36C25926D0023 COsigned.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C25926D0023 AWARDED:

EFFECTIVE: 04-01-2026 36C25926Q0065

Syreeta Newsuan-syreeta.newsuan@va.gov 303-712-5763

MDT

36C259 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111

X

621498

$25.5 Million

N/A

36C436

Department of Veterans Affairs Fort Harrison VA Health Care System

3867 Veterans Drive Fort Harrison MT 59636-9703

36C259

Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111

617M6

SHERIDAN MEMORIAL HOSPITAL ASSOCIATION

440 W LAUREL AVE

PLENTYWOOD MT 59254

G7WRXKTKXMF2

36C259

Department of Veterans Affairs Financial Service Center PO Box 149971 Austin TX 78714-9971

877-353-9791 512-540-5429

See CONTINUATION Page

Long Term Telehealth Services The Montana Veterans Affairs Health Care System, Fort Harrison, Montana VA Medical Center is requesting Telehealth services.

See Performance Work Statement (p.8) and Schedule of Services

Period of Performance 04/01/2026-03/31/2031

$0.00 See CONTINUATION Page

To be funded by individual task order x x 1 X 36C25926Q0065

11-17-2025

Catherine Kennedy Contracting Officer Kody Nelson, CEO & NH Administrator 3/19/2026 03-26-2026

36C25926D0023

Table of Contents

SECTION A

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

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

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

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.4 52.207-3 RIGHT OF FIRST REFUSAL OF EMPLOYMENT (MAY 2006)

C.5 52.216-18 ORDERING (AUG 2020)

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

C.7 52.216-22 INDEFINITE QUANTITY (NOV 2025) (DEVIATION)

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

C.9 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) . 125

C.10 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.11 VAAR 852.222-71 COMPLIANCE WITH EXECUTIVE ORDER 13899

(DEVIATION)(APR 2025)

C.12 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.13 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.14 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.15 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) 130

C.16 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (OCT 2025)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR: SHERIDAN MEMORIAL HOSPITAL

POC and Title: Kody Nelson, CEO & NH Administrator

Address: 440 West Laurel Avenue, Plentywood MT 59254

Phone: (406) 765-3702

FAX: (406) 765-3800

Email: knelson@sheridanmemorial.net

TIN: 81-0243720

UEI: G7WRXKTKXMF2

b. GOVERNMENT: Contracting Officer - Patricia Toliver, email: Patricia.toliver@va.gov

Contract Specialist-Syreeta Newsuan, email: syreeta.newsuan@va.gov

Department of Veterans Affairs

Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300

Greenwood Village CO 80111

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

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

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly in Arrears mailto:knelson@sheridanmemorial.net mailto:Patricia.toliver@va.gov https://vaww.aams.ecms.va.gov/AAMS_Production/DAV/zw1vyybjyn6-k1-y/syreeta.newsuan@va.gov

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

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

AMENDMENT NO DATE

001 11/06/2025

6. Federal Acquisition Regulations (FAR) require all contractors doing business with the Government to register and maintain registration in two separate and individual online databases:

a. CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS) - as prescribed in FAR Part 42.15, the Department of Veterans Affairs (VA) evaluates contractor past performance on all contracts that exceeds the simplified acquisition threshold. Additional information is found in section 4.9 of the Performance Work Statement (PWS).

b. SYSTEM FOR AWARD MANAGEMENT (SAM) - all prospective awardees shall be registered and maintain active registration in the SAM database prior to award, during performance, and through final payment of any contract resulting from this solicitation. After initial registration, the contractor is required to update registration data as changes occur and must re-register annually. Noncompliance will preclude the exercising of any option periods that may be included herein and may be cause for termination of the contract. Refer to FAR Clause 52.212-4(t) for more details.

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

8. MANDATORY WRITTEN DISCLOSURES: Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at OIG Hotline (va.gov) and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions.

