36C25718Q0185-001.docx

PERFORMANCE WORK STATEMENT FOR OFF-SITE CARDIOVASCULAR PHYSICIAN SERVICES

1. GENERAL:

Services Provided: The Contractor shall provide Board Certified or Board Eligible (Interventional) Cardiologist to provider On-Call Cardiology Consultation Services required to participate on-site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Amarillo VA Health Care System (AVAHCS), Amarillo, TX. These services are required to maintain our surgical complexity at the AVAHSC 24 hours a day 7 days a week. The Contractor’s physician(s) care shall cover the range of Cardiology services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by The American College of Cardiology (ACC): http://www.cardiosource.org/Science-And-Quality/Practice-Guidelines-and-Quality-Standards.aspx.

The following duty requirements are needed to meet the VHA-Directive 2010-018, Facility Infrastructure Requirements to Perform Standard, Intermediate or Complex Surgical Procedures.

On-Call Coverage: The AVAHCS is an intermediate facility and requires to provider 24/7 in-house interventional cardiology services within 15 minutes by phone and 30 minutes in person to the AVAHCS. Interventional Cardiology Services - The Contractor will provide on-call telephone consultation coverage 365 days per year, 24/7. If required, the Contractor will to come to the AVAHCS and evaluate the patients and take appropriate action. VA staff physicians will contact the Contractor that provides the on-call services by entering a consultation followed by making a call to the cardiologist on-call. The Contractor will provide the telephone number(s) of the on-call cardiologist to the AVAHCS. The Contractor will also be required after evaluating the patients to complete the required documentation/consultation in the computerized medical record system (CPRS) and arrange the appropriate actions to care for patients at the AVAHCS per VA Rules and Regulations. This on-call includes evaluation and treatment of Veteran patients presenting with Cardiac conditions requiring emergent/urgent Cardiovascular surgery or procedure. Required services include Emergent/Urgent Cardiovascular Surgery, Intracardiac Electrophysiological Procedures/Studies, and Emergent/Urgent Cardiovascular Outpatient Procedures. If required, the Contractor shall transfer the Veteran patient to a local hospital of the Contractor’s choice; however, it must be within 20 miles of the AVAHCS. The Contractor must be able to properly manage acute Cardiology patients and must have admitting privileges at the specified local hospital. Coverage will include consultation with the AVAHCS physicians regarding the appropriate medical care of Veterans presenting with Cardiac conditions and inpatient/outpatient treatment as required in the Contractor’s location of choice. A telephone response is expected within 30 minutes from the initial call. Charges for hospital care completed at a local hospital will be reimbursed by the AVAHCS, Non-VA Care Office, Louisville, KY. Reimbursement for off-site services will be paid through the Non-VA Care Office at 100% of Center for Medicare and Medicaid Services (CMS) rates or Diagnosis-Related Group (DRG) rates.

Schedule: The Contractor will provide a schedule to the VA Medicine Service Administrative Office which contains 90 days of on-call rotation. This will be provided at least three (3) working days before the start of each month. The on-call schedule will be e-mailed to the Administrative Officer for Medicine Service/Contracting Officer’s Representative (COR) or designee. The schedule will provide the names of the Cardiovascular Surgery and Cardiology Attending physicians assigned to provide the emergent/urgent coverage, as well as contact information, such as pager or cell phone numbers. The schedule will be updated and forwarded to the Medicine Service Administrative Office whenever changes are made.

1.1. Place of Performance - Contractor shall furnish services at off-site locations as part of his/her regular practice.

1.2. Authority: Title 38 USC 8153, Health Care Resources (HCR) Sharing Authority.

1.3. Policy/Handbooks the contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.3.1. VA Directive 1663: Health Care Resources Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

1.3.2. VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.3.3. VHA Handbook 1100.17: National Practitioner Data Bank Reports - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.3.4. VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards - http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.3.5. VHA Handbook 1100.19 Credentialing and Privileging - http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.3.6. VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

1.3.7. Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.4. Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.4.1. ACGME: Accreditation Council for Graduate Medical Education

1.4.2. CDC: Centers for Disease Control and Prevention

1.4.3. CEU: Certified Education Unit

1.4.4. CME: Continuing Medical Education

1.4.5. Contracting Officer (CO) – The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.4.6. Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.4.7. COS: Chief of Staff

1.4.8. CPARS: Contractor Performance Assessment Reporting System

1.4.9. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.4.10. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.4.11. DEA: Drug Enforcement Agency

1.4.12. FSMB: Federation of State Medical Boards

1.4.13. HHS: Department of Health and Human Services

1.4.14. HIPAA: Health Insurance Portability and Accountability Act

1.4.15. ISO: Information Security Officer

1.4.16. POP: Period of Performance

1.4.17. PPD: Purified Protein Derivative

1.4.18. PWS: Performance Work Statement

1.4.19. Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

1.4.20. QA/QI: Quality Assurance/Quality Improvement

1.4.21. QM/PI: Quality Management/Performance Improvement

1.4.22. QASP: Quality Assurance Surveillance Plan

1.4.23. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.4.24. Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.4.25. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers in Texas and New Mexico.

