36C25724R0010_1.docx

36C25724R0010

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C25724R0010 08-15-2024 Noel Ramirez, Contracting Officer 915-217-1245 11-18-2024 12:00pm

MDT

36C257 Department of Veterans Affairs VHA RPO West - NCO 17 El Paso Contracting Office 11495 Turner Road El Paso TX 79936 Noel Ramirez, Senior Contract Specialist noel.ramirez2@va.gov X X 621498 $25.5 Million N/A X 36C549 Department of Veterans Affairs Attn: Teri Stewart VA North Texas Healthcare System 4500 South Lancaster Road Dallas TX 75216 See Block 9 none Financial Services Center (FSC) Department of Veterans Affairs P.O. Box 149971 Austin TX 78714-8971 See CONTINUATION Page The Contractor shall provide Community-Based Outpatient Clinic (CBOC) services in Granbury, TX.

See CONTINUATION Page X

NOEL E. RAMIREZ

VA-VHA-RPOW-2024-0115

Table of Contents

B.1 CONTRACT ADMINISTRATION DATA…………………………………………………..…...……………4

B.2 SCHEDULE OF SERVICES 6

B.3 PERFORMANCE WORK STATEMENT…………………………………………………………….......…...9

SECTION D – ATTACHMENTS………………………………………………………………………………………...119

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

Contractor Name

Address

Point of Contact

Title

Phone

Email

Tax ID Number

UEI (Unique Entity Identifier)

b. GOVERNMENT:

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

5. CHANGES/MODIFICATIONS TO THE CONTRACT: The Contracting Officer will be the only person authorized to approve changes or modify any of the requirements under this resultant contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer will be authorized to make commitments or issue changes that affect price, quantity, delivery or quality of performance of this resultant contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered unauthorized by the local VAMC, and no adjustment will be made in the contract price to cover any increase in cost incurred as a result thereof.

6. SECURE FAX: In accordance with VA Handbook 6500, the following statement is required on all fax cover sheets; if it is determined the ordering process will include a fax: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.

7. System for Award Management: Federal Acquisition Regulation requires contractor registration in the System for Award Management (SAM) database prior to the award of a contract. Offerors and Contractors may obtain information on registration and annual confirmation requirements via the internet at https://www.sam.gov/portal/public/SAM/.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 SCHEDULE OF SERVICES

ITEM INFORMATION

BASE YEAR: 1 APRIL 2025 – 31 MAY 2026

QTY

PRICE

EST

AMOUNT

ESTIMATED 3,100 PMPM X 12 MONTHS = 37,200 ESTIMATED PMPM ANNUALLY

OPTION YEAR 1: 1 APRIL 2026 – 31 MAY 2027

ESTIMATED 3,317 PMPM X 12 MONTHS = 39,804 ESTIMATED PMPM ANNUALLY

OPTION YEAR 2: 1 APRIL 2027 – 31 MAY 2028

ESTIMATED 3,549 PMPM X 12 MONTHS = 42,588 ESTIMATED PMPM ANNUALLY

OPTION YEAR 3: 1 APRIL 2028 – 31 MAY 2029

ESTIMATED 3,797 PMPM X 12 MONTHS = 45,564 ESTIMATED PMPM ANNUALLY

OPTION YEAR 4: 1 APRIL 2029 – 31 MAY 2030

ESTIMATED 4,063 PMPM X 12 MONTHS = 48,756 ESTIMATED PMPM ANNUALLY

OPTION YEAR 5: 1 APRIL 2030 – 31 MAY 2031

ESTIMATED 4,347 PMPM X 12 MONTHS = 52,164 ESTIMATED PMPM ANNUALLY

OPTION YEAR 6: 1 APRIL 2031 – 31 MAY 2032

ESTIMATED 4,652 PMPM X 12 MONTHS = 55,824 ESTIMATED PMPM ANNUALLY

OPTION YEAR 7: 1 APRIL 2032 – 31 MAY 2033

ESTIMATED 4,977 PMPM X 12 MONTHS = 59,724 ESTIMATED PMPM ANNUALLY

OPTION YEAR 8: 1 APRIL 2033 – 31 MAY 2034

ESTIMATED 5,326 PMPM X 12 MONTHS = 63,912 ESTIMATED PMPM ANNUALLY

OPTION YEAR 9: 1 APRIL 2034 – 31 MAY 2035

ESTIMATED 6,000 PMPM X 12 MONTHS = 72,000 ESTIMATED PMPM ANNUALLY

SUMMARY:

