36C25718R0247-0001000.docx

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) 04-29-2019 none 36C257 Department of Veterans Affairs Network Contracting Office 17 11495 Turner Rd.

El Paso TX 79936

To all Offerors/Bidders

36C25718R0247 04-04-2019

X X X

05/10/2019 5:00 PM ET

X The purpose of this amendment is to provide a Q&A for questions received by RFP questions due date; and to extend the response due date as indicated above.

Frank Gamboa III Contracting Officer

CONTINUATION PAGE

Vendor Q&A

Q1. Is it mandatory to have an RN on PACT team?

A1. RN staffing is mandatory.

Q2. Will the new contractor inherit the patient’s last Primary Care vesting visit and be allowed to bill for one year from that date upon contract award?

A2. The successful offeror inherits the existing billable roster.

Q3. How many Choice/Mission Act referrals occurred in the past 12 months for enrolled veterans of the Beeville CBOC?

A3. This information is not immediately available. We are working to obtain.

Q4. In paragraph 4.7.9 it states that the Contractor will provide all medication, including any necessary vaccines that are to be administered to patients in the clinic. Please confirm that the following list of Vaccines are the responsibility of the contractor?

A4. No. The VA will provide vaccine stock as indicated below. See revised 4.7.9 PHARMACY SERVICES (PRESCRIPTION FULFILLMENT).

Q5. Are there any additional Vaccines required to be supplied by the contractor other than those listed in question 3 above?

A5. No

Q6. Pursuant to paragraph 4.7.9, please provide a list of Medications the government expects the contractor to dispense from the clinic that would not be a routine medication dispensed through the VA or an urgent/emergent medication dispensed through the VA’s contract with a local pharmacist.

A6. None

Q7. What is the number of Vaccines, by type as listed in question 3 and any additional Vaccines added by the government pursuant to question 4, that was provided to the Beeville CBOC Enrolled Veterans in the last 12 months?

A7. Exact numbers are not currently available. Please note that VA will provide the required vaccine stock.

Q8. In paragraph 2.5.5.1 it states that the contractor is to provide a Suicide Prevention Coordinator. This is normally a Social Worker or LCSW and would be a collateral duty of this position for a clinic of this size. Does the VA want the contractor to hire a dedicated person to perform this function?

A8. This can be a collateral duty for a staff Physician, Nurse Practitioner, Physician’s Assistant or RN.

Q9. How many Telehealth visits were originated (patient at the Beeville CBOC) from the Beeville CBOC in the last 12 months?

A9. 79

Q10. Does the current Beeville CBOC meet the new contract PACT Space Module Design Guide requirements as stated in paragraph 4.7 of the solicitation?

A10. No

Q11. Will the Contractors proposed space be required to meet the on-stage/off-stage design with the PACT Zone?

A11. Contractors are expected to build or retrofit space to align with the PACT space design guidelines as much as possible. The Source selection plan will assess and give credit accordingly.

Q12. Is the VA supplying the phones and phone system for the CBOC or is the contractor to provide? A12. Contractor

Q13. How many VA staffed personnel will be providing services at the CBOC? Please list by job title and number of days per month.

A13. This will be by remote VCT only. It will be based on referrals from Beeville PACT Team. Staff that will be treating patients via VCT will be PCHMI Psychologist, Mental Health Provider, Clinical Pharmacy Specialist, Primary Care Social Worker, and Dietitian. All will be providing part-time services remotely using the Telehealth Room. It is anticipated that the Telehealth Room will be used every business day for most of the business hours with these providers sharing the use of this room.

Q14. How many offices will be needed at the Beeville CBOC for the VA provided staff (by position/function) identified in question 12?

A14. See Space Requirements section. One Telehealth Room is required.

Q15. In paragraph 6.1.2 it states that the Contractor shall have ninety (90) days from contract award to commencement of medical care to local veterans. Will the government change this to 120 days?

A15. It will remain at ninety (90) days.

Q16. How many veterans using the Beeville CBOC are currently on the Primary Care billable roster?

A16. The Contractor is reimbursed for all patients meeting the current contracts billing requirements, this is typically greater than 90% of the authorized and assigned patients.

Q17. The deliver to address on the SF1449 and the delivery to address in the General Instructions for Proposal Submission (page 129 of 156) are not the same. Which address should we use for the delivery of the proposal?

