PWS DENTON CBOC FINAL July 26 2022.docx

PERFORMANCE WORK STATEMENT (PWS)

Outpatient Site of Care per VHA Handbook 1006.02 “VHA Site Classifications and Definitions”

1. GENERAL

1.1 SERVICES REQUIRED: The VA North Texas Health Care System (VANTHCS) requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in Denton County, Texas.

1.1.1 [X] Primary Care CBOC: offers both medical and mental health care (physically on site and by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care CBOCs are required to provide both primary care and mental health services Mental health services will be provided by VA staff via telehealth and by VA staff on-site. The vendor will only have to provide office/clinic space for the North Texas assigned staff.

1.2 PLACE OF PERFORMANCE: The Denton Contractor’s facility must be physically located in Denton County, Texas. Denton is approximately 51 miles from VANTHCS.

1.3 AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of VANTHCS, 4500 South Lancaster Road, Dallas, TX 75216-7167.

1.4 POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the Contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vhapublications/ or at http://www.va.gov/vapubs/. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/Resources.asp

1.5 DEFINITIONS/ACRONYMS:

1.5.1 ABMS: American Board of Medical Specialties

1.5.2 ACLS: Advanced Cardiac Life Support

1.5.3 ACGME: Accreditation Council for Graduate Medical Education

1.5.4 ACPE: American Council on Pharmaceutical Education

1.5.5 ACO: Administrative Contracting Officer

1.5.6 ADE: adverse drug events

1.5.7 AED: Automatic External Defibrillator

1.5.8 AIS: Automated Information Security

1.5.9 ANA: American Nurses Association

1.5.10 AOA: American Osteopathic Association

1.5.11 ARRT: American Registry of Radiologic Technology

1.5.12 ASC: Ambulatory Surgery Clinic

26 JULY 2022

1.5.13 Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e., CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

1.5.14 BAA: Business Associate Agreement

1.5.15 BI-RADS: Breast Imaging-Reporting and Data System; a quality assurance tool designed to standardize mammography reporting

1.5.16 BLS: Basic Life Support

1.5.17 BOS: Bureau of Osteopathic Specialists

1.5.18 CAHEA: Committee on Allied Health Education and Accreditation

1.5.19 CAP: College of American Pathologists

1.5.20 CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21 CBO: VA Central Billing Office.

1.5.22 CDC: Centers for Disease Control and Prevention

1.5.23 CEU: Certified Education Unit

1.5.24 CLIA: Clinical Laboratory Improvement Amendments

1.5.25 CME: Continuing Medical Education

1.5.26 CMS: Center for Medicare and Medicaid Services

1.5.27 CO: Contracting Officer

1.5.28 COPD: chronic obstructive pulmonary disease

1.5.29 COR: Contracting Officer’s Representative

1.5.30 COS: Chief of Staff

1.5.31 CPA: Collaborative Practice Agreement

1.5.32 CPS: Clinical Pharmacy Specialist

1.5.33 CPT: Current Procedural Terminology

1.5.34 CRNP: Certified Registered Nurse Practitioners

1.5.35 CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org/ .

1.5.36 CPARS: Contractor Performance Assessment Reporting System

1.5.37 CVT: Clinical Video Telehealth

1.5.38 DICOM: Digital Image and Communication in Medicine

1.5.39 DIGMA: Drop-in Group Medical Appointment

1.5.40 DRG: Diagnostic Related Group

1.5.41 DSS: Decision Support System

1.5.42 ECC Extended Care Center

1.5.43 Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

1.5.44 EPRP: External Peer Review Program

1.5.45 FDA: Food and Drug Administration

1.5.46 FSMB: Federation of State Medical Boards

1.5.47 HCC: Health Care Center - A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

1.5.48 HHS: Department of Health and Human Services

1.5.49 HCFA: HealthCare Financing Administration

1.5.50 HICPAC: Healthcare Infection Control Practices Advisory Committee- a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

1.5.51 HT: Home Telehealth

1.5.52 ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.53 ICD 10: International Classification of Diseases 10th edition

1.5.54 iMED: Software used by VA for informed consent

1.5.55 INR: International Normalized Ratio

1.5.56 ISO: Information Security Officer

1.5.57 LIP: licensed independent practitioner

1.5.58 MCCR: Medical Care Cost Recovery

1.5.59 Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence- based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the Veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions;