Contract Guaranteed Minimum and Contract Maximum

The fixed-price indefinite-delivery indefinite-quantity (IDIQ) contract will have a one-year base period with nine option periods. All PMPM quantities are estimated. The total guaranteed minimum quantity of services that the Government will acquire under this indefinite delivery, indefinite quantity (IDIQ) contract is $450,000.00, which also represents a bona fide need of the current fiscal year. The guaranteed minimum award amount is for the entire contract duration. The ceiling amount for the entire contract effort is $63,122,063.75.

Ordering Procedures

The Government does not guarantee that it will place any orders under this contract more than the guaranteed minimum award amount of $450,000.00. The aggregate value of orders placed under this contract shall not exceed the IDIQ contract maximum. See FAR clause 52.216-19, Order Limitations, for minimum and maximum values of each TO. Task Orders are contingent upon availability of funds per FAR clause 52.232-18.

This contract type allows the Department of Veteran Affairs Network Contracting Office 17 (NCO 17) contracting officers to place orders with the contractor on an as needed basis, in accordance with the FAR Clauses 52.216-18, Ordering. NCO 17 will obligate the funding and order the services by issuing a task order. The estimated enrollees or PMPM for performance of each task order shall be set forth in each task order.

The contractor shall initiate work when so directed by a Task Order. No work under any Task Order shall be performed unless specifically authorized by the contracting officer. Approval of a Task Order shall not constitute approval to exceed any item listed in the contract or general provisions of the contract. The contractor shall not exceed the task order amount or change the task order without prior written approval of the contracting officer.

Task orders within scope of the IDIQ contract will be issued unilaterally in accordance with the IDIQ contract terms and conditions and bilaterally when change in terms and conditions is negotiated in accordance with contract clauses FAR 52.212-4 (c), FAR 52.216-18, FAR 52.216-19 and FAR 52.216-22.

Each task order shall have an established period of performance or delivery date. Individual Task order shall not exceed a 12-month period.

Note: PMPM includes cost of unassigned patient visits, contractor shall not bill separately or propose an additional LIN or bill separately for these costs.

POST AWARD ORIENTATION

The Contracting Officer will schedule a post award orientation conference for contract orientation purposes as required by required by Procurement Policy Memorandum (PPM) 2019-01.

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1 Services Required: The VA North Texas Health Care System requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in Hood County, Texas, and the surrounding counties catchment area.

1.2 Site Classification: This site is classified as a Primary Care CBOC.

1.3 Place of Performance: Services shall be performed by contractor within the city limits of Granbury, Texas, on behalf of VA North Texas Health Care System, 4500 South Lancaster Road, Dallas, Texas, 75216.

1.4 Authority: Title 38 United States Code (USC) 8153 and FAR 12 in combination with FAR 15.

1.5 Policy and Regulations: The contractor is required to meet VHA performance and quality criteria, policy and standards including, but not limited to, access, quality of care, Veteran satisfaction, coordination of care, 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/vapubs/ or at http://www.va.gov/vhapublications/. Some VA policy documents include Standard Operating Procedures (SOPs) located on internal VA websites that are not available to the public. SOPs relevant to this requirement are provided as attachments under Section D. 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/docs/List-of-contracted-clinic-policy-documents.xlsx#

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties ACIP: Advisory Committee on Immunization Practices ACGME: Accreditation Council for Graduate Medical Education ACLS: Advanced Cardiac Life Support ACO: Administrative Contracting Officer ACPE: American Council on Pharmaceutical Education ADE: Adverse Drug Events AED: Automatic External Defibrillator AIS: Automated Information Security ANA: American Nurses Association AOA: American Osteopathic Association APRN: Advanced Practice Registered Nurse ARRT: American Registry of Radiologic Technology ASC: Ambulatory Surgery Center 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.

