McCurtain CBOC QA 05162024.pdf

1. QUESTION: In the Prescription Fulfillment paragraph 4.6.4.1 on page 43 of the solicitation it states that the Contractor will provide all medication, including any necessary vaccines that are to be administered to patients in the clinic. Will the Vaccines be provided to the clinic at the cost of the Contractor or the VA?

Government Response: Medications and Vaccines will be provided by the Contractor.

2. QUESTION: If the cost of vaccines discussed in question 1 above are the responsibility of the contractor, please confirm that the following list of Vaccines are the responsibility of the contractor?

TDAP

Pneumovax 23 Prevnar 13

TD

Flu, High dose flu Shingrix Twinrix (Hep A&B) Hep A Hep B

HPV

Depo

Government Response: A listing of medications and vaccines is incorporated into the RFP as an attachment. D.26 Medications Vaccine Listing

3. QUESTION: If the cost of vaccines is the responsibility of the contractor…. Are there any additional

Vaccines required to be supplied by the contractor other than those listed in question 2 above?

4. QUESTION: If the cost of vaccines is the responsibility of the contractor…. What is the number of

Vaccines, by type as listed in question 2 and any additional Vaccines added by the government pursuant to question 3, that was provided to the McCurtain CBOC Enrolled Veterans in the last 12 months?

5. QUESTION: Pursuant to the Prescription Fulfillment paragraph 4.6.4.1 on page 43 of the solicitation, please provide a list of Medications the government expects the contractor to dispense (at the cost of the Contractor) from the clinic that would not be a routine medication dispensed through the VA or an urgent/emergent medication dispensed through the VA contracted local pharmacy.

6. QUESTION: In paragraph 2.6.1 Diagnostic Radiologic Technologist it states: The contractor shall provide service. Please provide a detailed list of services the VA requires the Contractor to provide on-site “in-clinic.

Government Response: The Contractor shall make referrals for Radiological services to the VA in the electronic health record. PWS Para 2.6.1 Diagnostic Radiologic Technologist paragraph updated to reflect.

7. QUESTION: In paragraph 4.6.5.1 Radiology Services it states “The Contractor is responsible for providing Radiology Services. Please confirm the VA is requestion in clinic on-site x-ray to be provided by the Contractor.

electronic health record. PWS Para 4.6.5.1 updated to reflect.

8. QUESTION: In the Laboratory Services paragraph 4.6.5.3 on page 50 it states that the contractor is to send specimens to the VA Core Laboratory. Please provide the specific address for the VA Core

Laboratory.

Government Response: Jack C. Montgomery VA Medical Center 1011 Honor Heights Drive Muskogee, OK 74401-1318. PWS paragraph 4.6.5.3. updated to reflect.

9. QUESTION: In the Laboratory Services paragraph 4.6.5.3 on page 50 it states that the contractor is to send specimens to the VA Core Laboratory. Please the time the specimens need to arrive at the VA

Core Laboratory.

Government Response: Between 5:30pm and 6:00pm Central Time. PWS paragraph 4.6.5.3.

updated to reflect.

10. QUESTION: Does the current CBOC facility meet the new contract PACT Space Module Design Guide requirements as stated in the Space Requirements paragraph 4.9 on page 82 of the solicitation?

Government Response: Reference PWS Para 4.9.1 Contractor shall provide space that meets the standards outlined in the PACT Space Module Designed Guide.

11. QUESTION: Will the Contractors proposed space be required to meet the on-stage/off-stage design with the PACT Zone?

Government Response: Yes

12. QUESTION: How many VA staffed personnel will be providing services at the McCurtain CBOC?

Please list by job title and number of days per month.

Government Response: There will not be VA staffed personnel on site.

13. QUESTION: How many offices will be needed at the McCurtain CBOC for the VA provided staff (by position/function) identified in question 12.

Government Response: There will not be VA staffed personnel on site.

14. QUESTION: How many veterans using the McCurtain CBOC are currently on the Primary Care billable roster?

Government Response: As of 4/1/2024, there are 959 Veterans on the active panel and 23 pending their vesting visit.

15. QUESTION: Please provide the most recent Active Panel List (VSSC report) for the McCurtain CBOC

(no older than as of January 2024).

16. QUESTION: Please provide the most recent VSSC Patient Aligned Care Team COMPASS report for the

McCurtain CBOC. No older than as of January 2024.

17. QUESTION: Reference sections B.2 and 2.1, pages 8 and 16. In the Schedule of Services base year, the estimated quantity is 1000, and in the Minimum Patient Aligned Care Team (PACT) Staffing Requirements it states the total estimated patients enrolled/assigned to site: 980, which estimated quantity is correct?

Government Response: The estimated quantity used for the base year is 1,000 patients. The number of patients enrolled at the time is 980 patients.

18. QUESTION: Reference section 2 page 16. Is a full-time Clinic Manager/Administrator required to oversee the clinic operations and if so, would the VA prefer they be a Registered Nurse?