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psychoeducation, family education, skills training, peer support, and Compensated Work Therapy (CWT) and supported employment;

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.60 MQSA: Mammography Quality Standards Act

1.5.61 MSN: Master of Science in Nursing

1.5.62 NCCPA: National Commission on Certification of Physician Assistants

1.5.63 NLN: National League for Nursing

1.5.64 NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.5.65 OTC: Over the Counter

1.5.66 PA: Physician Assistant

1.5.67 PACS: Picture Archiving and Communications System

1.5.68 PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team-based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

1.5.69 Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.70 PCMH: Patient-Centered Medical Home

1.5.71 PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.5.72 PCP: Primary Care Provider

1.5.73 Phar.D.: Doctor of Pharmacy

1.5.74 POC: Point of Care Testing

1.5.75 PRIMARY CARE VISIT: an episode of care furnished in a clinic that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

1.5.76 PCMHI: Primary Care-Mental Health Integration

1.5.77 PWS: Performance Work Statement

1.5.78 QAPI: Quality Assessment and Performance Improvement

1.5.79 QASP: Quality Assurance Surveillance Plan

1.5.80 RME: reusable medical equipment

1.5.81 SOP (Clinical): Scope of Practice

1.5.82 SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.83 SFT: Store and Forward Telehealth

1.5.84 SMA: Shared Medical Appointments

1.5.85 SPD: Sterile Processing Division

1.5.86 SPE: Senior Procurement Executive

1.5.87 SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care and is only provided through a referral. These services are generally divided into two sub-categories: medicine specialties and surgery specialties. The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology; emergency; employee health; endocrinology; gastroenterology; general medicine; hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology; amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

1.5.88 SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.89 TJC: The Joint Commission

1.5.90 TIU: Text Integration Utility

1.5.91 TCT: Telehealth Clinical Technicians

1.5.92 VA: Veterans Affairs

1.5.93 VA EHR: VA electronic health record

1.5.94 VAMC: Veterans Affairs Medical Center

1.5.95 VetPro: a federal web-based credentialing program for healthcare providers.

1.5.96 VHA: Veterans Health Administration

1.5.97 VVC: VA Video Connect

1.5.98 WHEN: Weekend-Holiday-Every Night

2 STAFFING AND QUALIFICATIONS

2.1 MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS:

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI)staff). The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider.

Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA, the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: 8,000.

2.2 PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by Contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e., CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP. (If so, authorization for prescriptive authority is required). Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

2.3 PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor.

2.3.1 TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. At least one Primary Care Provider must be a physician.

OPTION 1: Physician (MD, DO): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified or board eligible by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e., CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications: CRNP’s (including subcontractors) must have an MSN from an NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e. CBOC); Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 3: Physician Assistant (PA): Qualifications: PA’s (including subcontractors) must meet one of the three following educational criteria: a) A bachelor’s degree from a PA training program which is certified by the CAHEA; or b) Graduation from a PA training program of at least twelve (12) months duration, which is certified by the CAHEA and a bachelor’s degree in a health care occupation or health related science; or c) graduation from a PA training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician. The duration of approved academic training and health care experience must total at least five (5) years. Authorization for prescriptive authority is required. PAs must be certified by the NCCPA. PA shall have current, full, active, and unrestricted license and registration in the state of the Outpatient Site of Care (i.e. CBOC); VA HANDBOOK 5005/78 PART II APPENDIX G8 PHYSICIAN ASSISTANT QUALIFICATION STANDARD http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=763&FType=2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.2 TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2 Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e., CBOC).

2.3.3 Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients.

The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence- based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

2.3.4 TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. Contractor to propose the mix of Clinical Associates from the options below.

OPTION 1: Licensed Practical Nurse (LPN): Qualifications: VA HANDBOOK 5005/3 PART II APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD http://vaww.va.gov/OHRM/Directives- Handbooks/Documents/5005.pdf Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e., CBOC).

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Must receive training to provide primary support or serve as backup for telehealth services.

