36C26018Q0141-001.docx

36C26018Q0141

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

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

531-18-3-178-0005

01-19-2018 Mark Erickson 2538884904 02-02-2018 12:00 Noon PST Department of Veterans Affairs Network Contracting Office 20 Suite 360 1495 Wilmington Drive Dupont WA 98327

X

Y 621112 $11 Million Net 30 days X

N/A

Department of Veterans Affairs

Please see Performance Work Statement, Section 20, Places of Performance.

Department of Veterans Affairs Network Contracting Office 20 Suite 360 1495 Wilmington Drive, Suite 360 Dupont WA 98327

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971 866-372-1141

See CONTINUATION Page

PSYCHIATRIST SERVICES ON A LOCUM TENENS BASIS FOR THE

VETERANS INTEGRATED SERVICES NETWORK 20 (VISN20),

INCORPORATING WASHINGTON, OREGON AND IDAHO VA FACILITIES.

Period of Performance:

It is anticipated that multiple BPAs will be awarded for continuous five (5) year periods, commencing on or about 01 March 2018 and expiring on or about 28 February 2023.

Interested vendors are advised to pay special notice to the Basis of Award section, page 35, before preparing their offer for submission to the Contracting Officer.

See CONTINUATION Page

531-3680160-178-820300-2560 0100203V1

Mark A. Erickson mark.erickson3@va.gov

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

1.0. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: (To be determined)

b. GOVERNMENT: Contracting Officer 36C260 Department of Veterans Affairs Network Contracting Office 20 Suite 360 1495 Wilmington Drive Dupont WA 98327

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

3.0. INVOICES: Invoices shall be submitted in arrears:

4.0. GOVERNMENT INVOICING INSTRUCTIONS: Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Invoice requirements are currently as follows: Invoice Number, Invoice Date, Purchase Order Number, Unit Price, Quantity and Unit of Measure, Total Invoice Price, Ship-To Location Name and/or code, Receipt of Goods/ Services, Invoice Payment Terms.

Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp. It states:

4.1. FSC Mandatory Electronic Invoice Submission: The Department of Veterans Affairs published a final rule in the Federal Register on November 27, 2012 to require contractors to submit payment requests in electronic form in order to enhance customer service, departmental productivity, and adoption of innovative information technology, including the appropriate use of commercial best practices. The rule is effective December 27, 2012.

4.2. Vendor Electronic Invoice Submission Methods: Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below:

4.3. VA’s Electronic Invoice Presentment and Payment System – The FSC uses a third-party contractor, TUNGSTEN NETWORK (formerly OB10), to transition vendors from paper to electronic invoice submission. Please see TUNGSTEN NETWORK contact information below to begin submitting electronic invoices, free of charge. The Department of Veterans Affairs Tungsten Number is: AAA544240062.

4.4. A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI).

The X12 EDI Web site (http://www.x12.org).

4.5. Vendor e-Invoice Set-Up Information: Please contact TUNGSTEN NETWORK at the phone number or email address listed below to begin submitting your electronic invoices to the VA Financial Services Center for payment processing, free of charge. If you have question about the e-invoicing program or TUNGSTEN NETWORK, please contact the FSC at the phone number or email address listed below:

a. TUNGSTEN NETWORK e-Invoice Setup Information: 1-877-489-6135;

b. TUNGSTEN NETWORK e-Invoice email: VA.Registration@ob10.com;

c. FSC e-Invoice Contact Information: 1-877-353-9791; and

d. FSC e-invoice email: vafsccshd@va.gov

e. For questions, refer to: http://www.tungsten-network.com/uk/en/veterans-affairs/

f. Remittance Address details to transact VA-FSC:

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

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

B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.219-11 VA Notice of Total Veteran-Owned Small Business Set-Aside. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

B.3 PERFORMANCE WORK STATEMENT (PWS)

PSYCHIATRIST SERVICES

For the

VETERANS INTEGRATED SERVICES NETWORK 20 (VISN20),

INCORPORATING VA FACILITIES IN THE STATES OF WASHINGTON, OREGON,

AND IDAHO.

1.0. GENERAL: Psychiatrist services on a locum tenens basis to provide healthcare resources in accordance with Public Law 104-262 and 38 U.S.C. 8153. Contractor agrees to provide outpatient psychiatrists as required for the Mental Health Departments of the Veterans Integrated Services Network 20 (VISN20), at VA facilities in the states of Washington, Oregon, and Idaho,

2.0. BACKGROUND:

2.1. Initial Requirement: Boise VA Medical Center currently has a 3.4 FTEE psychiatrist vacancy. Furthermore, we will be facing two overlapping maternity leaves in early to mid-2018. Until we are fully staffed, we seek locum tenens support to help cover that gap in our psychiatric coverage needs. The individuals will need to be board certified and/or board eligible. Actual start dates will be affected by the time necessary to complete the security background checks and credentialing/privileging of the providers.

