36C25819R0003-0002000.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 03-05-2019 Department of Veterans Affairs NCO22-Gilbert Network Contracting 3601 S. 6th Avenue Bldg. 45 Tucson

AZ

85723 Department of Veterans Affairs NCO22-Gilbert Network Contracting 3601 S. 6th Avenue Bldg 45 Tucson

AZ

85723 To all Offerors/Bidders

36C25819R0003 02-01-2019

X X X

4/1/2019 at 11:00am EST X The purpose of this amendment is to extend the proposal due date to 4/1/2019 and respond to questions pertaining to this solicitation.

See continuation pages for questions and answers.

Daniel Thiel

CONTINUATION PAGE

RESPONSE TO QUESTIONS

1. What is the current number of billable enrollees at the clinic. 1,022

2. What is the current PMPM? The current rate cannot be provided.

3. How many providers are at the existing clinic and are they physician or NPs? Two (2); One (1) Physician and One (1) Physician Assistant

4. Please provide which vaccines are to be provided by contractor and 12 month usage.

HAEMOPHILUS B CONJUGATE VACCINE (HIBERIX) – Hib/ 0 usage

HEPATITIS A VACCINE (HAVRIX, VAQTA)/ 0 usage

HEPATITIS B VACCINE (ENGERIX-B, RECOMBIVAX-HB)/ 0 usage

HEPATITIS A/HEPATITIS B RECOMB INJ (TWINRIX) / 0 usage

INFLUENZA VACCINE, INJ/ 478 usage

MEASLES, MUMPS AND RUBELLA (M-M-R II SINGLE DOSE VACCINE) – MMR / 0 usage

MENINGOCOCCAL VACCINE (MENACTRA, MENOMUNE) /0 usage

PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE (PREVNAR 13) /100 usage

PNEUMOCOCCAL 23-VALENT POLYSACC VACCINE (PNEUMOVAX) / 100 usage

TETANUS/DIPHTH. 0.5ML SYR (TENIVAC) – Td /10 usage

TET/DIPHTH/PERTUS (ADACEL, BOOSTRIX) – Tdap/ 100 usage

VARICELLA VIRUS VACCINE LIVE (VARIVAX) - Chicken Pox/ 0 usage

Zoster VACCINE LIVE (OKA/MERCK) INJ (ZOSTAVAX) – Shingles/ 41 usage Gardasil 9 (HPV Vaccination) 0 usage Typhoid / 0 usage

5. Will patients be vested with the startup of the clinic? Patients that are currently with the existing clinic will not have to be vested again; only newer patients will need to be vested.

6. How many female patients are enrolled in the clinic? As of February 26, 2019, 46 females

7. Can the phlebotomist and TCT be a shared role? No. Since a large portion of the lab draws will be completed in the mornings, the TCT will need to be available for the Telehealth appointments at those same times.

8. Does the clinic need its own DEA License or a DEA licensed provider? (2.21-Ryan Height Act). The contractor shall provide proof the clinic is DEA registered after award.

9. Will the VA be providing the AED? (4.6.4.7 ) The VA will provide the Contractor with an AED and train Contractor’s staff in its use and checks of the device.

10. Can the STAT labs/Asap labs be sent to the VA or go through the community care process? The can be sent to the VA or requested through the VA through the NonVA community care process. Will the VA be providing the lab courier? YES (4.6.6 Laboratory Services)

11. Will the VA be providing the collection tubes, containers, needles and hubs? Paragraph 4.6.6.1 The VA Shall supply specimen collection tubes and containers, collection needles and the corresponding hubs. A listing of the VA provided specimen collection tubes and, collection needles and hubs is available on the Phoenix VAHCS Pathology and Laboratory Medicine Service Sharepoint and as an attachment to the solicitation.

12. Does the clinic need a VA CLIA certificate or contractor’s CLIA certificate? (4.6.6.3.3) The Contractor must apply for and maintain a current VA CLIA Certificate.