Asynchronous Care: Care provided outside of bookable time and includes but is not limited to the following activities: refilling prescriptions, reviewing outside records, huddles and case management, team meetings, processing view alerts, secure messaging, and training.

BAA: Business Associate Agreement BI-RADS: Breast Imaging-Reporting and Data System; a quality assurance tool designed to standardize mammography reporting.

BLS: Basic Life Support BOS: Bureau of Osteopathic Specialists CAHEA: Committee on Allied Health Education and Accreditation CAP: College of American Pathologists CARF: Commission on Accreditation of Rehabilitation Facilities CBO: VA Central Billing Office.

CCNE: Commission on Collegiate Nursing Education CDC: Centers for Disease Control and Prevention CEU: Certified Education Unit CLIA: Clinical Laboratory Improvement Amendments CME: Continuing Medical Education CMS: Center for Medicare and Medicaid Services CNP: Certified Nurse Practitioner CNS: Clinical Nurse Specialist CO: Contracting Officer COPD: Chronic Obstructive Pulmonary Disease COR: Contracting Officer’s Representative COS: Chief of Staff CPA: Collaborative Practice Agreement CPARS: Contractor Performance Assessment Reporting System CPP: Clinical Pharmacist Practitioner CPT: Current Procedural Terminology CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org.

CVT: Clinical Video Telehealth DICOM: Digital Image and Communication in Medicine DIGMA: Drop-in Group Medical Appointment DRG: Diagnostic Related Group DSS: Decision Support System ECC: Extended Care Center 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.

EPRP: External Peer Review Program FDA: Food and Drug Administration FSMB: Federation of State Medical Boards FTE: Full Time Equivalent 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.

HCFA: Health Care Financing Administration HHS: Department of Health and Human Services 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.

HPE: Health Professions Education HPT: Health Professions Trainee HT: Home Telehealth ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories ICD: International Classification of Diseases iMED: software used by VA for informed consent.

INR: International Normalized Ratio LIP: Licensed Independent Practitioner MCCR: Medical Care Cost Recovery SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision making in a two-way conversation.

Mental Health Services: per VHA Directive 1160.01 is meant to include services for the evaluation, diagnosis, treatment, rehabilitation, suicide prevention and crisis intervention, and coordination of care for 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, including SUD

(b) Treatment services using evidence-based pharmacotherapy, somatic treatments, or primary evidence-based Psychotherapy (EBP) for patients with mental health conditions and substance use disorders

(c) Patient education

(d) Family education, family consultation, family psychoeducation and couples/marriage and family counseling 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)

(g) Suicide Prevention

(h) Referrals and coordination of care between other levels of care and community treatment programs.

Specialty mental health services include:

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

(b) Evidence-based psychotherapy

(c) Intensive Community Mental Health Integration (ICMHR)

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

(e) PTSD teams or specialists

(f) MST special clinics

(g) Homeless programs; and

(h) Specialty substance abuse treatment services

MQSA: Mammography Quality Standards Act MSN: Master of Science in Nursing NLN: National League for Nursing NLNAC: National League for Nursing Accreditation Commission NP: Nurse Practitioner NSQIP/CICSP: National Surgical Quality Improvement Program/Continuous Improvement in Cardiac Surgical Program OTC: Over the Counter PA: Physician Assistant PACS: Picture Archiving and Communications System 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.

PACT Support staff: PACT staff assisting providers in the actual delivery of care to patients. It consists of RNCMs, clinical associates, and administrative associates.

SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two-way conversation.

Parent Facility: VAMC responsible for performance monitoring and payment for contracted outpatient site of care services.

PBM: Pharmacy Benefits Management PCMH: Patient-Centered Medical Home PCMHI: Primary Care-Mental Health Integration PCMM: Patient Centered Management Module - is an enterprise application that enables users to (1) set up and define health care teams, (2) assign staff and their associated full-time equivalent (FTE) staff to positions within each team, (3) assign patients to the team, and (4) assign patients to specific team members.

