S02 36C25623R0079.docx

36C25623R0079

PAGE 1 OF

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.

UEI:

EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

02/14/2024 Thomas Kovarovic, Contract Specialist 850-226-1921 03-15-2024

3PM

CDT

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

X

621498 $25.5 Million

N/A

Department of Veterans Affairs Veterans Healthcare System of the Ozarks 1100 N. College Ave

Fayetteville AR 72703

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

FSC e-Invoice Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 invoice must be submitted electronically 1-877-489-6135

See CONTINUATION Page Community Based Outpatient Clinic, Harrison, Arkansas

See Schedule of Services on page 7 and the Performance Work Statement Statement On page 11 for detailed information.

Please submit all questions to Thomas Kovarovic at thomas.kovarovic@va.gov no later than 1 March 2024 at 3PM CDT.

Estimated start date of services will be 1 October 2024.

See CONTINUATION Page

Billy Morris Contracting Officer

Table of Contents

E2. ADDENDUM TO FAR 12.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS…………………………………………………………………………………………216

E.11 ADDENDUM TO FAR 12.212-2 EVALUATION—COMMERCIAL ITEMS………..226

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:

a. CONTRACTOR:

Name:

Title:

Address:

Phone:

Email Address:

b. GOVERNMENT: Contracting Officer 36C256 Billy Morris, billy.morris@va.gov, 501-257-1820

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

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 DISCLOSURES 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 instructions.

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

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.

B.2 SCHEDULE OF SERVICES

Services are required by The Veterans Health Care System of the Ozarks in a private hospital, office, or clinic environment to Veterans, primarily residing in Harrison, Arkansas.

The following capitated rates [utilizing a Per Member Per Month (PMPM) rate structure] are for the provision of Primary Health Care services at the Harrison CBOC. Prices shall be listed as an all-inclusive Per Member Per Month (PMPM) rate per month for services. The extended amount must equal the whole dollar unit price multiplied by the number of units (i.e., Estimated Quantity x Price Per Unit x 12 = Total Estimated Annual Cost).

The guaranteed minimum award amount for this contract is $25,000.00. The maximum value of all orders placed under this contract shall not exceed $15,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum amount.

*PMPM includes cost of unenrolled/unassigned patient visits, contractor shall not bill separately or propose an additional Line Item or bill separately for these costs.

Period of Performance: (Base Year and 4 one-year Option Periods) 04/01/2024 (or 150 days after date of award. However, the Contractor must have all start-up requirements in place and ready to commence operation NLT 143 calendar days from contract award. The final seven (7) days will be used for training and resolution of any last minute or unexpected technical or personnel related challenges.

Base Year – 10/01/2024 – 09/30/2025

Unit

Estimated Quantity

Price per Unit

PMPM

1,450

Total for Base Year $________________________

Option Year One – 10/01/2025 – 09/30/2026

Unit

Estimated Quantity

Price per Unit

PMPM

1,440

Total for Option Year 1 $________________________

Option Year 2 – 10/01/2026 – 09/30/2027

Unit

Estimated Quantity

Price per Unit

PMPM

1,425

Total for Option Year 2 $________________________

Option Year 3 –10/01/2027 – 09/30/2028

Unit

Estimated Quantity

Price per Unit

PMPM

1,415

Total for Option Year 3 $________________________

Option Year 4 – 10/01/2028 – 09/30/2029

Unit

Estimated Quantity

Price per Unit

PMPM

1,400

Total for Option Year 4 $________________________

TOTAL FOR BASE AND OPTION YEARS $___________________________

Orders shall be issued only by the Contracting Officer.

All unit prices shall be a fixed price and all inclusive.

The government reserves the right to negotiate additional staffing in the event that the CBOC does expand due to increase numbers beyond stated estimated quantities.

FAR 52.217-8, Extension of Services: 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 ORDERS: This is a Fixed Price (FP) Indefinite Delivery/Indefinite Quantity (IDIQ) contract (see FAR 52.216-22).

Ordering Procedures (Section 6.2.1 Billable Roster and 6.2.2 Invoicing and Payment for more information)

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. Specific billable processes for issuing task orders under the resultant contract includes: determining veteran eligibility, enrollment eligibility, and required Evaluation and Management Exams.

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

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1 SERVICES REQUIRED: The Veterans Health Care System of the Ozarks requires the following services to be provided in a private hospital, office or clinic environment to Veterans, primarily residing in Harrison, Arkansas.