Government Response: Reference PWS Section 2 which outlines the required clerical and clinical support required, including one Physician Director at 0.05FTE per PACT; one PCP per 1200 active patients per full time physician and 900 active patients per full time midlevel provider; one Registered Nurse Care Manager per 1.0 FTE PCP; one Clinical Associate per 1.0FTE PCP; one Administrative Associate per 1.0 FTE PCP; one Licensed Clinical Social worker at 1.0FTE per 2 PACTs;

one Phlebotomist/Laboratory Technician per 2 PACTs; and one Telehealth Clinical Technician per estimated 5,000 patients.

19. QUESTION: Reference section 2.6.1 page 22. Diagnostic Radiologic Technologist: The Contractor shall provide service. Radiology staffing shall be per the machine types and demands of the facility for each Radiologic procedure/modality, i.e. CT, MRI, US, Mammography, X-ray, etc.

Reference section 4.6.5.1 page 49. The Contractor is responsible for providing Radiology services. If contractor makes referral for services at Veterans request to EOVAHCS, the contractor will be responsible for entering requests for radiology procedures into the VA EHR.

Is the Contractor required to provide radiology services onsite or is it acceptable to the government if the Contractor sets up an arrangement to have these services provided locally with a radiology practice?

Government Response: The Contractor shall make referrals for Radiological services to the VA in the Electronic Health Record. PWS Para 2.6.1 Diagnostic Radiologic Technologist paragraph updated to

20. QUESTION: Reference section 2.8 page 28. Contractor to provide 1.0 TCT per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN).

Does the VA require 1.0 FTE TCT to provide telehealth services in the McCurtain County CBOC?

Government Response: Reference PWS Para 2.8 TELEHEALTH SERVICES CLINICAL STAFF: The following telehealth staffing shall be provided by the Contractor. Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services). The approximate number of patients is 1,000 therefore 1.0 FTE is not required. However, a TCT is required.

21. QUESTION: Reference section 4.6.3.4.3 page 41. The Contractor must develop a plan to assign women preferentially to the designated Women’s Health PCPs at the contracted site. All outpatient sites of care must have at least two WH-PCPs. (Because of small populations of women at most CBOCs, CBOC WH-PCPs will usually have mixed gender panels). It is necessary to have two WH-PCPs to provide full coverage for women during sick leave and vacation. All newly enrolling women should be assigned to a Women’s Health PCP. Women in panels of non-women’s health PCPs should be offered the opportunity to request transfer to a Women’s Health PCP at the same site of care. It is recommended that women Veterans be clustered in teams where the provider and all team members have experience, knowledge and established systems of care to provide equitable, high-quality care to women Veterans. It is recommended that Women’s Health PACT teamlets are assigned a panel size of at least 100 women Veterans, thus allowing all teamlet members to care for a volume of patients to support maintenance of expertise in the care of women.

With an estimated enrollment of 1000, are two WH PCP required for staffing the McCurtain County

CBOC?

Government Response: It is necessary to have two WH-PCPs to provide full coverage for women during WH-PCP sick leave and vacation. PWS para 4.6.3.4.3 updated to reflect.

22. QUESTION: Reference section 4.6.3.4.6 page 42. Emergency contraception (e.g., Levonorgestrel (Plan

B) etc.) must be available to all women Veteran patients in a timely manner (same day of their appointment) even if a provider has requested to opt out from providing emergency contraception to the patient because of a Rights of Conscience (ROC) Claim.

Who is to provide the Levonorgestrel, the VA, or the Contractor?

Government Response: The Contractor will be responsible for providing Levonorgestrel.

23. QUESTION: Reference section 4.6.4.1 page 43. The Contractor will provide all medications that are to be administered to patients in the clinic including any necessary vaccines.

Will the VA provide a list of all medications and vaccines that are to be provided by the Contractor and the amounts that have been administered in the clinic?

Will the contractor be responsible for providing COVID-19 vaccine?

attachment. D.26 Medications Vaccine Listing. COVID-19 Vaccine will be provided by the contractor.

24. QUESTION: Reference section 4.6.4.3.1 page 48. The contractor shall provide space as detailed in space requirements, supporting staffing, and ancillary support to allow for the provision of clinical pharmacy services. The support services shall be consistent for the CPS as with other prescribers for each Contractor's scheduled clinic

Reference section 4.6.6.5 page 58. Mental Health Support Services: The Contractor shall provide the following clerical support services for VA tele-health providers.

Reference section 4.6.8.5 page 69-70. Telepharmacy Services: The Contractor shall provide clerical support, including scheduling, and ancillary support for VA telepharmacy services as appropriate.

The support services should be consistent for each scheduled clinic to include but not limited to intake vitals by LVN/LPN, Unlicensed Assistive Personnel (health tech or nursing assistant), or similar, downloading of blood sugar from meters, POC INR testing and downloading, teaching patients how to use BP monitors at home, calling patients for lab reminders, scheduling patient visits and contacting patients who no-show for rescheduling.

How many contracted clerical and clinical support staff are required for all VA supported services on-site?

Government Response: Reference PWS Para 2 which outlines the required clerical and clinical support required, including one Physician Director at 0.05FTE per PACT; one PCP per 1200 active patients per full time physician and 900 active patients per full time midlevel provider; one

Registered Nurse Care Manager per 1.0FTE PCP; one Clinical Associate per 1.0FTE PCP; one

Administrative Associate per 1.0FTE PCP; one Licensed Clinical Social worker at 1.0FTE per 2 PACTs;

one Phlebotomist/Laboratory Technician per 2 PACTs; and one Telehealth Clinical Technician at

1.0FTE per estimated 5,000 patients.

