36C25721R0015 0001.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 NUMBERE

D 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 amendmen t, 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) 04-28-2021 36C257 Department of Veterans Affairs VHA Regional Procurement Office West El Paso Contracting Office 11495 Turner Road El Paso TX 79936

To all Offerors/Bidders

36C25721R0015 04-02-2021

X X X

05-07-2021 12:00 PM MST

X The purpose of this amendment is to post the questions received and answers for the Q&A period. No further questions will be accepted. Offer due date has also been extended till 05-07-2021 12:00 PM MST.

All other terms and conditions remain unchanged.

Frank Gamboa III Contracting Officer

VA-VHA-2020-58ED4EC5

CONTINUATION PAGE

RFP 36C25721R0015

Northeast San Antonio CBOC

QUESTIONS & ANSWERS

Q1. Section 2.1 Staffing and Qualifications 13 of 172 “Total Estimated Patients enrolled/assigned to site: 5400.”

Please provide the most recent 3-month billing figures/members/enrollees for primary care services.

· Answer: Billables for February 5,800, January 5,605, and December 5,523

Q2. Section 4.6.1.6.1 Prescription Fulfillment 39 of 172 Can the VA please provide the list of medications and vaccines the contractor will be responsible for providing? Additionally, can the VA also provide estimated utilization numbers/quantity for each medication/vaccine required (or historical information)?

· Answer: The contractor must provide ALL in-clinic medications. Whatever the clinic needs, they need to provide. We do not list specific meds, because then it becomes too exhaustive/restricted.

a. TDAP

b. Pneumovax 23

c. Prevnar 13

d. TD

e. Flu, high dose flu

f. Shingrix

g. Twinrix (Hep A&B)

h. Hep A

i. Hep B

j. HPV

k. Depo

Q3. Section 6.2.1 Billable Roster 104 of 172 Please confirm that the new contractor will inherit the patient’s last vesting visit and is eligible to bill for one year from that date upon contract award?

· Answer: No, required 90 days to vest patients. This can be accomplished utilizing the PACT Model (Telephone Visit, Nurse Visit, Face-to-Face).

Q4. Section 2.3 Discipline Specific Pact Team Members 19 or 172 Will the government confirm that the VA will provide the Primary Care Mental Health Integration (PC-MHI) ?

· Answer: Yes, confirmed

Q5. 4.9.1 80 of 172 PACT design guidelines state that a telehealth exam rooms to be 12’x12’ with an exam table, but this guidance on 4.9.1 only states that the 3 telehealth exam rooms should accommodate up to 2 guests, computer workstation and Clinical Video Telehealth equipment.

Will the government please clarify the size requirements?

· Answer: 12 X 12 Q6. 4.9.1 80 of 172 The solicitation states that 3 telehealth exam rooms are needed, will these rooms be used for the Clinical Pharmacy Specialist, Licensed Clinical Social Worker, Dietitian/Nutritionist, and Primary Care Mental Health Integration, as well as medical exams? Or will each Discipline require their own telehealth rooms?

· Answer: Require own telehealth room.

Q7. 4.9.1 80 of 172 Can the government confirm that the procedure room may also double as the Women’s Health Exam Room, or does it need to be separate?

· Answer: Yes

Q8. 4.9.1 80 of 172 Does each pact team require its own Women’s Health Exam Rooms?

· Answer: No

Q9. 4.9.1 80 of 172 Do all Women’s Health Exam rooms need to be a procedure room? PACT design guidelines state that a Women’s Health Exam room only needs to be an exam room with an en suite restroom

· Answer: No

Q10. 4.9.1 80 of 172 Does each PACT Team require a consultation room, along with the 3 exams rooms?

· Answer: No

Q11. 4.9.1 80 of 172 Is there a requirement for a separate group care room, or can the telehealth group care room be shared?

· Answer: Yes, separate group care room

Q12. SF 1449 Box 8 N/A The due date for this opportunity is listed as 12:00 MST on 5/02. Is it the government’s intent for proposals to be submitted on a Sunday?

· Answer: Date will be revised.

Q13. Do all the question and answers provided in the FAQ’s document as part of the solicitation apply to the current solicitation?

· Answer: Yes. They apply to this solicitation as well unless answers are revised on this or future amendments.

Q14. In paragraph 4.6.2.1.1.2 it states that “ The Contractor is to refer patients for mammograms to STVHCS radiological department via CPRS”. In paragraph 4.6.2.1.1 it also states that the Veteran may be referred to community care. If the VA is responsible for mammograms either at the STVHCS or via community care, will the Contractor need to ensure that the mammography facility is certified by the FDA as stated in paragraph 4.6.2.1.2. as well as all the reporting requirements stated in paragraphs 4.6.2.1.3?

· Answer: No

Q15. How many VA staffed personnel will be providing services at the NE San Antonio CBOC? Please list by job title and number of days per month.

