36C25623R0079 0003.pdf

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 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.

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)

1 25

MSO-2024-COM-0004

36C598

Department of Veterans Affairs Network Contracting Office 16 Central Arkansas Veterans HCS 2200 Fort Roots Drive, Bldg 41, Room 200 North Little Rock AR 72114 1706

36C598

Department of Veterans Affairs Network Contracting Office 16 Central Arkansas Veterans HCS 2200 Fort Roots Drive, Bldg 41, Room 200 North Little Rock AR 72114 1706

To all Offerors/Bidders

36C25623R0079

04-03-2024

X

X X

The purpose of this amendment is to answer all questions received by the deadline of 1 March 2024 at 3PM CDT.

Proposals are due as posted on Amendment 0002 by 15 April 2024 at 3PM Central Time Zone.

All other terms and conditions remain unchanged.

Thomas M. Kovarovic Contracting Officer

Questions for Solicitation 36C25623R0079 Harrison, CBOC

Contractor A Questions Received 29 Feb 2024

Question 1: RFP /Section B.2/Pages 7-8 Was it the VA's intention to show that enrollment will decline through Option Year 4?

Answer: Enrollment and Utilization Projections pulled in January 2023 reflect a decrease in projected enrollment of approximately 5% for the HAR catchment area.

Question 2: RFP/Section 2/Page 16 Is a full-time Clinic Administrator required and if so, would the VA prefer they be a Registered Nurse?

Answer: VA operated clinics for VHSO each staff a full time Nurse Manager. The Nurse Manager is a Registered Nurse providing oversight assistance with administrative and clinical matters.

Question 3: RFP /Section 2.3.2 Page 21 States “Discipline Specific 2: Clinical Pharmacy Specialist (CPS) Anti-Coagulation: This service will be provided by the VA pharmacy. The contractor shall provide ample space, support staffing, and ancillary support to allow for the provision of clinical pharmacy services.

RFP/Section 4.9.4.3/Page 58 States” Anticoagulation services will be provided by the Contractor using an invitro mechanical viscosity-based detection system.

Is it the Government's intent for the VA to provide all CPS anti-coagulation services?

Answer: Yes. Clinical Pharmacy services will be provided by VA via telehealth capabilities.

Question 4: RFP /Section 2.6.2/page 22 states "PHLEBOTOMIST: VA Parent Facility to describe FTE requirements, position qualifications, training requirements, and responsibilities.

What FTE requirements, position qualifications, training requirements, and responsibilities are needed for a phlebotomist?

Answer:

• Elements of Performance:

An individual qualified by education, experience, and knowledge related to the skill being reviewed assesses staff competence. * Footnote *: Qualifications for this individual are described in the Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88) under Subpart M: "Personnel for Nonwaived Testing," §493.1351 - §493.1495. A complete description of the requirement is located at https://www.ecfr.gov/cgi-bin/text-idx?SID=1248e3189da5e5f936e55315402bc38b&node=pt42.5.493&rgn=div5#sp42.5.49 3.m.

• Staff competence for nontechnical duties (for example, phlebotomy or histology specimen processing) is initially assessed and documented as part of orientation.

• Staff competence for nontechnical duties (for example, phlebotomy or histology specimen processing) is assessed and documented once every two years, or more frequently as required by laboratory policy or in accordance with law and regulation.

• The laboratory conducts the following competency assessments for staff and takes action when a staff member’s competence does not meet expectations:

- Direct observations of routine patient test performance, including patient preparation, if applicable, and specimen collection, handling, processing, and testing

- Monitoring, recording, and reporting of test results

- Review of intermediate test results or worksheets, quality control, proficiency testing, and preventive maintenance performance

- Direct observation of performance of instrument maintenance function checks and calibration

- Test performance as defined by laboratory policy (for example, testing previously analyzed specimens, internal blind testing samples, external proficiency, or testing samples)

- Problem-solving skills as appropriate to the job (See also WT.03.01.01, EP 6)

• During the first year of employment, each staff member's competence is assessed at least semiannually for all laboratory tests they perform. This assessment is documented.

Note: For waived testing competency requirements, refer to the "Waived Testing" (WT) chapter.

• After the first year of employment, each staff member’s competence is assessed on an annual basis for all laboratory tests they perform. This assessment is documented.

Note: For waived testing competency requirements, refer to the "Waived Testing" (WT) chapter.

• If a test, methodology, or instrumentation changes, or the individual’s duties change, their competence to perform these new skills or duties is assessed. This assessment is documented.

For histocompatibility testing, the competency assessment process includes the following:

- A defined system to confirm testing competence

- A previously tested specimen is given to each individual as an unknown in order to verify their ability to reproduce test results at least monthly

- Established acceptable performance criteria

- Documented performance levels

- Documented corrective action

Question 5: RFP/Section 2.6.2/Page 23 states "Waived Testing Personnel: VA Parent Facility to describe type of staffing (i.e., laboratory technician), FTE requirements, and facility defined requirements (to include how waived testing training will be provided) for this staffing.”

What type of staffing, FTE requirements, and facility defined requirements are needed for waived testing personnel?

