36C25721R0019 0002.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 03-30-2021 36C257 Department of Veterans Affairs VHA Regional Procurement Office West El Paso Contracting Office 11495 Turner Road El Paso

TX

79936

SEE BLOCK 6

To all Offerors/Bidders

36C25721R0019 03-31-2021

X X ** HOUR & DATE for Receipt of Offers is EXTENDED to:

1 May 2021 at 1200 MST X The purpose of this amendment is to post the questions received and answers and to extend the proposal due date to 1 May 2021 at 1200 MST.

Any further questions are due to noel.ramirez2@va.gov NO LATER THAN 6 April 2021 at 1300 MST.

All other terms and conditions remain unchanged.

MARISELA GALARZA

Contracting Officer

VA-VHA-2020-534D2907

36C257-21-R0019 – Southeast San Antonio CBOC Questions and Answers – 30 March 2021 (Question Period Closed on 19 March 2021)

1. On page 15 paragraph 2.8 of the RFP states, "Depending on the skills needed for the encounter, the Telepresenter can be a licensed independent provider (LIP), Registered Nurse, LPN, or Telehealth Clinical Technician (TCT)." Is it acceptable to the VA to use Medical Assistants as TCTs as we do in other CBOCs across the United States?

A: Yes

2. 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?

A: Yes

3. How many Choice/Mission Act referrals occurred in the past 12 months for enrolled veterans of the SE San Antonio (Pecan Valley) CBOC?

A: We do not have that information.

4. In the Prescription Fulfillment paragraph 4.6.3.1 on page 38 of the solicitation 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: Vaccines are the cost of the contractor.

5. 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?

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

A: List is confirmed.

6. 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 5 above?

A: No

7. If the cost of vaccines is the responsibility of the contractor….what is the number of vaccines, by type as listed in question 5 and any additional vaccines added by the government pursuant to question 6, that was provided to the SE San Antonio (Pecan Valley) CBOC enrolled veterans in the last 12 months?

A: We do not have that information.

8. Pursuant to the Prescription Fulfillment paragraph 4.6.3.1 on page 38 of the solicitation, please provide a list of medications the government expects the contractor to dispense (at the cost of the Contractor) from the clinic that would not be a routine medication dispensed through the VA or an urgent/emergent medication dispensed through the VA contracted local pharmacy.

A: 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.

9. In the Laboratory Services paragraph 4.6.4.4 on page 45 it states that the contractor is to send specimens to the VA Core Laboratory “Twice daily” once at the mid-day break and again after close of business. Due to patient fasting requirements we are concerned about the duration of patient fasting for the afternoon specimen collections. Please confirm the VA wants specimens to be delivered twice a day or does the VA only require 1 delivery each day after the mid-day break.

A: Correct the requirement is Twice daily.

10. Does the current CBOC facility meet the new contract PACT Space Module Design Guide requirements as stated in the Space Requirements paragraph 4.9 on page 78 of the solicitation?

A: No

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

A: N/A

12. How many VA staffed personnel will be providing services at the SE San Antonio (Pecan Valley) CBOC? Please list by job title and number of days per month.

A: 3 (Social Worker, Mental Health and Nutritionist). 5 days a week.

13. How many offices will be needed at the SE San Antonio (Pecan Valley) CBOC for the VA provided staff (by position/function) identified in question 12?

A: 3.

14. How many veterans using the SE San Antonio (Pecan Valley) CBOC are currently on the Primary Care billable roster?

A: 2,242

15. In reference to: E.9 52.212-2 EVALUATION; Factor 1 – Technical; Sub-factor (A) – Experience/Management Plan; 5) Proposed Staffing; Paragraph i and Paragraph ii.i. Provide a list of the names of the qualified physicians, physician assistants, nurse practitioners, and other primary care provider staff intended to be utilized in the performance of this contract and/or describe the mechanism used to provide qualified physicians, physician assistants, nurse practitioners, and primary care provider staff to perform the contract work.

Question: Are these two consecutive points asking for exactly the same information? If so, in the interest of limiting space, which can we remove? If they are not identical requests, can Government clarify what different information is requested?

A: See this sentence in the paragraph: “…and/or describe the mechanism used to provide qualified physicians, physician assistants, nurse practitioners, and primary care provider staff to perform the contract work.”