OPTION 2: Licensed Vocational Nurse (LVN): Qualifications: VA HANDBOOK 5005/3 PART II APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION STANDARD http://vaww.va.gov/OHRM/Directives- Handbooks/Documents/5005.pdf . Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e., CBOC).

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Must receive training to provide primary support or serve as backup for telehealth services.

OPTION 3: Medical Assistant (MA):Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Must receive training to provide primary support or serve as backup for telehealth services

OPTION 4: Health Care Technician (HCT) (as part of PACT teamlet, not primary telehealth technician) : Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Must receive training to provide primary support or serve as backup for telehealth services.

2.3.5 TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per

1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.4 DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline- specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated. VANTHCS will provide a minimum of two (2) PACT social workers, one full time clinical pharmacy specialist and one full time clinical dietitian. The contractor will only be responsible to provide office space/consult rooms for these clinicians to conduct care. Any other needed discipline specific PACT team members will be provided by the VA for specific care and/or appointments.

2.5 SPECIALTY CARE STAFFING: Specialty Care is to be provided by the VANTHCS. Specialty Care referrals, including referrals for care in the community, are initiated by submitting the appropriate specialty consult in the VA EHR.

2.6 ANCILLARY SUPPORT SERVICES STAFFING: The following specialty staffing shall be provided by the Contractor.

2.6.1 DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: Radiology staffing shall be per the machine types and demands of the facility for each Radiologic procedure/ modality, i.e., CT, MRI, US, MAMMOGRAPHY, X-ray, etc. Radiologist staffing is based upon the number of exams and type performed in the typical 8-hour day. Suggested appointment length for MRI, CT, and ultrasound exams is 30 minutes. NOTE: National Radiology Program Office SharePoint or intranet site for most up-to-date guidance.

[X ] X-Ray Machine staffing standard: Requires one (1) Technologist per machine per 8- hour shift. Qualifications: Must be certified in general radiologic technology by the ARRT and possess an active, current certification. For CT and MRI, must also possess an Advanced ARRT certification specific to the respective modality. Must meet radiological technologist requirements of the state in which the services are provided. VA HANDBOOK 5005/77-part 2 Appendix G25

Diagnostic Radiologic Technologist Qualification Standard http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=754&FType=2 Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care.

2.6.2. PHLEBOTOMIST/LABORATORY TECHNICIAN: FTE Ratio Performance Standard: At least two FTE phlebotomist are required for the location. Qualifications: Certificate of completion of Phlebotomy course and/or two years’ experience as a phlebotomist within the past three years (preferred). Position Responsibilities: Responsible for performance functions to include but not limited to: recording specimens in the computer, collecting patient blood and/or urine specimens, labeling specimens, answering questions relative to patient specimens, instructing, and assisting patients. Performs direct patient support work to include: collecting information from patients, providing personal patient care, and educating patients on pre-testing and post procedure activities. Functions as a resource for non-laboratory personnel on specimen collection requirements and patient preparation for provider, verifies identifiers such as patient identification, time of sample, type of test requested, and identifies unusual conditions and discrepancies which may cause erroneous results

2.7 GENERAL AND SPECIALTY MENTAL HEALTH STAFFING: General and Specialty Mental Health staffing will be provided by VANTHCS. The Contractor is only responsible for providing space to the assigned general and specialty mental health staff.

2.8 TELEHEALTH SERVICES CLINICAL STAFF: VA will provide two Telehealth Clinical Technicians (TCT). Contractor shall provide trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services). All staff providing telehealth related services (primary TCT(s) and back-ups) must be trained in teleretinal imaging, teledermatology, teleaudiology, tele-mental health, teleprimary care etc. The qualifications, competencies, and position responsibilities noted below apply to primary TCT(s) and back-ups. The Telepresenter can be any clinically trained person assisting the provider in the presentation of the Veteran using video-conferencing. 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). Telepresenters can also serve as TCT back-ups. The number and discipline of Contractor’s staff trained to function as a TCT back-up or Telepresenter will be based on the volume and type of telehealth services provided.

2.8.1 Qualifications: All staff providing telehealth related services into the clinic shall be appropriately credentialed and; where necessary, privileged. All contractor staff who support and manage telehealth services must be working within permitted licensure and scope of practice. Where non-licensed staff is supporting telehealth services the Contractor’s licensed staff must provide appropriate clinical supervision.