2.2. Award will be based in part on Candidates’ qualifications, including Curriculum Vitae (CV) criteria, availability, and Psychiatric Board Certification or ability to be certified, VA experience, experience, and price.

2.3. Providers will need to be scheduled for orientation/training prior to the start of their first shift, at the government’s expense. Orientation shall be scheduled between the Contractor and the Contracting Officer’s Representative (COR) as needed.

3.0. SCOPE OF SERVICES: Candidates must effectively communicate and collaborate with multiple disciplines in behavioral health and primary care. The position is primarily an outpatient psychiatry position which consists of managing an outpatient caseload; providing outpatient consultation to Behavioral Health department and Primary Care clinics at VA; providing coverage for our outpatient behavioral health same day access clinic; performing some consultation/liaison work associated with inpatient medical/surgical services; providing clinical coverage for colleagues, including inpatient psychiatry coverage, as needed; and participate in other duties as assigned. Typical patients seen will include those with PTSD, mood disorders, anxiety, psychosis, substance abuse problems, and personality disorders. All documentation is made in our computerized medical record. The work performed will be within the VISN20 region.

4.0. SPECIFIC TASKS:

4.1. The Psychiatrist will see an average of (8-12) eight to twelve patients per day in the clinic.

4.2. The Psychiatrist will be assigned to outpatients in the clinic from 8:00 a.m. to 4:30 p.m. five days per week. Routine clinic scheduling will include six hours daily of patient care.

4.3. Ten hours during the week (roughly two hours daily) are allocated for administrative time to complete view alerts, return calls to patients, attend required meetings, respond to e-mails, and complete notes.

4.4. The Psychiatrist will have responsibility for, but not limited to, diagnostic psychiatric evaluations, risk assessments, treatment planning, collaboration and consultation with other behavioral health providers and primary care providers, performing a diagnostic work ups, ordering tests and consultations as clinically appropriate, prescribing appropriate medications, providing limited individual therapy and referring to other behavioral health providers for more involved psychotherapy needs, and documenting as appropriate in the electronic medical record.

4.5. Psychiatrists provided by the Contractor to perform the services stated in this contract will be credentialed and receive privileges by the VA. Contractor shall provide evidence that shows the submitted candidate(s) is/are not listed on the exclusion list imposed by the Department of Health and Human Services Office of Inspector General as authorized by the Balanced Budget Act of 1997 (BBA) (Public Law 105-33). Contractor can obtain this information at the following website: http://exclusions.oig.hhs.gov/.

4.6. Psychiatrists provided by the Contractor shall dictate concise and comprehensive reports utilizing VA telephone dictation processes, or may type manually into the computerized medical record.

4.7. The services to be performed by the Psychiatrist will be performed consistent with the VA policies and procedures and the regulations of the Medical Staff Bylaws of the VA facility in which services are to be performed.

4.8. The services to be performed by Psychiatrists will be reviewed by the Staff of the VA facility in which services are to be performed.

4.9. Psychiatrists must be present at the VA facility during working hours and must be performing the required services identified in the Performance Work Statement or the cost will be decreased accordingly during each billing cycle. In the event the VA incurs additional cost for ensuring patient care is maintained due to the Psychiatrist missing a shift, the Contractor shall be responsible for those costs. The payment for holiday time (for work performed in the case of an emergency) and for any leave, including sick leave or vacation time, is the responsibility of the Contractor.

4.10. The Psychiatrist will be required to use the hospital computer system to include checking electronic reports on a daily basis for accuracy and completeness, entering progress notes for each visit and/or patient contact, completing electronic clinic reminders and approving patient results via electronic signature. The Psychiatrist shall adhere to all facility policies and requirements regarding medical record documentation. The Psychiatrist will also be responsible for reviewing patient information via the computerized patient record system, such as but not limited to: labs, medications, and progress notes from other providers. It is the responsibility of the Psychiatrist to ensure that all electronic medical record entries are completed and electronically signed each day prior to leaving the facility.

4.11. The parties agree that such personnel shall not be considered VA employees for any purpose and shall be considered employees of the Contractor.

