36C25721R0043 0002.pdf

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)

1 11

0002 05-12-2021

N/A

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

36C25721R0043

04-02-2021

X

X 1

** HOUR & DATE for Receipt of Offers is EXTENDED to: 05-31-2021 12:00 PM MST

X 1

The purpose of this amendment is to post answers for the Q&A period and revise the schedule of services.

All other terms and conditions remain unchanged.

Frank Gamboa III Contracting Officer

VA-VHA-2020-58ED4EC5

CONTINUATION PAGE

RFP 36C25721R0043

New Braunfels, TX and Seguin, TX CBOC Services

QUESTIONS & ANSWERS

New Braunfels and Seguin CBOC Questions

Q1. Section 2.3 Discipline Specific Pact Team Members 20 or 172 Will the government confirm that the VA will provide the Primary Care Mental Health Integration (PC-MHI) at the New Braunfels facility?

- Answer: Yes

Q2. Section 2.3 Discipline Specific Pact Team Members 20 or 172 Will the government confirm that the VA will provide the Primary Care Mental Health Integration (PC-MHI) at the Seguin facility?

Q3. 4.9.1 79 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 consult 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

Q4. 4.9.1 79 of 172 Are the telehealth requirements consistent between New Braunfels and Seguin locations?

Q5. 4.9.1 79 of 172 The solicitation states that 3 telehealth consult rooms are needed, should these spaces be designated to specific VA staff, as well as medical exams? If so, who will be using them, or will each Discipline require their own telehealth rooms?

- Answer: Each discipline requires their own telehealth room.

Q6. 4.9.1 79 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: Procedure room double as the Women’s Exam Room.

Q7. 4.9.1 79 of 172 Does each pact team require its own Women’s Health Exam Rooms?

Q8. 4.9.1 79 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 Q9. 4.9.1 79 of 172 Does each PACT Team require a consultation room, along with the 3 exams rooms?

- Answer: No

Q10. 4.9.1 79 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.

Q11. 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.

Q12. 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.

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

- Answer: 8, Social Worker, Pharm. D., Mental Health (5 days a week) and Prosthetic Technician, 5 days a week; 2 Radiology Technicians , 5 days a week, 2 Physical Therapist, 5 days a week.

Q14. How many offices will be needed at the New Braunfels CBOC for the VA provided staff (by position/function) identified in question 13?

- Answer: 4, Social Worker, Pharm. D., Mental Health and Prosthetic Technician

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

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

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

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

Q17. How many veterans using the New Braunfels CBOC are currently on the Primary Care billable roster?

- Answer: 5,104

Q18. How many veterans using the Seguin CBOC are currently on the Primary Care billable roster?

- Answer: 1,167

Q19. What factors did the government consider that resulted in the New Braunfels CLINs growing from 5,900 enrollees in the Base year to 8,780 in OP9?

- Answer: Based on estimated growth in the community.

Q20. What factors did the government consider that resulted in the Seguin CLINs growing from 1,260 enrollees in the Base year to 1,953 in OP9?

- Answer: Based on estimated growth in the community.

Q21. Can the government provide a breakdown showing the number of enrollees by the enrollees home zip code for New Braunfels?

- Answer: Data is not available.

Q22. Can the government provide a breakdown showing the number of enrollees by the enrollees home zip code for Seguin?

- Answer: Data is not available.

Q23. Is the contractor responsible for setting up a contract (at the cost of the contractor) with a local provider for the diagnostic mammography, breast ultrasounds or breast screening MRI’s listed in paragraph 4.6.2.2 or are these referred to the VA for community care at the cost of the VA?

- Answer: No, contractor is not responsible for setting up.

Q24. In paragraph 4.6.2.2 it 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 4.6.2.2. second bullet point as well as all the reporting requirements stated in the third bullet point in paragraph 4.6.2.2?

Q25. 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.

Q26. On page 14 paragraph 2.2 Physician Director (Mandatory for all Sites): FTE Ratio Performance Standard: 0.05 FTE per PACT. Is the contractor required to provide 0.05 FTE Physician Director for New Braunfels and 0.05 Physician Director for Seguin? If yes, is it acceptable to have a 0.10 FTE Physician Director cover both sites?

Q27. On page 14 paragraph 2.2 Physician Director of the Solicitation states, “Contractor’s Physicians performing under this contract shall be board certified (or board eligible)….” On page 14 paragraph 2.3.1 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?

Q28. On page 20 paragraph 2.8 of the solicitation 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.”

Given that the starting enrollment in the Seguin CBOC is 1,260, is it acceptable to hire a part time TCT at the Seguin CBOC? Is it acceptable if the TCT in the Seguin CBOC is shared with the New Braunfels

CBOC?

