36C25721R0022 0003.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

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 CODECODE

E. IMPORTANT:

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).

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)

1 9

0003 MSO-2021-COM-0034

36C257

Department of Veterans Affairs North Texas Veterans Health Care Center Network Contracting Office 17 (NCO17) 124 E. Hwy 67, Suite 100 Duncanville TX 75137

36C257

NCO 17

Department of Veterans Affairs North Texas Veterans Health Care Center 124 E. Hwy 67, Suite 100 Duncanville TX 75137

To all Offerors/Bidders 36C25721R0022

07-09-2021 X

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, 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:

(a) By completing Items 8 and 15, and returning 1__________ 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 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. ** HOUR & DATE for Receipt of Offers: SEPTEMBER 30, 2021, 4PM CST

The purpose of this amendment is to post the Questions and Answers. As a result of this amendment:

1. Follow up questions are due no later than September 10, 2021, 4PM, CST. No additional questions will be accepted or considered thereafter.

2. Amendment table on page 4 is updated to reflect Amendment No. 0003 issued September 8, 2021.

3. The answers to offerors' questions begin on page 2 of this amendment.

All other terms and conditions remain unchanged.

CARLOS LEON

CONTRACTING OFFICER

3. EFFECTIVE DATE

09/08/2021

X

Continuation Page

Questions and Answers Killeen, TX CBOC SOL 36C25721R0021

1. Can the government clarify when VA related training will be conducted? Will it be with 89 days based on section 6.1.3 or will it be held on day 113 since contractors are given 120 to start up the contract. The startup time for this requirement is not clear.

a. The government requires the CBOC to be operational within 90 days of contract award.

Training will commence by day 83.

2. Does the contractor bear the cost of lab courier services or is a contract in place for lab courier services?

a. The Contractor shall bear the cost of lab courier services.

3. Can the government clarify if the contractor is required to provide telehealth clinical technician?

a. In accordance with the solicitation, paragraph 2.8 telehealth services clinical staff shall be provided by the VA through referral.

4. Will the government provide the automated call distribution system (Section 4.5.8)?

a. Yes.

5. Does the government require any office space for expanded PACT members? For example, Social Worker, Dietitian, CPS, Mental Health, ETC? If so, how many office spaces?

a. Yes.

b. Two (2) private offices; one (1) telehealth; and one (1) swing office.

6. How many VA employees will work at the clinic per day?

a. Two (2) mental health providers and two (2) telehealth technicians.

7. How many exam rooms per PACT are required? Based on our experience, the government prefers 2-3 exam rooms per PACT. The SOL does not clearly state the minimal exam room requirements per PACT.

a. Three (3) exam rooms per provider.

8. Can the women’s and procedure rooms count towards the total exam room requirement? For example, if the government requires 5 exams rooms and request 1 women’s exam rooms, the vendors can propose 4 exam rooms and 1 women’s exam room for a total of 5 exam rooms.

a. Yes, two (2) rooms with ensuite bathroom can count toward requirement.

b. All rooms should be fully equipped exams rooms to include stirrups on the exam table.

Procedure rooms can count toward the requirement. However, women’s exam rooms must be a dedicated space per PACT.

9. Can the government clarify the five (5) break room requirement? What are break rooms going to be used for?

a. There is a requirement for one break room for staff.

10. Can the government clarify the bathroom requirement? How many guest/ patient bathrooms are required for men and women, and how many are required for VA and contract staff?

a. The Government requires one (1) Men’s and one (1) Women’s multi-stall public restroom. The Government also requires one (1) Male and one (1) Female single stall restroom in the administrative area.

b. Additionally, the Government requires one (1) male and one (1) female private restroom in each exam areas. In addition, we require 1 public unisex restroom in the public area.

11. The SOL requires 2130sf for “open area, reception, waiting room?” The can the government clarify this requirement? How much space is required for the waiting room, PACT zone, and other areas of the clinic? Are there other areas in the clinic that this space should be used for?

a. Offerors must use one of the PACT Space Module Design Guide that we use in the PWS.

b. All open shared waiting space.