25. QUESTION: Reference section 4.6.5.4.3 page 51. The laboratory tests designated as waived under the Clinical Laboratory Improvement Amendments of 1988 and all amendments (CLIA), 42 CFR 493.15(b) and 493.15(c). In the CLIA regulations, waived tests were defined as simple laboratory examinations and procedures that are cleared by the FDA for home use; employ methodologies that are so simple and accurate as to render the likelihood of erroneous results negligible; or pose no reasonable risk of harm to the patient if the test is performed incorrectly. To perform these tests, The Contractor must apply for and maintain a current VA CLIA Certificate. The application for the VA CLIA Certificate, obtained from the Chief Medical Technologist, is sent to the National Enforcement Office who issues the CLIA Certificate.

Reference 4.6.5.4.4 section 51. In addition, the Contractor must apply for and maintain an Oklahoma Department of Health Level II Clinical Laboratory Permit. In the performance of these tests, the Contractor must comply with the terms and requirements of the Ancillary Testing Policy, CM 113-14. The Ancillary Testing Policy is included in Section D (attachments).

RFP asks to get the CLIA Certificate through VA, is the intent for more VA lab oversight?

Are there lab draws outside of the CLIA waiver that would require the Oklahoma Department of Health Level II permit?

Government Response: Reference PWS Para 4.6.5.4.4 The Contractor must apply for and maintain a current VA CLIA Certificate. Yes, this provides more VA Lab oversight.

Reference para 4.6.5.4.5. The Contractor does not have to maintain an Oklahoma Department of Health Level II Clinical Laboratory Permit. PWS para 4.6.5.4.5 updated to NA.

26. QUESTION: Reference section 4.9.1 page 82. Podiatry services shall be provided by the Contractor via a VA referral for services.

Reference section 4.9.1 page 83. Primary care areas will include an accessible patient height & weight station; two (2) general patient care rooms; multi-use/bariatric patient care room; women veteran patient care room with a private women veteran patient toilet; and podiatry patient care room.

Will the Contractor provide podiatry services via telehealth or refer the patient to the VA?

Government Response: Reference PWS Para 4.6.7.1.1 Podiatry services shall be provided by the Contractor via a VA referral for services in the EHR. PWS Para 4.6.7.1.1 updated to reflect.

PWS Para 4.9.1 updated removing podiatry patient care room.

27. QUESTION: Reference section 4.9.1 page 82. The Nurse’s Station will include four (4) clinical staff workstations; a hoteling workstation; huddle space; point of use medication alcove; team copy/supply alcove; medical equipment storage room; sterile supplies storage room; clinical supplies storage room; full gas cylinder storage room; empty gas cylinder storage room; staff lactation room; universal staff toilet; universal staff toilet/shower; and staff personal property locker alcove.

Is the nurse's station for four (4) clinical staff workstations the same thing as the PACT Space Module Design Guide's PACT Teamlet work area with four (4) clinical staff workstations?

Or is this in addition to the PACT Teamlet work area?

What is a hoteling workstation?

Is a universal staff shower required in the McCurtain County CBOC?

Government Response: Reference PWS para 4.9.1 Yes, the nurse's station for four (4) clinical staff workstations is the PACT Space Module Design Guide's PACT Teamlet work area with four (4) clinical staff workstations. Hoteling workstation is as space that can be utilized by multiple employees when needed. PWS para 4.9.1 updated to remove universal staff toilet/shower.

28. QUESTION: Reference section 4.9.1 page 82. Will the government please confirm if 8 data ports are required per room?

Government Response: The PWS does not identify number of data points required per room. As guidance, IT requires a minimum of three data ports. Some spaces may need more, depending on their purpose/how many pieces of equipment need connected to the network.

29. QUESTION: Reference section 4.9.1 page 83. Tele-health will require four (4) rooms. One (1) teleretinal imaging patient care room; one (1) telehealth patient care room; and two (2) counseling patient care rooms. Consult Rooms will be three spaces. Two (2) consult patient care rooms; and one interview patient care room.

Are the 3 spaces for consult rooms separate from the 4 tele-health rooms which includes two counseling patient care rooms?

Government Response: Yes, they are separate.

30. QUESTION: Reference section 4.9.5.2.3 page 84. 4.9 PACT space standards are found in the PACT

Space Module Design.

Will the Government please confirm if VA will provide the phone circuit and physical phones?

Government Response: Yes, the VA Medical Center will provide phone circuits and physical phones.

Reference PWS para 4.11.

31. QUESTION: Reference section 4.11.1.2 page 91. The installation and maintenance of the network cabling infrastructure within the facility including all cabling located inside the walls and plenum space of the structure, cabling racks, network equipment racks, patch panels, wall ports, extension cabling from the demarc to the communications closet, and a secure communications closet space to house the networking equipment. Cabling infrastructure and closet design shall adhere to ANSI/ITA-568, ISO/IEC 11801, and VA EHRM standards.