16. In reference to: E.9 52.212-2 EVALUATION; Factor 1 – Technical; Sub-factor (A) – Experience/Management Plan; 5) Proposed Staffing; ii) Providers; ii. “Provide copies of the following information on any physician to be assigned to this solicitation. Include physicians providing coverage relief.” AND iii. “Curriculum Vitae “AND iii) Nurse Practitioners; i. “Transcripts from an Accredited Nurse Practitioner Program”.

Question 1: With a maximum of thirty (30) pages allowed, can these be presented post award? Or can they be submitted in an Appendix outside of the 30-page limit?

Question 2: As the time period for getting official transcripts is lengthy, can the NP transcripts be submitted post-award?

A: Yes, to questions 1 and 2 – CVs/transcripts may be submitted after award, however, the proposed staffing plan/coverage relief plan must be submitted with proposals, which are limited to 30 pages.

17. In reference to: E.9 52.212-2 EVALUATION; Factor 1 – Technical; Sub-factor (A) – Experience/Management Plan; 5) Proposed Staffing; iii) Nurse Practitioners; ii. “ii. List the number of administrative support staff and describe the level of training and experience that will be utilized to meet the administrative support functions of this contract, including, such functions as patient scheduling, medical record documentation, record processing and reporting, grievance system and quality assurance and performance improvement.” AND E.9 52.212-2 EVALUATION; Factor 1 – Technical; Sub-factor (A) – Experience/Management Plan; 9) “List the number of administrative support staff and describe the level of training and experience that will be utilized to meet the administrative support functions of this contract, including such functions as patient scheduling, medical record documentation, record processing and reporting.”

Question 1: As these two items are identical in wording for the information regarding administrative support staff AND with a maximum of 30 pages is allowed can one of these items be removed.

A: Yes, there is only on E.9 found on the RFP.

Question 2: As performance measurement process and quality control will be covered in Sub-factor (B) – Quality Control, items 2) “Describe the performance measurement process that will be implemented to monitor quality, appropriateness of care, access, and patient satisfaction.” and 3) “Provide information on proposed quality improvement plan.” Can we eliminate the need for this duplicate information from one of these two locations?

A: No. One describes the process to monitor quality, appropriateness of care, access, and patient satisfaction. The other is the proposed quality improvement plan. They are separate items.

18. In reference to: E.9 52.212-2 EVALUATION; Factor 2 – Geographic Location/Suitability and Accessibility of Facility; 1.” Proposed contractor’s facility must be located within Southeast San Antonio, Texas, Bexar County, Zip Codes 78220/78222/78223. The parent facility is the South Texas Veterans Health Care System (STVHCS). A site visit may be conducted as part of the evaluation process.”

Question: What is required from the Offeror on this line item that will not be covered in Factor 2 – Geographic Location/Suitability and Accessibility of Facility; 2. “Describe location of proposed facility to be utilized under this contract. Include mailing address, street address, city, village, town and county as applicable.”?

A: All requirements are listed in paragraphs 1 – 6 in Factor 2, to include the approved location.

19. In Section B.2 Price/Cost Schedule on pages 97-99, Base year Line Item Number 0001 of the RFP states the base year estimated enrollment is 2,452. As the incumbent contractor, the latest billed enrollment quantity for the SE San Antonio (Pecan Valley) CBOC was 2,079 which is 373 enrollees (approximately 15%) lower than the estimated enrollment stated. Secondly, on page 61 paragraph 4.7.2.4 of the RFP states, “The Contractor shall be responsible for ensuring all Veterans assigned to Contractor’s site of care in PCMM have at least one qualifying encounter with Contractor’s PCP at least every 12 months.” The current qualifying encounter cycle of the contract in place is for 16 months. Moving from 16 months qualifying encounter to 12 months will have a significant impact on the enrollment, cost, and pricing; approximately 72 enrollees will not be eligible for billing by the contractor on day one. Taking these two factors, higher estimated quantity in RFP than current eligible enrollment and moving the qualifying encounter from every 16 months in current to 12 months as stated in RFP, would result in the PMPM quantity to be about 445 (18%) lower than the estimate of 2,452.

Could the VA please explain the rationale behind the RFP stated estimated starting Quantity of 2,452 for PMPM costs which is 22% higher than a more realistic starting quantity of around 2,007 allowing a contract to more accurately capture PMPM costs?

A: Taking into consideration current billable roster and projected increases.

20. On page 14 paragraph 2.4 of the RFP states, “The following discipline specific staffing shall be provided by VA” which includes CPS Anti-Coagulation. On page 39 paragraph 4.6.4.5 of the RFP states, “Anticoagulation services will be provided by Contractor”.

If the VA is providing the CPS Anti-Coagulation, wouldn’t the VA provide anticoagulation services?

