Draft Onsite Gastroenterology PWS QASP 11202020.pdf

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SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform onsite Gastroenterology Physician Services to eligible beneficiaries of the Department of Veterans Affairs

Medical Center, Cheyenne (hereinafter referred to as VAMC). The Contractor’s physician (s)’ care shall cover the range of Gastroenterology services as would be provided in a state-of-the-art health care medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by the American College of Physicians- Internal Medicine http://www.acponline.org/clinical_information/guidelines/ and American College of Gastroenterology Guidelines: http://gi.org/clinical-guidelines/.

Place of Performance: Services shall be provided on site, VAMC Cheyenne, 2360 East Pershing Blvd, Cheyenne WY, 82001

Pricing Instructions:

The offeror is instructed to edit the number of sub-clins to correspond with the number of key personnel submitted for the contract line item number (CLIN). Affiliate Offerors shall include the “title” of the personnel submitted. Other commercial health care Offerors shall identify by title/position or level of experience the key personnel submitted. Also, renumber SUB-CLINs if adding or removing Key Personnel.

The offeror is instructed to include all other than price and cost information supporting the proposed price as directed in Instructions to Offerors addendum to 52.212-1 and/or Section D- Contract Documents, Exhibits, or attachments, VA Directive 1663

The Contractor shall propose 6 key personnel to be credentialed and be available for scheduling to meet the requirements of the contract

Period of Performance: BASE YEAR: April 1 2021 to September 30 2021

0001 43235 Upper GI endoscopy diagnoisis 8 EA

0002 43236 Upper GI endoscopy diagnoisis 0 EA

0003 43239 Upper GI endoscopy biopsy 81 EA

0004 43244 Upper GI endoscopy/ligation 2 EA

0005 43245 EGD/W dilate gastric/duodenal strictr 1 EA

0007 43246 Place gastrostomy tube 0 EA

0008 43247 EGD w/pushing food 1 EA

0009 43248 Upper GI endoscopy/guide wire 13 EA

0010 43249 Esophagus endoscopy dilation 20 EA

0011 43251 Operative upper GI endoscopy 4 EA

0012 43255 Operative upper GI endoscopy 1 EA

0013 44389 Colo through stoma w/biopsy 0 EA

0014 44390 Colo thru stoma w/removal of foreign body 0 EA

CLIN

No.

SUB-

CLIN

Description Qty. Unit Unit Cost TotalAnnual Cost

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0015 44394 Colo thru stoma w/snare 0 EA

0016 45330 Diagnostic sigmoidoscopy 1 EA

0017 45331 Sigmoidoscopy and biopsy 3 EA

0018 45334 Sigmoidoscopy w/control of bleed 0 EA

0019 45338 Flex sig w/snare resection polyp 0 EA

0020 45378 Diagnostic colonoscopy 40 EA

0021 45379 Colonoscopy w/fb removal 3 EA

0022 45380 Colonoscopy and biopsy 113 EA

0023 45381 Colonoscopy,submucous inj. 14 EA

0024 45382 Colonoscopy, flexible 2 EA

0025 45385 Lesion removal colonoscopy 138 EA

0026 45388 Colonoscopy w/ablation 5 EA

0027 45399 Unlisted procedure colon (colo rigid or flex) 1 EA

0028 91110 Capsule endoscopy 1 EA

0029 00740 Anesthesia for procedures upper abdomen 0 EA

0030 00810 Anesthesia for procedures lower abdomen 0 EA

TOTAL FOR BASE Hours

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OPTION YEAR 1: _1 October 2021___ to 30 September 2022___