4.12. The Contractor shall be responsible for protecting the personnel furnishing services under this contract. To carry out this responsibility, the Contractor shall provide the following for those personnel:

1. Worker’s compensation;

1. Professional liability insurance;

1. Health examinations;

1. Income tax withholding; and

1. Social security payments.

4.13. The services covered by this contract shall be furnished by the Psychiatrist during work hours as defined herein. The Psychiatrist will also be required to furnish such services during non-working hours and National holidays as described below:

4.13.1. The following terms have the following meanings:

a. Work hours: 8 hours per day between 8:00 A.M. and 4:30 P.M., five days per week;

b. Non-work hours: 15.5 hours per day between 4:30P.M. and 08:00 A.M.;

c. Monday thru Friday, five days per week, and 24 hours per day, on Saturday and Sunday, two days per week when assigned on-call duties.

d. National holiday: The ten holidays observed by the Federal Government are:

1. New Year’s Day;

1. Martin Luther King, JR’s Birthday;

1. Washington’s Birthday;

1. Memorial Day;

1. Independence Day;

1. Labor Day;

1. Columbus Day;

1. Veterans Day;

1. Thanksgiving Day; and

1. Christmas Day.

Any other day specifically declared by the President of the United States will be considered a national holiday.

e. Overtime: Regular hourly rate applies.

f. On-call and Emergency Department (ED) coverage rates: A one-time charge to wear pager, and remain within 1 hour of the facility. In addition, normal hourly rate applies to hours worked in the facility and for phone calls associated with call. Psychiatrist will participate in an “on call” rotation schedule at a frequency of 1:8 or less frequent rotation. The weekdays (Monday through Thursday) are rotated at a frequency of 1:8 or less, and the weekends (Friday, Saturday, Sunday, and holiday) are rotated at 1:8 or less.

4.14. Services rendered will be verified by a record keeping system, maintained by the Chief of Staff or designee, which assures the VA pays for only those services actually requested.

4.15. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).

4.16. As part of the pre-award Contractor responsibility determination and during the performance of the contract for the purpose of on-going Contractor competency evaluation, the VA will perform or require for evaluation, from the Contractor one or more of the following:

a. Submission of information to allow evaluation of the psychiatrists’ capacity to meet or exceed the requirements of the contract;

b. Submission of evidence of accomplishment of training and education that is required by the terms of the contract;

c. Submission of evidence of experience and achievements in work similar to that required by the contract; and

d. Board certification or licensure that meets or exceeds standards relative to the industry being contracted.

4.17. The Department of Veterans Affairs will not pay any hiring fees if the locum tenens physician is hired for a permanent position.

4.18. All Psychiatrists who require access to the Department of Veterans Affairs' computer systems shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance. All Psychiatrists who require access to the Department of Veterans Affairs' computer systems shall complete the VA Information Security and Privacy training prior to being granted access and annually thereafter to maintain access privileges. If the investigation is not completed prior to the start date of the contract, the Contractor will be responsible for the actions of those individuals they provide to perform work for VA.

4.18.1. Position Sensitivity; The position sensitivity has been designated as Low Risk.

4.18.2. Background Investigation: The level of background investigation commensurate with the required level of access is National Agency Check with written Inquiries.

4.18.3. Contractor Responsibilities:

4.18.3.1. The Contractor shall bear the expense of obtaining background investigations. If the investigation is conducted by the Office of Personnel Management (OPM), the Contractor shall reimburse VA within 30 days. The estimated cost for a low risk level background check is $232.00 each.

4.18.3.2. The Contractor shall prescreen all providers requiring access to the computer systems to ensure they maintain a U.S. citizenship and are able to read, write, speak and understand the English language.

4.18.3.3. The Contractor shall submit or have their providers submit the following required forms to the VA Office of Security and Law Enforcement within 30 days of receipt:

a. Standard Form 85P, Questionnaire for Public Trust Positions;

b. Standard Form 85P-S, Supplemental Questionnaire for Selected Positions;

c. FD 258, U.S. Department of Justice Fingerprint Applicant Chart;

d. VA Form 0710, Authority for Release of Information Form;

e. Optional Form 306, Declaration for Federal Employment; and

f. Optional Form 612, Optional Application for Federal Employment.

4.18.3.4. The Contractor, when notified of an unfavorable determination by the Government shall withdraw the provider from consideration from working under the contract.

4.18.3.5. Failure to comply with the Contractor Personnel Security Requirements may result in termination of the contract for default.

5.0. GOVERNMENT RESPONSIBILITIES:

5.1. The VA Office of Security and Law Enforcement will provide the necessary forms to the Contractor or to the Contractor's providers after receiving a list of names and addresses.