A17. Department of Veterans Affairs, Attn: Frank Gamboa III, 11495 Turner Rd. El Paso, TX 79936

Q18. As obtaining transcripts for the proposed Nurse Practitioners will take several weeks, is it acceptable to submit the CVs and licenses for the Nurse Practitioners with our proposal and forward the official transcripts of their NP education to the CO upon contract award?

A18. Yes

Q19. The requirement in Sub-factor (a) Experience/Management Plan/5 Proposed Staffing/ iii Nurse Practitioners,/ii - List the number of administrative support staff is exactly the same as the requirement in Sub-factor (a) Experience/Management Plan/9 List the number of administrative support staff (page 136 of 156) - Is this an intended duplication and should we include this information in both places?

A19. It was an inadvertently included in both sub-factors. At this time in the process, please include in both.

Q20. Is it acceptable to include Parts 1-4 together in a single 3-ring binder (4 binders) with appropriate tabbing to distinguish the parts? Or does the Government want each Part in individual binders?

A20. Parts 1-4 together in a single 3-ring binder (4 binders) with appropriate tabbing to distinguish the parts.

Q21. Will the VA provide the VOIP phones for the CBOC?

A21. No

Q22. Does the current clinical space meet the new contract requirements? If not, what requirements are missing?

A22. No. Some retrofitting of space will be required. Please see PWS for specifications.

Q23. Can the government confirm radiologic services are required? Does the current site provide radiology services?

A23. No and no. See revised sections 2.5.2 DIAGNOSTIC OR THERAPEUTIC RADIOLOGIC TECHNOLOGIST and 4.6.7 RADIOLOGY SERVICES.

Q24. Can the government share the current vested roster as of 04/2019? CLIN 1 states the estimated quantity at 493, however attachment D19 states the estimated quantity to be 497 as of 6/5/2018. Can the government please clarify?

A24. 563 assigned as of 4-22-19; 561 payable (vested) as of 3-31-19.

Q25. Will there be a MH CLIN to bill against?

A25. No. Not applicable for this contract.

Q26. To ensure vendors can properly plan and develop a proposal that meets all of the solicitation’s requirements can the proposal submission date be extended by 30 days from Q&A released? This will give us adequate time to obtain required documentation, develop clinical designs, and recruit the staffing / teamlete requirements.

A26. Due to acquisition time constraints, the solicitation will only be extended by seven (7) days from original due date.

Q27. Paragraph 2 states, “Actual panel sizes can be determined by the VA in accordance with PCMM Handbook 1101.02.” It is our understanding that PCMM Handbook 1101.02 has been superseded by VHA Directive 1406. Please clarify if panel sizes should be in accord with PCMM Handbook 1101.02 or with VHA Directive 1406.

A27. VHA Directive 1406. See revised 2.1 MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS

Q28. Does the government require separate/ additional support for CPS?

A28. CPS will be supported using same telehealth room and TCT support staff.

Q29. Can the government clarify who will provide the telehealth staff (VA or vendor)?

A29. Contractor

Q30. Is the contractor responsible for lab courier services, or is this service provided under a different contract?

A30. Contractor is responsible for transportation of specimens to VA.

Q31 Does the government require a PACT model design for this requirement?

A31. Contractors are expected to build or retrofit space to align with the PACT space design guidelines as much as possible.

Q32. 4.7.1.4 States: “Telehealth Room: for patients to meet confidentially in an individual or group setting with providers at VA via electronic transmissions. Should accommodate up to 8 guests, computer work station and Clinical Video Telehealth equipment.” Can the government clarify how many telehealth rooms they need and the size for each room?

A32. 1 Room needed. This single room can meet all of the Telehealth requirements.

Q33. Does the government require a group room, if so what size?

A33. Yes, the telehealth room should be sized to meet the group room requirement.

Q34. Can the government clarify the statement on page 139 Factor (5) Price: “(b) All non-price factors (Factors 1-2), when combined, are significantly more important to the Government when compared to price (Factor 3), and each sub-factor of Factor 1 is equal in importance, for the purposes of determining the best value to the Government; therefore, the Government may award to other than the lowest priced offeror if it is in the Government’s best interest to do so.” In our experience, all non-price factors are more important when combined compared to price? Is the government looking for LPTA proposals from vendors? The current site is remote with limited resources and real estate development opportunities which puts significate risk on vendors.

A34. “(b) All non-price factors (Factors 1-2), when combined, are significantly more important to the Government when compared to price (Factor 3).” The second part only relates to Factor 1 and its sub-factors.