Will the government please confirm if CAT 6 wiring is preferred and not CAT 6A?

Government Response: Reference PWS para 4.11.2.6.7 updated to read: “Infrastructure installer should install CAT6A patch panels and connectors in the rack”

32. QUESTION: Reference section 4.11.2.5. page 93. Power requirements

Will the government please confirm the Power Requirements and if two 20-amp dedicated on each of the two racks is acceptable?

Government Response: Reference PWS para 4.11.2.5 Power requirements.

33. QUESTION: Reference section 4.11.2.6.6 page 93. Racks: both racks will have 2 shelves on the bottom installed to hold IT computers.

Will the government please confirm if shelves are required?

Government Response: Reference Para 4.11.2.6.6 Racks requirement per the PWS.

34. QUESTION: Reference section 4.11.2.6.7 page 93. Racks: infrastructure installer should install Leviton

CAT6 patch panels and connectors in the rack.

Could the government please confirm if a comparable brand to Leviton is suffice.

Government Response: Reference PWS para 4.1.2.6.7 updated to read “Infrastructure installer should install CAT6A patch panels and connectors in the rack”

35. QUESTION: Reference section 6.1.2 page 106. The Contractor shall have 120 days from contract award to commencement of the provision of medical care to local Veterans.

Would the VA consider 180 days from contract award to commencement of the provision of medical care to local Veterans due to the national shortage of building supplies?

Government Response: PWS para 6.1.2. updated to reflect: The Contractor shall have 180 calendar days from contract award to commencement of the provision of medical care to local Veterans.

However, the Contractor must have all start-up requirements in place and ready to commence operation NLT 173 calendar days from contract award.

36. QUESTION: Factor B - Past Performance. Offerors are encouraged to include a narrative, limited to no more than 2 pages per contract identified, in the Past Performance References attachment that demonstrates satisfactory performance under the referenced contract.

Quality and Satisfaction Rating for Contracts Completed in the Past Three (3) Years. Provide any information currently available (letters, metrics, customer surveys, independent surveys, etc.) which demonstrates customer satisfaction with overall job performance and quality for same or similar type contracts.

Given that one survey could be more than two pages, will the VA allow the bidder to provide letters, customer surveys, independent surveys, etc. as an attachment and not count towards the 2-page limit per contract in the Past Performance?

Government Response: Past Performance page limit shall not exceed 7 pages. The letters, metrics, customer surveys will not be counted towards the 7-page limit. Any information that exceeds this page limit will not be reviewed.

37. QUESTION: Will the VA please provide the McCurtain County CBOC historical billed enrollment for the past five years?

Government Response:

Average number of Veterans on billable roster are as follows:

FY22-914

FY23-950

FY24(10/2023 to 02/2024)-960

38. QUESTION: Does the current McCurtain County CBOC facility meet the PACT Space Module Design guidelines? If yes, will the VA make a cost leveling adjustment to ensure competitive bidding?

Government Response: Please reference PWS Para 4.9.1 Contractor shall provide space that meets the standards outlined in the PACT Space Module Designed Guide.

39. QUESTION: Does the current McCurtain County CBOC facility meet the space requirements for this

RFP? If not, will the location be "grandfathered in" and available for rebid "as is"?

40. QUESTION: Please confirm if the Contract is to provide the Licensed Clinical Social Worker staffing required in paragraph 2.2.3

Government Response: Yes, Reference PWS Para 2.3.3

41. QUESTION: Please clarify the requirement for radiology services. Paragraph 4.6.5.1 says “The

Contractor is responsible for providing Radiology services. If contractor makes referral for services at Veterans request to EOVAHCS, the contractor will be responsible for entering requests for radiology procedures into the VA EHR.” Paragraph 2.6.2 requires the provision of a Diagnostic Radiologic Technologist. We do not see any requirements related to radiology in the Space Requirements section 4.9. We note that provision of radiology services on site will be costly for a 1000 patient clinic.

a. May the contract refer all radiology services to EOVAHCS?

b. If yes, please confirm the contractor does not need to staff a Diagnostic Radiologic Technologist

Government Response: The Contractor shall make referrals for Radiological services to the VA in the

42. QUESTION: 4.9.1 under Space Requirements.

a. Is the “Nurse’s Station” listed in this paragraph the same thing as the PACT Teamwork Zone required by the PACT Space Module Design Guide?

b. Would the VA consider removing the requirement for a “podiatry patient care room” as these services are not offered at the CBOC?

c. Please clarify the total number of “primary care areas” required. For example, can the “women veteran patient care room” double as a “multi-use/bariatric patient care room”?

d. Please confirm that three (3) consult rooms are required, as this amount seems excessive for a 1000 patient clinic.

e. May the “shared group/multifunction room” also be used as the “staff conference room”? With a PACT Teamwork Zone and group room, it seems excessive to have additional staff meeting space for a 1000 patient clinic.

Government Response: Reference PWS Para 4.9.1 Space Requirements.

a) Yes, the Nurse’s station is the PACT Teamwork Zone required by the PACT Space Module Design Guide

b) podiatry patient care room is removed

c) Yes, The Primary Care area includes a height/weight station; two general patient care rooms; one multi-use/bariatric care room; women's health care room with bathroom. Yes, the women's health room can double as a multi-use/bariatric patient care room if it meets the parameters for both rooms.

d) Three consult rooms are required per space requirements; the consult rooms can be dual-purpose rooms.

e) Yes, the shared group/multifunction room can be dual purpose.