Q29. 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.

Q30. 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

Q31. On page 78 paragraph 4.9.1 of the Solicitation states, “Contractors shall provide space that meets the standards outlined in the PACT Space Module Design Guide (see link above) and for the purposes of this solicitation the following minimum space requirements are:” and includes a telehealth group room, 3 telehealth consultation rooms, and a teleretinal room. Given that the Seguin location has a much lower enrollment, does the VA want the same number of rooms, i.e. telehealth group room, telehealth consultation rooms and teleretinal room in both the New Braunfels and Seguin CBOC facilities?

Q32. How many VA staffed personnel will be providing services in the New Braunfels and how many offices will be needed for VA provided staff?

- Answer: 8 VA Staff, 6 offices

Q33. How many VA staffed personnel will be providing services in the Seguin CBOCs and how many offices will be needed for VA provided staff?

- Answer: 3, 3 offices

Q34. On page 84 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.

Q35. On page 95 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?

Q36. On page 141 paragraph 2. Part 1 states, “Requirements for Technical Capability. Limit of 30 pages

– any pages beyond 30 will not be reviewed by the evaluators.” Given that this proposal is covering two clinics and two sets of staff, would the VA considering expanding the page limitation?

- Answer: Yes. Revised to read “Requirements for Technical Capability. Limit of 60 pages – any pages beyond 30 will not be reviewed by the evaluators.”

Q37. On page 141 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 148 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.

Q38. In the Instructions to Offeror paragraph 7. Part 6 – Subcontracting Plan on page 142 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.

Q39. In Section E.9 52.212-2 Evaluation-Commercial Items under Sub-factor (A) – Experience/Management Plan on page 148 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.

Q40. In Section E.9 52.212-2 Evaluation-Commercial Items under Factor 2 – Geographic Location/Suitability on page 150 of the Solicitation states, “1. Proposed contractor’s facility must be located within New Braunfels, Texas.” Is the VA also evaluating contractors who provide a facility located in Seguin, Texas?

Q41. In attachment D.0 Frequently Asked Questions, question 26 states the VA will require a clinic manager. Is it acceptable to have one Clinic Manager cover both the New Braunfels and Seguin CBOCs?

Q42. In attachment D.1 QASP in the header on page 3 states, “VHA Contracted Outpatient Clinics Quality Assurance Surveillance Plan (QASP) New Braunfels CBOC.” Should the heading in the QASP be changed to include both the New Braunfels and Seguin CBOCs?

- Answer: Yes. It will be revised at award.

Q43. 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: Yes.

Q44. REVISED SCHEDULE OF SERVICES

B.2 SCHEDULE OF SERVICES

LINE

ITEM

NUMBER SCHEDULE OF SERVICES EST QTY UNIT

UNIT

PRICE

TOTAL EST

COST

Primary Care Services at Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Base

POP Begin: 09-01-2021 POP End: 08-31-2022 New Braunfels, TX

5,900

PMPM

0002 Primary Care Services at Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Base

POP Begin: 09-01-2021 POP End: 08-31-2022

Seguin TX

1,260 PMPM

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 1 POP Begin: 09-01-2022 POP End: 08-31-2023

6,220

1002 Primary Care Services at Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 1 POP Begin: 09-01-2022 POP End: 04-30-2023*

(*deactivation date) Seguin TX

1,323 PMPM

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 2 POP Begin: 09-01-2023 POP End: 08-31-2024

7,873

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 3 POP Begin: 09-01-2024 POP End: 08-31-2025

8,698

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 4 POP Begin: 09-01-2025 POP End: 08-31-2026

9,307

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 5 POP Begin: 09-01-2026 POP End: 08-31-2027

9,958

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 6 POP Begin: 09-01-2027 POP End: 08-31-2028

10,655

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 7 POP Begin: 09-01-2028 POP End: 08-31-2029

11,401

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 8 POP Begin: 09-01-2029 POP End: 08-31-2030

12,199

Capitation Rates Per Member Per

Month (PMPM).

Contract Period: Option 9 POP Begin: 09-01-2030 POP End: 08-31-2031

13,053

GRAND TOTAL

SUMMARY:

BASE YEAR TOTAL $

OPTION YEAR 1 TOTAL $

OPTION YEAR 2 TOTAL $

OPTION YEAR 3 TOTAL $

OPTION YEAR 4 TOTAL $

OPTION YEAR 5 TOTAL $

OPTION YEAR 6 TOTAL $

OPTION YEAR 7 TOTAL $

OPTION YEAR 8 TOTAL $

OPTION YEAR 9 TOTAL $

GRAND TOTAL $

End of Document

B.2 SCHEDULE OF SERVICES