0001 43235 Upper GI endoscopy diagnoisis 8 EA

0002 43236 Upper GI endoscopy diagnoisis 0 EA

0003 43239 Upper GI endoscopy biopsy 81 EA

0004 43244 Upper GI endoscopy/ligation 2 EA

0005 43245 EGD/W dilate gastric/duodenal strictr 1 EA

0007 43246 Place gastrostomy tube 0 EA

0008 43247 EGD w/pushing food 1 EA

0009 43248 Upper GI endoscopy/guide wire 13 EA

0010 43249 Esophagus endoscopy dilation 20 EA

0011 43251 Operative upper GI endoscopy 4 EA

0012 43255 Operative upper GI endoscopy 1 EA

0013 44389 Colo through stoma w/biopsy 0 EA

0014 44390 Colo thru stoma w/removal of foreign body 0 EA

0015 44394 Colo thru stoma w/snare 0 EA

0016 45330 Diagnostic sigmoidoscopy 1 EA

0017 45331 Sigmoidoscopy and biopsy 3 EA

0018 45334 Sigmoidoscopy w/control of bleed 0 EA

0019 45338 Flex sig w/snare resection polyp 0 EA

0020 45378 Diagnostic colonoscopy 40 EA

0021 45379 Colonoscopy w/fb removal 3 EA

0022 45380 Colonoscopy and biopsy 113 EA

0023 45381 Colonoscopy,submucous inj. 14 EA

0024 45382 Colonoscopy, flexible 2 EA

0025 45385 Lesion removal colonoscopy 138 EA

0026 45388 Colonoscopy w/ablation 5 EA

0027 45399 Unlisted procedure colon (colo rigid or flex) 1 EA

0028 91110 Capsule endoscopy 1 EA

0029 00740 Anesthesia for procedures upper abdomen 0 EA

CLIN

No.

SUB-

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OPTION YEAR 2:1 October 2022_ to 30 September 2023___

0001 43235 Upper GI endoscopy diagnoisis 8 EA

0002 43236 Upper GI endoscopy diagnoisis 0 EA

0003 43239 Upper GI endoscopy biopsy 81 EA

0004 43244 Upper GI endoscopy/ligation 2 EA

0005 43245 EGD/W dilate gastric/duodenal strictr 1 EA

0007 43246 Place gastrostomy tube 0 EA

0008 43247 EGD w/pushing food 1 EA

0009 43248 Upper GI endoscopy/guide wire 13 EA

0010 43249 Esophagus endoscopy dilation 20 EA

0011 43251 Operative upper GI endoscopy 4 EA

0012 43255 Operative upper GI endoscopy 1 EA

0013 44389 Colo through stoma w/biopsy 0 EA

0014 44390 Colo thru stoma w/removal of foreign body 0 EA

0015 44394 Colo thru stoma w/snare 0 EA

0016 45330 Diagnostic sigmoidoscopy 1 EA

0017 45331 Sigmoidoscopy and biopsy 3 EA

0018 45334 Sigmoidoscopy w/control of bleed 0 EA

0019 45338 Flex sig w/snare resection polyp 0 EA

0020 45378 Diagnostic colonoscopy 40 EA

0021 45379 Colonoscopy w/fb removal 3 EA

0022 45380 Colonoscopy and biopsy 113 EA

0023 45381 Colonoscopy,submucous inj. 14 EA

0024 45382 Colonoscopy, flexible 2 EA

0025 45385 Lesion removal colonoscopy 138 EA

0026 45388 Colonoscopy w/ablation 5 EA

CLIN

No.

SUB-

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0027 45399 Unlisted procedure colon (colo rigid or flex) 1 EA