12. Is a call center/area required for the clinic?

a. No.

13. What is the current vested roster as of July 2021?

a. This is a new CBOC requirement; there is no incumbent or current contract.

14. Can the government provide the current utilization rates for the clinic?

15. How many women veterans are assigned to the clinic?

a. This is a new CBOC requirement; there is no incumbent or current contract. However, the current estimate is 115.

b. This number is an estimate and is subject to change.

16. Is the PACT model designed required for this opportunity to include on-stage off-stage design?

a. Yes, the PACT model design is required for work zone layout zone and patient entry.

17. Will the government allow the “Property Improvements” of the proposed space to be calculated in CLIN 001? Said differently, can vendors price CLIN 001 with the total cost of the property/ clinical site improvement?

a. Yes.

18. Can the government extend the proposal due date by four weeks to allow vendors adequate time to respond to the solicitation requirements and allow time for answers to questions?

a. The solicitation has been extended to allow time for response to the solicitation questions and answers and proposal submission.

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

20. Who is the current incumbent contractor for this requirement?

21. If there is an incumbent contractor, what is the contract number?

22. Is the contractor responsible for COVID 19 screening services?

23. Due to COVID 19 can submission be by email only?

24. Can the government clarify the naming convention for this CBOC opportunity?

a. Killeen VA Clinic

25. Document D.23, the Past Performance Questionnaire states in the Background that “The

VANTHCS requires Teleradiology Services.” This could be misleading to potential past performance reviewers. Will the VANTHCS modify the Questionnaire to remove the reference to Teleradiology?

a. The CO has included the correct survey via this amendment to the solicitation.

26. Page 5 – B2 The CLINs reflect a Base Year enrollment of 6000 and a growth to 7200 by Year 3. It appears both the Killeen and Copperas Cove CBOCs are new requirements. As such,

a. Will the VA provide a “guaranteed” level of enrollment for the Killeen and/or Copperas Cove CBOC?

i. No.

b. Will the Copperas Cove CBOC level of enrollment negatively impact the enrollment for the Killeen CBOC?

i. No. Each clinic will have its own patient load.

c. Is it the VA’s intent to have two CBOC’s (Killeen and Copperas Cove) within 15 minutes of each other with the same high enrollment?

i. No.

ii. One (1) clinic will be located in Killeen, TX

iii. One (1) clinic will be located in Copperas Cove.

27. Page 19 – 2.6.2 indicates the VA will be responsible for providing a Phlebotomist. Is this correct?

a. No. The contractor shall provide the Phlebotomist.

28. Page 20 – 2.8 indicates the VA will be responsible for providing Telehealth Clinical technician (TCT). Is this correct?

a. Yes. Telehealth Tech is to be provided by the VA; however, space is to be provided by the contractor.

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

a. Two (2) mental health providers and two (2) telehealth technicians for 40 hours per week, resulting in a total of three (3) rooms.

b. Also, one (1) mental health group room.

30. Page 36 – 4.5.3 (a) states the “the Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the Clinic.” Please provide a listing and utilization rate of those medications and vaccines.

a. Vaccines are to be provided at the cost of the contractor. Since there is no current contract, estimates are based on utilization at a CBOC of similar size.

Acetaminophen 325mg tab=218 Albuterol 0.083% inhalant=146 Aspirin Chewable 81mg tab=91 Aspirin 325mg tab=91 Carbamide Peroxide Solution 6.5%=46 Ceftriaxone Inj 1 gram vial=100 Clonidine 0.1mg tab=128 Dextrose 24 gram/31 gram squeeze tube=36 Diphenhydramine inj 50mg/1mL vial=109 Diphenhydramine 50mg tab=36 Epinephrine Autoinjector 0.3mg/0.3mL pen=36 Glucagon Kit 1mg vial=18 Hydrocortisone Cream 1% 0.9 gram packet=364 Insulin Human Regular 100 Units/mL10mL vial=36 Insulin Aspart (Novolog) 100 Units/mL 10mL vial=55 Ketorolac 60mg 2mL vial=64 Lidocaine Pf Inj 1% 2mL vial=128 Methylprednisolone Acetate 40mg 1mL inj=73 Neomycin/Polymixin/Bacitracin Ointment 0.9 gram packet=183 Nitroglycerin 0.4mg SL tablets=46 Silver Nitrate Applicators=1800 Silver Sulfadiazine Cream 1% cream=36 Triamcinolone Acetonide 40mg 1mL inj=73