2.8.2 Competency – TCTs, Telepresenters, Store and Forward Imagers et al. and their back-ups, shall be expected to provide clinical care in compliance with established clinical protocol. Additional guidelines governing operations will be utilized and provided to Contractor by VA. TCTs, Telepresenters, Store and Forward Imagers and back-ups shall be expected to successfully complete training programs required for certification as a TCT, Telepresenter and/ or Store and Forward Imager and back-up including VA required training and any VA training mandated for TCT, Telepresenter, Teleretinal Imagers. TCTs, Telepresenters, and Store and Forward Imagers shall be responsible for maintaining imager and/or other required certification. TCTs, Telepresenters, and Store and Forward Imagers and back-ups shall be expected to demonstrate competency on the function and use of the telehealth equipment including digital retinal and dermatology imaging system, teleaudiology hardware and software. VA will provide training to TCTs, Telepresenters, Store and Forward Imagers and back-ups and document competency.

2.8.3 Training: Contractor’s TCTs, RNs, LPNs, LIPs and support staff providing telehealth services shall be required to complete all Telehealth required training, both virtual and in-person. Contractor’s Telehealth Staff shall be required to attend conference calls intended to support and maximize delivery of care as required by the VA.

2.8.4 TCT Position Responsibilities: TCT manages the Telehealth Services offered by the clinic (i.e., presenting, equipment management, training, imaging, audiology services, etc.) and is responsible for the provision of covered services to enrolled and unassigned patients presenting for care. The Contractor’s telehealth services shall include but are not limited to: coordinating telehealth clinic set up, scheduling, equipment management, provision of data on request, attendance on VA or Network Telehealth Team calls, maintaining records required for quality control processes, and participating in performance improvement activities. The TCT shall be responsible for conveyance of clinically appropriate in-person interaction or on-site observations (e.g., assisting with hearing aid fittings, detection of alcohol use, etc.) with the Veteran patient to the telehealth provider. The TCT shall be responsible for gathering and transmitting telehealth images, sounds, data and all other supporting data to the assigned VA providers or reading centers within timelines established by policy. The TCT shall provide technology education to patients including but not limited to: review of acquired data or images for anatomic and general findings, review of photos, and provision of VA approved handouts. The TCT shall communicate regularly with the Facility Telehealth Coordinator (FTC) to work out any process issues, equipment needs/problems, data collection and any other logistical issues.

2.8.5 Telepresenter Position Responsibilities: Include 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.

2.9 LICENSE AND ACCREDITATION: Contract physician(s) and all other contract licensed providers assigned by the Contractor to perform the services covered by this contract shall have a current license to practice in the state where the outpatient site is located. All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contract providers who have current, full, and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action, or denied upon application will not be considered for the purposes of this contract.

2.9.1 Technical Proficiency/Board Certification: Personnel shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read, and write English fluently.

2.9.2 The Contractor must ensure that all individuals who provide services and/or supervise services at the Contractor’s Outpatient Site of Care, including individuals furnishing services under contract are qualified to provide or supervise such services.

2.9.3 Position specific competencies shall be completed for all staff annually.

2.9.4 Contractor staff qualifications, licenses, certifications and facility Joint Commission or equivalent accreditation must be maintained throughout the contract period of performance. If Contractor’s staff is not directly employed by the treating facility, documentation must be provided to the COR to ensure adequate certification. All actions required for maintaining certification must be kept up to date always. Documentation verifying current licenses, certifications and facility accreditation must be provided by the Contractor on an annual basis.

2.9.5 The Contractor is responsible for assuring that all persons, whether they be employees, agents, subcontractors, providers, or anyone acting for or on behalf of the Contractor, are properly licensed always under the applicable state law and/or regulations of the provider’s license, and shall be subject to credentialing and privileging requirements by VA.

2.9.6 The Contractor shall not permit any employee to begin work at an Outpatient Site of Care prior to confirmation from the VA that the individual’s background investigation has been reviewed and released to the Office of Personnel Management (OPM), by the Security and Investigations Center (SIC), and that credentialing and privileging requirements have been met. Any changes related to the providers' licensing or credentials will be reported immediately to the VA Credentialing Office. Failure to adhere to this provision may result in one or more of the following sanctions, which shall remain in effect until the deficiency is corrected:

2.9.6.1 The VA will not pay the capitation payment due on behalf of an enrolled patient if service is provided or authorized by unlicensed personnel, without regard to whether such services were medically necessary and appropriate.