0028 91110 Capsule endoscopy 1 EA

0029 00740 Anesthesia for procedures upper abdomen 0 EA

OPTION YEAR 3: 1 October 2023_ to 30 September 2024__

0002 43236 Upper GI endoscopy diagnoisis 0 EA

0003 43239 Upper GI endoscopy biopsy 81 EA

0004 43244 Upper GI endoscopy/ligation 2 EA

0005 43245 EGD/W dilate gastric/duodenal strictr 1 EA

0007 43246 Place gastrostomy tube 0 EA

0008 43247 EGD w/pushing food 1 EA

0009 43248 Upper GI endoscopy/guide wire 13 EA

0010 43249 Esophagus endoscopy dilation 20 EA

0011 43251 Operative upper GI endoscopy 4 EA

0012 43255 Operative upper GI endoscopy 1 EA

0013 44389 Colo through stoma w/biopsy 0 EA

0014 44390 Colo thru stoma w/removal of foreign body 0 EA

0015 44394 Colo thru stoma w/snare 0 EA

0016 45330 Diagnostic sigmoidoscopy 1 EA

0017 45331 Sigmoidoscopy and biopsy 3 EA

0018 45334 Sigmoidoscopy w/control of bleed 0 EA

0019 45338 Flex sig w/snare resection polyp 0 EA

0020 45378 Diagnostic colonoscopy 40 EA

0021 45379 Colonoscopy w/fb removal 3 EA

0022 45380 Colonoscopy and biopsy 113 EA

0023 45381 Colonoscopy,submucous inj. 14 EA

CLIN

No.

SUB-

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0024 45382 Colonoscopy, flexible 2 EA

0025 45385 Lesion removal colonoscopy 138 EA

0026 45388 Colonoscopy w/ablation 5 EA

0027 45399 Unlisted procedure colon (colo rigid or flex) 1 EA

0028 91110 Capsule endoscopy 1 EA

0029 00740 Anesthesia for procedures upper abdomen 0 EA

OPTION YEAR 4: 1 October 2024_ to 30 September 2025__

0002 43236 Upper GI endoscopy diagnoisis 0 EA

0003 43239 Upper GI endoscopy biopsy 81 EA

0004 43244 Upper GI endoscopy/ligation 2 EA

0005 43245 EGD/W dilate gastric/duodenal strictr 1 EA

0007 43246 Place gastrostomy tube 0 EA

0008 43247 EGD w/pushing food 1 EA

0009 43248 Upper GI endoscopy/guide wire 13 EA

0010 43249 Esophagus endoscopy dilation 20 EA

0011 43251 Operative upper GI endoscopy 4 EA

0012 43255 Operative upper GI endoscopy 1 EA

0013 44389 Colo through stoma w/biopsy 0 EA

0014 44390 Colo thru stoma w/removal of foreign body 0 EA

0015 44394 Colo thru stoma w/snare 0 EA

0016 45330 Diagnostic sigmoidoscopy 1 EA

0017 45331 Sigmoidoscopy and biopsy 3 EA

0018 45334 Sigmoidoscopy w/control of bleed 0 EA

0019 45338 Flex sig w/snare resection polyp 0 EA

0020 45378 Diagnostic colonoscopy 40 EA

CLIN

No.

SUB-

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0021 45379 Colonoscopy w/fb removal 3 EA

0022 45380 Colonoscopy and biopsy 113 EA

0023 45381 Colonoscopy,submucous inj. 14 EA

0024 45382 Colonoscopy, flexible 2 EA

0025 45385 Lesion removal colonoscopy 138 EA

0026 45388 Colonoscopy w/ablation 5 EA

0027 45399 Unlisted procedure colon (colo rigid or flex) 1 EA

0028 91110 Capsule endoscopy 1 EA

0029 00740 Anesthesia for procedures upper abdomen 0 EA

Total for base performance period and all option years: $_________________________

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Performance Work Statement for Onsite Gastroenterology Physician Services

1. GENERAL:

1.1. Services Provided: The Contractor shall provide Board Certified /Board Eligible Gastroenterology Physician Services on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the _Cheyenne VAMC.

1.2. Place of Performance - Contractor shall furnish services at the Cheyenne VAMC, 2360 East Pershing Blvd, Cheyenne WY, 82001.