Answer: TJC requirements include:

1. The person from the organization whose name appears on the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) certificate, or a qualified designee, provides orientation and training to and assesses the competency of staff who perform waived testing

2. Staff who perform waived testing have received orientation in accordance with the organization’s specific services. The orientation for waived testing is documented.

3. Staff who perform waived testing have been trained for each test that they are authorized to perform. The training for each waived test is documented.

4. Staff who perform waived testing that requires the use of an instrument have been trained on its use and operator maintenance. The training on the use and operator maintenance of an instrument for waived testing is documented.

5. Competency for waived testing is assessed using at least two of the following methods per person per test:

- Performance of a test on a blind specimen

- Periodic observation of routine work by the supervisor or qualified designee

- Monitoring of each user's quality control performance

- Use of a written test specific to the test assessed

6. Competence for waived testing is assessed according to organization policy at defined intervals, but at least at the time of orientation and annually thereafter. This competency is documented.

Note 1: When a physician or other licensed practitioner performs waived testing that does not involve an instrument and the test falls within their specialty, the organization may use the medical staff credentialing and privileging process to document evidence of training and competency in lieu of annual competency assessment. In this circumstance, individual privileges include the specific waived tests appropriate to the scope of practice that they are authorized to perform. At the discretion of the person from the organization whose name appears on the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) certificate or according to organization policy, more stringent competency requirements may be implemented.

Criteria. Test systems are simple laboratory examinations and procedures which—

(1) Are cleared by FDA for home use;

(2) Employ methodologies that are so simple and accurate as to render the likelihood of erroneous results negligible; or

(3) Pose no reasonable risk of harm to the patient if the test is performed incorrectly.

Knowledge —

(i) Score 1.

(A) Minimal scientific and technical knowledge is required to perform the test; and

(B) Knowledge required to perform the test may be obtained through on-the-job instruction.

(ii) Score 3. Specialized scientific and technical knowledge is essential to perform preanalytic, analytic or postanalytic phases of the testing.

(2) Training and experience —

(i) Score 1.

(A) Minimal training is required for preanalytic, analytic and postanalytic phases of the testing process; and

(B) Limited experience is required to perform the test.

[57 FR 7139, Feb. 28, 1992, as amended at 58 FR 5221, Jan. 19, 1993; 82 FR 48773, Oct. 20, 2017]

Question 6: RFP /Section 4.8.1/Page. 49 "The Contractor will provide all medications that are to be administered to patients in the clinic (including any necessary vaccines).”

Will the Government provide a list of all medications and vaccines that are to be provided by the Contractor and the amounts that have been administered in the clinic?

Will the contractor be responsible for providing RSV and COVID-19 vaccine?

Answer: Yes

Question 7: RFP /section 4.9.1/Page 54 states “RADIOLOGY SERVICES - The Contractor is responsible for entering requests for radiology procedures into the VA EHR. All imaging orders shall be clinically appropriate. X-rays shall be performed by the contractor on site. All other radiology services (e.g., CT, MRI, US, mammography, etc.) shall be provided by All other radiology services (e.g., CT, MRI, US, mammography, etc.) shall be provided by either VHSO or by the Office of Community Care if the Veteran is eligible. The VHSO hospital at Fayetteville, AR provides CT, MRI, US, Bone Density, Nuclear Medicine, and some IR procedures.

Radiology orders placed to the VHSO Fayetteville location for those services will be scheduled by Fayetteville Radiology AMSAs.”

RFP/Section 4.12/page 103 states “Contractors shall provide space that meets the standards outlined in the PACT Space Module Design Guide (see link above) and for the purposes of this solicitation the following minimum space requirements are: Contractors shall provide space for diagnostic imaging, nuclear medicine and interventional radiology that meets the standards outlined in the VHA Imaging Services Design Guide https://www.cfm.va.gov/til/dGuide/dgImaging.pdf For all imaging applications, please contact the National Radiology Program for final guidance”.

RFP/Section 4.12.1.5/page 104 states “Radiology: The Contractor shall provide space large enough (approx. 20ft x 16 ft or larger) for diagnostic equipment which includes radiation safety barrier for technologists, workstation (control room), overhead ceiling mounted rails for x-ray tube, and table”.

Will the Government please confirm that the contractor will be required to provide space for diagnostic imaging, nuclear medicine and interventional radiology?

Answer: Contractors shall provide space for diagnostic imaging that meets the standards outlined in the VHA Imaging Services Design Guide https://www.cfm.va.gov/til/dGuide/dgImaging.pdf. Space for nuclear medicine and interventional radiology is not required as these services will be provided by VA.

https://www.federalregister.gov/citation/57-FR-7139 https://www.federalregister.gov/citation/58-FR-5221 https://www.federalregister.gov/citation/82-FR-48773 https://www.cfm.va.gov/til/dGuide/dgImaging.pdf

Question 8: RFP/Section 4.9.3.3/Page 53 States “The Contractor is responsible for sending specimens to the VA Core Laboratory Monday-Friday”.

Will the Government please verify that contractor will provide courier services once per day to the VA Core Laboratory and not twice a day?

Answer: Once per day is sufficient.

Question 9: RFP/Section 4.9.9.6/Page 86 States "It is anticipated the VA will utilize Telehealth Services at this site for up to ____ hours per week during Monday through Friday from ____ a.m. to _____ p.m. Telehealth staff will be available Monday through Friday from XXX to XXX”

How many hours and during what times will Telehealth Services be expected? And what FTE of TCT is required by the contractor?