9. FAR DEVIATION FEB 2025 Instructions: IMPORTANT NOTICE REGARDING THE SYSTEM FOR AWARD MANAGEMENT (SAM): System updates may lag policy updates. The System for Award Management (SAM) may continue to require entities to complete representations based on provisions that are not included in agency solicitations, including 52.223-22, Public Disclosure of Greenhouse Gas Emissions and Reduction Goals- Representation, and paragraph (t) of 52.212-3, Offeror Representations and Certifications-Commercial Products and Commercial Services. Contracting officers will not consider these representations when making award decisions or enforce requirements. Entities are not required to, nor are they able to, update their entity registration to remove these representations in SAM".

10. POST AWARD ORIENTATION: The Contracting Officer will schedule a post award orientation conference for contract orientation purposes as in accordance with https://dvagov.sharepoint.com/sites/VACOOALALF/ALFA/SitePages/VAAM.aspx?reg=M842.

https://dvagov.sharepoint.com/sites/VACOOALALF/ALFA/SitePages/VAAM.aspx?reg=M842

B.2 SCHEDULE OF SERVICES

This is a Fixed Price, Indefinite Delivery/Indefinite Quantity (FP-IDIQ) Contract for Tele-health.

Service shall be provided off-site as an Other Outpatient Services (OOS) Community Based Outpatient Clinic. The contractor shall furnish all personnel to provide services necessary to perform Tele-health services to eligible beneficiaries of the Montana Veterans Affairs Health Care System. The contractor will be reimbursed at the rates specified within the price/cost schedule for services provided.

Contractor performing services under this contract shall provide a continuum of care from prevention to diagnosis and treatment, to appropriate referral and follow-up. Contractor’s outpatient site of care shall have the necessary professional medical staff, diagnostic testing and treatment capability, and referral arrangements needed to ensure continuity of health care.

The contractor shall provide services solely dedicated to Veterans regardless of gender or age.

Those patients needing specialty care shall be referred to VA.

ORDERING PROCEDURES: This will be a fixed-priced Indefinite Delivery Indefinite Quantity (IDIQ) contract. VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management Model (PCMM) software program used to track primary care clinic Veteran rosters. Specific billable processes for issuing task orders under the resultant contract include determining Veteran eligibility, enrollment eligibility, and at least one qualifying encounter by the Contractor's primary care provider (PCP) within the previous 12 months.

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. In order to remain enrolled in the clinic, patients must have a qualifying visit within 12 months of their last visit. Please review in detail to ensure compliance for issuance of subsequent task orders and payment processing.

Any services to be furnished under this contract shall be ordered by issuance of task orders by the Contracting Officer or Administrative Contracting Officer. Ordering procedures are monthly and based on PMPM. Orders may be issued electronic commerce methods.

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

Task Order Procedures: The minimum/maximum amount of services the Government will acquire under the contract for the base period of performance and all exercised option years shall not exceed $949,900.00. Minimal amount:$30,000.00; Maximum: $949,900.00.