43. QUESTION: May candidate transcripts be provided post-award? Transcripts can take weeks to obtain, and this timeline is beyond the control of the Contractor.

Government Response: Unofficial Transcripts can be submitted with the offer, however after award the official transcript will be required.

44. QUESTION: The candidate documents list on page 187 to be submitted with the proposal provide an advantage to the incumbent. This is because many qualified candidates are not willing to provide personal documentation until there is a live opening. Would the VA consider removing requirements to submit candidate documents with the initial proposal submission?

Government Response: Each offeror must submit a complete proposal consisting of: Technical Proposal, Past Performance, and Price. Technical Capability page limit shall not exceed 45 pages.

The Cover sheet, Table of Content, Floor Plans and Drawings, Certification(s), Transcript(s), Certificate(s), License(s), and Curriculum Vitae (s) will not be counted towards the Technical Capability page limit. Any information that exceeds this page limit will not be reviewed.

45. QUESTION: Will the VA provide the lab specimen tubes?

Government Response: The contractor is responsible for supplying lab specimen tubes.

46. QUESTION: What is the cost of the GE5500 EKG machine?

Government Response: Reference PWS para 4.6.5.2 EKG machine will be provided by the VA at no cost to the Contractor. PWS updated to reflect “ This will be supplied by VA at no cost to the contractor.”

47. QUESTION: Paragraph 4.6.3.4.7, would the VA be willing to provide Well Women’s Health Services

Supplies, including Thin Prep Pap Test, Pap Smear Collection Kits, Cytobrushes, as well as the IFOBT kits? In our experience, these supplies are difficult for the contractor to procure.

Government Response: The Contractor is responsible for purchasing supplies.

48. QUESTION: Will the government grant 180 calendar day from contract award to commencement of services under the RFP?

Government Response: PWS para 6.1.2. updated to ”The Contractor shall have 180 calendar days from contract award to commencement of the provision of medical care to local Veterans. However, the Contractor must have all start-up requirements in place and ready to commence operation NLT 173 calendar days from contract award.”

49. QUESTION: What is the most current billable roster?

Government Response: Billable roster for February 2024 was 955.

50. QUESTION: Will the VA please provide the historical enrollment for the past five years?

Government Response:

Average number of Veterans enrolled at McCurtain County are as follows:

FY22-914

FY23-950

FY24(10/2023 to 02/2024)-960

51. QUESTION: Does the current space meet the contract requirements?

52. QUESTION Will the VA be supplying the telephones, fax, scanners, and printers for the CBOC?

Government Response: Yes, Reference PWS para 4.11.

53. QUESTION: Will the VA provide the “thin-prep” solution for the female pap exams??

Government Response: The Contractor is responsible for purchasing supplies.

54. QUESTION: Will the VA provide a list of all medications and vaccines that are to be provided by the

Contractor and the amounts that have been administered in the clinic?

55. QUESTION: Will the Government please confirm if VA will provide the phone circuit and physical phones?

56. QUESTION: Please provide a Microsoft Word version of the solicitation document.

Government Response: An excel version of the schedule will be posted.

57. QUESTION: How many days should Offerors hold their prices firm?

Government Response: General Instructions for Proposal Submissions. a. Period of Acceptance of Offers. FAR 52.212-1(c) is hereby modified by this addendum as follows: The offeror agrees to hold prices in its offer firm for at least one hundred eighty (180) calendar days from the date specified for the receipt of offers (SF 1449, block 8).

58. QUESTION: Reference section 4.6.1.1.1.1. PACT Trainings page 33. “PACT 100 is offered as 8-1 hour interactive live virtual trainings or TMS on-demand courses.” Please confirm training will occur during normal business hours.

Government Response: Training occurs during normal business hours.

59. QUESTION: Reference section B.2 Schedule of Services page 7. Please provide current enrollment/patients at the McCurtain County CBOC.

60. QUESTION: Reference section E.2.f Addendum to FAR 52.212-1 page 172. States “Offerors are instructed to provide Davis Bacon Rates for proposed Patient Aligned Care Team (PACT) Design Buildouts IAW DBA rates for the McCurtain County, Oklahoma.” Please confirm that if PACT Design Buildouts are not required by the offeror, that no DBA rates need to be provided.

Government Response: Reference PWS para 4.9 Space Requirements as it pertains to PACT Design about Davis Bacon Act.

61. QUESTION: Reference section E.2.f Addendum to FAR 52.212-1 page 172. States “Offerors are instructed to provide Davis Bacon Rates for proposed Patient Aligned Care Team (PACT) Design Buildouts IAW DBA rates for the McCurtain County, Oklahoma.” Will the Government please explain what they are requesting for “DBA rates” – is this a budget from a construction company utilizing DBA rates, or a copy of the applicable Davis Bacon rates for the McCurtain County, OK, area?

62. QUESTION: Reference section E.2.f Addendum to FAR 52.212-1 page 172. If an offeror is required to provide Davis Bacon rates for proposed PACT Design buildouts, which volume should that information be provided?