Revised PWS addressing some questions above:

B.5 PERFORMANCE WORK STATEMENT (PWS)

PERFORMANCE WORK STATEMENT (PWS)

Outpatient Site of Care per VHA Handbook 1006.02 “VHA Site Classifications and Definitions”

1. GENERAL:

1.1. SERVICES REQUIRED: The VHA South Texas Veterans Health Care System (STVHCS) requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in Bee County, Texas and surrounding counties.

[X] Other Outpatient Clinical Services Site of Care (Less than 500 encounters registered in primary care and mental health stop class within any given fiscal year or does not include MH Services) Clinical services are provided to remote areas through a Telehealth clinic or other arrangement. If any other services are provided in this venue (external to a VA clinic or facility), they must be associated with, attached to, and coordinated by a health care delivery site located in a clinic or facility. Primary Care services will be provided on-site by Contractor staff. Mental Health services will be provided on-site by VA staff via telehealth (PCMHI).

1.2. PLACE OF PERFORMANCE: Beeville, Texas.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of STVHCS.

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. 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, patient safety and performance, including, but not limited to, the following:

1.4.1. Title 21 C.F.R 900.12(c), “Mammography Quality Standards” http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf

1.4.2. Title 21 CFR, “Food and Drugs” Section 1300-end”. https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html

1.4.3. 38 USC. Section 7332, regarding a timely special consent for any medical treatment for drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus (HIV), or sickle cell anemia, to a Veteran with health insurance. A special consent from the Veteran is needed to allow VA to release bills and medical records associated with the treatment. http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html

1.4.4. 42 CFR Part 482, “Conditions of Participation” http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf

1.4.5. 42 CFR 493.15(b), “Laboratories Performing Waived Tests” http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf

1.4.6. Clinical Laboratory Improvement Amendments (CLIA): http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp

1.4.7. VA Directive 1663, “Health Care Resources Contracting – Buying” https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.8. VA Directive 6371, “Destruction of Temporary Paper Records” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2

1.4.9. VHA Record Control Schedule 10-1

http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf

1.4.10. "Patient Medical Records-VA" 24VA10P2 https://www.oprm.va.gov/privacy/privacy_SOR.aspx

1.4.11. VHA Handbook 1101.11(2), “Coordinated Care for Traveling Veterans” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

1.4.12. VHA Directive 2007-033, "Telephone Service for Clinical Care," http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605

1.4.13. VHA Directive 2008-015, “Public Access to Automated External Defibrillators (AEDs): Deployment, Training, and Policies for use in VHA Facilities” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1665

1.4.14. VHA Directive 1088, “Communicating Test Results to Providers and Patients” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.15. VHA Directive 2009-038 “VHA National Dual Care Policy” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058

1.4.16. VHA Directive 1033, “Anticoagulation Therapy Management” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129

1.4.17. VHA Directive 1108.08, “VHA Formulary Management Process” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291

1.4.18. VHA Directive 1230 “Outpatient Scheduling Processes and Procedures” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

1.4.19. VHA Directive 1115, “Military Sexual Trauma (MST) Program” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6402

1.4.20. VHA Directive 2010-053, “Patient Record Flags”. www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341

1.4.21. VHA Directive 2011-012, “Medication Reconciliation” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2390

1.4.22. VHA Directive 2011-020, “Automated Safety Incident Surveillance and Tracking System (ASISTS)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407

1.4.23. VHA Directive 1199, “Reporting Cases of Abuse and Neglect”, https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5624

1.4.24. VHA Directive 2012-026, “Sexual Assaults and Other Defined Public Safety Incidents in VHA” The directive specifically includes contracted sites of care and defines procedures specific to patient disruptive behavior. https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797

1.4.25. VA Handbook 0730, “Security and Law Enforcement”

http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=755&FType=2

1.4.26. VHA Directive 1003.4, "VHA Patient Advocacy Program," https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

1.4.27. VHA Handbook 1004.07, “Financial Relationships between Health Care Professionals and Industry” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

1.4.28. VHA Handbook 1006.02, “VHA Site Classifications and Definitions” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970

1.4.29. VHA Handbook 1050.01, “VHA National Patient Safety Improvement Handbook” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389

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

1.4.31. VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.32. VHA Handbook 1100.19, “Credentialing and Privileging” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.33. VHA Directive 1306, “Querying State Prescription Drug Monitoring Programs (PDMP)” www.va.gov/vhapublications/viewpublication.asp?pub_id=3283

