36C25822R0050.pdf

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. DUNS: DUNS+4:

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. 2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 211

36C25822R0050 12-29-2021

Arcelia Medina 520-792-1450 X 4313 02-03-2022

1500 EST

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

X

621498

$22 Million

N/A

X

New Mexico VA Healthcare System 1501 San Pedro Drive, SE

Albuquerque NM 87108

NCO22 - Network Contracting 3601 S. 6th Avenue Tucson AZ 85723

This is accomplished through the Tungsten Network located at:

http://www.fsc.va.gov/einvoice.asp This is mandatory and the sole method for submitting invoices.

Purchase of contracted Community Based Outpatient Clinic (CBOC) services in Truth or Consequences, New Mexico in support of the New Mexico Veterans Administration Health Care System (NMVAHCS).

This requirement is being solicited under the authority of 38 USC 8153 and FAR Part 15.

Please reference Schedule of Services on page 5 and the Performance Work Statement on page 9.

Period of Performance will be for one (1) Base Year and nine (9) Twelve (12) month option years.

X 1

Trevor Hood

VA-VHA-RPOW-2022-271061

36C25822R0050

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 PERFORMANCE WORK STATEMENT (PWS)

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (JAN 2011)

C.4 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (JUN 2016)

C.5 52.216-18 ORDERING (AUG 2020)

C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.7 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.8 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.9 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) . 139

C.10 52.219-9 SMALL BUSINESS SUBCONTRACTING PLAN (SEP 2021)

C.11 52.223-99 ENSURING ADEQUATE COVID-19 SAFETY PROTOCOLS FOR

FEDERAL CONTRACTORS (OCT 2021) (DEVIATION)

C.12 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN

1997)

C.13 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.14 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.15 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM

REQUIREMENTS (DEC 2009)

C.16 VAAR 852.211-72 TECHNICAL INDUSTRY STANDARDS (NOV 2018)

C.17 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.18 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (OCT 2019)

C.19 VAAR 852.219-71 VA MENTOR-PROTÉGÉ PROGRAM (DEC 2009)

C.20 VAAR 852.219-72 EVALUATION FACTOR FOR PARTICIPATION IN THE VA

MENTOR-PROTÉGÉ PROGRAM (DEC 2009)

C.21 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE

C.22 SUBCONTRACTING COMMITMENTS MONITORING AND COMPLIANCE (JUL

2018) (DEVIATION)

C.23 VAAR 852.219-76 SUBCONTRACTING PLANS MONITORING AND

COMPLIANCE (JUL 2018)

C.24 VAAR 852.237-72 CRIME CONTROL ACT—REPORTING OF CHILD ABUSE

(OCT 2019)

C.25 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.26 MANDATORY WRITTEN DISCLOSURES

C.27 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 WAGE DETERMINATION

D.2 ATTACHMENT LISTING

SECTION E - SOLICITATION PROVISIONS

E.1 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL

ITEMS

E.2 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORATED

BY REFERENCE (JAN 2008)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.5 52.211-6 BRAND NAME OR EQUAL (AUG 1999)

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.222-5 CONSTRUCTION WAGE RATE REQUIREMENTS—SECONDARY SITE

OF THE WORK (MAY 2014)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.10 ADDENDUM TO 52.212-2 EVALUATION-COMMERCIAL ITEMS (OCT 2014) ... 193

E.11 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (FEB 2021)

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:

POC Name: _________________________ Title: ______________________________ Company Name: _____________________ Address: ___________________________

City: _______________________________ Email: _____________________________ Phone #: ___________________________

DUNS #: ___________________________

b. GOVERNMENT: Contracting Officer 36C262 / P: 505-256-2856 Department of Veterans Affairs, NCO22 - Network Contracting 3601 S. 6th Avenue, Tucson AZ 85723

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

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly

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.

This is accomplished through the Tungsten Network located at:

http://www.fsc.va.gov/einvoice.asp This is mandatory and the sole method for submitting invoices.

