36C25718R0773-0002000.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) none 10-2-2019 549 Bridgeport 36C257 Department of Veterans Affairs Contracting Office (138C) 5001 N. Piedras St El Paso

TX

79930-4221 36C257 El Paso Contracting Office Department of Veterans Affairs 11495 Turner Road El Paso

TX

79936-1372 To all Offerors/Bidders

36C25718R0773

X X

X The purpose of this amendment is to answer questions from contractors.

See continuation pages.

Carlos Leon Contracting Officer

CONTINUATION PAGE

1. What is the current vesting roster for September 2019?

a. Use the numbers estimated in the RFP

2. Does the current site meet the new contract requirements?

a. No, not setup for the PACT

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

a. Yes

4. Can the government confirm the number of telehealth rooms they require for mental health and primary care?

a. Four rooms

5. Are lab courier services required for this contract, or are lab courier services provided under a different contract?

a. VA provides this service.

6. Can the PACT teamlet level support all VA provided PC-MHI, or does the government requirement addition support for PC-HMI?

a. Base on clinic size there is no requirement for additional support PC-MHI.

7. Will the government consider changing the contract start up requirement to 120 days? Due to the limited number of available commercial spaces in the Wise Count, TX would allow venders to better prepare for the new contract requirements.

a. No

8. Can the government provide a utilization report for the Bridgeport CBOC?

a. No

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

a. 29

10. How many Telehealth visits were originated (patient at the Wise County CBOC) from the Wise County CBOC in the last 12 months?

a. We do not have that info currently

11. Does the government want two (2) physical copies and one (1) copy in CD format for all factors?

a. Only 2 CD copies of each, NO paper!

12. With reference to the Instructions to Offerors: for all three factors, the solicitation states to submit the physical copies 'in CD format'. Can the Government please clarify?

a. Only the CD copies are required- no hard paper copies please.

13. Can we include both Volume 1 and Volume 2 in the same binders and on the same CDs?

a. We prefer you separate each Volume.

14. On page 162 paragraph 2.a. of the RFP states, "Offeror must submit two (2) physical copies, in CD format, of the technical capabilities." For clarification purposes, for the technical proposal does the VA want 2 printed out physical copies of the technical proposal on paper plus a CD, or does the VA only want 2 physical copies of the CD?

a. See above answers

15. Will the VA or the Contractor be financially responsible for the cost of 10-day bridge medications?

a. The VA is responsible for that cost

16. In paragraph 4.6.4.1.1 it states that the Contractor will provide all medication, including any necessary vaccines that are to be administered to patients in the clinic. Will the Vaccines be provided to the clinic at the cost of the Contractor or the VA?

a. The VA does not provide any vaccines or medications to the clinics.

17. If the cost of vaccines is the responsibility of the contractor…. What is the number of Vaccines, by type as listed in question 4 and any additional Vaccines added by the government pursuant to question 5, that was provided to the Wise County CBOC Enrolled Veterans in the last 12 months?

a. The Contractor maintains that information in their file.

18. Pursuant to paragraph 4.6.4.1.1, Will the contracted local pharmacy used for 10 day Urgent/Emergent medications be via the VA contract or will the Contractor need to set-up a contract with the local pharmacy at the contractors’ expense?

a. The VA has a contract in place for this requirement.

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

a. The contractor is responsible for this requirement.

20. How many veterans using the Wise County CBOC are currently on the Primary Care billable roster?

a. Use the estimated number of patients listed in the RFP.

21. How many times per year does the VA anticipate that the Contractor staff will be required to travel to and attend VA mandated meetings on-site at the VAMC or other VA Facility?

a. No more than once a quarter.

22. Are the Mental Health offices and Telehealth rooms identified in paragraph 2.7 included in the rooms described in paragraph 4.7.3, 4.7.4 and 4.7.5? or are they in addition too?

a. All facilities regardless of size should have at least four designated telehealth rooms (144sf.) 2 MH Staff offices (125sf.), 1 for other clinical staff (125sf.)

23. Will the Davis-Bacon Act apply to the construction/renovation work that will be necessary to make ready the space for the Wise county CBOC?

a. This is a service contract and the building is part of the requirement, the VA is not responsible for any construction related issues.