PCP: Primary Care Provider Phar.D.: Doctor of Pharmacy PMPM: Per Member Per Month-reimbursement methodology for services provided under the PC and MH LINs based on all-inclusive monthly rate per Veteran that meets qualifying encounter criteria in the previous twelve months of the contract period. This methodology also accounts for costs of unassigned/unenrolled visits based on estimates provided to contractors and it supports the PACT model in increasing coordination, quality, and continuity of care of Veterans receiving services at the Outpatient Site of Care.

POC: Point of Care Testing Primary Care Visit: an episode of care furnished in a clinic or virtually 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.

PWS: Performance Work Statement QAPI: Quality Assessment and Performance Improvement QASP: Quality Assurance Surveillance Plan REACH VET: Recovery Engagement and Coordination for Health Veterans Enhanced Treatment- REACH VET summarizes information from the Veterans Health Record and uses predictive modeling to identify Veterans at statistical risk for suicide and other negative outcomes. This tool supplements clinical strategies used to identify at-risk Veterans and may help providers intervene prior to these negative outcomes occurring.

RME: Reusable Medical Equipment SFT: Store and Forward Telehealth SMA: Shared Medical Appointments SOP (Clinical): Scope of Practice SPD: Sterile Processing Division SPE: Senior Procurement Executive Specialty Care Visit: 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.

STORM: Stratification Tool for Opioid Risk Monitoring TCT: Telehealth Clinical Technician TIU: Text Integration Utility TJC: The Joint Commission TMS: Talent Management System VA: Veterans Affairs VA ECHO: VA Extension for Community Health Outcomes VA EHR: VA electronic health record VAMC: Veterans Affairs Medical Center VAST: VHA Site Tracking database VetPro: a federal web-based credentialing program for healthcare providers.

VHA: Veterans Health Administration VSSC: VHA Support Service Center VVC: VA Video Connect 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), discipline specific team members (Clinical Pharmacist Practitioners (CPPs), Licensed Social Workers, Registered Dietitian/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 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 Pharmacist Practitioner (CPP) shall be provided the same support staffing when they are working in the capacity of an advanced practice provider. The contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The contractor shall 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. The total estimated patients assigned to site is approximately 3,100 at the start of contract award.

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 and shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. The physician director may also be credentialed and privileged to function as a PCP. (If so, authorization for prescriptive authority is required). Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO). Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site.

2.2 Primary Care Teamlet Staffing (Mandatory for all sites): All primary care teamlet staffing shall be provided by contractor.

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 mid-level 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 PCPs shall be a physician. If more than 4 providers are required, at least two PCPs shall 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. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO). Position Responsibilities: Responsible for the provision of covered services to assigned 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 virtual 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: Advanced Practice Registered Nurse (APRN): Qualifications: APRN’s (including subcontractors) shall possess a master’s degree from a program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE) and maintain full and current certification as a Certified Nurse Practitioner (CNP) from the American Nurses Association or another nationally recognized certifying body in either Adult Health or Family Practice. Authorization for prescriptive authority is required. CNPs shall prescribe controlled substances in accordance with limitations imposed by the Controlled Substances Act and the CNP’s State licensure on the authority to prescribe or administer controlled substances. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Advanced Practice Nurse located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO). Position Responsibilities: Responsible for the provision of covered services to assigned 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 virtual 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) shall be a graduate of a training program which is accredited by the Accreditation Review Commission on Education of PA (ARC-PA) or one of its predecessor organizations. Additionally, PAs shall have a master’s degree in any discipline or a bachelor’s degree in any discipline with one year of experience as a PA. PAs shall have successfully passed the PA National Certifying Exam (PANCE). Authorization for prescriptive authority is required. PA shall have current, full, active, and unrestricted license and registration in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician Assistant located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO). Position Responsibilities: Responsible for the provision of covered services to assigned 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 virtual 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.