63. QUESTION: Reference section E.2.f Addendum to FAR 52.212-1 page 172. We kindly request that

Offerors be allowed to include an Executive Summary outside of the 45 page technical proposal limitation so we can adequately present our team, summary of our approach, and the benefits to the McCurtain County CBOC.

Government Response: Each offeror must submit a complete proposal consisting of: Technical Proposal, Past Performance, and Price. Technical Capability page limit shall not exceed 45 pages.

The Cover sheet, Table of Content, Floor Plans and Drawings, Certification(s), Transcript(s), Certificate(s), License(s), and Curriculum Vitae (s) will not be counted towards the Technical Capability page limit. Any information that exceeds this page limit will not be reviewed.

64. QUESTION: Reference section B.3 PWS 2.6.1 page 22. 2.6.1 DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: The Contractor shall provide service. Radiology staffing shall be per the machine types and demands of the facility for each Radiologic procedure/ modality, i.e. CT, MRI, US, MAMMOGRAPHY, X-ray, etc. Radiologist staffing is based upon the number of exams and type performed in the typical 8-hour day. Suggested appointment length for MRI, CT, and ultrasound exams is 30 minutes.

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

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care.

Q. Please clarify if Radiology is mandated onsite or can be referred to the community.

reflect.

65. QUESTION: Reference section B.3 PWS 4.6.4.1. page 43. 4.6.4.1. Prescription Fulfillment - The

Contractor will provide all medications that are to be administered to patients in the clinic including any necessary vaccines.

Please provide a list of required medications and vaccines to be administered on site by the contractor.

attachment. D.26 Medications Vaccine Listing.

66. QUESTION: Reference section B.3 PWS 4.6.5 page 49. ANCILLARY SUPPORT SERVICES:

4.6.5.1 RADIOLOGY SERVICES - The Contractor is responsible for providing Radiology services. If contractor makes referral for services at Veterans request to EOVAHCS, the contractor will be responsible for entering requests for radiology procedures into the VA EHR. All imaging orders shall be clinically appropriate.

4.6.5.1.1 Responsibilities: N/A

4.6.5.1.2 Interpretation of x-rays performed at contractor’s site of care N/A

Q. Please clarify what type of radiology service will the contractor be responsible for and what can be referred to the VAMC/ Care in the community.

reflect.

67. QUESTION: Reference section B.3. 4.6.5.2 page 49. 4.6.5.2 Electrocardiogram Services: MUSE-compatible EKGs shall be used which are interfaced with the VA EHR Imaging. The name and model number of the EKG machine needed is GE 5500 with modem. This will be supplied by VA at cost to the contractor. EKGs are done by the Outpatient Site of Care and documentation will be sent electronically from the GE 5500 EKG machine directly into the VA EHR Imaging. When MUSE -compatible system is not available EKGs will be confirmed, interpreted and documented by the Contractor’s licensed provider. The report will be scanned directly into the VA EHR Imaging by the Outpatient Site of Care. The EKGs will be confirmed and/or read by Contractor’s providers.

Q. Please confirm the VA is asking for reimbursement for a VA purchased EKG and if so, what is the cost?

Government Response: EKG machine will be provided by the VA at no cost to the Contractor. PWS updated reflect.

68. QUESTION: Reference section B.3 PWS 4.6.6.7.10.24 page 60. 4.6.6.7.10.24 Pharmacotherapy with approved, appropriately- regulated opioid agonists (e.g., Buprenorphine or methadone) must be available to all patients diagnosed with opioid dependence for whom it is indicated and for whom there are no medical contraindications.

Q. Will Buprenorphine or methadone be provided by the VA?

Government Response: Contractor is responsible for entering order for medication in the EHR, then the VA Pharmacy will fill the medication and mail it to patients.

69. QUESTION: Reference section B.3 PWS 4.6.7.1. page 68. 4.6.7.1 Podiatry Services.

4.6.7.1.1 Podiatry services shall be provided by the Contractor via a VA referral for services.

Q. Please confirm this will be VA care in the community referral.

Government Response: Contractor is responsible for entering referral for the VA's podiatry services into the EHR. PWS Paragraph 4.6.7.1.1 updated to reflect.

70. QUESTION: Why was this solicitation not set aside for veteran owned small businesses under the VA rule of two?

Government Response: Reference Block 10 of solicitation checked boxes. This acquisition is set aside 100% for Service-Disabled Veterans Small Business

71. QUESTION: On what dates was the market research performed and what were the findings?

Government Response: The market research report is an internal document to the Government and is used to determine the acquisition strategy used for these services. The market research findings are exhibited in the Government’s determination to publish this solicitation as an SDVOSB set-side.

72. QUESTION: Please advise how many exam rooms and how many consultation rooms the VA requires per PACT team.

Government Response: Reference paragraph 4.9 Space Requirements: Exam Rooms per PACT: Two general patient care rooms; one multi-use/bariatric patient care room; and one women's health care room with ensuite bathroom. Consult rooms per PACT: Two consult patient care rooms and one interview patient care room. Rooms can have dual purposes.