24. On page 96 paragraph 4.12 states, "The Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming services per FAR 52.212-4(a)."

What methods will the VA use to calculate an equitable price reduction or adequate consideration?

a. The equitable adjustment should be based on the difference between the reasonable cost of performing the contract without the addition, deletion, or substitution and the reasonable cost of performing with it. the contractor should not be left in a better or worse profit position on the unchanged work after the change than it was before the change.

What process exists for the contractor to· dispute the VA's calculation of an equitable price reduction or adequate consideration?

b. The contractor has the right to pursue a claim under the Disputes clause.

In what percentage of contracts does the VA exercise its rights under FAR 52.212-4(a)?

c. I do not have an answer for this question.

25. Will the contractor be required to set up a contract with a local x-ray provider near the proposed CBOC or will all x-rays be referred to the NTXVAMC.

a. The VA will provide all Radiology services.

26. In Paragraph 4.6.4.3 it states that the Contractor is responsible for sending specimens to the VA core Laboratory twice daily. Please confirm that the VA requires two (2) lab courier deliveries to the NTXVAMC core lab.

a. Once a day- the VA will provide courier.

27. Is the maximum cap of $9,000,000 the firm/fixed maximum the VA will accept for the total value of the proposals?

a. We can’t tell you what to propose, submit proposal and the evaluation team will decide if it is reasonable.

28. On page 6 in section B.2 Schedule of Services in the RFP it shows the estimated quantity in the base year as 1692. In addition, on page 14 paragraph 2.1 of the RFP states, "Total Estimated Patients enrolled/assigned to site: 1692." As the incumbent Contractor, it should be noted that the billable enrollment in the Decatur CBOC is actually 1602 which is approximately 5% lower than the stated enrollment. Will the VA adjust the estimated quantity to reflect the actual billable enrollment in order to ensure all bidders are pricing to the current enrollment?

a. All the numbers are estimated- either way it will not reach the full 2 PACT- there is no need for a change.

With an estimated enrollment of 1692 which is less than two full PACT teams will the VA allow for one of the PACT RNs to also serve as the Administrator?

b. No

29. On page 26 paragraph 2.12 of the RFP states, "Contractor staff shall complete VA mandatory training as requested and complete ACLS/BLS training and keep ACLS/BLS certifications current throughout the life of the contract." Will providers be expected to keep a current ACLS certification even if the CBOC does not have a crash cart? If the CBOC has AED equipment, will BLS certification be sufficient.

a. YES. BLS is enough.

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

a. There are no set days or times for the staff, they will be available as needed.

b. MH, Pharm, Dietician and social worker

31. Will the VA provided staff require an office at the Decatur CBOC? If yes, what type and size?

a. All facilities regardless of size should have at least four designated telehealth rooms (144sf.) 2 MH Staff offices (125sf.), 1 for other clinical staff (125sf.)

32. Will the new contractor inherit the patients’ last vesting visit and be allowed to bill for one year from that date upon contact award?

a. No, the billing will start the date of the contract award.

33. On page 33 paragraph 4.3.2 of the RFP states, "At no additional cost the Contractor shall provide approximately SO/month telehealth visits with the VAMC parent for Veterans who are not assigned for care at the Contractor's outpatient site of care." Is it the VA's intention for the Contractor to see approximately 50 telehealth visits per month for unassigned patients? If so, does the VA anticipate that these visits would be covered by the full time TCT?

a. Yes, but due to the size of the clinic the VA will like to modify the actual number to 20 telehealth visits.

34. On page 46 paragraph 4.6.4.1.1 of the RFP states, "The Contractor will provide all medications ., including any necessary vaccines that are to be administered to patients in the clinic." On page 49 paragraph 4.6.5.2.1 of the RFP states, "In accordance with TJC standards, the Contractor shall actively participate in routine inspections in collaboration with the local VA Pharmacy on a VA-specified regular basis. All medication storage sites will be inspected to ensure that medications are being stored properly (e.g., under appropriate refrigeration, and USP800 compliant if required; externals separated from internals; expiration dates checked, etc.) and VA Medication Inspection Form (VA Form 10-0053) will be completed, signed by the inspecting Pharmacy personnel and the Clinic Nurse Manager." Does the monthly inventory and site inspections apply to the Contractor when the VA is not providing the medications or vaccines?

a. The pharmacy will conduct inspection twice a year.

b. The monthly inventory does not apply to the contractor.