Answer: It is anticipated the VA will utilize Telehealth Services at this site for up to 16 hours per week during Monday through Friday from 8:00 a.m. to 4:30 p.m. Telehealth staff will be available Monday through Friday from 8:00 a.m. to 4:30 p.m.

Question 10: RFP/Section 4.9.9.7 Page 86 states “The Contractor shall provide tele-eye imaging services for a target population of patients, to include those at risk of diabetic retinopathy, glaucoma, and macular degeneration”.

RFP/Section 4.12.1.3/Page 104 States “Telepsychiatry: One Behavioral Telehealth room required”.

RFP/Section 4.12.4/Page 104 States “Tele pharmacy: The Contractor shall provide space for clinical pharmacy telehealth services at the CBOC location as appropriate”.

Will tele-eye imaging services be provided in the tele-psychiatry or tele-pharmacy rooms identified in the Space Requirements?

Answer: 4.9.9.4 Space, Space and Equipment Requirements for Telehealth The Contractor is required to follow VA requirements and processes for space and equipment when delivering telehealth services and must be prepared to offer synchronous and asynchronous services by telehealth. Designated space for asynchronous telehealth services is required; for synchronous services, space may be interchanged with office space for in-person care if necessary equipment and connectivity requirements are met. The VA will provide all video conferencing equipment, peripherals, and asynchronous telehealth equipment (e.g.

teledermatology camera, eye imaging equipment) and all associated Information Technology Equipment and access to the VA confidential data network. The VA will maintain the VA-provided telehealth equipment.

The following rooms have been designated for telehealth services at this site:

(1) provider room

(1) telepsych room

(1) CVT/teleretinal room

(1) telederm imaging room

Will the Government please confirm how many telehealth rooms are required in the clinic to provide all telehealth services, i.e. teleeye imaging, telepsychiatry, telepharmacy, etc.?

Answer: 4 total, as outlined in above 4.9.9.4

Question 11: RFP/Section 4.9.10/Page 87 States "Telephone Access to Clinical Care: The Contractor must make provisions for toll free telephone care, twenty-four (24) hours a day, seven (7) days a week, including evenings, weekends and holidays, for all Veterans, in accordance with VHA Directive 1090, ""Telephone Access for Clinical Care, "" dated 09/20/23 (or subsequent revisions thereto)”

Will the Government allow the Contractor to use the parent VA facility's after hours WHEN call center to provide after-hours telephone access?"

Answer: Yes. Harrison CBOC has their own voice gateway, PRI, AA, etc., so it is capable of doing it, just like any other CBOC. Voice team needs a ticket submitted to review the requirements and document the work.

Question: 12 RFP/Section 4.12/Page 103 States "PACT space standards are found in the PACT Space Module Design”.

Will the Government please confirm if the VA will provide the phone circuit and physical phones?

Answer: See attached 2016-06 VA Specification for full Area Fayetteville Communications Technology Design Guide for Questions 12-17.

Contractor shall furnish and install the following:

1) Racks

2) Cabinets

3) Enclosures

4) Cable management panels.

5) Building entrance terminal and protectors.

6) Primary and secondary building entrance protection

7) Surge protection devices

8) Power distribution units

9) Uninterruptible power supply units

Electrical Contractor shall furnish and install the following:

10) Power circuits to telecommunications spaces and equipment.

Unless noted otherwise, the following items will be the responsibility of the Department of OI&T:

11) All electronics and active data networking equipment, etc.

12) Telephones PC’s, printers, video display terminals, etc.

Question 13: RFP/Section 4.14.1.2/Page 115 States "The installation and maintenance of the network cabling infrastructure within the facility including all cabling located inside the walls and plenum space of the structure”.

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

Answer: Belden, Berk-Tek or comparable Cat 6A (or greater) cabling should be used for all UTP cabling home runs (voice and data). The standard network drop consists of phone and two data jacks with one white, one blue and one red cat 6A or better cable.

Question 14: RFP/Section 4.14.2.5.1-2/Page 118 States "Power Requirements: Four (4) L6- 20 receptacles, One (1) L6-30 receptacle in the closet”

Will the Government please confirm the power requirements and if two 20-amp dedicated receptacles are acceptable?

Answer:

A. The room shall be served by a dedicated panel board, located in the room with sufficient capacity to provide for current and future needs by having spare breakers and an additional 20% capacity for the panel above the designed needs.

B. In addition to the circuits required to power the IT equipment and/or UPS equipment, provide a separate 120V, dedicated 20A circuit with two quadraplex receptacles centered on each side wall, two quadraplex receptacles centered on each front wall on either side of the room door, and three quadraplex receptacles centered on the rear wall. All receptacles shall be 18 in [450 mm] above finished floor. Allow three quadraplex receptacles on each 20A circuit. Per VA Electrical Design Manual.

C. A minimum of two normal power dedicated 208 volt 3-phase 20AMP twist-lock grounded electrical outlet – 1 emergency power, hard wired and dedicated for UPS as shown.

D. No electrical installations shall induce trip hazards into a Telecommunication Room from the conduits or from the need to place electrical cords on the floor.