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

AMENDMENT NO DATE

Under the authority of Public Law 104-262, Title 38 U.S.C. 8153 the Contractor shall provide continuous delivery of primary and preventative medical care services for Veterans enrolled with the New Mexico Veterans Affairs Health Care System (hereinafter NMVAHCS) at the Contractor’s clinic facility (CBOC) in Truth or Consequences, New Mexico for all assigned patients in accordance with the terms and conditions stated herein, on behalf of the NMVAHCS located at 1501 San Pedro Drive SE, Albuquerque, New Mexico, 87108. The Contractor’s clinic (CBOC) site shall be in the Truth or Consequences, New Mexico city limits.

NMVAHCS shall be the primary Medical Center (Parent Facility) referring eligible Veteran beneficiaries to the Contracted Community Based Outpatient Clinic (CBOC). Services shall be for one (1) Base Year with nine (9) optional one-year renewal periods, to be exercised at the Government’s discretion. Services shall be provided in accordance with all terms and conditions of this contract.

Ordering Procedures: VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management Module (PCMM) software program used to track primary care clinic veteran rosters. Specific billable processes for contract includes determining veteran eligibility, enrollment eligibility, and patient vesting as further defined in the PWS.

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

Quantities are estimates ONLY. This is an ID/IQ contract. Stated contract minimum(s) are the only guaranteed quantities. The guaranteed minimum on any option period is only guaranteed if the option is exercised.

Place of Performance is Truth or Consequences, New Mexico.

Task Order Procedures: The resulting contract will have services ordered via Task Order.

Task Order Procedures are listed in FAR 52.216-18 “Ordering” and FAR 52.216-19 “Order Limitations.” Task Orders will be placed annually by the Administrative Contracting Officer.

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0.00 MO __________________ __________________

Contractor to provide all labor, personnel, staff, training and location for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum:725 Maximum: 1000

Contract Period: Base POP Begin: 10-01-2022 POP End: 09-30-2023

0001AA

835.00 EA __________________ __________________

Primary Care Services at capitation rates per member per month

(PMPM)

Estimated 835 patients

Contract Period: Base

0001AB

126.00 EA __________________ __________________

Primary Care Mental Health Integration Services: (PACT Expanded

Team Members for Mental Health). It is estimated that 12% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 126 patients

Contract Period: Base for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum:725 Maximum: 1000

Contract Period: Option 1 POP Begin: 10-01-2023

POP End: 09-30-2024

1001AA

854.00 EA __________________ __________________

(PMPM)

Estimated 854 patients

Contract Period: Option 1

1001AB

129.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 12% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 129 patients

Contract Period: Option 1 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 750 Maximum: 1025

Contract Period: Option 2 POP Begin: 10-01-2024 POP End: 09-30-2025

2001AA

874.00 EA __________________ __________________

(PMPM)

Estimated 874 patients

Contract Period: Option 2

2001AB

132.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 132 patients

Contract Period: Option 2 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 760 Maximum: 1050

Contract Period: Option 3 POP Begin: 10-01-2025 POP End: 09-30-2026

3001AA

894.00 EA __________________ __________________

(PMPM)

Estimated 894 patients

Contract Period: Option 3

3001AB

135.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 135 patients

Contract Period: Option 3 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 780 Maximum: 1100

Contract Period: Option 4 POP Begin: 10-01-2026

POP End: 09-30-2027

4001AA

915.00 EA __________________ __________________

(PMPM)

Estimated 915 patients

Contract Period: Option 4

4001AB

138.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 138 patients

Contract Period: Option 4 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 800 Maximum: 1100

Contract Period: Option 5 POP Begin: 10-01-2027 POP End: 09-30-2028

5001AA

936.00 EA __________________ __________________

(PMPM)

Estimated 936 patients

Contract Period: Option 5

5001AB

141.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in

PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 141 patients

Contract Period: Option 5 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 825 Maximum: 1125

Contract Period: Option 6 POP Begin: 10-01-2028 POP End: 09-30-2029

6001AA

957.00 EA __________________ __________________

(PMPM)

Estimated 957 patients

Contract Period: Option 6

6001AB

144.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 144 patients

Contract Period: Option 6 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 832 Maximum: 1150

Contract Period: Option 7

POP Begin: 10-01-2029 POP End: 09-30-2030

7001AA

979.00 EA __________________ __________________

(PMPM)

Estimated 979 patients

Contract Period: Option 7

7001AB

147.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 147 patients

Contract Period: Option 7 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 850 Maximum: 1175

Contract Period: Option 8 POP Begin: 10-01-2030 POP End: 09-30-2031

8001AA

1,002.00 EA __________________ __________________

(PMPM)

Estimated 1002 patients

Contract Period: Option 8

8001AB

151.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 151 patients

Contract Period: Option 8 for Primary Care Services at the Community Based Outpatient Clinic.