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

EST

QUAN

TITY

UNIT PER

UNIT

PRICE

TOTAL

COST PER

MONTH

TOTAL COST

PER YEAR

0001 Telehealth Services Contract Period: Base POP Begin: 04-01- POP End: 03-31-2027

PRINCIPAL NAICS

CODE: 621498 - All Other Outpatient Care Centers

PRODUCT/SERVICE

CODE: Q201 - Medical

– Managed Healthcare

115.00 PMP

M

$119.03 $13,687.88 $164,254.50

1001 Telehealth Services Contract Period: Option POP Begin: 04-01- POP End: 03-31-2028

PRINCIPAL NAICS

CODE: 621498 - All Other Outpatient Care Centers

PRODUCT/SERVICE

CODE: Q201 - Medical

– Managed Healthcare

117.00 PMP

M

$121.41 $14,204.50 $170,454.02

2001 Telehealth Services Contract Period: Option POP Begin: 04-01- POP End: 03-31-2029

PRINCIPAL NAICS

CODE: 621498 - All Other Outpatient Care Centers

PRODUCT/SERVICE

CODE: Q201 - Medical

– Managed Healthcare

119.00 PMP

M

$123.83 $14,736.25 $176,834.95

3001 Telehealth Services Contract Period: Option POP Begin: 04-01- POP End: 03-31-2030

PRINCIPAL NAICS

CODE: 621498 - All Other Outpatient Care

121.00 PMP

M

$126.31 $15,283.51 $183,402.12

Centers

PRODUCT/SERVICE

CODE: Q201 - Medical

– Managed Healthcare

4001 Telehealth Services Contract Period: Option POP Begin: 04-01- POP End: 03-31-2031

PRINCIPAL NAICS

CODE: 621498 - All Other Outpatient Care Centers

PRODUCT/SERVICE

CODE: Q201 - Medical

– Managed Healthcare

123.00 PMP

M

$128.84 $15,846.83 $190,161.94

GRAND

TOTAL

$885,107.53

(End Of Schedule of Services)

B.3 PERFORMANCE WORK STATEMENT

Contracted Outpatient Sites of Care (e.g., CBOC) PWS Template

1. GENERAL:

1.1 Services Required: The Montana VA Health Care System requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in the counties of: Daniels, Lincoln, Richland, Roosevelt, Sheridan, and Silver Bow.

1.2 Site Classification: This site is classified as an [X] Other Outpatient Service (OOS) .

1.3 Place of Performance: Services shall be performed by contractor within the city limits of Plentywood, MT 59254 on behalf of Montana VA Health Care System.

1.4 Authority: Title 38 United States Code (USC) 8153 and FAR 12 and VAAR 873.

1.5 Policy and Regulations: The contractor is required to meet VHA performance and quality criteria, policy and standards including, but not limited to, access, quality of care, Veteran satisfaction, coordination of care, and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vapubs/ or at http://www.va.gov/vhapublications/. Some VA policy documents include Standard Operating Procedures (SOPs) located on internal VA websites that are not available to the public. SOPs relevant to this requirement are provided as attachments under Section D. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/docs/List-of-contracted-clinic-policy-documents.xlsx#

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties ACGME: Accreditation Council for Graduate Medical Education ACLS: Advanced Cardiac Life Support ACO: Administrative Contracting Officer ACPE: American Council on Pharmaceutical Education ADE: Adverse Drug Events AED: Automatic External Defibrillator AIS: Automated Information Security ANA: American Nurses Association AOA: American Osteopathic Association APRN: Advanced Practice Registered Nurse http://www.va.gov/vapubs/ http://www.va.gov/vhapublications/ https://www.patientcare.va.gov/primarycare/docs/List-of-contracted-clinic-policy-documents.xlsx https://www.patientcare.va.gov/primarycare/docs/List-of-contracted-clinic-policy-documents.xlsx

ARRT: American Registry of Radiologic Technology ASC: Ambulatory Surgery Center Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e., CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

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

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

BLS: Basic Life Support BOS: Bureau of Osteopathic Specialists CAHEA: Committee on Allied Health Education and Accreditation CAP: College of American Pathologists CARF: Commission on Accreditation of Rehabilitation Facilities CBO: VA Central Billing Office CCNE: Commission on Collegiate Nursing Education CDC: Centers for Disease Control and Prevention CEU: Certified Education Unit CLIA: Clinical Laboratory Improvement Amendments CME: Continuing Medical Education CMS: Center for Medicare and Medicaid Services CNP: Certified Nurse Practitioner CNS: Clinical Nurse Specialist CO: Contracting Officer COPD: Chronic Obstructive Pulmonary Disease COR: Contracting Officer’s Representative COS: Chief of Staff CPA: Collaborative Practice Agreement CPARS: Contractor Performance Assessment Reporting System CPP: Clinical Pharmacist Practitioner CPT: Current Procedural Terminology CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org.

CVT: Clinical Video Telehealth DICOM: Digital Image and Communication in Medicine DIGMA: Drop-in Group Medical Appointment DRG: Diagnostic Related Group DSS: Decision Support System ECC: Extended Care Center Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.”

Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for http://www.cswe.org/

VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

EPRP: External Peer Review Program FDA: Food and Drug Administration FSMB: Federation of State Medical Boards FTE: Full Time Equivalent HCC: Health Care Center - An HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia HCFA: Health Care Financing Administration HHS: Department of Health and Human Services HICPAC: Healthcare Infection Control Practices Advisory Committee - a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

HPE: Health Professions Education HPT: Health Professions Trainee HT: Home Telehealth ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories ICD: International Classification of Diseases iMED: software used by VA for informed consent INR: International Normalized Ratio LIP: Licensed Independent Practitioner MCCR: Medical Care Cost Recovery Mental Health Services: per VHA Directive 1160.01 is meant to include services for the evaluation, diagnosis, treatment, rehabilitation, suicide prevention and crisis intervention, and coordination of care for both substances use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems, including SUD

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

(c) Patient education

(d) Family education, family consultation, family psychoeducation and couples/marriage and family counseling when it is associated with benefits to the Veterans

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST)

(g) Suicide Prevention

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

Specialty mental health services include:

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

(b) Evidence-based psychotherapy

(c) Intensive Community Mental Health Integration (ICMHR)

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

(e) PTSD teams or specialists

(f) MST special clinics

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

MQSA: Mammography Quality Standards Act MSN: Master of Science in Nursing NLN: National League for Nursing NLNAC: National League for Nursing Accreditation Commission NP: Nurse Practitioner NSQIP/CICSP: National Surgical Quality Improvement Program/Continuous Improvement in Cardiac Surgical Program OTC: Over the Counter PA: Physician Assistant PACS: Picture Archiving and Communications System PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care.

PACT provides accessible, coordinated, comprehensive, patient-centered care, in team-based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions PACT Support staff: PACT staff assisting providers in the actual delivery of care to patients. It consists of RNCMs, clinical associates, and administrative associates.

SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two-way conversation Parent Facility: VAMC responsible for performance monitoring and payment for contracted outpatient site of care services.

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

PCP: Primary Care Provider Phar.D.: Doctor of Pharmacy

PMPM: Per Member Per Month-reimbursement methodology for services provided under the PC and MH LINs based on all-inclusive monthly rate per Veteran that meets qualifying encounter criteria in the previous twelve months of the contract period. This methodology also accounts for costs of unassigned/unenrolled visits based on estimates provided to contractors and it supports the PACT model in increasing coordination, quality, and continuity of care of Veterans receiving services at the Outpatient Site of Care POC: Point of Care Testing Primary Care Visit: an episode of care furnished in a clinic or virtually that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

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

RME: Reusable Medical Equipment SFT: Store and Forward Telehealth SMA: Shared Medical Appointments SOP (Clinical): Scope of Practice SPD: Sterile Processing Division SPE: Senior Procurement Executive Specialty Care Visit: The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology;

emergency; employee health; endocrinology; gastroenterology; general medicine;

hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology; amputation follow-up; amputation; anesthesia;

cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN);

neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

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

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

VHA: Veterans Health Administration VSSC: VHA Support Service Center VVC: VA Video Connect WHEN: Weekend- Holiday- Every- Night

2. STAFFING AND QUALIFICATIONS:

2.1 Minimum Patient Aligned Care Team (PACT) Staffing Requirements:

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), discipline specific team members (Clinical Pharmacist Practitioners (CPPs), Licensed Social Workers, Registered Dietitian/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff). The contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full-time physician and 900 active patients per full-time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be at least three full-time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacist Practitioner (CPP) shall be provided the same support staffing when they are working in the capacity of an advanced practice provider. The contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the contractor shall communicate to the VA, the contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards.

The total estimated patients assigned to site is: 117.

Physician Director (Mandatory for all sites): FTE Ratio Performance Standard: 0.05 FTE per PACT. Responsible Party: Shall be provided by Montana VA Health Care System.