E. Coordinate all electrical outlet locations with OIT before installation begins.

Question 15: RFP/Section 4.14.2.6.1/Page 118 States "Racks: Two standard 19” wide data/relay racks.

Will the Government please confirm if a 2 post or 4 post rack is required?

Answer:

A. Acceptable Manufacturer: Chatsworth.

1) Ladder racking shall be 4 posts and constructed with aluminum, 12” wide and be black in color.

2) UL Classified and Listed.

Question 16: RFP/Section 4.14.2.6.6/Page 118 States "Racks: both racks will have 2 shelves on the bottom installed to hold IT computers”.

Will the Government please confirm if shelves are required?

Answer: Shelves are required.

Question: 17 RFP/Section 4.14.2.6.7/Page 118 States "Racks: Infrastructure installer should install Leviton CAT6 patch panels and connectors in the rack”.

Will the Government please confirm if a comparable brand to Leviton is suffice?"

Answer:

5-2.06 Wall plates A. Manufacturer – Hubbell plates as specified below:

1) QuickPort Single Gang 4-Port wall plates with ID Windows.

2) For all faceplates with opening that do not have jacks installed the contractor must provide and install blanks.

5-2.07 Jacks

A. Manufacturer – Hubbell. Provide wall plates as specified below:

1) Hubbell Wall Plate

a. Single Gang wall Plate, white, Hubbell part #1FP140W

2) Hubbell Connector

a. Hubbell CAT 6A Connector, GREEN for Data Jacks, part # HXJ6GN

b. Hubbell CAT 6A Connector, BLUE for Data Jacks, PART # HXJ6B25

c. Hubbell CAT 6A Connector, WHITE for Telephone Jacks, PART #

HXJ6W25

d. Hubbell CAT 6A Connector, ORANGE for Wireless Jacks, PART #

HXJ60R25

B. UTP Cable

A. Manufacturer – Berk-Tek, Provide UTP Cable as specified below:

B. Berk-Tek LANmark 1000 Category 6 Cable

a. Plenum rated cable Berk-Tek LANmark 1000 for Data (Green)

b. Plenum rated cable Berk-Tek LANmark 1000 for Data (Blue)

c. Plenum rated cable Berk-Tek LANmark 1000 for Telephone (Pink)

d. Plenum rated cable Berk-Tek LANmark 1000 for Wireless (Orange)

C. Manufacturer – Leviton. Provide Made in the USA UTP Slimline Patch Cables as specified below:

01) CAT 6A 3’ Yellow Patch Cords

02) CAT 6A 5’ Orange Patch Cords

03) CAT 6A 7’ Black Patch Cords

04) CAT 6A 10’ Gray Patch Cords

05) CAT 6A 14’ Blue Patch Cords

06) CAT 6A 25’ Red Patch Cords

CAT 6A 50’ Green Patch Cords

Question 18: RFP/Section 6.1.2/Page 134 States "The Contractor shall have 150 calendar days from contract award to commencement of the provision of medical care to local Veterans.”

Would the VA consider 180 calendar days from contract award to commencement of the provision of medical care to local Veterans?

Answer: Yes

Question 19: RFP/Section E.2 Part 3/Page 217 States "Each section and volume shall be a ""stand alone"" document and be complete by itself. Any offeror that does not submit the correct number of electronic copies (and any other requirements) will be rendered technically unacceptable and will not be considered further for award. Proposals will consist of submitting two separate proposal volumes: Volume I - Price and Volume II - Technical Capability and Past Performance.

RFP/Section E.2 Part 3 item d/Page 218 States “The completion and submission of the following items will constitute Volume II - Technical Capability Proposal. Offeror must submit one (1) copies of Volume II:

Section Document Title

1 Technical Capability

2 Past Performance

3 Include Attachments shown above in item 3d with Volume II

Question 19: Does the Government want Volume I in one stand-alone document by itself and Volume II with all 3 sections in one stand-alone document by itself?

Answer: Yes. Volume I Will be price in a stand-alone document by itself, and Volume II will consist of Technical Capability, Past Performance, and attachments in a stand-alone document by itself.

Question 20: RFP/Section E.2 Part 3, Item d/Page 218 states "The Offeror shall submit the following legible attachments that require to be filled-in signed and submitted with the proposal along with Volume II.

D.1 QASP

D.2 Contractor Rules of Behavior

D.3 Conflict of Interest

D.4 Contractor Certification-Immigration

D.17 Past Performance Questionnaire - Fill as necessary

Does the Government want the bidder to include the PPQs in Volume II even though they have not been filled out since the reference is sending the PPQ directly to the Contracting Officer?

Answer: Yes. Include the PPQs in Volume II as I revised the solicitation to direct the following:

"Past performance questionnaires are to be included in the past performance section of the technical proposal in Volume II." This should be submitted on the due date of proposals in block 8 of the 1st page of the solicitation or as revised by any amendments.

Question 21: RFP/Section E.2 Part 3, Item d/Page 218 States "The Offeror shall submit the following legible attachments that require to be filled-in signed and submitted with the proposal along with Volume II.