5.2. Upon receipt, the VA Office of Security and Law Enforcement will review the completed forms for accuracy and forward the forms to OPM to conduct the background investigation.

5.3. The VA facility will pay for investigations conducted by the Office of Personnel management (OPM) in advance. In these instances, the Contractor will reimburse the VA facility requiring the services within 30 days.

5.4. The VA Office of Security and Law Enforcement will notify the Contracting Officer and Contractor after adjudicating the results of the background investigations received from OPM.

5.5. The Contracting Officer will ensure that the Contractor provides evidence that investigations have been completed or are in the process of being requested.

6.0. PERFORMANCE MONITORING:

6.1. Monitoring of Psychiatrist’s time shall be demonstrated through sign-in/sign out sheets. The Psychiatrist shall be required to sign an attendance log upon reporting to work and departing from work. The Contracting Officer’s Representative (COR) will be the VA official responsible for verifying contract compliance. The COR will work with the Administrative Officer to the Chief of Staff to verify compliance. After contract award, any incidents of Contractor provider noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

6.2. The Psychiatrist shall fall under all the existing VA quality monitors relating to services provided such as, medical records review, Peer Review, Incident reporting, Infection Control, etc.

6.3. Any hours worked beyond the normally scheduled shifts must be approved by the CO or COR in advance of working the hours. Any time not approved in advance will not be paid by the VA.

6.4. The Contractor will be held accountable for the same competency monitoring required of the psychiatry service monitors. Focused and Ongoing Professional Practice Evaluation (FPPE) will be performed consistent with psychiatry service policy with at least quarterly reviews for FPPE and six month reviews for OPPE, as applicable.

6.5. The Performance Requirements Summary applicable to this PWS is provided, below:

Indicator

MEASURES

Standard

Access

Quality Care

7.0. COMPLIANCE:

7.1. The Psychiatrist shall comply with all current VHA policies. The Psychiatrist is required to meet VHA performance and quality criteria and standards including, but not limited to, customer satisfaction, preventative index, chronic disease index and clinical guidelines. Performance and quality standards may change during the course of the contract. New or revised quality/performance criteria or standards will be provided to the Psychiatrist before their implementation date. Compliance with mandated performance is required as a condition of this contract.

7.2. The services required in this agreement shall be performed in accordance with established principles and ethics of the medical profession. The quality of healthcare provided shall meet or exceed the current recognized standards established by the American Medical Association (AMA), Joint Commission on Accreditation of Health Care Organizations (JCAHO), Veterans Health administration regulations and medical staff by-laws and those of other professional associations, which specify standards of performance for the medical profession.

7.3. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).

7.4. All Psychiatrists are required to comply with VA mandatory annual training requirements. It is anticipated that the contract psychiatrists’ work load will allow completion of all mandatory annual training during scheduled duty shifts. The Contractor will be reimbursed at the standard rate if additional hours are worked to accomplish these requirements.

7.5. Should the need for remote access arise, the Contractor shall first obtain the approval of the COR and the Facility ISO (Information Security Officer). The Contractor shall then request a Virtual Private Network (VPN) account, for remote access, from the Facility ISO.

8.0. SECURITY REQUIREMENT:

8.1. Any contract resulting from this solicitation will be subject to the Privacy Act of 1974. Federal Acquisition Regulations 52.224-1 Privacy Act Notification and 52.224-2 Privacy Act are incorporated by reference.

8.2. The Psychiatrist shall be responsible for providing responsible management of medical care. Care provided will respect and integrate the patient’s beliefs, values and cultural influences. The Psychiatrist shall involve the patient in care decisions by keeping him/her fully informed about the diagnosis, plan of care and treatment goals, risks and benefits of proposed treatment, and prognosis; shared decision making shall be pursued.

8.3. Health Insurance Portability and Accountability Act (HIPPA): VHA (and therefore the Psychiatrist) must comply with all applicable privacy and confidentiality statues and regulations.

9.0. GOVERNMENT-FURNISHED EQUIPMENT (GFE)/GOVERNMENT-FURNISHED INFORMATION (GFI): The VA will provide the Psychiatrist with access to the Veterans Health Information System Technology Architecture (VISTA), formally known as the Decentralized Hospital Computer Program (DHCP), as well as the VA’s patient record computer system, Computerized Patient Record System (CPRS) that contains patient medical records, medication profiles, laboratory and radiology data, and other diagnostic test results. Access will be for the following purposes, only:

1. Obtaining patient specific information;

1. Requesting specialty consults, laboratory, radiology, or other diagnostic tests;

1. Communicating with VA Staff about patient care issues;

1. Checking formulary status of drugs; and

1. Physician input. It is the responsibility of the contracted physician(s) to ensure that all CPRS entries and encounters are completed within 48 hours of the patient encounter.