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

Teamlet Member 1: Primary Care Provider (PCP): FTE Ratio Performance Standard:

Current standards are 1200 active patients per full-time physician and 900 active patients per full-time mid-level provider. Contractor shall propose quantity of FTE to meet standard

FTE ratio to panel size. Primary Care Provider shall be provided by Montana VA Healthcare System.

Option 1: Physician (MD/DO): Shall be provided by Montana VA Health Care System Option 2: Advanced Practice Registered Nurse (APRN):

Option 3: Physician Assistant (PA):

Teamlet Member 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or the commission on Collegiate Nursing Education (CCNE).

Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA Handbook 5005, Appendix G6. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, virtual care, view alerts management, shared medical appointments, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and virtual care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

Teamlet Member 3: Clinical Associate FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. Contractor to propose the mix of Clinical Associates from the options below.

Option 1: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN):

Qualifications: Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA Handbook 5005, Appendix G13. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas.

Option 2: Unlicensed Assistive Personnel (Health Technician, Medical Assistant, Certified Nursing Assistant). This staffing is part of the PACT Teamlet, not the primary telehealth clinical technician (TCT): Qualifications: Completion of an accredited medical assistant, certified nursing assistant, or patient care/health technician training program.

Other education such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on VA parent facility Chief of Staff determination. See Nursing Assistant qualification standards in VA Handbook 5005, Appendix G46 for additional qualifications. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas.

Teamlet Member 4: Administrative Associate: FTE Ratio Performance Standard:

Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. Qualifications:

Required education and experience demonstrating skills and abilities to provide clerical support and administrative functions to support site operations. Completion of scheduling training per VA policies and guidance. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care.

Provide clerical support and administrative functions to PACT staff and collaborate with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans. Provide guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA.

Provide scheduling services in accordance with VA policies and guidance.

2.3 Discipline Specific PACT Team Member (Required for all sites): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated. The following discipline specific staffing shall be provided by Montana VA Health Care System.

Discipline Specific 1: Clinical Pharmacist Practitioner (CPP) – PACT: FTE Ratio Performance Standard: 1.0 FTE per 3,600 Veterans. Shall be provided by Montana VA Health Care System.

Discipline Specific 2: Clinical Pharmacist Practitioner (CPP) Anti-Coagulation - PACT:

FTE Ratio Performance Standard: 1.0 FTE per 3,600 Veterans. Shall be provided by Montana VA Health Care system

PANDED PACT STAF

Discipline Specific 3: Licensed Social Worker (this position provides general/medical social work services): FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Shall be provided by Montana VA Health Care System.

Discipline Specific 4: Registered Dietitian/Nutritionist: FTE Ratio Performance Standard: 1 FTE per 5 PACTs. Shall be provided by Montana VA Health Care System.

Discipline Specific 5: Primary Care Mental Health Integration (PCMHI):

PCMHI is a required component of PACT, providing mental health expertise for Veterans whose conditions can be managed collaboratively in primary care. Where primary care services are offered, PCMHI services shall include Co-located Collaborative Care (CCC) providers who attend PACT huddles and provide consultative advice, brief assessment and problem-focused treatment, and Mental Health Collaborative Care Managers (CoCM) who use the evidence-based Mental Health Collaborative Care Management Model to provide longitudinal follow-up and decision support for specific mental health conditions.

FTE Ratio Performance Standard - The following ratios are the minimum necessary to adequately provide required PCMHI services.

• Co-located Collaborative Care (CCC): 0.5 FTE CCC per 1200 primary care patients.

This ratio includes PCMHI Behavioral Health Consultants (Licensed Independent Providers such as the providers included in options 1-3 below), as well as Providers with Prescribing Privileges (PwPP) (such as the providers included in options 4-6 below (depending on the provider’s scope of practice)).

• Collaborative Care Management: 0.17 FTE Collaborative Care Managers per 1200 primary care patients. (Typically options 2-5 below) per PACT. Collaborative Care Managers will also require a consulting PwPP (options 4 - 6 depending on the provider’s scope of practice). Collaborative Care Managers (CoCMs) have specialized training in behavioral health and are typically RNs but could also be other Licensed Practitioners (LP) of varying disciplines.