73. QUESTION: Please advise how many telehealth rooms (by type) the VA requires in this facility and if the VA would like exam tables in the rooms.

Government Response: Reference paragraph 4.9 Space Requirements: One tele retinal room; one patient care room; and two counseling patient care rooms. PWS section 4.9 updated to read (1) telehealth patient care room requires an exam table. “

74. QUESTION: Please confirm the size and number of small group rooms and large group rooms required in this facility.

Government Response: Reference paragraph 4.9 Space Requirements: One staff conference room (approx. 75NSF); one staff multipurpose/breakroom (approx. 75NSF); one shared/group/multifunction room (approx. 120NSF). Conference room and shared/group/multifunction room can also be combined. Note: identified size for space are recommended.

75. QUESTION: Please confirm the number of procedure rooms and women’s health exam rooms required in this clinic.

a. Can a procedure room count toward the number of required women’s health exam rooms?

Government Response: Reference paragraph 4.9 Space Requirements: A minimum of two general patient care rooms, one multi-use/bariatric patient care room, and a women veteran patient care room with a private women veteran patient toilet is required. Yes, the multi-use/bariatric patient care room and the women's health exam room can be combined as long as the space has an ensuite restroom.

76. QUESTION: Does the current CBOC meet the government’s space requirements, and if not, will the location be “grandfathered in” and available for rebid “as-is”?

Government Response: Reference paragraph 4.9 Space Requirements: Offeror's proposal should meet the PACT requirements per the PWS.

76. QUESTION: Please confirm the new CBOC must be designed with the on/Stage-Off/Stage concept as laid out in the PACT Design Guide.

Government Response: Reference paragraph 4.9 Space Requirements: Front entrance will include a vestibule/indoor buffer; wheelchair corral; mobile lift corral; public health kiosk area; assisted veteran electronic check-in area; veteran information/welcome area storage alcove; veteran information station; patient education workstation. Yes, on/Stage-Off/Stage is required for the facility.

77. QUESTION: Will podiatry services be conducted in procedure rooms?

Government Response: PWS Paragraph 4.6.7.1.1 updated to read Podiatry services shall be provided by the Contractor via a VA referral for services in the EHR.

78. QUESTION: Please provide the number of billable enrollees on the most current invoice.

Government Response: Billable roster for February 2024 was 955.

79. QUESTION: Please list all VA staff that will be onsite at the clinic and the approximate number of days per week they will be there.

Government Response: VA staff will not be on site.

80. QUESTION: Will the new Contractor inherit the patients’ last vesting visit and be allowed to bill for one year from the date upon contract award?

Government Response: Yes, Section B.2 Schedule of Services (page 8) states that the Contractor will be provided a list of all enrolled patients at the beginning of the contract and will be able to bill for these patients immediately.

81. QUESTION: Will the government be making site visits prior to the award? If so, how much advance notice will the contractor be given?

Government Response: The government will give 2 weeks advanced notice if the government does a site visit. Please refer to 2. Requirements for Technical Proposals, Factor 1, Sub-factor (e) – Geographic Location/Accessibility (site visit may be conducted prior to award).

82. QUESTION: How many Mission Act referrals, for Primary Care, were made in the past 12 months for enrolled veterans of the McCurtain CBOC?

Government Response: In FY23, there were 893 referrals. So far, in FY24, there have been 475 through March 2024.

83. QUESTION: Will the government consider extending the start-up time to 180 days instead of 120?

Government Response: PWS paragraph 6.1.2 updated to ”The Contractor shall have 180 calendar days from contract award to commencement of the provision of medical care to local Veterans.

However, the Contractor must have all start-up requirements in place and ready to commence operation NLT 173 calendar days from contract award.”

84. QUESTION: Transcripts are required to be submitted for NP candidates with the proposal. Can these transcripts be submitted after the award?

Government Response: Unofficial Transcripts can be submitted with the offer, however after award the official transcript will be required.

85. QUESTION: Proof of ACLS and BLS are required to be submitted for Physicians with the proposal. Can these be submitted after the award?

Government Response: Offerors shall provide copies of the following for any physician(s) to be assigned to perform services under the contract, including any physicians to provide coverage relief:

• Board Certification or Board Eligible in Internal Medicine and/or Family Practice

• Active, current, unrestricted license in the state where the outpatient site of care (CBOC) is located

• Curriculum Vitae.

Reference PWS para 2.12. Contractor staff shall complete VA mandatory training as requested and complete ACLS/BLS training and keep ACLS/BLS certifications current throughout the life of the contract.

86. QUESTION: Please list the vaccines the contractor is responsible for purchasing and provide information on how many of each vaccine were used at the clinic in the past year.

attachment. D.26 Medications Vaccine Listing.

87. QUESTION: Please advise how mental health will be managed in the clinic (is contractor or VA providing, or will it be referred to VAMC)

Government Response: Reference PWS para 2.8.4. TCT Position Responsibilities. The VA will provide Behavior Medicine services via telehealth.

88. QUESTION: Telephones. Will VA be supplying the telephones and telephone system for the clinic?

Including fax?

89. QUESTION: Will the existing number be rolled over to the new contractor?

Government Response: Yes, Section B.2 Schedule of Services (page 8) states that the Contractor will be provided a list of all enrolled patients at the beginning of the contract and will be able to bill for these patients immediately.