All services are to be provided in accordance with the Performance Work Statement (PWS) and all VA regulatory and directive guidance as listed.

Minimum: 870 Maximum: 1200 Contract Period: Option 9 POP Begin: 10-01-2031 POP End: 09-30-2032

9001AA

1,025.00 EA __________________ __________________

(PMPM)

Estimated 1025 patients

Contract Period: Option 9

9001AB

154.00 EA __________________ __________________

Team Members for Mental Health). It is estimated that 15% of the patient load will require Primary Care Mental Health Integration Services. All such encounters meeting the description of services in PWS Section 4.6.5.1 shall be invoiced against this SLIN at the established PMPM rate.

Estimated 154 patients

Contract Period: Option 9

GRAND TOTAL __________________

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL

1.1. SERVICES REQUIRED: The New Mexico VA Healthcare System (NMVAHCS) requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in Truth or Consequences, New Mexico, and the nearby vicinity.

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 on-site by the contractor. For every 8 hour day, no fewer than 6 clinical hours are scheduled for direct patient care.

1.2. PLACE OF PERFORMANCE: Within the city limits of Truth or Consequences, NM. This location is approximately 150 miles from NMVAHCS, the parent facility.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of the New Mexico VA Health Care System located at 1501 San Pedro DR SE Albuquerque, NM 87108.

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. ADPAC: Automated Data Processing Application Coordinator

1.5.8. AED: Automatic External Defibrillator

1.5.9. AIS: Automated Information Security

1.5.10. ANA: American Nurses Association

1.5.11. AOA: American Osteopathic Association

1.5.12. ARRT: American Registry of Radiologic Technology

1.5.13. ASC: Ambulatory Surgery Clinic

1.5.14. 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.

1.5.15. BAA: Business Associate Agreement

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

1.5.17. BLS: Basic Life Support

1.5.18. BOS: Bureau of Osteopathic Specialists

1.5.19. CAHEA: Committee on Allied Health Education and Accreditation

1.5.20. CAP: College of American Pathologists

1.5.21. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.22. CBO: VA Central Billing Office.

1.5.23. CBOC: Community Based Outpatient Clinic

1.5.24. CDC: Centers for Disease Control and Prevention

1.5.25. CEU: Certified Education Unit

1.5.26. CLIA: Clinical Laboratory Improvement Amendments

1.5.27. CME: Continuing Medical Education

1.5.28. CMS: Center for Medicare and Medicaid Services

1.5.29. CO: Contracting Officer

1.5.30. COPD: Chronic Obstructive Pulmonary Disease

1.5.31. COR: Contracting Officer’s Representative

1.5.32. COS: Chief of Staff

1.5.33. CPA: Collaborative Practice Agreement

1.5.34. CPS: Clinical Pharmacy Specialist

1.5.35. CPT: Current Procedural Terminology

1.5.36. CRNP: Certified Registered Nurse Practitioners

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

1.5.38. CPARS: Contractor Performance Assessment Reporting System

1.5.39. CVT: Clinical Video Telehealth

1.5.40. DICOM: Digital Image and Communication in Medicine

1.5.41. DIGMA: Drop in Group Medical Appointment

1.5.42. DRG: Diagnostic Related Group

1.5.43. DSS: Decision Support System

1.5.44. ECC Extended Care Center

1.5.45. 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.

1.5.46. EPRP: External Peer Review Program

1.5.47. FDA: Food and Drug Administration

1.5.48. FSMB: Federation of State Medical Boards

1.5.49. 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.

1.5.50. HHS: Department of Health and Human Services

1.5.51. HCFA: HealthCare Financing Administration

1.5.52. 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.