(See the VHA Directive 1160.01, Uniform Mental Health Services for more information on PCMHI requirements).

A mix of the following disciplines shall be selected to meet the PCMHI FTE ratio performance standard and PCMHI service requirements. Staffing ratio outlined is “minimum” and may be increased by the VA to provide appropriate integrated mental health care.

Option 1: Psychologist: Shall be provided by Montana VA Health Care System.

Option 2: Licensed Social Worker (Mental Health) (this position provides mental health services as part of the PCMHI team):

Option 3: Licensed Professional Mental Health Counselor (LPMHC):

Option 4: Psychiatrist:

Option 5: Advanced Practice Registered Nurse (APRN):

Option 6: Mental Health Clinical Pharmacist Practitioner (CPP):

Option 7: Registered Nurse (RN):

2.4 Specialty Care Staffing: The following specialty staffing shall be provided by Montana VA Health Care System.

Podiatrist: FTE Ratio Performance Standard: 1.0 FTE per an estimated 950 patients requiring podiatry services with only a single room available for services or 1 FTE per an estimated 1300 patients requiring podiatry services with two rooms and clinical support (such as a nail technician). Staffing ratio may be adjusted upward locally to provide VA standard patient care average of 14 – 16 patients/8-hour period being seen.

Physical Therapist: FTE Ratio Performance Standard: 1.0 FTE per an estimated 5000 Veterans assigned to the clinic. Staffing ratio may be adjusted upward locally to provide VA standard patient care as determined by local facility input to provide appropriate physical therapy services.

2.5 Ancillary Support Services Staffing: The following ancillary support staffing shall be provided by Montana VA Health Care System.

X-Ray Diagnostic Radiologic Technologist: FTE Ratio Performance Standard: 1 FTE technologist per x-ray machine per 8-hour time period with backup required during times of planned and unplanned staff absences.

Phlebotomist: Shall be provided by the contractor. Laboratory specimens shall be collected, prepared for transport, packaged, and forwarded to a VA facility for testing using sample requirement information supplied by the Ft. Harrison Laboratory (See Attachment A). The VA laboratory will supply sample collection supplies to include needles, vacutainer holders, tubes, transfer tubes, frozen sample shippers, shipping boxes, printed labels for use on all patient primary, secondary sample containers, and miscellaneous supplies.

Contractor will supply labor and facilities including an adequate centrifuge (can achieve 1000-1500 g force) for sample processing, refrigerator and freezer space for holding and/or freezing samples prior to shipping. All laboratory testing samples shall be forwarded to VA Fort Harrison for testing except when transport time will affect the quality of the sample (See Attachment B) and any sample/test that cannot be shipped will be run by the contractor’s laboratory . This will be initiated by communication with the Primary Care Provider (PCP) and a consult entered in order to process these labs via fee-basis and paid through NAO. A copy of those results must be faxed to the Ft. Harrison Lab at 406-447- 7991 within 24 hours of test completion. If any result meets the VA Laboratory’s definition of a critical value (See Attachment C), the attending physician must be notified immediately, and notification documented on that report. Patient identification will follow requirements of the Joint Commission (JC) using two of the following:

• patient’s full name,

• patient’s date of birth and/or

• patient’s full social security number

The Contractor will use UPS or Federal Express overnight services for sample shipping to the Ft. Harrison Laboratory and all samples shipped on Friday will be shipped with DELIVER SATURDAY designation. The VA will cover these shipping charges by providing the contractor an account number from the shipping entity that can provide the best service from your location. Lab work not performed at VA Fort Harrison shall be performed in a laboratory which has been accredited by the JC, the Commission on Laboratory Accreditation of the College of American Pathologists (CAP), or Clinical Laboratory Improvement Amendments (CLIA), (Public Law 100-578). The laboratory must have all licenses, permits, accreditation and certificates required by law and the State of Montana available for review and display. A copy of the offeror’s current CLIA certificate must be faxed to the Contracting Officer and the Ft. Harrison Laboratory Manager at 406-447-7991 upon request prior to award. The charges incurred from emergent specialty evaluations, diagnostic testing and care provided at sites other than the VA Fort Harrison shall have prior authorization and shall be obtained on Fee Basis.