35. On page 168 paragraph 3) of the RFP states, "Describe procedures to be implemented for accountability and safeguarding of medications provided by the Parent Facility." If the Contractor is providing all medications and necessary vaccines administered in the clinic, what medications will the Parent Facility be providing the Contractor?

a. None

36. On page 48 paragraph 4.6.5.1.8 of the RFP states, "The Contractor shall provide counseling to patients, family or caregivers." And on page 50 paragraph 4.6.3.2.7 of the RFP states, "The Contractor shall meet all requirements for anticoagulation management. " However, on page 20 paragraph 2.4.2 and page 50 paragraph 4.6.5.3 it states the VA provides Clinical Pharmacy Services (CPS). If the VA is providing the CPS, wouldn't the CPS provide counseling to patients, family and/or caregivers? And if the VA is providing the CPS, how can the Contractor meet all requirements for anticoagulation management?

a. The VA CPS will provide the anti-coagulation therapy; the contractor will reinforce counseling to the patient and family.

37. If the cost of vaccines discussed in question 3 above are the responsibility of the contractor, please confirm that the following list of Vaccines are the responsibility of the contractor?

i. TDAP

ii. Pneumovax 23

iii. Prevnar 13

iv. TD

v. Flu, High dose flu

vi. Shingrix

vii. Twinrix (Hep A&B

viii. Hep A

ix. Hep B

x. HPV

xi. Depo

a. We do not list specific meds, or vaccines because then it becomes too exhaustive/restricted, the vendor must provide any med needed to be given in-clinic.

38. If the cost of vaccines is the responsibility of the contractor…. Are there any additional Vaccines required to be supplied by the contractor other than those listed in question 4 above?

a. yes

39. On page 52 paragraph 4.6.4.3 of the RFP states, "The contractor is responsible for entering lab orders; sending specimens to the VA Core Lab twice daily ; and paying any costs of all lab work , except for lab work sent to the VA or emergency lab work sent to another site which has been authorized by the VA Communications Center and paying any costs associated with transportation of specimens to the VA and for arranging such transportation in a proper secure method ." Currently the VA provides laboratory courier services for all the contracted and VA operated CBOCs. The Decatur CBOC used to provide courier services and then the VA took it over in April 2019. Will the VA consider continuing to provide the laboratory services under the new contract? With the volume of specimens to be delivered to the VA and the 1 ½ hour distance from Decatur/Bridgeport to the VA Medical Center, would the VA consider having specimens sent to the VA Core Lab once daily as it is currently being delivered?

a. Yes

40. On page 56 paragraph 4.6.5. I of the RFP states, "It is estimated that for every PACT Team or 1000 patients, Primary Care Mental Health will need a 0.5 FTEE (LIP) and a 0.17 FTEE (TIDES Nurse). Does the VA or the Contractor provide the Primary Care Mental Health LIP? Jf the Contractor provides the LIP, will the VA allow for one of the PACT staff to provide the LIP services or is the Contractor required to hire a separate person to cover this? In the current Decatur /Bridgeport CBOC, the nurses and the VA LCSW provide the TIDES Nurse services. Will the VA continue to provide the LCSW and the Contractor the nurse to support TIDES Nurse services? If so, can the nurse be a part of the PACT Team or is this a separate hired position required to provide the 0.17 FTEE TIDES Nurse?

a. This clinic does not have the volume needed for a separate TIDES Nurse. VA will provide the Social worker.

