shall provide to the Government, one (1) copy of the Operation and Service manual for each type of equipment with any proposals regarding this contract.

Question: The proposal instruction found in E.2 only mention providing Experience and Price. There is no mention in the proposal instructions for providing one (1) copy of the Operation and Service manual for each type of equipment with any proposals regarding this contract. Please clarify.

PWS Section 3.1 sentence 3 is revised to read:

Contractor shall provide to the Government, one (1) copy of the Operation and Service manual for each type of equipment upon request following award regarding this contract.

BASIS FOR AWARD: Offers submitted for this procurement will be evaluated using FAR Part 15 procedures. The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered.

Question: By reading this paragraph it appears the government intends to make only one award. I suggest allowing contractors to propose on service locations they would like to operate instead of only allowing contractors to propose the entire VISN. If the contract is indeed $80M over a 5-year period that would equate to $16M/yr. The NAICS code definition of this solicitation is $16M/yr. By allowing multiple awards, by location, the VA will have more options to consider which in turn will be most advantageous to the government.

During the acquisition planning with the program office, it was determined that a single award for the requirement was most beneficial to the government.

6. TECHNICAL QUESTIONS: Technical questions shall be accepted by the Government via e-mail only no later than 1600 Central Time (CT) 09-16-2022.

Question: Clearly this date was before the solicitation was issued. Kindly provide a new date for the submission of questions.

The solicitation was revised to reflect 10-16-2022.

7. Home O2 Price Schedule Question: The estimated annual amounts on Line Items 0015 and 0016 for Biloxi are much higher than the same line items for all the other areas on this VISN 16 Price Schedule. If the estimated quantities are correct, does that mean that Portable Oxygen Concentrators for Biloxi are used for daily portability? Normally POCs are used for travel only. Please clarify the estimated quantities for these line items.

Yes, the numbers listed for Biloxi are correct. Currently, they have several patients using POC for daily portability. However, there is a possibility of reduction in use POC portability as cases are clinically reviewed annually.

· Can we bid on some but not all centers?

This solicitation is all-inclusive of the named Medical Centers. Individual bids are not being accepted for this solicitation.

· As paying with a purchase card has two negative impacts on the contract. 1) increase cost by between 1.6% and 3% for credit card fees 2) because it makes the contract non assignable Banks will not take it as collateral again increase the cost and possible reducing the number of offers. Will you consider using Tungsten and pay via VIS?

Yes. We will consider using Tungsten.

· Please review quantities for Lines 09016 there appears to be typo. A is 10 times the rest.

Base Year: November 30, 2022 to November 29, 2023

Option Year One: November 30, 2023 to November 29, 2024

Option Year Two: November 30, 2024 to November 29, 2025

Option Year Three: November 30, 2025 to November 29, 2026

Option Year Four: November 30, 2026 to November 29, 2027

· CLIN 9004 A, B, C, D, E- indicate quantities in excess of 500 patients with 10 LPM concentrators. This is more than patients with 5 LPM concentrators. This is 10 times what would be normal. Is this correct?

Below, for CLIN 09004, I calculated NOLA’s quantities for 11 months. The 1st month is the initial set-up which had the correct numbers in CLIN 09003. This gives us 12 months of calculation.

Option Year One: November 30, 2023 to November 29, 2024

Option Year Two: November 30, 2024 to November 29, 2025

Option Year Three: November 30, 2025 to November 29, 2026

Option Year Four: November 30, 2026 to November 29, 2027

· Please review CLIN 02009 A, B, C, D, E, quantities are 250 M/H refills per month equals an M-90/H refill for ½ patients every month. Is this correct?

Yes, it is correct. Estimates are to ensure item availability.

· Please review CLIN 00021 A, B, C, D, E, quantities as they appear high. Are they correct?

Yes. They are correct.

· Please review CLIN 09008 A, B, C, D, E, quantities as they appear low. Are they correct?

The original numbers are correct.

· Please review CLIN 09021 A, B, C, D, E, quantities as they appear high. Are they correct?

(NOLA-Update) – The original numbers are correct.

· Please review CLIN 07008 A, B, C, D, E, quantities as they appear low. Are they correct?

Yes. They are correct.