13. Radiology Services- Patients will be sent to VA for radiology or through the standard non-VA community care process? (4.6.7) Yes. Both request (main facility or NonVA Care) require a consult into VISTA utilizing CPRS.

14. Electrocardiogram Services Is the VA providing the EKG? ( 4.6.9) This will be supplied by VA at cost to the contractor.

15. Pharmacy Services (4.6.10)

a. Is the contractor responsible for 10 day urgent medications? No. They will be filled through the local contracted pharmacy through the VA local contract.

b. Is the contractor responsible for vaccines? The Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic.

c. Please provide the list of vaccines to be provided by contractor?

HAEMOPHILUS B CONJUGATE VACCINE (HIBERIX) - Hib

HEPATITIS A VACCINE (HAVRIX, VAQTA)

HEPATITIS B VACCINE (ENGERIX-B, RECOMBIVAX-HB)

HEPATITIS A/HEPATITIS B RECOMB INJ (TWINRIX)

INFLUENZA VACCINE, INJ

MEASLES, MUMPS AND RUBELLA (M-M-R II SINGLE DOSE VACCINE) – MMR

MENINGOCOCCAL VACCINE (MENACTRA, MENOMUNE)

PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE (PREVNAR 13)

PNEUMOCOCCAL 23-VALENT POLYSACC VACCINE (PNEUMOVAX)

TETANUS/DIPHTH. 0.5ML SYR (TENIVAC) - Td

TET/DIPHTH/PERTUS (ADACEL, BOOSTRIX) - Tdap

VARICELLA VIRUS VACCINE LIVE (VARIVAX) - Chicken Pox

Zoster VACCINE LIVE (OKA/MERCK) INJ (ZOSTAVAX) – Shingles Gardasil 9 (HPV Vaccination) Typhoid

16. Breast Cancer Screening (4.6.22.1)

a. Who will be responsible for providing mammograms? Mammograms will be done at the VA or through our community partners.

17. Please list all VA employees (by function) that will be on site and number of hours per week for each. None

18. In section 4.7.10 the rfp states that the contractor is responsible for closed circuit TV… but it will be monitored by VAMC… what are the specific requirements for the equipment. How many cameras, what is being monitored (outside or inside the clinic)? Both inside and outside the clinic must be monitored. The number of cameras will be dependent on the size and layout of the CBOC. See paragraph 4.7.10 for definition.

19. Would the VAMC allow the CMD to be less than a full time employee as long as at least 0.05 FTE is spent on administrative duties? Yes, if there is a 1.0 FTE provider (medical doctor)

20. Section 2.1 of the RFP states: “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” Does the government require additional staffing at the CBOC to support the VAMC CPS? If so, what specific additional staff is required and what FTE? No additional staffing. MSA clerks should be able to make appointments for the CPS when needed.

21. Section 2.52 of the RFP requires 1.0 TCT per 5,000 patients. Does this mean the CBOC should be staffed with a 0.25 TCT tech? It should read 1.0 TCT up to 5,000 patients.

22. Section 2.5.3 of the RFP requires:

PHLEBOTOMIST/LABORATORY TECHNICIAN: Contractor provided nursing assistant, licensed practical nurse (LPN), registered nurse (RN), or any staff deemed competent by the contractor to perform the duties necessary to properly identify patients, procure, label and process laboratory specimens.

Does the VA require a FT phlebotomist or can this duty be combined with TCT duties and be staffed by one LPN for both? No, the VA does not require a FT phlebotomist. Since a large portion of the lab draws will be completed in the mornings, the TCT will need to be available for the Telehealth appointments at those same times. The LPN can complete the duties, but will be competing with the regular primary care appointments. A combination of the LPN and TCT can complete duties.

23. Section 2.9 of the RFP states that ACLS/BLS/VA is mandatory.

Is just BLS sufficient for the CBOC staff? Yes

24. Section 4.6.15.7 of the RFP states that ”Tele-Mental Health Services: The Contractor shall provide tele-mental health services” However, the RFP also states that the VAMC will provide MH staff. Please clarify what, specific services are to be provided by the contractor. The contractor shall provide a tele-health technician while the VAMC will provide the mental health staff.