1.4.34. VHA Handbook 1101.10, “Patient Aligned Care Team (PACT)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977

1.4.35. VHA Directive 1105.03, “Mammography Program Procedures and Standards” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6423

1.4.36. VHA Directive 1106, “Pathology and Laboratory Medicine Service (P&LMS) Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7477

1.4.37. VHA Handbook 1108.05, “Outpatient Pharmacy Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209

1.4.38. VHA Directive 1120.02 Health Promotion and Disease Prevention Core Program Requirements https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5965

1.4.39. VHA Handbook 1122, “Podiatric Medical and Surgical Services” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5959

1.4.40. VHA Directive , “1330.01(2) Health Care Services for Women Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332

1.4.41. VHA Handbook 1160.01, “Uniform Mental Health Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762

1.4.42. VHA Handbook 5005, Part 2, Appendix G15, “Licensed Pharmacist Qualification Standards” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2

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

1.4.44. Title 38 CFR §17.107, “VA Response to Disruptive Behavior of Patients” (2010) www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdf

1.4.45. Title 38 CFR § 1.203, “Information to be reported to VA Police” (2003) https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203

1.4.46. “Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers,” Occupational Safety and Health Administration (OSHA) OSHA 3148-01R 2004) https://www.osha.gov/Publications/osha3148.pdf

1.4.47. “Violence: Occupational Hazards in Hospitals, National Institute for Occupational Safety and Health” (NIOSH) NIOSH 2002-101, April 2002.

http://www.cdc.gov/niosh/docs/2002-101/default.html

1.4.48. VA Assistant Secretary OSP Memo, Clarification of Policy for Sexual Assault Reporting, June 2011.

http://www.diversity.va.gov/products/files/DAW/v10i05.docx

1.4.49. VHA Directive 1231 Outpatient Clinic Practice Management https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296

1.4.50. Access to VHA Clinical Programs for Veterans Participating in State-Approved Marijuana Programs https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711

1.4.51. VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

1.4.52. Provision of Medical Statements and Completion of Forms by VA Health Care Providers https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300

1.4.53. VHA Handbook 1108.11, “Clinical Pharmacy Services”

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3120

1.4.54. VHA Directive 1605.01, “Privacy and Release of Information” www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3233

1.4.55. VHA Handbook 5005, part 2, Appendix G20, “Dietitian Qualification Standard” www.va.gov/vapubs/viewPublication.asp?Pub_ID=764&FType=2

1.4.56. VHA Directive 1177 Cardiopulmonary Resuscitation https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7487

1.4.57. VHA Directive 1108.10 Promotion of Drugs and Drug-related Supplies by Pharmaceutical Company Representatives https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=6435

1.4.58. VHA Directive 1608 Comprehensive Environment of Care (CEOC) Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3171

1.4.59. VHA Directive 1003 VHA’s Veteran Customer Service Program https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=268

1.4.60. VHA Handbook 1003.1 Key Elements of VHA’s Veteran Customer Service Program https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=422

1.4.61. VHA Handbook 1003.2 Service Recovery in the Veterans Health Administration https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=433

1.4.62. VHA Handbook 1330.03, Maternity Health Care and Coordination www.va.gov/vhapublications/viewpublication.asp?pub_id=2803

1.4.63. VHA Directive 1330.02 Women Veterans Program Manager https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7484

1.4.64. VA Handbook 6500 Risk Management Framework for VA Information Systems - Tier 3: VA Information Security Program https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=793&FType=2

1.4.65. Amendment to VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962

1.4.66. VHA Directive 1192 Seasonal Influenza Prevention Program for VHA Health Care Personnel https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.67. VHA Handbook 1660.03 Conflict Of Interest For The Aspects Of Contracting For Sharing Of Health-Care Resources (HCR) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3152

1.4.68. VA Directive 6008 Acquisition and Management of VA Information Technology Resources https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=891&FType=2

1.4.69. VA Handbook 6500.6 Contract Security https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=471&FType=2

1.4.70. VHA Directive 1300.01 National Viral Hepatitis Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6421

1.4.71. VHA Directive 1210 Chiropractic Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6425

1.4.72. VHA Directive 1341 Providing Health Care for Transgender and Intersex Veterans https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6431

1.4.73. VHA Directive 1004.08 Disclosure of Adverse Events to Patients https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8120

1.4.74. VHA Directive 1005(1) Informed Consent for Long-Term Opioid Therapy for Pain https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3005