31. Page 40 – 4.5.3 (c) requires that Contractor provide support staff and ancillary support to

Clinical Pharmacy Telehealth services. Will the VA require separate, dedicated staff for these functions?

a. Telehealth pharmacy services will be provided by VA pharmacy staff. However, on site staff provided by the contractor will handle administrative functions of any on-site telehealth visits (i.e. complete vitals, check-in patients, ensure equipment is on and functioning, escort patients to/from room, check-out patient, etc.).

32. Page 41 – 4.5.4 (b) states the VA will supply a MUSE compatible EKG at Contractor cost. Please provide the cost to the Contractor for this device.

a. VA will supply a MUSE compatible EKG at cost to the VA as government furnished equipment (GFE).

33. Page 41 – 4.5.4 (c) requires the contractor will deliver laboratory specimens via courier to the VA twice daily. Will the VA consider once daily service?

34. Page 86 – 4.8.21 Will the VA provide a preference for either Dome and Bullet Cameras versus Fisheye or 360 cameras.

a. Fisheye/360 cameras are preferred and provides more coverage.

35. Page 87 – 4.10.1 e The contractor is unable to network contractor owned equipment to VA network if it is not owned and operated by VA. Will the Government please provide a list of the equipment the VA will supply the contractor, such as copiers, fax, printers, scanners, or other peripheral office equipment or lab label printers.

a. OIT provides printers, scanners, and label printers.

b. Copiers, faxes and peripherals office equipment will have to be provided by the Facility or Logistics.

36. Page 88 – 4.10.1 (i) Will the Government please confirm that VA will supply small desktop color printer for patient education documents since contractor owned equipment is not permitted on VA network?

37. Page 89 – 4.10.2 e Could the government please confirm the Power Requirements and if two 20-amp dedicated receptacles are acceptable?

a. The Government confirms 4.10.2 e of the solicitation lists the correct power requirements.

38. Page 89 – 4.10.2 (f) Would the government please confirm if shelves are required?

39. Page 173 – E-9 Evaluation – Factor 1 – Sub-factor (a) (4) (c) require submission of providers CV’s and NP Transcripts. Will these pages be counted against the page limit?

40. Page 174 – Factor 1 – Sub-factor (b) 1) requires results of latest Joint Commission accreditation.

Will these pages be excluded from the page count?

41. Please explain how many vested patients the contractor will begin with on opening day of the clinic. It is our understanding that this is a new CBOC, and we assume that given the wait time for appointing at the VAMC, the VA will roll full panels of patients to the contractor on opening day of the clinic.

a. Please confirm this is in fact the case, and if so, how many patients will be rolled over on opening day as well as the future rollovers thereafter.

i. Approximately 6000 will be enrolled within 1st year.

b. If the VA does not intend to roll over patients from the VAMC, please confirm the VA is aware the overall cost of the first year of services will be greatly increased as the contractor assumes much more risk for ramping up. For example, under this scenario the Government would bear the cost of the contractor starting with multiple PACT teams that will not be fully paneled upon start-up.

i. The Government does not agree to this.

42. Will the Phlebotomist/Laboratory Technician be provided by the VA or the Contractor?

a. The Phlebotomist will be provided by the contractor.

43. Will the VA be adding Juneteenth to the list of Federal Holidays in paragraph 3.4.

44. In paragraph 4.5.3.(a) 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 to be provided at the cost of the contractor.