25. Instructions to offers discusses unbalanced. Will the government permit small business to recover facility build-out and start up costs in year one? The offeror shall take this into account when submitting their quote.

26. Please confirm that the government will require the new CBOC to be built with the On-stage/Off-stage design in the PACT Design Guide. No, based on the expected size of the primary care panel.

27. In answering questions, the government has said that the current space is acceptable. Will the government permit the contractor to remodel the facility while seeing patients in the clinic? Yes, utilizing safety and privacy precautions.

28. For the On-stage/Off-stage design, will the government require two sliding doors for each exam room, or can the door to the team work area be a traditional swinging door? It can be traditional.

29. Will the government consider extending the start up timeline from 90 to 120 days? No

30. Please extend the deadline for 30 days upon posting of final answers to questions. Extension granted to 4/1/2019

31. Section 4.6.22.4.2. “In order to be initially designated as a Women’s Health PCP (WH-PCP), a provider must have at least one of the following:

4.6.22.4.2.1. Documentation of attendance at a Women’s Health Mini-Residency within the previous 3 years;

4.6.22.4.2.2. Documentation of at least 20 hours of women’s health continuing medical education (CME) or continuing education unit (CEU) within the last 3 years

4.6.22.4.2.3. Documentation of at least 3 years in a practice with at least 50% women patients within the previous 5 years;

4.6.22.4.2.4. Evidence of completion of an internal medicine or family practice residency; women’s health fellowship; or women’s health, adult or family practice NP or PA training within the previous 3 years;

4.6.22.4.2.5. Documentation of a current preceptorship arrangement with an experienced WH-PCP such as weekly meetings (for at least 6 months); or

4.6.22.4.2.6. Evidence of being recognized as a known women’s health leader and subject matter expert with experience practicing, teaching, and/or precepting women’s health.

4.6.22.4.2.6.1.1.1. Renewal of status for Women’s Health PCPs requires ten (10) hours of CME or CEU in women’s health every 2 years and Skills Proficiency Check and Pap Sample adequacy review by the Womens Health Medical Director (WHMD) at the main facility.

Please clarify if the government requires the provider to possess one of the requirements listed in 4.6.22.4.2.1 – 4.6.22.4.2.6 before they can be hired? Will the government allow the provider to obtain one of the requirements after they are hired? Before they can be hired.

32. Will the new contractor inherit the patient’s last Primary Care vesting visit and be allowed to bill for one year from that date upon contract award? Yes

33. In paragraph 4.6.10 it states that the Contractor will provide all medication, including any necessary vaccines that are to be administered to patients in the clinic. Please confirm that the following list of Vaccines are the responsibility of the contractor? See updated list below.

HAEMOPHILUS B CONJUGATE VACCINE (HIBERIX) - Hib

HEPATITIS A VACCINE (HAVRIX, VAQTA)

HEPATITIS B VACCINE (ENGERIX-B, RECOMBIVAX-HB)

HEPATITIS A/HEPATITIS B RECOMB INJ (TWINRIX)

INFLUENZA VACCINE, INJ

MEASLES, MUMPS AND RUBELLA (M-M-R II SINGLE DOSE VACCINE) – MMR

MENINGOCOCCAL VACCINE (MENACTRA, MENOMUNE)

PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE (PREVNAR 13)

PNEUMOCOCCAL 23-VALENT POLYSACC VACCINE (PNEUMOVAX)

TETANUS/DIPHTH. 0.5ML SYR (TENIVAC) - Td

TET/DIPHTH/PERTUS (ADACEL, BOOSTRIX) - Tdap

VARICELLA VIRUS VACCINE LIVE (VARIVAX) - Chicken Pox

Zoster VACCINE LIVE (OKA/MERCK) INJ (ZOSTAVAX) – Shingles Gardasil 9 (HPV Vaccination) Typhoid

34. Are there any additional Vaccines required to be supplied by the contractor other than those listed in question 33 above? No

35. Pursuant to paragraph 4.6.10, please provide a list of Medications the government expects the contractor to dispense from the clinic that would not be a routine medication dispensed through the VA or an urgent/emergent medication dispensed through the Contractors’ contract with a local pharmacist. None

36. What is the number of Vaccines, by type as listed in question 33 and any additional Vaccines added by the government pursuant to question 34, that was provided to the Payson CBOC Enrolled Veterans in the last 12 months? See response to question 4.