A: Yes, VA is providing the CPS Anti-Coagulation and anti-coagulation services.

21. On page 15 paragraph 2.8 of the RFP states, “The following telehealth staffing shall be provided by the Contractor. Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up.” On page 14-15 paragraphs 2.4.1-2.4.5, it states that CPS, LCSW, Registered Dietitian/Nutritionist and PCMHI is Contractor supported/VA provided telehealth delivery. On page 57 paragraph 4.6.7.1 it states, “It is anticipated the VA will utilize Telehealth Primary Care at this site for up to 40 hours per week during Monday thru Friday from 8:00 a.m. to 4:30 p.m.”

What support is required for the Discipline Specific PACT Team Members? Is the one TCT described on page 15 paragraph 2.8 and page 57 paragraph 4.6.7.1 sufficient to cover all the above telehealth and support requirements? Is the VA requiring a separate TCT for Mental Health Support? Will the VA clarify the Contractors on-site labor obligation for total TCT services?

A: One TCT will be sufficient to cover all telehealth. Included, but are not limited to the following: Assist the primary care or specialty care provider with the Veteran physical exam as needed, provide Veteran education, documentation and assistance with workload capture for the completion of the visit, per scope of practice and manage required screenings and complete clinical reminders, documentation, scheduling and opening and closing the encounter.

22. Given the current pandemic we are in and underdetermined future of face to face visits, will the Contractor be able to utilize VVC visits in addition to Face to Face and phone calls as it is stated in the Southwest San Antonio RFP?

A: Yes.

23. On page 25 under Enhance Care Management & Coordination of Care it states, “Improve Critical Transitions Process: Inpatient to Outpatient: develop systems to identify admitted primary care patients; provide follow up care either by face to face visit or telephone visit within 2 days’ post discharge and document the follow up care in the VA HER and communicate among the team.”

Given the pandemic we are in; will the Contractor be able to use VVC in addition to Face to Face and phone calls for follow up services for Inpatient to Outpatient care?

A: Yes.

24. On page 32 paragraph 4.6.3.1 of the RFP states, “The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic.”

Will the VA provide a list of all the medications and vaccines required to be administered in the clinic and the historical usage for pricing? Will the Contractor be required to provide the COVID-19 vaccine?

A: 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. Contactor will be required to provide the COVID-19 vaccine.

25. On page 32 paragraph 4.6.3.1 states, “Urgent/Emergent medications needed will be filled via a contracted local pharmacy for up to 10 days.”

Are the urgent/emergent medications provided by the contracted local pharmacy provided at the VA’s expense?

A: Yes.

26. On page 56 paragraph 4.6.7 Tele Health Support and Services in the RFP states, “The VA will maintain the VA-provided telehealth equipment.”

Does the VA provide all equipment in the telehealth rooms including exam tables?

A: VA provides the telehealth equipment not exam tables.

27. On page 69 paragraph 4.9 Space Requirements in the RFP states, “For any buildout/construction that might be required to prepare space for performance of this contract, Davis-Bacon Wages (https://www.dol.gov/agencies/whd/government-contracts/construction) must be paid to any personnel working on the buildout/construction of the space and certified payrolls for all buildout/construction workers are due to the COR and Contracting Officer no later than 10 business days prior to the clinic opening.”

Because any construction work will be merely incidental to the furnishing of services under the contract, will the VA consider removing this requirement in order to reduce the cost of preparing space for the provision of the contracted primary and specialty care services?

A: No. Davis-Bacon Act requirements cannot be removed.

28. On page 90 paragraph 6.1.2 of the RFP states, “The Contractor shall have 90 days from contract award to commencement of the provisions of medical care to local Veterans. However, the Contractor must have all start-up requirements in place and ready to commence operations NLT 83 calendar days from contract award.”

With the size of the project logistics and completion turnkey, the realistic accelerated cycle from award to completion dictates 30 days for technical drawings for permit, 30 days for permit, and 90 days for construction minimum to complete without around the clock shift work and accelerated construction costs to complete. Based on an unknown award date, would the VA consider a 180-day start-up schedule from award to provide a cost savings and assure performance by all bidders?

A: To be looked at on a case by case basis.

29. In Section E.1 52.212-1 Instructions to Offerors-Commercial Items starting on page 130 of the Solicitation, there are no instructions for proposal submission, i.e. format, the evaluation factors, how proposal should be submitted (electronic or hard copy), etc.

Will the VA provide this information?