41. On page 57 paragraph 4.6.5.2.1.8 of the RFP states, "To ensure the availability of outreach and referral services to homeless Veterans, all Contractor sites must designate at least one outreach specialist, usually a clinical social worker, to provide services to homeless Veterans. In smaller sites serving less than 10,000, this may be a collateral assignment." Given that the VA is providing the staff for Mental Health Services including the Social Workers, will the VA be designating one of their Social Workers as the outreach specialist or is it acceptable to the VA if the Contractor utilize one of the PACT Team members, i.e. RN or LVN to provide this service as a collateral assignment?

a. VA will provide the services a Social worker is assigned

42. On page 58 paragraph 4.6.5.2.1.9 of the RFP states, " In smaller sites serving less than 10,000, the Suicide Prevention Coordinator (SPC) may be a collateral assignment." Is it acceptable to the VA if one of the PACT nurses serves as the Suicide Prevention Coordinator?

a. VA will provide a suicide prevention coordinator

43. On page 59 paragraph 4.6.5.2.2.4 of the RFP states, "A Comprehensive MH diagnostic and treatment planning evaluation must be completed within 30 days of the same day evaluation." If Mental Health services are provided by VA staff, how can the Contractor ensure comprehensive MH diagnostic and treatment planning evaluations are completed within 30 days?

a. The VA – not the contractor- is responsible for the 30-day window.

44. Does the VA require two courier trips per day, or will one trip be acceptable?

a. One will suffice.

45. Will the VA require a clinic manager?

a. Yes

46. On page 75 paragraph 4.7.9.5 of the RFP states, "Contractor shall ensure that Dietitians electronically complete an Event Capture System form for all direct patient care, whether individual visits, group visits or team meetings that discuss individual patients. " On page 21 paragraph 2.4.4 of the RFP it states the VA provides the Registered Dietitian/Nutritionist support. How can the Contractor ensure the VA's Dietitian electronically completes an Event Capture System form if the Contractor is not responsible for the Dietitian/Nutritionist?

a. The VA supplies the service, the contractor is not responsible for the Event capture

47. On page 89 paragraph 4.8 of the RFP states, "Contractor must meet Joint Commission and VHA standards regarding EOC and shall provide the following Safety and Health EOC documents , as required by Joint Commission, with the submission of their proposal/within 15 calendar days after contract award." Is the Contractor required to submit Safety and Health EOC documents with the submission of the proposal OR within 15 calendar days after contract award? Which would the VA prefer?

a. Within 15 days after award

48. What will the clinic be named?

a. Depends on the location

49. On page 80 paragraph under space requirements in the RFP states, "Doors for each PACT patient care room should be sliding and follow the design standards outlined in the PACT design guide. “In an effort to minimize costs, will the VA consider swinging doors in the PACT exam rooms?

a. No

50. On page 90 paragraph 4.9 of the RFP states, "all equipment attaching to a VA network will be owned by the VA and controlled by the VA." And in section 4.9.4.5 states the contractor is responsible for procurement, installation and maintenance of all printers. Who is responsible for the procuring the networked printers that are attached to the VA network for printing out of CPRS? Currently the VA owns and supplies the attached network printers, will that remain the same?

a. The VA will provide any equipment necessary that is attached to the VA network

51. In Attachment D.9 Past Performance Questionnaire paragraph l it says, "The Contractor identified below has requested that you complete a past performance questionnaire on their behalf. This questionnaire will be used by the Contracting Officer to assess the likelihood that the Contractor will perform successfully on an impending requirement for the VA North Texas Health Care System (VANTHCS). Your prompt completion and return of this questionnaire is greatly appreciated." In paragraph 3 of the Past Performance Questionnaire, it asks the Reference of Contractor being evaluated to provide the "Dollar Amount of contract identified in paragraph l above." However, there is no "dollar amount of contract identified" in paragraph 1. Is the VA looking for the Reference of Contractor to provide the contract dollar amount for the reference?

a. Questionnaire can be corrected by you to read “Dollar amount of contract identified in paragraph 2 above”. A corrected copy is attached.

52. On page 156 Section D - Contract Documents, Exhibits, or Attachments of the RFP, it references D.2, D.3, D.8, D.9 and D.12 as being attached documents . In addition, EZGovOpps provides the same attachments as listed above. Will the VA be providing the remaining attachments, i.e. D.1, D.4, D.5, D.6, D. 7, D.10 and D.11?

a. The remaining attachments are references for once the contract is awarded. There are multiple links throughout the PWS that provide the same information.

53. Thin-Prep PAP testing supplies are not available for purchase by contractor, will the VA supply?

a. Yes, the VA will supply.

54. Please confirm the facility must have fire sprinklers if it is a one-story building.

a. This is a VA wide requirement for all clinics, including contracted clinics, that care for patients.

End of Document