D.1 QASP

D.2 Contractor Rules of Behavior

D.3 Conflict of Interest

D.4 Contractor Certification-Immigration

D.17 Past Performance Questionnaire - Fill as necessary

RFP/Section E.11/Page 229-230 States Factor 3. Price: D. The Offeror shall submit the following legible attachments that require to be filled-in signed and submitted with the proposal.

D.1 QASP

D.2 Contractor Rules of Behavior

D.3 Conflict of Interest

D.4 Contractor Certification-Immigration

D.17 Past Performance Questionnaire - Fill as necessary

Should the QASP, Contractor Rules of Behavior, Conflict of Interest, Contractor Certification- Immigration, and PPQ be included in Volume I Price or Volume II Technical Capability and Past Performance?"

Answer: The QASP, Contractor Rules of Behavior, Conflict of Interest, Contractor Certification- Immigration, and PPQ should be included in Volume II Technical Capability and Past Performance. I revised the solicitation at E.11 Factor 3. Price. Item D was removed entirely. The following verbiage was omitted: D. The Offeror shall submit the following legible attachments that require to be filled-in, signed and submitted with the proposal:

Section Attachment Title

D.1 QASP

D.2 CONTRACTOR RULES OF BEHAVIOR

D.3 CONFLICT OF INTEREST

D.4 CONTRACTOR CERTIFICATION-IMMIGRATION

D.17 PAST PERFORMANCE QUESTIONNAIRE – Fill as necessary

The completion and submission of the above items will constitute an offer (Price Proposal) and will indicate the offeror’s unconditional assent to the terms and conditions in the solicitation and any attachments hereto.

Question 22: RFP/Section E.2/Page 218 States "The following information shall be provided for each contract listed in the past performance:

I. Name and address of contracting activity II. Name and telephone number of Contracting Officer III. Name and telephone number of Program Manager/COR (COR) IV. Dates of contract performance V. Total contract value VI. List of major subcontractors

Offerors should not provide general information on their performance on the identified contracts. General performance information will be obtained from the references”.

Does the Government want the bidder to include the Contract Number for the reference as well?

Answer: E2. Item 3e Section E, Item I, is revised to read "I. Name and address of contracting activity and Contract Number."

Question 23: RFP/Section E.2/Page 219 States "NOTE: Past performance questionnaires are to be forwarded directly to the Contracting Officer by 3pm CST, November 30, 2023.

When would the Government like for the references to submit the PPQ to the Contracting Officer by?

Answer: Revised the solicitation to state "Past performance questionnaires are to be included in the past performance section of the technical proposal in Volume II." This should be submitted on the due date of proposals listed in block 8 of the 1st page of the solicitation or as revised by any amendments.

Question 24: RFP/Section 4.12.1.5/Page 104 States "Radiology: The Contractor shall provide space large enough (approx. 20ft x 16 ft or larger) for diagnostic equipment which includes radiation safety barrier for technologists, workstation (control room), overhead ceiling mounted rails for x-ray tube, and table. RAD rooms typically contain a chair with ceiling mounted curtains for a dressing area and a stationary stool with adjustable height for patient positioning with upright imaging.

Does the Government feel that the Radiology space at the existing clinic in Harrison, AR is large enough?"

Answer: Yes

Question 25: RFP/Section 4.12/Page 103 “Does the incumbent contractor's space fit the Government's facility and space requirements”?

Answer: Yes

Contractor B Questions Received 3-1-2024.

Question 1: On what dates was the market research performed and what were the findings?

Answer: Market Research was conducted from May 2023 – November 2023 and it was found that this requirement can be set aside as a SDVOSB Set-Aside. It was found there are two or more SDVOSB contractors who are capable of providing CBOC services. The research shows that there are currently successful SDVOSB contractors providing CBOC services for the Veterans Administration with CPARS ratings of Satisfactory and above.

Question 2: Please advise how many exam rooms and how many consultation rooms the VA requires per PACT team.

Answer: Solicitation, 4.12.1.1 Primary Care: The Contractor shall provide no less than two exam rooms per PACT team, no less than one consult room per PACT team, no less than two Women’s Health specific exam rooms, separate corridors for patient and staff access to maintain on-stage/off-stage model, vital signs area, no less than one procedure room per PACT team, no less than one PACT group room, conference room, and team workstation(s) for all PACT staff. No less than one public restroom accessible from the lobby area, no less than one patient restroom accessible within the Women's Health exam area, no less than one staff restroom and breakroom.

Question 3: Please advise how many telehealth rooms (by type) the VA requires in this facility and if the VA would like exam tables in the rooms.

Answer: VHSO HAR requires 4 TH rooms:

one is a provider room which requires a desk and exam chair, one is for MH which needs a provider chair and 2 chairs for the Veteran/guest, one TH/CVT room needs a bed, chair, and adjoining restroom, and one Telederm/Teleretinal imaging room needs a table (for Canon machine), a chair, a rolling stool/chair, and storage.

Question 4: Please confirm the size and number of small group rooms and large group rooms required in this facility.

Answer:

(1) 4.12.1.1 Primary Care: The Contractor shall provide no less than..one PACT group room.

(2) 4.12.1.3 Telepsychiatry: ..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).

(3) 4.12.1.4 Tele pharmacy: Space should provide privacy for patients to meet confidential 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).