· Answer: 3, Social Worker, Pharm. D., Mental Health (3 days a week)

Q16. How many offices will be needed at the NE San Antonio CBOC for the VA provided staff (by position/function) identified in question 15?

· Answer: 3, Social Worker, Pharm. D., Mental Health (3 days a week)

Q17. How many veterans using the NE San Antonio CBOC are currently on the Primary Care billable roster?

· Answer: 5,800

Q18. What factors did the government consider that resulted in the CLINs growing from 5,400 enrollees in the Base year to 7,044 in OP9?

· Answer: Based on estimated growth in the community.

Q19. Can the government provide a breakdown showing the number of enrollees by the enrollees home zip code?

· Answer: Data is not available.

Q20. Can the government provide a breakdown showing the number of enrollees by the zip codes that will be serviced by the NE San Antonio CBOC as listed in the solicitation (78220, 78239, 78244)?

· Answer: Data is not available.

Q21. The Solicitation Standard Form 1449 in box 8. Offer Due Date/Local Time is 05/02/2021 1200 MST. May 2nd is a Sunday. Will the VA change the proposal due date to Monday, 05/03/2021?

· Answer: Yes, due date will be revised.

Q22. On page 9 paragraph 1.1 and 1.2 indicate the Northeast San Antonio, Texas CBOC be in zip codes 78220, 78239 or 78244. One of the three zip codes is actually in the southeast quadrant of San Antonio. The current NE-410 CBOC is located in Northeast San Antonio in zip code 78217 which borders zip code 78239, and directly adjacent to the suggestion zip code boundary. Would the VA consider the NE San Antonio facility located in zip code 78217 based on the demographics of enrolled Veterans, growth in zip code 78217, road network, access to the NE Veterans served, and the immediate close proximity to the neighboring 78239 zip code currently in the RFP?

· Answer: Yes

Q23. On page 13 paragraph 2.1 Physician Director of the Solicitation states, “Contractor’s Physicians performing under this contract shall be board certified (or board eligible)….” On page 14 paragraph 2.2.1 Option 1: Physician (MD): Qualifications under the Primary Care Teamlet Staffing states, “Physicians performing under this contract shall be board certified…” Is it acceptable to the VA if the physicians are board certified or board eligible regardless of whether they are the Physician Director or a physician as part of the Primary Care Teamlet staffing?

· Answer: Yes

Q24. On page 37 paragraph 4.6.2.6 of the RFP states, “The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic.” Will the VA please confirm that the following vaccines are the responsibility of the Contractor?

a. TDAP

b. Pneumovax 23

c. Prevnar 13

d. TD

e. Flu, high dose flu

f. Shingrix

g. Twinrix (Hep A&B)

h. Hep A

i. Hep B

j. HPV

k. Depo

· Answer: Yes, vaccines are the responsibility of the Contractor.

Q25. In reference to D.0 Frequently Asked Questions, for further clarification on the use and application of the Davis Bacon Act, we ask and provide the following information. The use of the Davis- Bacon specification and clause is normally utilized in GSA/VA facilities based contracts, and not in service contracts that are paid by PMPM rate with the facility and all other services and components inclusive in the PMPM rate for each billable enrollee. In short, there is no construction contract vehicle, as part of the specification, in this personal services contract vehicle being solicited and procured by the government. Davis Bacon unintentionally, is being utilized out of context for this type of service contract procurement. CBOC procurements across the U.S. have not utilized the Davis Bacon requirement as it was determined that it was not related or relevant to this type of service contract procurement and raises construction costs by over 50% unnecessarily. Based on this information and cost affect for all bidders, would the government consider removing its Davis Bacon Act requirement from this CBOC solicitation as it appears to not be applicable and saves substantial costs in startup and to the VA?

· Answer: CBOCs are not considered personal service contracts and the Government will not consider removing its Davis-Bacon Act requirement from this CBOC solicitation. Below is the reason as to why.

Historically, community-based outpatient clinic (CBOC) procurements have been considered services contracts and logically included clauses for wages required under the Service Contract Act (SCA). This practice was questioned in a June 2020 GAO protest in which a potential vendor, alleged the CBOC solicitation should also include wages required under the Davis-Bacon Act (DBA). The Protester's argument was that, although it was primarily a services contract, the solicitation also included construction work that the VA would pay for indirectly; further, that the buildout of the proposed facility must be constructed pursuant to VA's very specialized requirements. As a result of the protest, OGC District Contract Law National Practice Group (DCNPG) contacted the Department of Labor (DOL) to request its opinion on inclusion of the DBA.

DOL policy and legal staff advised that the protested CBOC solicitation should have included the DBA. In addition to adding DBA language and clauses to solicitations still in the planning stages, DOL advised that any applicable CBOC procurement in which construction was ongoing should include the DBA Q26. How many VA staffed personnel will be providing services in the NE San Antonio CBOC and how many offices will be needed for VA provided staff?