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority

1.4. Policy/Handbooks: the contractor shall be subject to the following policies, including any subsequent updates during the period of performance:

1.4.1. VHA Handbook 1100.17: National Practitioner Data Bank Reports https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.2. VHA Handbook 1100.18: Reporting And Responding To State Licensing Boards https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.3. VHA Handbook 1100.19: Credentialing and Privileging

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.4. VHA Directive 1192: Seasonal Influenza Prevention Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.5. VHA Directive 1220: Facility Procedure Complexity Designation Requirements to Perform Invasive Procedures In Any Clinical Setting https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8365

1.4.6. VA Directive 1663: Health Care Resources Contracting - Buying https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.7. VHA Handbook 1907.01: Health Information Management and Health Records https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.4.8. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8365 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

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1.5. Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.5.1. ABIM: American Board of Internal Medicine –Gastroenterology http://www.abim.org/specialty/gastroenterology.aspx

1.5.2. ACG: American College of Gastroenterology

1.5.3. ACP: American College of Physicians, Internal Medicine

1.5.4. ACGME: Accreditation Council for Graduate Medical Education

1.5.5. ACLS: Advanced Cardiac Life Support

1.5.6. AOD: Admitting Officer of the Day

1.5.7. BLS: Basic Life Support

1.5.8. CCNE:Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation

1.5.9. CDC: Centers for Disease Control and Prevention

1.5.10. CR: Contract Discrepancy Report

1.5.11. CEU: Certified Education Unit

1.5.12. CME: Continuing Medical Education

1.5.13. CMS: Centers for Medicare and Medicaid Services

1.5.14. Contracting Officer (CO) – The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.5.15. Contracting Officer’s Representative (COR) – A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.16. COS: Chief of Staff

1.5.17. CPARS: Contractor Performance Assessment Reporting System

1.5.18. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.5.19. DEA: Drug Enforcement Agency

1.5.20. ED: Emergency Department

1.5.21. EHR: Electronic Health Record - electronic health record system used by the VA

1.5.22. FSMB: Federation of State Medical Boards

1.5.23. HHS: Department of Health and Human Services

1.5.24. HIPAA: Health Insurance Portability and Accountability Act

1.5.25. HR: Human Resources

1.5.26. ISO: Information Security Officer

1.5.27. Medical Emergency - a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other http://www.abim.org/specialty/gastroenterology.aspx http://www.aacn.nche.edu/accreditation

Revision 07/16/2020 Page 10 of 34 serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.5.28. MOD: Medical Officer of the Day

1.5.29. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.5.30. NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

1.5.31. Non-Contract Provider - any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.5.32. NP: Nurse Practitioner

1.5.33. NPPES: National Plan and Provider Enumeration System

1.5.34. PA: Physician Assistant

1.5.35. PALS: Pediatric Advanced Life Support

1.5.36. POP: Period of Performance

1.5.37. PPD: Purified Protein Derivative

1.5.38. PWS: Performance Work Statement

1.5.39. Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

1.5.40. QA/QI: Quality Assurance/Quality Improvement

1.5.41. QM/PI: Quality Management/Performance Improvement

1.5.42. QASP: Quality Assurance Surveillance Plan

1.5.43. Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.5.44. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers.

1.5.45. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

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

1.5.47. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean the Cheyenne VA Medical Center.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License – The Contractor’s physician (s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any http://www.nlnac.org/

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State, Territory, or Commonwealth of the United States or the District of Columbia) when services are performed onsite on VA property.

All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician (s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2. Board Certification - Contractor’s physician (s) shall be Board Certified /Board Eligible by the American Board of Internal Medicine (ABIM) in Internal Medicine and Gastroenterology, and be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) or equivalency. All continuing education courses required for maintaining certification must be kept up to date at all times. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.1.3. Credentialing and Privileging –Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by the Contractor’s physician (s) prior to obtaining approval by the Cheyenne VAMC Professional Standards Board, Medical Executive Board and Medical Center Director.

2.1.3.1. If the Contractor’s physician (s) is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4. Technical Proficiency – The Contractor’s physician (s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed.

Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all Contractor’s physician (s) and the Contractor’s physician (s) shall be responsible for abiding by the Facility's Medical Staff By- Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements:

Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. Contractor’s physician (s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for Contractor’s physician (s).

2.1.6. Training (ACLS, BLS, EHR and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor’s physician(s) as required by the VA.Other training may become required. VA will communicate any changes to the training requirement to the contractor.

Training (The following training is mandatory per VHACO for Contracted Physicians)

Frequency (once a year, etc)

Annual Hours

Blood Administration:

Complications

Once a year

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Blood Administration:

Administration (all contract employees who administer blood components)

Once a year

Government Ethics Once a year

Hospice and Pallative Care for VA Clinicians

Once a year

Military Sexual Trauma (MST) for Medical Providers

Once a year

Moderate Sedation In-Service Training

Once a year

Prevention of Workplace Harassment/No Fear Act

Once a year

VHA MRI Safety Training Level 1 Training (all who enter MRI suites)

Once a year

VA Core Values Training (ICARE Recommitment)

Once a year

VA Privacy and Information Security Awareness and Rules of Behavior

Once a year

VHA Privacy and HIPAA Focused Training

Once a year

ACLS/BLS Once every two years

Patient Abuse Once a year

Patient Safety Once a year

Patient Rights Once a year

Prevention/Management of Disruptive Behavior/Violence Prevention Level I

Once a year

Suicide Prevention: Suicide Risk Management Training for Clinicians

Once a year

SUX Infection Control and Bood Borne Pathogens

Once a year

EHR Once a year

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VISTA Imaging Once a year

2.1.7. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year.

2.1.7.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative

Tuberculosis Skin Test (TST) or interferon-gamma release assays (IGRA) for all

Contractor’s physician (s) {This is applicable to all health care workers}. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results. The TST or IGRA testing shall be repeated annually.

2.1.7.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.1.7.3. VARICELLA: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.1.7.4. ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor physicians {This is applicable to all health care workers}.

2.1.7.5. INFLUENZA: Contractors shall provide proof that all Contractor physicians have received the annual Influenza vaccine unless it is contraindicated. If the Contractor physician has a medical contraindication to the vaccine they shall be required to wear a mask during the Influenza season . {This is applicable to all health care workers}.

2.1.7.6. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor’s physician

(s) {This is applicable to all health care workers}; provide their own Hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.1.7.7. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.8. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.9. DEA - Contractor shall provide copy of current DEA certificate.

2.1.10. Conflict of Interest: The Contractor and all Contractor’s physician (s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf

Revision 07/16/2020 Page 14 of 34 relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.1.11. Citizenship related Requirements:

2.1.11.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;

2.1.11.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States.

Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.11.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.11.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.11.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.1.12. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.12.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed Contractor’s physician (s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount http://oig.hhs.gov/exclusions/index.asp

Revision 07/16/2020 Page 15 of 34 claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.12.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non Personal Healthcare Services: The parties agree that the Contractor and all Contractor’s physician (s) shall not be considered VA employees for any purpose.

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Prohibition against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s).

2.6. Inherent Government Functions: Contractor and Contractor’s physician (s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.7. No Employee status: The Contractor shall be responsible for protecting Contractor’s physician

(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.7.1. Workers’ compensation

2.7.2. Professional liability insurance

2.7.3. Health examinations

2.7.4. Income tax withholding, and

2.7.5. Social security payments.

2.8. Tort Liability: The Federal Tort Claims Act does not cover Contractor or Contractor’s physician (s). When a Contractor or Contractor’s physician has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (Contractor’s physician (s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.9. Key Personnel:

2.9.1. The The VA Full Time Equivalency (FTE):FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays.

2.9.2. The number of Board Certified /Board Eligible Gastroenterology physicians required to be on site on a daily basis is 1as defined in paragraph Hours of Operation in this section.