Question 5: Please confirm the number of procedure rooms and women’s health exam rooms required in this clinic.

i. Can a procedure room count toward the number of required women’s health exam rooms?

Answer: PACT Space Module Design Guide, 4.0 Planning and Design, 4.4 PACT Space Module Support Components, Women’s Health Exam: Women’s Health can utilize the Procedure Room with dedicated toilet room provided in a standard PACT module.

4.12.1.1 Primary Care: The Contractor shall provide no less than two exam rooms per PACT team, no less than one consult room per PACT team, no less than two Women’s Health specific exam rooms, separate corridors for patient and staff access to maintain on-stage/off-stage model, vital signs area, no less than one procedure room per PACT team, no less than one PACT group room, conference room, and team workstation(s) for all PACT staff. No less than one public restroom accessible from the lobby area, no less than one patient restroom accessible within the Women's Health exam area, no less than one staff restroom and breakroom.

There are currently two PACT teams at this location.

Question 6: Does the current CBOC meet the government’s space requirements, and if not, will the location be “grandfathered in” and available for rebid “as-is”?

Answer: Current space meets requirements.

Question 7: Please confirm the new CBOC must be designed with the on/Stage-Off/Stage concept as laid out in the PACT Design Guide.

Answer: On/Stage-Off/Stage design is preferrable but not required.

Question 8: Please provide the number of billable enrollees on the most current invoice.

Answer: Feb 2024 invoice = 1,502 billable enrollees

Question 9: Please list all VA staff that will be onsite at the clinic and the approximate number of days per week they will be there.

Answer: routine and unannounced EOC inspections Telehealth staff onsite 1 day per week to cover scheduled appointments with the option for additional days as needed.

Question 10: Will the new Contractor inherit the patients’ last vesting visit and be allowed to bill for one year from the date upon contract award?

Answer: In order for the new Contract to count the vesting visit, the Veteran would have to have a visit scheduled and attended with the new Contractor. Once an establishment of care appointment is completed, the new Contractor will inherit the patient and be allowed to bill.

Question 11: Will the government be making site visits prior to the award? If so, how much advance notice will the contractor be given?

Answer: Yes. The government reserves the right to visit the site without any advanced notice.

However, regularly scheduled visits will occur. The notice of visit can be determined at award.

Question 12: How many Mission Act referrals, for Primary Care, were made in the past 12 months for enrolled veterans of the Harrison CBOC?

Answer: There were a total of 6 patients referred to Community Care – Primary Care from the HAR CBOC in the last 12 months, with 10 total Community Care – Primary Care referrals in

FY23.

Question 13: Transcripts are required to be submitted for NP candidates with the proposal. Can these transcripts be submitted after the award?

Answer: Yes

Question 14: Proof of ACLS and BLS are required to be submitted for Physicians with the proposal. Can these be submitted after the award?

Answer: Yes

Question 15: Please list the vaccines the contractor is responsible for purchasing and provide information on how many of each vaccine were used at the clinic in the past year.

Answer: HAR immunizations March 18, 2023 – March 18, 2024:

Immunization Name Count of Immunizations

COVID-19 (MODERNA), MRNA, LNP-S, BIVALENT, PF, 50 MCG/0.5 ML OR

25MCG/0.25 ML DOSE

COVID-19 (MODERNA), MRNA, LNP-S, PF, 50 MCG/0.5 ML (AGES 12+

YEARS)

HEP B, ADULT 8

INFLUENZA, HIGH-DOSE, QUADRIVALENT 194

INFLUENZA, INJECTABLE, QUADRIVALENT, PRESERVATIVE FREE 82

PNEUMOCOCCAL CONJUGATE PCV20, POLYSACCHARIDE CRM197

CONJUGATE, ADJUVANT, PF

PNEUMOCOCCAL POLYSACCHARIDE PPV23 4

RSV, BIVALENT, PROTEIN SUBUNIT RSVPREF, DILUENT

RECONSTITUTED, 0.5 ML, PF

RSV, RECOMBINANT, PROTEIN SUBUNIT RSVPREF, ADJUVANT

RECONSTITUTED, 0.5 ML, PF

TD (ADULT), 2 LF TETANUS TOXOID, PRESERVATIVE FREE,

ADSORBED

TD (ADULT), 5 LF TETANUS TOXOID, PRESERVATIVE FREE,

ADSORBED

TDAP 135

ZOSTER RECOMBINANT 216

Grand Total 904

HAR immunizations FY23

Immunization Name Count of Immunizations

COVID-19 (MODERNA), MRNA, LNP-S, BIVALENT, PF, 50 MCG/0.5 ML OR

25MCG/0.25 ML DOSE

COVID-19 (MODERNA), MRNA, LNP-S, PF, 100 MCG/0.5ML DOSE OR 50

MCG/0.25ML DOSE

HEP A, ADULT 1

HEP B, ADULT 8

INFLUENZA VACCINE, QUADRIVALENT, ADJUVANTED 15

INFLUENZA, HIGH-DOSE, QUADRIVALENT 78

INFLUENZA, INJECTABLE, QUADRIVALENT 10

INFLUENZA, INJECTABLE, QUADRIVALENT, PRESERVATIVE FREE 12

PNEUMOCOCCAL CONJUGATE PCV20, POLYSACCHARIDE CRM197

CONJUGATE, ADJUVANT, PF

PNEUMOCOCCAL POLYSACCHARIDE PPV23 3

TD (ADULT), 2 LF TETANUS TOXOID, PRESERVATIVE FREE, ADSORBED 8

TD (ADULT), 5 LF TETANUS TOXOID, PRESERVATIVE FREE, ADSORBED 1

TDAP 83

ZOSTER RECOMBINANT 154

Grand Total 483

Question 16: Please advise how mental health will be managed in the clinic (is contractor or VA providing, or will it be referred to VAMC)

Answer: Performance Requirement: Contractor shall involve PCMHI staff in the care of patients with mental health needs.