The Contractor is not required to provide this service. Care will be provided through either a VA Montana Mental Health staff member or via Care in The Community consult sent by the Primary Care Provider. Any contract site performing phlebotomy will have oversight by VA laboratory.

Waived Testing Personnel: The identified staff shall meet facility defined requirements of Montana VA Health Care System receive training specific to the testing activity, receive orientation specific to the needs of the service, and have been documented to be competent to perform the test. Staff that has not completed a medical laboratory certification program shall have documented comprehensive training commensurate with the test system to ensure proficiency. It is the contractor’s responsibility to ensure staff performing testing is following procedure manual and manufacturer’s guidelines, performs and document quality control as defined, document results, participates in mandatory competency, and performs proficiency testing.

2.6 General and Specialty Mental Health Staffing Requirements and Options: The following mental health staffing shall be provided by Montana VA Health Care System via Telehealth modality or Care in the Community Consult placed by Primary Care Provider.

General MH Staffing FTE ratio performance standard is 9 total FTE per 1000 Veterans seen in general outpatient MH, which includes an interdisciplinary team of 8 clinical staff and 1 administrative support staff. The team incorporates the evidence-based Collaborative Chronic Care Model (CCM), which is based on the original design for chronic disease management, published by Wagner, et al. (1996). The CCM requires Behavioral Health Interdisciplinary Program (BHIP) teams to establish processes to incorporate six necessary elements: organizational leadership and support; work role redesign; Veteran self-management support; provider decision support; information management; and community linkages.

Specialty MH Staffing FTE shall be incorporated into the general mental health ratios in order to ensure access for the local Veteran population. This may include telehealth or referrals to other locations for required staffing on site. See the Uniform Mental Health Services VHA Directive 1160.01 for Specialty Mental Health requirements.

Required: Administrative Support Staff: FTE Ratio Performance Standard: Current minimum standard is 1.0 FTE administrative staff per 1000 Veterans receiving General and Specialty MH services:

Required: For the additional 8.0 FTE of clinical staff per 1000 Veterans receiving General and Specialty MH services, a mix of the following disciplines listed below shall be selected to meet general and specialty MH FTE ratio performance standard and general and specialty MH service requirements. The staffing ratio outlined above is the “minimum” necessary to adequately provide evidence-based treatment, medication management and other indicated services, care coordination and proactive population management. This staffing ratio may be increased by the VA to provide mental health care. See the Uniform Mental Health Services Directive 1160.01 for General and Specialty Mental Health requirements.

Option 1: Psychiatrist Option 2: Advanced Practice Registered Nurse (APRN):

Option 3: Physician’s Assistant:

Option 4: Mental Health Clinical Pharmacist Practitioner (CPP):

Option 5: Psychologist:

Option 6: Licensed Social Worker (Mental Health):

Option 7: Licensed Professional Mental Health Counselor (LPMHC):

Option 8: Marriage and Family Therapist (MFT):

Option 9: Registered Nurse (RN):

Option 10: Addiction Therapist:

Additional General and Specialty Mental Health Staffing Requirements: The following general and specialty MH staffing shall be provided by Montana VA Health Care System.

Suicide Prevention Coordinator (SPC): Per VHA Directive 1160.07, Suicide Prevention Program, all sites with 10,000 patients or more shall designate at least 1 full time equivalent SPC to provide suicide prevention services. NOTE: In smaller facilities this may be a collateral assignment.

Homeless Outreach Specialist: To ensure the availability of outreach and referral services to homeless Veterans, all sites with 10,000 patients or more shall designate at least one outreach specialist, usually a clinical…