1.1.1 [X] 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 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.

1.2 PLACE OF PERFORMANCE: The Contractor shall provide a community-based outpatient clinic (CBOC) within the city limits of Harrison, Arkansas.

1.3 AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of the Veterans Health Care System of the Ozarks. Procurement Authority is in accordance with FAR Parts 12 and 15.

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:

1.5.1 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 Center

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 ASYNCHRONOUS CARE: Care provided outside of bookable time and includes but is not limited to the following activities: refilling prescriptions, reviewing outside records, huddles and case management, team meetings, processing view alerts, secure messaging and training.

1.5.15 BAA: Business Associate Agreement

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

1.5.17 BLS: Basic Life Support

1.5.18 BOS: Bureau of Osteopathic Specialists

1.5.19 CAHEA: Committee on Allied Health Education and Accreditation

1.5.20 CAP: College of American Pathologists

1.5.21 CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.22 CBO: VA Central Billing Office.

1.5.23 CBOC: Community Based Outpatient Clinic

1.5.24 CDC: Centers for Disease Control and Prevention

1.5.25 CEU: Certified Education Unit

1.5.26 CLIA: Clinical Laboratory Improvement Amendments

1.5.27 CME: Continuing Medical Education

1.5.28 CMS: Center for Medicare and Medicaid Services

1.5.29 CO: Contracting Officer

1.5.30 COPD: chronic obstructive pulmonary disease

1.5.31 COR: Contracting Officer’s Representative

1.5.32 COS: Chief of Staff

1.5.33 CPA: Collaborative Practice Agreement

1.5.34 CPS: Clinical Pharmacy Practitioner

1.5.35 CPT: Current Procedural Terminology

1.5.36 CRNP: Certified Registered Nurse Practitioners

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

1.5.38 CPARS: Contractor Performance Assessment Reporting System

1.5.39 CVT: Clinical Video Telehealth

1.5.40 DICOM: Digital Image and Communication in Medicine

1.5.41 DIGMA: Drop in Group Medical Appointment

1.5.42 DRG: Diagnostic Related Group

1.5.43 DSS: Decision Support System

1.5.44 ECC Extended Care Center

1.5.45 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.

1.5.46 EPRP: External Peer Review Program

1.5.47 FDA: Food and Drug Administration

1.5.48 FSMB: Federation of State Medical Boards

1.5.49 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.

1.5.50 HHS: Department of Health and Human Services

1.5.51 HCFA: HealthCare Financing Administration

1.5.52 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.

1.5.53 HT: Home Telehealth

1.5.54 ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.55 ICD 10: International Classification of Diseases 10th edition

1.5.56 iMED: software used by VA for informed consent

1.5.57 INR: International Normalized Ratio

1.5.58 ISO: Information Security Officer

1.5.59 LIP: licensed independent practitioner

1.5.60 MCCR: Medical Care Cost Recovery

1.5.61 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.

1.5.62 TMS: Talent Management System

1.5.63 VHSO: Veterans Health Care System of the Ozarks

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

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

(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.

1.5.64 MQSA: Mammography Quality Standards Act

1.5.65 MSN: Master of Science in Nursing

1.5.66 NLN: National League for Nursing

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

1.5.68 OTC: Over the Counter

1.5.69 PA: Physician Assistant

1.5.70 PACS: Picture Archiving and Communications System

1.5.71 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.

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

1.5.73 PCMH: Patient-Centered Medical Home

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

1.5.75 PCP: Primary Care Provider

1.5.76 Phar.D.: Doctor of Pharmacy

1.5.77 POC: Point of Care Testing

1.5.78 PRIMARY CARE VISIT: an episode of care furnished in a clinic or virtually 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.

1.5.79 PCMHI: Primary Care-Mental Health Integration

1.5.80 PWS: Performance Work Statement

1.5.81 QAPI: Quality Assessment and Performance Improvement

1.5.82 QASP: Quality Assurance Surveillance Plan

1.5.83 RME: reusable medical equipment

1.5.84 SOP (Clinical): Scope of Practice

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

1.5.86 SFT: Store and Forward Telehealth

1.5.87 SMA: Shared Medical Appointments

1.5.88 SPD: Sterile Processing Division

1.5.89 SPE: Senior Procurement Executive

1.5.90 SPECIALTY CARE VISIT: 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.

1.5.91 PACT SUPPORT STAFF: PACT staff assisting providers in the actual delivery of care to patients. It consists of RNCMs, clinical associates, and administrative associates.