1.5.53. HT: Home Telehealth

1.5.54. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.55. ICD 10: International Classification of Diseases 10th edition

1.5.56. iMED: Software Used By VA For Informed Consent

1.5.57. INR: International Normalized Ratio

1.5.58. ISO: Information Security Officer

1.5.59. IRM: Information Resource Management

1.5.60. LIP: licensed independent practitioner

1.5.61. MCCR: Medical Care Cost Recovery

1.5.62. 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 psycho-education, 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.

1.5.63. MQSA: Mammography Quality Standards Act

1.5.64. MSN: Master of Science in Nursing

1.5.65. NCCPA: National Commission on Certification of Physician Assistants

1.5.66. NLN: National Leave for Nursing

1.5.67. NMVAHCS: New Mexico VA Healthcare System

1.5.68. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing

Improvement in Cardiac Surgical Program

1.5.69. OEHRM: Office of Electronic Health Record Modernization

1.5.70. OTC: Over the Counter

1.5.71. PA: Physician Assistant

1.5.72. PACS: Picture Archiving and Communications System

1.5.73. 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.

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

1.5.75. PCMH: Patient-Centered Medical Home

1.5.76. PCMM: Primary Care Management Module- a software program used to track

Primary Care Clinic Veteran rosters.

1.5.77. PCP: Primary Care Provider

1.5.78. Phar.D.: Doctor of Pharmacy

1.5.79. POC: Point of Care Testing

1.5.80. 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.

1.5.81. PCMHI: Primary Care-Mental Health Integration

1.5.82. PWS: Performance Work Statement

1.5.83. QAPI: Quality Assessment and Performance Improvement

1.5.84. QASP: Quality Assurance Surveillance Plan

1.5.85. RME: Reusable Medical Equipment

1.5.86. SOP (Clinical): Scope of Practice

1.5.87. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care.

Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.88. SFT: Store and Forward Telehealth

1.5.89. SMA: Shared Medical Appointments

1.5.90. SPC: Suicide Prevention Coordinator

1.5.91. SPD: Sterile Processing Division

1.5.92. SPE: Senior Procurement Executive

1.5.93. 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.

1.5.94. 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.

1.5.95. TJC: The Joint Commission

1.5.96. TIU: Text Integration Utility

1.5.97. TCT: Telehealth Clinical Technicians

1.5.98. VA: Veterans Affairs

1.5.99. VA EHR: VA electronic health record

1.5.100. VAMC: Veterans Affairs Medical Center

1.5.101. VetPro: A Federal Web-Based Credentialing Program For Healthcare Providers.

1.5.102. VHA: Veterans Health Administration

1.5.103. VVC: VA Video Connect

1.5.104. 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 located at:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430 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 (NMVAHCS will provide CPS services for this CBOC). 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: 835.

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. Contractors Physicians performing under this contract shall be Board Eligible 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. May also be credentialed and privileged 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 Handbook 5005, Appendix G2 located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 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. If the Physician Director supervises mid-level providers, some states may have additional requirements (such as this physician needs to be on-site to fulfill supervision requirements). Be sure to include any state-specific supervision requirements here and delete this instruction prior to submission.

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. If you require at least one of your PCPs to be a physician indicate that here. Delete this instruction prior to submission.

OPTION 1: Physician (MD): 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 Handbook 5005, Appendix G2 located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&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, telehealth, and telephone care visits during regular clinic hours, and collaborating with PACT staff to de1velop 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 a 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 in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA Handbook 5005-4, Appendix G6 located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&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, telehealth, 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 in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005-78 Appendix G8 Physician Assistant Qualification Standard located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&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, telehealth, 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 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 in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA Handbook 5005-4, Appendix G6 located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 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.

2.3.3. 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: 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 HANDBOOK 5005-3

APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE

QUALIFICATION STANDARD located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 .

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 aability 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. Staff will be assigned telehealth trainings in TMS by the Connected Care Section. Staff will receive face-to-face training once all trainings are completed in TMS.

OPTION 2: 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 HANDBOOK 5005-3

APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE

QUALIFICATION STANDARD located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 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 aability 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. Staff will be assigned telehealth training in TMS by the Connected Care Section. Staff will receive face-to-face training once all trainings are completed in TMS

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.