1.4.26. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

1.4.27. VETPro: a federal web-based credentialing program for healthcare providers.

1.4.28. Amarillo Veterans Affairs Health Care System (AVAHCS): Unless identified with the name of a different VA Health Care System, for purposes of this contract, this term shall mean the Amarillo VA Health Care System, Amarillo, Texas.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License - The Contractor’s physician (s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia) when services are performed onsite on VA property.

All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2. Board Certification - All Contractor’s physician(s) shall be Board Certified by the Board of their respective specialty, i.e. for Cardiology, Cardiovascular Surgeons, The American Board of Thoracic Surgery; for Cardiac Electrophysiology, The American Board of Cardiac Electrophysiology, etc.

2.1.3. Credentialing and Privileging – The requirements of the Government as stated in this Performance Work Statement are for the performances of professional medical services. The Director of the AVAHCS grants privileges. When services are not performed at the AVAHCS and the services are distributed to two or more Health Care Providers (HCPs) of the group and the services are not directed towards a single provider, then the HCP is not required to be credentialed and privileged. If the HCP in a group is providing all of the service, or all of a specific service, the HCP MUST be credentialed and privileged. When applicable, compliance with the credentialing and privileging processes is essential to the performance under this contract.

2.1.4. Technical Proficiency - Contractor’s physician(s) shall be technically proficient in the skills necessary to fulfill the Government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

2.1.5. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.6. DEA - Contractor shall provide copy of current DEA certificate.

2.1.7. Conflict of Interest: The Contractor and all Contractor’s physician(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.8. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.8.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed Contractor’s physician(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.8.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by AVAHCS COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the AVAHCS COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non-Personal Healthcare Services: The parties agree that the Contractor and all Contractor’s physician(s) shall not be considered VA employees for any purpose.

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Prohibition Against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s).

2.6. Inherently Governmental Functions: Contractor and Contractor’s physician(s) shall not perform inherently Governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of Government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.7. No Employee status: The Contractor shall be responsible for protecting Contractor’s physician(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.7.1. Workers’ compensation

2.7.2. Professional liability insurance

2.7.3. Health examinations

2.7.4. Income tax withholding, and

2.7.5. Social security payments.

2.8. Tort Liability: The Federal Tort Claims Act does not cover Contractor or Contractor’s physician(s). When a Contractor or Contractor’s physician(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or Contractor’s physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

3. HOURS OF OPERATION:

3.1. On-call services will be available seven (7) days per week, 24 hours per day, including all federal holidays. If required, the Contractor shall transfer the Veteran patient to a local hospital of the Contractor’s choice; however, it must be within 20 miles of the AVAHCS. The Contractor must be able to properly manage acute Cardiology patients and must have admitting privileges at the specified local hospital.

3.1.1.1. On-call contractor’s physician(s) must be available at all times for phone consultations with VA residents and physicians.

3.2. The Contractor must be able to provide Cardiology/Cardiovascular Surgery services immediately upon notification by the AVAHCS. Cardiovascular surgical services and interventional/invasive/EP cardiology procedures will be provided on an urgent or emergent referral and includes any pre or post care as required by the condition of the patient as outlined previously in this document.

3.2.1. Unless a state of emergency has been declared, the Contractor shall be responsible for providing services.

4. CONTRACTOR RESPONSIBILITIES:

4.1. Clinical Personnel Required: The Contractor shall provide Contractor’s physician(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.2. Standards of Care: The Contractor’s physician(s)’ care shall cover the range of cardiology services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1. The American College of Cardiology (ACC):http://www.cardiosource.org/Science-And-Quality/Practice-Guidelines-and-Quality-Standards.aspx.

4.2.2. VA Standards: VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443.

4.2.3. The professional standards of The Joint Commission (TJC) http://www.jointcommission.org/standards_information/hap_requirements.aspx

4.2.4. The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.2.5. The requirements contained in this PWS

4.3. Medical Records:

4.3.1. Authorities: Contractor’s physician(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

4.3.3. Disclosure: Contractor’s physician(s) may have access to patient medical records: however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VAMC.

4.3.5. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Darrin Helton, (806) 355-9703 Ext 4528, darrin.helton@va.gov.

4.4. Performance Standards, Quality Assurance (QA) And Quality Improvement(QI):

4.4.1. Quality Management/Quality Assurance Surveillance: Contract personnel shall be subject to Quality Management measures. Contractor performance will be monitored by the Government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.4.2. Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that the Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.4.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

4.4.4. Registration with Contractor Performance Assessment Reporting System

4.4.4.1. As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates Contractor past performance on all contracts that exceed $150,000, and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for Contractor responsibility determination information.

4.4.4.2. Each Contractor whose contract award is estimated to exceed $150,000 requires a CPARS evaluation. A Government Focal Point will register your contract within thirty days after contract award and, at that time, you will receive an email message with a User ID (to be used when reviewing evaluations). Additional information regarding the evaluation process can be found at www.cpars.gov or if you have any questions, you may contact the Customer Support Desk @ DSN: 684-1690 or COMM: 207-438-1690.