1.4.75. VHA Handbook 1907.01 Health Information Management and Health Records https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.4.76. VHA Directive 1198 Intimate Partner Violence Assistance Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8192

1.4.77. VHA Directive 1031 Antimicrobial Stewardship Programs (ASP) https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8195

1.4.78. VHA Directive 1108.13 Provision and Use of Nursing Medication Management Protocols in Outpatient Team-Based Practice Settings https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8199

1.4.79. VHA Directive 1004.04 State-Authorized Portable Orders (SAPO) https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8240

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 Clinic

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

1.5.14. BAA: Business Associate Agreement

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

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: chronic obstructive pulmonary disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

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

1.5.36. CPARS: Contractor Performance Assessment Reporting System

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

1.5.38. CVT: Clinical Video Telehealth

1.5.39. DICOM: Digital Image and Communication in Medicine

1.5.40. DIGMA: Drop in Group Medical Appointment

1.5.41. DRG: Diagnostic Related Group

1.5.42. DSS: Decision Support System

1.5.43. ECC Extended Care Center

1.5.44. EHR Electronic Health Record

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 An 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. INR: International Normalized Ratio

1.5.56. ISO: Information Security Officer

1.5.57. LIP: licensed independent practitioner

1.5.58. MCCR: Medical Care Cost Recovery

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

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

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

(b) Evidence-based psychotherapy;

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

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

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.60. MQSA: Mammography Quality Standards Act

1.5.61. MSN: Master of Science in Nursing

1.5.62. NCCPA: National Commission on Certification of Physician Assistants

1.5.63. NLN: National League for Nursing

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

1.5.65. OTC: Over the Counter

1.5.66. PA: Physician Assistant

1.5.67. PACS: Picture Archiving and Communications System

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

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

1.5.70. PCMH: Patient-Centered Medical Home

1.5.71. PC-MHI: Primary Care-Mental Health Integration

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

1.5.73. PCP: Primary Care Provider

1.5.74. Phar.D.: Doctor of Pharmacy

1.5.75. POC: Point of Care Testing

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

1.5.77. PCMHI: PRIMARY CARE-MENTAL HEALTH INTEGRATION:

1.5.78. PWS: Performance Work Statement

1.5.79. QAPI: Quality Assessment and Performance Improvement

1.5.80. QASP: Quality Assurance Surveillance Plan

1.5.81. RME: reusable medical equipment

1.5.82. SOP (Clinical): Scope of Practice

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

1.5.84. SMA: Shared Medical Appointments

1.5.85. SPD: Sterile Processing Division

1.5.86. SPE: Senior Procurement Executive

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

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

1.5.89. TJC: The Joint Commission

1.5.90. TIU: Text Integration Utility

1.5.91. TCT: Telehealth Clinical Technicians

1.5.92. VA: Veterans Affairs

1.5.93. VAMC: Veterans Affairs Medical Center

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

1.5.95. VHA: Veterans Health Administration

1.5.96. VISTA: Veterans Health Information Systems and Technology Architecture

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 Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI)staff). The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406. PCMM Handbook 1101.02. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor 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: see estimated quantity by year under Price Schedule and Services.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT. Responsible Party: Shall be provided by Contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified (or board eligible) by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP. (If so, authorization for prescriptive authority is required). Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

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

2.3.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. At least one of the PCPs must be a physician.

OPTION 1: Physician (MD): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified (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. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications: CRNP’s (including subcontractors) must have an MSN from an NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e. CBOC); Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone 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 meet one of the three following educational criteria: a) A bachelor’s degree from a PA training program which is certified by the CAHEA; or b) Graduation from a PA training program of at least twelve (12) months duration, which is certified by the CAHEA and a bachelor’s degree in a health care occupation or health related science; or c) graduation from a PA training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician. The duration of approved academic training and health care experience must total at least five (5) years. Authorization for prescriptive authority is required. PAs must be certified by the NCCPA. PA shall have current, full, active, and unrestricted license and registration in the state of the Outpatient Site of Care (i.e. CBOC); VA HANDBOOK 5005/78 PART II APPENDIX G8 PHYSICIAN ASSISTANT QUALIFICATION STANDARD http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=763&FType=2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standards are 1.0 FTE RNCM per 1.0 FTE PCP. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2 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 of the Outpatient Site of Care (i.e. CBOC). Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, 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 CPRS for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

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

2.3.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standards are 1.0 FTE clinical associate per 1.0 FTE PCP.