· Answer: 3, Social Worker, Pharm. D., Mental Health

Q27. On page 86 paragraph 4.9.20 of the Solicitation states, “Closed Circuit Television (CCTV): Shall be provided by the Contractor to monitor building entrances, restricted areas, mission critical asset areas, and alarm conditions. CCTV system shall be used for surveillance and observations of defined exterior areas, such as site and roadway access points, parking lots, and building perimeter, and interior areas such as hallways, common areas and waiting areas, CCTV system will be viewed from a VA location determined by the VA Physical Security Officer. The design, installation, and use of CCTV cameras shall support the visual identification and surveillance of persons, vehicles, assets, incidents, and defined locations. The Contractor shall contact the VA Physical Security Officer at STXVHCS prior to installation of CCTV system to ensure proper placement.” The requirement for the VA to be able to monitor the CCTV activities remotely appears to be intended for a VA leased and operated facility as opposed to a contractor operated and leased facility. Our current contracted CBOC facilities across the U.S. utilize high resolution CCTV security cameras for both interior and exterior monitoring and routinely have recording capability of up to 30 days. This is the only specification that requests the government to monitor these cameras which require cellular based services and special equipment to accomplish. Was it the VA’s intent to utilize this level of monitoring by the government, as opposed to the contractor responsibility, to monitor the camera activities at the privately leased contracted facility? Was this requirement placed in the specification in error as it is not normally utilized? Will you please clarify?

· Answer: Yes, VA’s intent to utilize this level of monitoring by the government.

Q28. On page 98 paragraph 4.13.3.5 and Attachment D.1 QASP from the solicitation indicates the Standard and Acceptable Quality Level (AQL) for Non-Traditional Encounters is 49% and that the Contractor shall exceed the 49% ratio. Prior to the COVID-19 pandemic, the National (26.71%), VISN 17 (25.32%) and STVHCS (25.49%) scores were consistently much lower than 49%. Even during COVID-19 pandemic in FY 2020 when more patients were using non-traditional encounters, the year to date National (39.93%), VISN 17 (41.54%) and STVHCS (39.36%) scores were all lower than the 49% AQL for this measure. In addition, the SW San Antonio and SE San Antonio CBOC RFPs have their AQLs not to exceed 20% for non-traditional encounters. Will the VA consider lowering the AQL for this measure to be in line with the other two SW & SE San Antonio CBOCs with a not to exceed 20% for non-traditional encounters?

· Answer: Yes

Q29. On page 144 paragraph 2. Part 1 states, “Submit one e-mailed electronic copy and one redacted electronic copy for evaluation. Offerors must ensure that redacted copies are free of any and all logos, quotes, and any other information that can easily identify their business.” On page 151 Sub-factor (A) – Experience/Management Plan, the contractor is to identify all relevant company experience in providing the same/similar types of services identified in this solicitation, including VA experience, and other government and/or private sector experience. Provide a clinical and administrative contact point for each experience episode provided. Our company has extensive relevant CBOC experience and is the incumbent contractor of the 4 San Antonio CBOCs, New Braunfels CBOC, and Seguin CBOC contracts as well as other Texas CBOC contracts, if we provide our VA experience as requested above, the VA is going to be able to easily identify our company. How would the VA like us to present a redacted version of our experience and contact points?

· Answer: Logos, quotes, and any other information that can easily identify their business is in reference to headers and footers that typically include such information. Providing a clinical and administrative contact point for each experience episode will suffice.

Q30. In the Instructions to Offeror paragraph 7. Part 6 – Subcontracting Plan on page 145 of the Solicitation states, “Offerors to submit one electronic e-mailed copy of their subcontracting plan (large businesses only), Section D attachment D.25.” Is it acceptable with the VA, if we replace the template included as Attachment D.25 Small Business Subcontracting Plan Revised 01/26/2017 with the VA FSS Subcontracting template revised 10/20/2020? This is the template we are required to use to submit our Small Business Plan for approval by the U.S. Department of Veterans Affairs, VA Federal Supply Schedule Services, Office of Acquisition, Logistics and Construction, Hines, Illinois.

· Answer: Yes. The VA FSS Subcontracting template revised 10/20/2020 is acceptable.

Q31. In Section E.8 52.212-2 Evaluation-Commercial Items under Sub-factor (A) – Experience/Management Plan on page 151 it says, “identified all relevant company experience in providing the same/similar types of services identified in this solicitation, including VA experience, and other government and/or private sector experience. Provide a clinical and administrative contact point for each experience episode provided.” Is the VA looking for a list of all relevant contract experience and the point of contact? With the number of contracts we have along with the page limitations outlined in the RFP, it is physically impossible to include all this information. Would the VA consider removing the page limitation or reducing the amount of relevant company experience requested?

· Answer: Experience is within the past three years as indicated in that same paragraph.

Q32. Please verify the zip codes 78220, 78239 and 78244 are the correct zip codes to be included part of the NE San Antonio solicitation location preference. The zip code 78220 is also used in the SE San Antonio solicitation.

· Answer: the correct zip codes are 78239, 78244, 78217.

End of Document