4.4.4.3. For contracts with a period of one year or less, the Contracting Officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the Contractor’s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the Contractor’s designated representative for comment. The Contractor representative will have sixty (60) days to submit any comments and re-assign the report to the CO.

4.4.4.4. Failure for the Contractor’s representative to respond to the evaluation within those sixty (60) days, will result in the Government’s evaluation being placed on file in the database with a statement that the Contractor failed to respond; the Contractor’s representative will be “locked out” of the evaluation and may no longer send comments.

5. GOVERNMENT RESPONSIBILITIES:

5.1.1. CO RESPONSIBILITIES:

CO – Valeria Gutierrez / SAO West NCO 17 11495 Turner Road El Paso, TX 79936-1372 / (915) 217-1238 / valeria.gutierrez@va.gov

5.1.1.1. The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract.

5.1.1.2. The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof.

5.1.1.3. In the event that contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for Contractor personnel to be provided by the VA; replacement of the contract personnel and/or renegotiation of the contract terms or termination of the contract.

5.1.2. COR Responsibilities:

5.1.2.1. The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.1.2.2. The COR will be responsible for monitoring the Contractor’s performance to ensure all specifications and requirements are fulfilled. Quality Improvement data that will be collected for ongoing monitoring.

5.1.2.3. The COR will maintain an electronic record-keeping system of patients being referred for services. The COR will review this data when invoices are received and certify all invoices for payment by comparing the services documented on the VA record-keeping system and those on the invoices. Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.1.2.4. The COR will review and certify invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference.

6. SPECIAL CONTRACT REQUIREMENTS:

6.1. Reports/Deliverables: The Contractor shall be responsible for complying with all reporting requirements established by the Contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required.

6.1.1. The following are brief descriptions of required documents that must be submitted by Contractor: upon award; weekly; monthly; quarterly’; annually, etc. identified throughout the PWS and are provided here as a guide for Contractor convenience. If an item is within the PWS and not listed here, the Contractor remains responsible for the delivery of the item.

Copy of Sub Contracting Plan (as required) Copy of Contractor Certification Statement if non-subcontracting possibilities exist.

7. INFECTION CONTROL:

7.1. Standard precautions will be observed for all patients. Persons with infectious diseases that require additional precautions will be cared for utilizing transmission based isolation.

7.2. The service will comply with the Occupational Health program, which includes annual screening for Tuberculosis (TB) and appropriate testing and screening after exposures to contagious diseases.

8. ADMINISTRATIVE TASKS/TIME AND CLINICAL TASK/TIME:

8.1. The Contractor may be required to attend meetings via teleconference with the AVAHCS medical and administrative staff to discuss patient care and contract issues.

9. REQUIREMENTS AND HOW THEY WILL BE BILLED:

9.1. Payments made to the Contractor by the Department of Veterans Affairs (VA) under this contract shall be for the total cost of services provided. The Contractor hereby agrees, that in no event shall the Contractor or his agents bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against the beneficiary, the beneficiary’s family, private insurer, Medicare, or any other entity acting on the beneficiary’s behalf, for services provided pursuant to this contract. When properly invoiced and processed, VA payment for services provided to VA beneficiaries under the terms of this agreement shall constitute payment in full. At no time, when the VA patient is being seen at the Contractor’s off-site location, is the VA patient to be seen and/or sent to another provider within the Contractor’s private practice or outside of their private practice for additional services not approved by the initial Non-VA Care authorization. Any question in this regard should be directed to Non-VA Care Section.

9.2. Reimbursement for VA beneficiaries presented prior to the expiration of this agreement shall be made at the contract rate in effect at the time of patient referral/time services are provided. The Contractor shall provide an invoice by the 10th of the month following the month when services are provided.

9.3. The documentation and coding of consults, treatment, procedures, progress notes, etc., will be in accordance with 1997 documentation guidelines published by the Center for Medicare and Medicaid Services, CMS, and all applicable coding standards. All diagnosis(es) will be coded using the current International Classification of Disease Index, ICD-9-CM or ICD-10-CM, when applicable. All procedures and treatment will be coded using current CPT or HCPCS codes with qualifying modifiers as indicated by the American Medical Association and CMS. Where global CPT codes exist, distinguishing professional services will include a 26 modifier. Contractor shall submit invoices for services provided monthly, in arrears, for consultations, or upon completion of treatment.

9.4. For services provided outside of the AVAHCS, invoices shall be mailed to the following address:

10. CLINICAL POINT OF CONTACT:

10.1. The Cardiology Nurse Navigator and/or Program Manager at the VA are the contractor’s clinical point of contact at the VA for the purposes of receiving approved referrals, requests for documentation, and for receipt of reports. This individual will be responsible for coordinating VA resources to assist in the continuity of care for VA patients when necessary and informing the Contractor who the appropriate contact person is in each situation. In the absence of the Cardiology Nurse Navigator and/or Program Manager, the Contractor should contact the referring physician or the VA Chief of Medicine for assistance.