45. If the cost of vaccines discussed in question 4 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

l. Meningococcal

46. If the cost of vaccines is the responsibility of the contractor…. Please list any additional Vaccines required to be supplied by the contractor other than those listed in question 5 above.

a. Added Meningococcal (Menveo). Any other vaccine determined as needed by a provider or new to the market would also be provided by the Contractor.

47. 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 the contractor should expect to provide to Veterans enrolled in the Killeen CBOC in a 12-month period?

a. Estimates of usage are based on similarly sized CBOCs.

b. See Question #30.

48. Pursuant to paragraph 4.5.3.(a) 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. Contractor would provide any medications, supplies, or treatments needed for in clinic use. Medication examples include but are not exclusive to the following items:

Acetaminophen 325mg tab Albuterol 0.083% inhalant Aspirin Chewable 81mg tab

Aspirin 325mg tab Carbamide Peroxide Solution 6.5% Ceftriaxone Inj 1 gram vial Clonidine 0.1mg tab Dextrose 24 gram/31 gram squeeze tube Diphenhydramine inj 50mg/1mL vial Diphenhydramine 50mg tab Epinephrine Autoinjector 0.3mg/0.3mL pen Glucagon Kit 1mg vial Hydrocortisone Cream 1% 0.9 gram packet Insulin Human Regular 100 Units/mL10mL vial Insulin Aspart (Novolog) 100 Units/mL 10mL vial Ketorolac 60mg 2mL vial Lidocaine Pf Inj 1% 2mL vial Neomycin/Polymixin/Bacitracin Ointment 0.9 gram packet Nitroglycerin 0.4mg SL tablets Silver Nitrate Applicators Silver Sulfadiazine Cream 1% cream Triamcinolone Acetonide 40mg 1mL inj

49. Pursuant to paragraph 4.5.3.(a), will the set-up, management, and cost of the contract with the local pharmacy for urgent/emergent medication be the responsibility of the VA or the Contractor?

a. Cost for urgent/emergent medications from the local contract pharmacy will be the responsibility of VA.

50. Will the Contractors proposed space be required to meet the on-stage/off-stage design with the

PACT Zone?

51. Can the government provide a breakdown showing the number of enrollees by the enrollee’s home zip code?

Copperas Cove 76522 6147 Killeen 76540 87 Killeen 76541 1689 Killeen 76542 8223 Killeen 76543 3832 Ft. Hood 76544 744 Killeen 76547 110 Harker Heights 76548 4744 Killeen 76549 8051

52. What is the address of the VA Core Laboratory used to support the Killeen CBOC?

a. 1901 Veterans Memorial BLVD., BLDG. 163, Temple, TX 76504

53. Please list all positions the VA will staff on site at the CBOC by title and number of hours per week/month those employees will be on site.

a. Mental Health and telehealth tech

b. 40 hours per week

54. How many dedicated offices will the VA need in the Killeen CBOC for VA staff?

a. Four (4) office spaces are required for VA staff.

55. On the Solicitation main page, item #8, it states that proposal is due at 4pm EST. Please confirm Eastern Standard Time or Central Standard Time.

a. CST

56. On E.9 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014); Factor 1, Sub-factor A; item 4C, please clarify that you wish only Curriculum vitae and transcripts of Nurse Practitioners?

a. Yes

And follow-up to this, can these be provided post-award?

a. Yes

57. In E.9 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014); Factor 1, Sub-factor A, please clarify the difference of what you are looking for between items # 4(a) and 8 regarding recruitment methods.

a. 4a is the mechanism used to provide qualified staffing

b. 8 is the turnover and providing adequate staffing to support the contract

58. In E.9 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014); Factor 1, Sub-factor A, please confirm that items 4 (c) and 11 are identical and clarify where you would prefer the information to be inserted.

a. Number 11 will be removed.

59. In section 4.8 Space Requirements, can the Women’s Health Exam Rooms double for standard exam rooms (reducing standard exam room count by two)?

60. In section 4.8 Space Requirements, please confirm PCMHI rooms must be 180-240 square feet instead of the standard 120 square feet.

a. The standard health exam room is 125 square feet.