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2.9.3. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event a scheduled physician is unable to complete an assigned shift, the contractor shall provide replacement physician coverage within 2 hours and notify the Contracting Office Representative (COR) at the Cheyenne VAMC immediately of the schedule change.

2.9.4. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 60 calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions.

2.9.4.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 45 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.9.4.2. For temporary substitutions where the key person shall not be reporting to work for three consecutive work days or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.9.4.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility.

Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s physician (s), s/he may request, without cause, immediate replacement of said Contractor’s physician (s) .The CO and COR shall deal with issues raised concerning Contractor’s physician (s) conduct. The final arbiter on questions of acceptability is the CO.

2.9.4.4. Contingency Plan: Because continuity of care is an essential part of VAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor’s physician (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. HOURS OF OPERATION

3.1. VA Business Hours:

Clinic or OR One day a week back up coverage only, not regularly scheduled

3.1.1. Patients must be seen by a Contractor’s physician (s) on-site at Cheyenne VAMc in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

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3.1.2. Contractor’s physician (s) shall be available and present in clinic during normal Cheyenne VAMC clinic hours, which will be established, and may be revised, as deemed appropriate for patient care by the Chief of Staff. Currently, normal clinic hours are 0730-1600

3.1.3. Off-hours Coverage: Not applicable

3.2. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs:

• New Year’s Day

• President’s Day

• Martin Luther King’s Birthday

• Memorial Day

• Independence Day

• Labor Day

• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any day specifically declared to be a national holiday.

3.3. Cancellations: COR must be advised a minimum of 45 days prior to notify patients of Cancelled services. Cancelation of scheduled services shall be avoided whenever possible.

3.3.1. Unless a state of emergency has been declared or clinics are otherwise cancelled by the VAMC, the Contractor shall be responsible for providing services.

4. CONTRACTOR RESPONSIBILITIES

4.1. Clinical Personnel Required: The Contractor shall provide Contractor’s physician (s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

4.1.1. Contractor’s physician (s) shall be responsible for signing in and out when in attendance.

Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices.

4.2. Standards of Care: The Contractor’s physician (s)’ care shall cover the range of Gastroenterology services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by:

4.2.1. American College of Gastroenterology (ACG) Guidelines: http://gi.org/clinical-guidelines/ .

4.2.2. American College of Physicians (ACP)- Internal Medicine:

http://www.acponline.org/clinical_information/guidelines/

4.2.3. The professional standards of the Joint Commission (TJC):

http://www.jointcommission.org/standards_information/standards.aspx

4.2.4. The standards of the American Hospital Association (AHA):

http://www.hpoe.org/resources?show=100&type=8 and;

4.2.5. The requirements contained in this PWS

4.3. MEDICAL RECORDS

http://gi.org/clinical-guidelines/ http://www.acponline.org/clinical_information/guidelines/ http://www.jointcommission.org/standards_information/standards.aspx http://www.hpoe.org/resources?show=100&type=8

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4.3.1. Authorities: Contractor’s physician (s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C.

552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to:

a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled ‘Patient Medical Records-VA’ (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

4.3.3. Disclosure: Contractor’s physician (s) may have access to patient medical records:

however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA ‘s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of VHA Handbook 1907.01, Health Information Management and Health Records and VHA Directive 1605.01, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 and all guidelines provided by the VAMC.

4.3.5. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility.

The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Dan Dial, 307-778-7372.

4.4. Direct Patient Care: 100 % of the time involved in direct patient care.

4.4.1. Per the qualification section of this PWS, the Contractor shall provide the following staff:

4.4.1.1. Board Certified /Board Eligible Gastroenterologist

http://www.rms.oit.va.gov/SOR_Records/24VA19.asp https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3233 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3233 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 https://vaww.va.gov/vaforms/va/pdf/VA3288.pdf https://vaww.va.gov/vaforms/va/pdf/VA3288.pdf https://vaww.va.gov/vaforms/medical/pdf/10-5345.pdf https://vaww.va.gov/vaforms/medical/pdf/10-5345.pdf

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4.4.2. Scope of Care: Contractor’s physician (s) (as appropriate and within scope of practice/privileging) shall be responsible for providing Gastroenterology care, including, but not limited to :

4.4.2.1. Clinic and Surgical Care: Contractor’s physician (s)) shall provide clinical Gastroenterology services. Contractor’s physician (s) shall be present on time for any scheduled clinics/surgeries as documented by physical presence in the clinic or operating room at the scheduled start time.