90. QUESTION: Does the government require CAT6 or CAT6A cabling?

Government Response: Reference PWS para 4.11.2.6.7 updated to read “Infrastructure installer should install CAT6A patch panels and connectors in the rack”.

91. QUESTION: Will the government add price realism language to the current solicitation? To prevent contractors from deliberately underbidding this contract?

Government Response: Please reference Solicitation Basis for Contract Award para a and b, page 191.

92. QUESTION: Please clarify the specific equipment required for this solicitation and which technologists are required.

2.6.1 DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: The Contractor shall provide service. Radiology staffing shall be per the machine types and demands of the facility for each Radiologic procedure/ modality, i.e., CT, MRI, US, MAMMOGRAPHY, X-ray, etc. Radiologist staffing is based upon the number of exams and type performed in the typical 8-hour day. Suggested appointment length for MRI, CT, and ultrasound exams is 30 minutes.

[X] CT Machine staffing standard: Requires two (2) Technologists per 8-hour shift.

[X] MRI Machine staffing standard: Requires two (2) Technologists per 8-hour shift.

[X] Ultrasound Machine staffing standard requires one (1) Technologist per 8-hour shift [X] X-Ray Machine staffing standard: Requires one (1) Technologist per machine per 8- hour shift.

Qualifications: Must be certified in general radiologic technology by the ARRT and possess an active, current certification. For CT and MRI, must also possess an Advanced ARRT certification specific to the respective modality. Must meet radiological technologist requirements of the state in which the services are provided.

Government Response: The Contractor shall make referrals for Radiological services to the VA in the Electronic Health Record. PWS Para 2.6.1 Diagnostic Radiologic Technologist paragraph updated to

93. QUESTION: Is the contractor responsible for providing radiology room, machine, and staff? Can radiology services be subcontracted to local community?

PG 49: 4.6.5.1 RADIOLOGY SERVICES - The Contractor is responsible for providing Radiology services. If contractor makes referral for services at Veterans request to EOVAHCS, the contractor will be responsible for entering requests for radiology procedures into the VA EHR. All imaging orders shall be clinically appropriate.

4.6.5.1.1 Responsibilities: N/A

4.6.5.1.2 Interpretation of x-rays performed at contractor’s site of care N/A

Government Response: The Contractor shall make referrals for Radiological services to the VA in the Electronic Health Record. PWS Para 2.6.1 Diagnostic Radiologic Technologist paragraph updated to

94. QUESTION: Can the VA describe preferred size and furnishings for the mobile technology vestibule as well as the number of seats preferred for patient seating?

4.9.1 Contractors shall provide space that meets the standards outlined in the PACT Space Module Design Guide (see link above) and for the purposes of this solicitation the following minimum space requirements are: Front entrance will include a vestibule/indoor buffer; wheelchair corral; mobile lift corral; public health kiosk area; assisted veteran electronic check-in area; veteran information/welcome 36C25923R0040 area storage alcove; veteran information station; patient education workstation. The waiting area will include family seating; lactation room; refreshment station; vending area; veteran/guest seating; mobile technology vestibule; mobile technology patient seating.

Government Response: Reference PWS section 4.9 Space Requirements. The recommended size of the mobile technology vestibule is 100 Net Square Feet (NSF) with a minimum of one chair and one bariatric chair with arms. Patient seating for the waiting area should include at minimum two armchairs; one bariatric chair with arms; and one sofa. Para 4.9 updated to reflect.

95. QUESTION: Can the VA confirm a multi-use/bariatric patient care room and a separate women’s veteran patient care room is required for a 1 PACT team clinic? Will the VA approve (1) Procedure/Women’s Health Exam room with ensuite restroom at minimum standards provided in PACT design guide with available bariatric lift equipment instead of two separate rooms for multi-use/bariatric patient care room and women’s veteran patient care room with ensuite restroom?

4.9.1 pg. 83: Primary care areas will include an accessible patient height & weight station; two (2) general patient care rooms; multi-use/bariatric patient care room;

women veteran patient care room with a private women veteran patient toilet.

Government Response: Reference PWS section 4.9 Space Requirement: The two rooms can be combined if it includes an ensuite restroom for women's health exam room specifications.

96. QUESTION: Please confirm that the contractor is responsible for supplying the LCSW.

2.3.3 Discipline Specific Licensed Clinical Social Worker

Government Response: Yes, Reference PWS para 2.3.3 for FTE and Qualifications.

97. QUESTION: Please confirm that the contractor needs onsite radiology and a radiology technician.

98. QUESTION: Does the VA require the contractor to have x-ray equipment onsite in the CBOC or can the contractor subcontract this service at a local imaging facility?

99. QUESTION: Is the contractor responsible to provide and administer COVID-19 vaccine in the CBOC?

Government Response: The Contractor is responsible for providing and administering the vaccine to patients.

100. QUESTION: EKG GE 5500 with modem is being supplied at cost to the contractor, what is the cost of the EKG?

Government Response: Reference PWS para 4.6.5.2 Electrocardiogram Services. EKG machine will be provided by the VA at no cost to the Contractor. PWS updated to reflect.