1.5.92 SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two way conversation.

1.5.93 TJC: The Joint Commission

1.5.94 TIU: Text Integration Utility

1.5.95 TCT: Telehealth Clinical Technicians

1.5.96 VA: Veterans Affairs

1.5.97 VA EHR: VA electronic health record

1.5.98 VAMC: Veterans Affairs Medical Center

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

1.5.100 VHA: Veterans Health Administration

1.5.101 VVC: VA Video Connect

1.5.102 WHEN: Weekend- Holiday- Every Night

2. STAFFING AND QUALIFICATIONS

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 Pharmacist Practitioners (CPPs), Licensed Social Workers, Registered Dietitian/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 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 Pharmacist Practitioner (CPP) shall be provided the same support staffing when they are working in the capacity of an advanced practice provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. 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: 1450.

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 or board eligible by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. The physician director may also be credentialed and privileged to function 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. Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site. The physician will be available to the Advanced Practice Registered Nurse (APRN), either in person or via electronic or telephonic communication, for consultation and referral. Should an emergency arise, necessitating the absence of the APRN or the collaborating physician from patient care responsibilities, provision for comparable coverage shall be arranged at the first possible opportunity. The physician and APRN will perform under agreement through an Arkansas Collaborative Practice Agreement (CAP) and Quality Assurance Plan (QAP).

2.2 PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor.

2.2.1 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. At least one PCP is required to be a physician.

OPTION 1: Physician (MD/DO): 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 or board eligible 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. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. 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. Position Responsibilities: Responsible for the provision of covered services to assigned 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 and virtual 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: Advanced Practice Registered Nurse (APRN): Qualifications: APRN’s (including subcontractors) must possess a master’s degree from a program accredited by the NLNAC or CCNE and maintain full and current certification as a Certified Nurse Practitioner (CNP) from the American Nurses Association or another nationally recognized certifying body in either Adult Health or Family Practice. Authorization for prescriptive authority is required. CNPs shall prescribe controlled substances in accordance with limitations imposed by the Controlled Substances Act and the CNP’s State licensure on the authority to prescribe or administer controlled substances. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CNP 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. Position Responsibilities: Responsible for the provision of covered services to assigned 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 and virtual 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 3: Physician Assistant (PA): Qualifications: PA’s (including subcontractors) must be a graduate of a training program which is accredited by the Accreditation Review Commission on Education of PA (ARC-PA) or one of its predecessor organizations. Additionally, PAs must have a Master’s degree in any discipline or a Bachelor’s degree in any discipline with one year of experience as a PA. PAs must have successfully passed the PA National Certifying Exam (PANCE). Authorization for prescriptive authority is required. PA shall have current, full, active, and unrestricted license and registration in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G8. Position Responsibilities: Responsible for the provision of covered services to assigned 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 and virtual 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.

2.2.2 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 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 the provision of covered services to assigned 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, virtual care, view alerts management, shared medical appointments, 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 virtual 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. AREG – CLINICAL ASSOCIATE [X] Mandatory for all sites

2.2.3 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) or 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. Position Responsibilities: Responsible for the provision of covered services to assigned 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 ability 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. Please indicate if this staff member will receive training as back-up for telehealth services (e.g., S&F, CVT). Delete this instruction prior to submitting.

OPTION 2: Health Technician (Medical Assistant). This staffing is part of the PACT Teamlet, not the primary telehealth clinical technician (TCT): Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on VA Chief of Staff determination. Position Responsibilities: Responsible for the provision of covered services to assigned 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 ability 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. Please indicate if this staff member will receive training as back-up for telehealth services (e.g., S&F, CVT). Delete this instruction prior to submitting.CAL ASSOCIATE [X] Mandatory for all sites

2.2.4 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. Completion of scheduling training per VA policies and guidance. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. Provide 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. Provide guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA. Provide scheduling services in accordance with VA policies and guidance.

2.3 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.

2.3.1 DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) 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. 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.

2.3.2 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. 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.

EXPANDED PACT STAF

2.3.3 DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER (this position provides general/medical social work services): This service will be provided by the VA Social Work Service. The contractor shall provide ample space, support staffing, and ancillary support to allow for the provision of social work services.

2.3.4 DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST: This service will be provided by the VA Nutrition & Food Services. The contractor shall provide ample space, support staffing, and ancillary support to allow for the provision of social work services.

2.3.5 DISCIPLINE…