4.4.2.1.1. Operative Services: Contractor’s physician (s) shall provide comprehensive clinical gastroenterology services including the full range of colonoscopy and Esophagogastroduodenoscopy (EGD) procedures such as:

Colonoscopy

Colonoscopy via colostomy

Colonoscopy w/biopsy(ies)

Colonoscopy w/ablation of tumor/polyp/lesion

Colonoscopy w/removal of tumor/polyp/lesion by hot forcep

Colonoscopy w/removal of tumor/polyp/lesion by snare technique

Colonoscopy w/out biopsy

Colonoscopy w/ submucosal

Esophagogastroduodenoscopy (EGD)

EGD diagnostic

EGD w/biopsy(ies)

EGD w/removal of tumor/polyp/lesion by hot forcep

EGD w/removal of tumor/polyp/lesion by snare technique

4.4.2.1.2. Contractor’s physician (s) shall provide consultative services at the patient’s bedside if the patient is not ambulatory and in the clinic setting if the patient is able to report to the outpatient clinic. Procedures shall be scheduled for completion within 30 days of the date of the consult.

4.4.2.2. Medications: Contractor’s physician(s) shall follow all established medication policies and procedures. No sample medications shall be provided to patients.

4.4.2.3. Discharge education: Contractor’s physician(s) shall provide discharge education and follow up instructions that are coordinated with the next care setting for all Gastroenterology clinical or surgical patients.

4.4.3. ADMINISTRATIVE: estimated 0% of time not involved in direct patient care

4.4.3.1. Quality Improvement Meetings: The Contractor’s physician (s) shall participate in continuous quality improvement activities and meetings with committee participation as required by the VAMC Chief of Service, Chief of Staff, or designee.

Meeting Frequency (once a year, etc.)

Annual Hours

N/A - -

4.4.3.2. Staff Meetings: The contractor’s physician (s) shall attend staff meetings as required by the VAMC Chief of Service, Chief of Staff, or designee. Contractor to communicate

Revision 07/16/2020 Page 20 of 34 with COR on this requirement and report any conflicts that may interfere with compliance with this requirement.

Meeting Frequency (once a year, etc.)

Annual Hours

N/A

4.4.3.3. QA/QI documentation: The contractor’s physician (s) shall complete the appropriate QM/PI documentation pertaining to all procedures, complications and outcome of examinations.

4.4.3.4. Patient Safety Compliance and Reporting: Contractor’s physician (s) shall follow all established patient safety and infection control standards of care. Contractor’s physician (s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to the COR VA Safety Policy. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and submit to the COR the Patient Safety Report, following up with COR as required or requested.

4.5. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY

IMPROVEMENT(QI)

4.5.1. Quality Management/Quality Assurance Surveillance: Contractor’s physician(s) shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of medical records, and Peer Reviews. Methods of Surveillance: Focused Provider Practice Evaluation (FPPE) and Ongoing Provider Practice Evaluation (OPPE).

Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.5.2. Patient Complaints: The CO will resolve complaints concerning Contractor’s physician (s) relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that The Contractor’s physician (s) is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.5.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives.

Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

4.5.4. Performance Standards:.

4.5.4.1. Measure: Provider Quality Performance

Performance Requirement:

Standard: OPPE documentation for all (100%) staff providing services under the contract. All staff (100%) meet Standards.

Acceptable Quality Level: 95%meet Standards

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