A: When the original solicitation was posted, beta.Sam.gov caused formatting issues. This was immediately identified, and Amendment 0001 was posted on 5 March 2021. This amendment corrected any formatting issues and the information requested in question 29 above is identified in ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS.

30. The RFP lists the paragraph below under the Provider heading. Does the VA require a copy of state licenses for just all providers or do they require a copy of state license for all staffing including, RNs, LPNs, etc?

“Provide a list of the names of the qualified physicians and other primary care provider staff intended to be utilized in the performance of this contract and/or describe the mechanism used to provide qualified physicians and primary care provider staff to perform the contract work. Also submit a copy of licenses for all staffing.”

A: For all staffing.

31. The RFP lists the required documentation for Nurse Practitioners. Can the following documentation requirements be submitted at the time of hire? Or will the VA accept a current CV in place of transcripts?

Nurse Practitioners:

Transcripts from an Accredited Nurse Practitioner Program

Requiring these documents be submitted with the proposal is unrealistic and provides a significant advantage to the incumbent. To collect these required documents would demand that we permanently hire all the required staff in less than 30 days. Asking candidates to provide such documentation before there is an available position is not a common practice in recruiting/staffing.

In the event, the VA requires the transcripts and graduate certificates for the required positions, would the VA accept a “DegreeVerify Certificate” from the National Student Clearinghouse? The National Student Clearinghouse is an agency the VA uses to confirm education.

A: VA will accept a current CV in place of transcripts.

32. How many veterans are currently on the billable roster?

A: 2,242.

33. What is the historical enrollment for the past five years?

A: Increases by approximately 300 per year.

34. Does historical enrollment support projected growth of 625 veterans over contract period?

A: Yes.

35. Will the new Contractor inherit the patients’ last vesting visit and be allowed to bill for one year from the date upon contract award?

A: Yes.

36. Since its implementation, how many Mission Act referrals have occurred for enrolled veterans at the CBOC?

A: We do not have that information.

37. Can you please specify how many of the referrals were for primary care patients?

A: We do not have that information.

38. Can you please specify the types of specialty services by number of patients?

A: We do not have that information.

39. Will the VA require a clinic manager?

A: Yes

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

A: 3 (Social Worker, Mental Health and Nutritionist). 5 days a week.

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

A: Yes.

42. What additional COVID-19 related services will be required?

A: Submit consults for testing, relay results, and provide follow-up care.

43. The RFP requires courier services two times daily. Is this needed? Will the VA consider once daily service?

A: Twice daily.

44. Will all MH/PCMHI requirements will be staffed by VA, either in-person or by Telehealth?

A: Staffed by VA (in person and telehealth).

45. 2.8 states Telehealth TCT 1/5000 patients, will the VA require TCT 1.0 FTE?

A: No.

46: 3.1 Sates hours of operation 0800-1630, please confirm Monday-Friday.

A: Monday through Friday, 8:00 a.m. to 4:30 p.m.

47. 6.1.2 requires 120-day buildout, but references start-up requirements must be NLT 83 days, please clarify that should read 113 days.

A: To be looked at on a case by case basis. This is dependent on the award date and required start date which are unknown at this time due to extensions of the RFP.

48. Since data lines are currently taking 180 days for installation will the VA consider extending the buildout time?

A: To be look at on a case by case basis. This is dependent on the award date and required start date which are unknown at this time due to extensions of the RFP.

49. Please confirm if the contractor is responsible for the procurement, installation and maintenance of all printers, copiers, scanners, fax machines, shredders, or other peripheral office equipment. Will the VA network this equipment? If not, please provide a list of equipment that the VA will provide.

A: VA will provide laptops, printers, copiers, and network lines.

50. Will the VA will provide Women’s Health Pap test kits (Thin Prep)?

A: Yes.

51. Please include a revised copy of the QASP. The copy attached to beta.sam has been digitally signed by the COR and cannot be updated with the contractor’s signature.

A: Please print, sign, scan and return the contractor signed copy with proposals.

52. Will the government further define the boundaries of where they would like the CBOC located?

A: No.

53. Does the government require sliding doors on the primary care patient exam rooms? If so, are they required on both sides of the room?

A: Yes.

54. Does the current clinic design meet the requirements of the RFP?

A: No.

55. Can you please confirm anticoagulation services will be provided off site by VA?

A: Yes, confirmed.

56. Can you please confirm all XRAY services will be performed off site by VA?

A: Yes, confirmed.

END OF QUESTIONS/END OF DOCUMENT

End of Document