37. In the updated CLINS, shown in Amendment 0001 to the solicitation, the government shows a 10% growth in OP1 over the Base period, 9.1% growth in OP2, 8.3% growth in OP3 and 7.7% growth in OP4. Historically (since FY14) the enrollment levels as shown in the Payson PACT COMPASS report, has grown an average of 4.3% per year. Alternatively, the veteran population as shown in VetPop2016 shows the veteran population in Gila county is expected to decline over 1.5% per year for the foreseeable future. In addition, the surrounding counties show the veteran population declining over 2% each year for the foreseeable future. Please explain how the government came up with the estimated grown shown in the CLINS considering the above presented information based on actual results shown in the PACT COMPASS and government population estimates. The increases are based on historical vested veteran patient increases per year.

38. As this is an electronic submission, is there a file size limit? Is there a preferred file format? Please submit either PDF or word document. File limit size is 5MB. Multiple e-mails may be sent with the proposal attachments.

39. Please verify that Government does NOT want offeror to submit resumes/licenses of key clinic personnel with the submission. A copy of licenses must be provided with offer and will be updated annually.

40. The adjusted patient total was 1,000 as the PMPM. However, as of today there are 1,090 according CPRS. The total was around 1,000 in October, but was that based off the billable list? Also, if it were 1,000 in October, wouldn’t it be appropriate to assume it would be at 1,100 when this contract goes live? So, shouldn’t the bid start at 1,100 with an additional 100 in subsequent years? The historical number of patients is consistently variable, the numbers change. Also, is it safe to assume this contract will need 2 PACT teams before conclusion of the 5 years? Historical data does not present robust growth in Payson. If two PACTs are needed the contract can be modified to account for the growth.

41. There is 0.05 FTE requirement for the medical director and according to Directive 1406, the panel size for 1.0 FTE PCP is 1,200. Is it safe to assume that this clinic will need 2 providers, as the panel is almost at 1,200 and 0.05 would put the provider over 1.0? Yes

42. In the last pre-solicitation, there was a requirement of continuity of care for at least 3 months with current employees. Is this still a requirement in this solicitation? The solicitation contains FAR clause 52.237-3 Continuity of Services and 52.222-17, Nondisplacement of Qualified Workers. If not, the VA directive 1406 states that there is a reduced panel size for new providers or new PACTS, with panel size being 50% for the first 6 months and 75% up to a year. Is this a requirement? Reduction of panel is based on different factors, including the providers work history (VA or non VA), and the availability of providers for the patients to be moved to.

43. The government states that the current clinic meets the current space requirements in this solicitation. However, the current clinic does not have a separate waiting room for VA and private patients. In addition, can the group room be the same as the Telehealth room, as it is set-up currently? The current clinics does not meet the telehealth standard that the new clinic must meet requirements.

44. In section 4.7.10.1.10, it states the room needs to be 10”x10” for technological equipment, however the room is currently smaller then that, plus the server and equipment or less the 3”x3”. Does this room need to be expanded or does it only need to be big enough to access equipment? The room must meet the Performance Work Statement requirements.

45. The wages listed for the teamlet in section C.17 are listed based of federal minimums are different then the ones in WD-1577 for Arizona. Are the wages in C.17 to be used for the bid? The wage determination in Attachment Section D shall be used for bid.

46. Can the phlebotomist and Tele Health Tech be the same position to start the contract? Currently the VA picks up labs at noon, so it would only be a 0.5 FTE? Please see response to question 7.