Standard: Contractor’s PCMHI penetration rate shall meet or exceed 8%

Mental Health services will be provided by the Veterans Health Care System of the Ozarks. The contractor will be required to provide mental health registered nurse support staff and space for the VA Mental Health providers.

2.7 GENERAL AND SPECIALTY MENTAL HEALTH STAFFING: Staffing Mental Health services will be provided by VA via telehealth capabilities. The contractor shall provide one-room location on-site for patients to meet confidentiality in an individual or group setting with providers at the VA via electronic transmissions…

RN intake to include:

Update emergency contact medication update (are they taking medications, any side effects, any OTC meds)

What things in your life are causing you stress or worry that need to be discussed today?

Depression screen

Inquiry about sleep (# hours, difficulty sleeping, nightmares)

Appetite

Anxiety on a scale of 0-10 anger/irritability on a scale of 0-10

Thoughts of SI/HI?

History of SA? Plan for SA? Means/access to commit?

ETOH use?

Illicit drug use?

Questions about safety including access to firearms

Documentation of speech, thought process/content, hallucinations/delusions

Ensure VVC patients have the appointment link - resend if needed.

Same as Above

SI Patients:

1:1 protocol crisis intervention, handoff to higher level of care

OPTION 8: The contractor will provide nursing support for mental health services: The MH RN will perform MH Initial Evaluations and complete intake for routine and walk in MH appointments. The RN will assist in screening for SI patients following 1:1 protocol, managing crisis calls, and completing/assigning secure messages as appropriate. Registered Nurse (RN):

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. Position Responsibilities: Responsible for disease-specific care management for assigned and unassigned patients presenting for care per VHA Handbook

1160.01 and the requirements of this contract.

Question 17: Please confirm if the VA will supply the telephones and will the existing number be rolled over to the new contractor?

Answer: VA will supply physical telephones. The existing telephone contact number(s) will roll over to the new contract site.

Question 18: Does the government require CAT6 or CAT6A cabling?

Answer: Belden, Berk-Tek or comparable Cat 6A (or greater) cabling should be used for all UTP cabling home runs (voice and data). The standard network drop consists of phone and two data jacks with one white, one blue and one red cat 6A or better cable.

Question 19: Will the government add price realism language to the current solicitation? To prevent contractors from deliberately underbidding this contract?

Answer: No. We will evaluate to determine that prices are fair and reasonable.

Question 20: 4.12.1.3 – pg. 100: One Behavioral Telehealth room required. 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 tele psychiatry equipment. VA will also provide the networking capability to support the tele psychiatry equipment. Contractor will provide clerical support, including scheduling, for VA tele psychiatry CRNP.

Is the contractor required to supply the desk, chair, patient chair(s) and administrative office supplies for the Behavioral Telehealth space? Does the VA require/prefer handwashing sink, filing cabinet storage in the space? Will the VA provide networking capability to support computers, TV, and videoconferencing equipment? Does the VA require a minimum square-footage for the space?

Answer: Furniture and office supplies will be supplied by the Contractor. Videoconferencing equipment will be supplied by VA. See 4.14 Equipment, Office Supplies, and Technical Support for network/circuit requirements for Contractor and VA. Square footage should meet ADA requirements.

Question 21: 4.12.1.4 – pg. 101: Tele pharmacy: The Contractor shall provide space for clinical pharmacy telehealth services at the CBOC location as appropriate. Clinical Pharmacy services will be provided by the VA via telehealth capabilities. Space should provide privacy for patients to meet confidential 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).

To confirm, the VA will be providing the desk, chair, patient chair(s), TV, and videoconferencing equipment for the Tele pharmacy space? Will the VA provide networking capability to support computer, TV, and videoconferencing equipment? Does the VA require/prefer handwashing sink? Does the VA require a minimum square-footage for the space?

Answer: VA will provide the videoconferencing equipment and VA network computer. the space with desk, chair and TV would be provided by the contractor. The minimum SF would be

110 SF office and a handwashing sink would NOT be required unless the space may be a shared space with another treatment modality that would require such.

Question 22: 4.12.1.5 – pg. 101: Radiology: The Contractor shall provide space large enough (approx. 20ft x 16 ft or larger) for diagnostic equipment which includes radiation safety barrier for technologists, workstation (control room), overhead ceiling mounted rails for x-ray tube, and table. RAD rooms typically contain a chair with ceiling mounted curtains for a dressing area and a stationary stool with adjustable height for patient positioning with upright imaging. The entire room will require lead lined radiation shielding on external walls/doors and for technologist in the equipment control panel area (with lead implanted glass for patient observation). Space should be ADA compliant, able to accommodate wheelchair/handicap equipment of all sizes, contain a chair for both technologist and patient, CPU access, patient ceiling mounted lift, and either a dressing room or area for patients to dress according to exam(s). [DP(1].