Teamlet Member 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP Qualifications: Graduate of a school of professional nursing 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 in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Nurse located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO). Position Responsibilities: Responsible for the provision of covered services to assigned 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, virtual care, view alerts management, shared medical appointments, 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 virtual 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.

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) or Licensed Vocational Nurse (LVN): Qualifications: Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Licensed Practical or Vocation nurse located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO). Position Responsibilities: Responsible for the provision of covered services to assigned 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. Shall receive training as back-up for telehealth services (e.g., S&F, CVT).

Option 2: Unlicensed Assistive Personnel (Health Technician, Medical Assistant, Certified Nursing Assistant). This staffing is part of the PACT Teamlet, not the primary telehealth clinical technician (TCT): Qualifications: Completion of an accredited medical assistant, certified nursing assistant, or patient care/health technician training program. Other education such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on VA parent facility Chief of Staff determination. See VA qualification standards for Nursing Assistant located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO) for additional Nursing Assistant qualifications. Position Responsibilities: Responsible for the provision of covered services to assigned 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. Shall receive training as back-up for telehealth services (e.g., S&F, CVT).

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 provide clerical support and administrative functions to support site operations. Completion of scheduling training per VA policies and guidance. See VA qualification standards for Medical Support Assistant located at: VA Qualifications Standards - Office of the Chief Human Capital Officer (OCHCO) for additional qualifications. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. Provide clerical support and administrative functions to PACT staff and collaborate with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans. Provide guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA. Provide scheduling services in accordance with VA policies and guidance.

2.3 Discipline Specific PACT Team Member (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. Staff will be provided by VA. Contractor will provide adequate space and support staff for VA staff to deliver care on-site, virtually, or a combination of these methodologies for the following:

Discipline Specific 1: Clinical Pharmacist Practitioner (CPP): The contractor will provide referrals to CPP through the consult process in the VA EHR.

Discipline Specific 2: Clinical Pharmacist Practitioner (CPP) Anti-Coagulation: The contractor will provide referrals to CPC Anti-Coagulation through the consult process in the VA EHR.

Discipline Specific 3: Licensed Social Worker (this position provides general/medical social work services): The contractor will provide referrals to Social Work through the consult process in the VA EHR.

Discipline Specific 4: Registered Dietitian/Nutritionist: The contractor will provide referrals to Registered Dietician. Nutritionist through the consult process in the VA EHR.

Discipline Specific 5: Primary Care Mental Health Integration (PCMHI): The contractor will provide referrals to PCMHI through the consult process in the VA EHR.

2.4 Specialty Care Staffing: Services will be provided by VA either virtually or at a VA facility. Contractor will provide adequate space and support staff for VA staff to deliver care on-site, virtually, or a combination of these methodologies for the following:

Podiatrist: The contractor will provide referrals to Podiatry through the consult process in the VA EHR.

Physical Therapist: The contractor will provide referrals to Physical Therapy through the consult process in the VA EHR.

2.5 Ancillary Support Services Staffing: The following ancillary support staffing shall be provided by the contractor. The contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to these services during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters).

X-Ray Diagnostic Radiologic Technologist: FTE Ratio Performance Standard: 1 FTE technologist per x-ray machine per 8-hour time period with backup required during times of planned and unplanned staff absences. Qualifications: Shall be certified in general radiologic technology by the ARRT and possess an active, current certification. Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located (if license or certification is required for that state); otherwise, qualifications as per VA Handbook 5005, Appendix G25. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care.

Phlebotomist: Any contract site performing phlebotomy will have oversight by VA laboratory.

FTE Performance Standard: A minimum of one full time phlebotomist is required. Qualifications: Certificate of completion of Phlebotomy course and/or two years’ experience as a phlebotomist within the past three years (preferred). Position Responsibilities: Performs phlebotomy (venipuncture) and urine specimen collection on patients. Works as a phlebotomy technician, obtaining venous blood specimens from adults using knowledge of human anatomy, aseptic technique, and phlebotomy material selection (i.e., vacutainer, syringe, butterfly). Ensures proper identification of patients.