2.9.6.2 The VA may refer the matter to the appropriate licensing authority for action, as well as notify the patient that he/she was seen by a provider outside the scope of the contract and may pursue further action.

2.9.6.3 The Contractor shall notify COR, Contracting Officer, and the VA Chief of Staff when any provider furnishing services under this contract is reported to the National Practitioner Data Bank.

This notification shall include the name, title, and specialty of the provider.

2.10 CREDENTIALING AND PRIVILEGING: A Texas licenses is required for all health care providers that provide care via telehealth modalities. Credentialing and privileging of all health care professionals who are permitted by law and the facility to practice independently will be done in accordance with the provisions of VHA Handbook 1100.19. Credentialing for all health care professionals who claim licensure, certification, or registration, as applicable to the position and who are not currently credentialed in accordance with VHA Handbook 1100.19, must be credentialed in accordance with VHA Directive 2012-030. This VHA Handbook and VHA Directive provide updated VHA procedures regarding credentialing and privileging, to include:

VHA policy concerning VetPro; the Expedited Medical Staff Appointment Process; credentialing during activation of the facility Disaster Plan; requirements for querying the FSMB; credentialing and privileging requirements for Telemedicine and remote health care; clarifications for the Summary Suspension of Privileges process in order to ensure both patient safety and practitioner rights; and the credentialing requirements for other required providers.

2.10.1 Contractor shall ensure that all health care professionals who are permitted by law and the facility to practice independently participate in the Credentialing and Privileging process through VHA’s electronic credentialing system, “VetPro”. No services are to be provided by any contract provider requiring credentialing and privileging until the parent VA Medical Executive Board and Director have granted approval. The Contractor shall be provided copies of current requirements and updates as they are published.

2.10.2 Credentials and Privileges shall require renewal annually in accordance with VA and TJC requirements. Credentialed providers assigned by the Contractor to work at the site shall be required to report specific patient outcome information, such as complications, to the VA.

Quality improvement data provided by the Contractor and/or collected by the VA will be used to analyze individual practice patterns. The Service Chief, Primary Care Service Line will utilize the data to formulate recommendations to the Medical Executive Board when clinical privileges are being considered for renewal.

2.10.3 Contractor shall ensure that all health care professionals who claim licensure, certification, or registration, as applicable to the position and who are not currently credentialed in accordance with VHA Handbook 1100.19 participate in the Credentialing process through VA’s “VetPro,” in accordance with VHA Directive 2012-030. No services are to be provided by any contract provider requiring credentialing until the parent facility has granted approval.

The Contractor shall be provided copies of current requirements and updates as they are published.

Since Contracted Nurse Practitioners, Clinical Pharmacy Specialists, and Physician Assistants are not recognized by the VA as independent practitioners, they function under a VA Scope of Practice (not Clinical Privileges). The VA Scope of Practice must adhere to applicable practice acts within that state. The credentials and scope of practice for Nurse Practitioners, Clinical Pharmacy Specialists, and Physician Assistants are reviewed at the time of the initial appointment and at least every two years thereafter by an appropriate VA discipline-specific Professional Standards Board.

2.11 CME/CEU: Contractor staff registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. CME hours shall be reported to the Credentialing Office for tracking. These documents are required for both privileging and re privileging. Failure to provide will result in loss of privileges.

2.11.1 TRAINING (ACLS/BLS/VA MANDATORY): 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. Copies of current certifications shall be provided to the COR. ACLS certification is required for health care personnel that order, administer, monitor, or supervise moderate sedation, monitored anesthesia care, or general anesthesia, according to current VHA policy. The contractor shall coordinate, and cover contract staff travel expenses in accordance with General Services Administration (GSA) rates. https://www.gsa.gov/portal/category/100000.

2.11.2 ACCESS TO PATIENT INFORMATION: In performance of official duties, Contractor’s provider(s) have regular access to printed and electronic files…