Will the VA be providing any of the following equipment for the radiology space:

• Overhead ceiling mounted rails for x-ray tube and table

• X-ray tube and table

• Stationary stool with adjustable height for upright imaging

• CPU access, furniture, computer equipment, or networking connectivity

• Ceiling mountable patient lift and related accessories

• Does the VA prefer/require storage area, filing cabinets, or the like to be provided by contractor in the radiology space? Does the VA require/prefer a minimum square-footage for the changing area/room outside of general ADA compliance?

Answer: Square footage should meet ADA compliance standards. Contractor is responsible for room equipment needs to include lifts, rails, tube, and furniture. The workstation for the equipment should come from the manufacturer.

Question 23: Will the contractor or VA provide the EKG? If the VA is providing, is it at cost to the contractor? What is the cost?

Answer: EKG is provided by the Contractor. To note, the GE5500 is an outdated version and Contractor should anticipate use of the MACVU 360.

Question 24: 2.6.1 & 4.9 X-ray Diagnostic Radiologic Technologist & Radiology Services

Will the Contractor be permitted to secure a contract with a local imaging facility to perform x-rays for the contract?

Answer: No. See 4.9.1.1 X-rays performed on-site: X-rays shall be performed by the Contractor on site at the outpatient site of care, using Contractor provided equipment. Contractor must provide FDA approved equipment that conforms to the VA EHR Imaging listing for Digital Image and Communication in Medicine (DICOM) (3.0) DICOM imaging listing and HL7 communications information can be found in the attachments section.

Question 25: 2.7 General and Specialty Mental Health Staffing

Will the Government be supplying the RN to perform intake for these services?

Answer: No

Question 26: 2.8 Telehealth Services Clinical Staff.

Will the Government supply the Telehealth Technician?

Answer: Yes

Question 27: 4.2.1 Registration and Enrollment

Is the Contractor responsible for entering and processing the 1010EZ forms for new enrollments?

Answer: No. VA eligibility staff enter forms for new enrollments.

Question 28: 4.8.2.9 Quarterly and annual anticoagulation quality assurance summaries

Since the Government is managing the anticoagulation with VA PharmD’s will the VA be providing the quarterly and annual quality assurance summaries?

Answer: Any anticoagulation quarterly and annual QA summaries will be the VA responsibility as long as anticoagulation is managed by VA.

Question 29: 4.9.4.2 Non-Mandated POC testing.

Will the Government provide the Accu-Check Inform II whole blood glucose testing equipment?

Answer: Will the Government provide the Accu-Check Inform II whole blood glucose testing equipment?

Question 30: 4.9.6 & 4.9.8 Mental Health Services - General and Specialty Mental Health Services.

Please provide the estimated FTEE for the RN support position for VA Mental Health Providers, and any specialty training required for this duty.

Answer: OPTION 8: The contractor will provide nursing support for mental health services: The MH RN will perform MH Initial Evaluations and complete intake for routine and walk in MH appointments. The RN will assist in screening for SI patients following 1:1 protocol, managing crisis calls, and completing/assigning secure messages as appropriate. Registered Nurse (RN):

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. Position Responsibilities: Responsible for disease-specific care management for assigned and unassigned patients presenting for care per VHA Handbook

1160.01 and the requirements of this contract.

Supplemental training for MH RN intake requirements can be conducted with the VA MHC virtually or onsite.

Question 31: 4.14 The contractor is responsible for:

4.14.1.10 Providing one small desktop color printer for patient education.

VA will not network any contractor provided equipment to the VA network; will the Government be providing this color desktop printer?

Answer: Yes

Contractor C Questions Received 3-1-24.

Question 1: Please confirm that radiology services are required to be provide on-site. We note that provision of radiology services on site will be costly for a 1400 patient clinic.

Answer: Yes. See 4.9.1 RADIOLOGY SERVICES - The Contractor is responsible for entering requests for radiology procedures into the VA EHR. All imaging orders shall be clinically appropriate. X-rays shall be performed by the contractor on site. All other radiology services (e.g., CT, MRI, US, mammography, etc.) shall be provided by All other radiology services (e.g., CT, MRI, US, mammography, etc.) shall be provided by either VHSO or by the Office of Community Care if the Veteran is eligible. The VHSO hospital at Fayetteville, AR provides CT, MRI, US, Bone Density, Nuclear Medicine, and some IR procedures. Radiology orders placed to the VHSO Fayetteville location for those services will be scheduled by Fayetteville Radiology AMSAs. If a patient is eligible and elects to receive their exam in the Community, the ordering provider places a Consult to the Office of Community Care (OCC) and OCC schedulers will call the patient to schedule. Mammography is only available via Community Care

See also 4.9.1.1 X-rays performed on-site: X-rays shall be performed by the Contractor on site at the outpatient site of care, using Contractor provided equipment. Contractor must provide FDA approved equipment that conforms to the VA EHR Imaging listing for Digital Image and Communication in Medicine (DICOM) (3.0) DICOM imaging listing and HL7…