10.0. SUBMISSION OF QUALIFICATIONS:

10.1. The Contractor must provide the following documentation for each proposed psychiatrist along with the candidate’s information:

1. Evidence of an unrestricted license in a US state, territory or US commonwealth;

1. Evidence of demonstrated current clinical competence to perform appropriate outpatient care services;

1. Evidence of Board Certification or Board Eligibility as a Psychiatrist;

1. Evidence of a professional degree and education applicable to medical staff members, e.g., MD, DO;

1. Evidence of current professional liability insurance;

1. Evidence of current privileges (if applicable);

1. Evidence of current TB surveillance status;

1. Evidence of current Hepatitis B vaccination and titer;

1. Names of most current employer(s) and two peer reference contacts;

1. Evidence of current ACLS or BCLS certification(s);

k. The Department of Veterans Affairs utilizes computerized patient medical records. Thus, incumbent must have basic keyboarding skill (25 wpm or greater), basic computer navigation skills, and the ability to work efficiently with electronic medical records. The Contractor shall provide a statement attesting to the written and spoken literacy of each provider, and well as their computer literacy.

10.2. All Psychiatrists shall have a current, full, and unrestricted license to practice medicine in any state, territory, or commonwealth of the United States or in the District of Columbia. If required by the State of Licensure, current registration shall also be maintained.

10.3. Psychiatrists who have current, full and unrestricted licenses in one or more states, but who have, or have ever had, a license restricted, suspended, revoked, voluntarily surrendered pending action, or denied upon application shall not be considered for the purposes of this contract.

11.0. OTHER PERTINENT INFORMATION OR SPECIAL CONSIDERATIONS:

11.1. DEFINITIONS:

11.1.1. Contracting Officer: The Contracting Officer (CO) is responsible for the overall administration of this contract. The Contractor is advised that only the Contracting Officer, acting within the scope of his/her duties and responsibilities, has the authority to make changes to the contract, which affect contract prices, terms and conditions of this contract:

11.1.2. Contracting Officer Representative: A Contracting Officer Representative (COR) will be designated to represent the Contracting Officer in furnishing technical guidance and advice under this contract. The foregoing is not to be construed as authorization to interpret or furnish advice and information to Contractor relative to the financial or legal aspects of the contract. Those matters are the responsibility of the Contracting Officer and shall not be delegated.

12.0. GOVERNING LAW: This contract shall be governed, construed and enforced in accordance with Federal Law.

13.0. MARKETING: Contractor shall not advertise or use any marketing material, logos, trade names, service marks, or other material belonging to the VA Medical Center without the VA Medical Center’s consent.

14.0. ORDER OF PRECEDENCE: The terms, conditions, and attachments referenced herein, including any formal written modifications thereto, constitute the complete agreement between the parties and take precedence over any other language, oral or written.

15.0. INVOICES: Invoices shall be submitted monthly in arrears, and in accordance with the invoicing instructions above, Section B.1, Contract Administration Data, paragraph 4, Government Invoicing Instructions.

16.0. PROPOSED PROVIDERS: The Contractor will provide the following information for each Psychiatrist they are recommending:

a. Providers Full Name (Including Middle Name):

i. Date of Birth;

ii. Place of Birth;

iii. Social Security Number;

iv. Home Address; and

v. E-mail address.

b. One Current License:

i. State of Licensure;

ii. License Number; and

iii. Expiration Date of License.

c. Most Recent Facility Where Privileges Are/Were Held;

d. Professional school where degree obtained:

i. City and State of Professional School;

ii. Year of Graduation; and

iii. ECFMG number.

17.0. IDENTIFICATION OF POSSIBLE FOLLOW ON WORK:

17.1. This contract is explicitly for locum tenens services and not to be construed as implying that follow on work or conversion to full-time permanent employment.

17.2. It is anticipated that psychiatrist services on a locum tenens basis will be required beyond an initial six (6) month period.

17.3. VISN20 Psychiatry Departments have full-time vacancies. The Psychiatrists are eligible to apply for a vacant position. However, any such application is a separate process from this locum tenens contract, and no finder’s fee will be paid to the Contractor should one of the individuals they provide to perform these services is hired after applying for a position at the VA.

18.0. IDENTIFICATION OF NON-DISCLOSURE REQUIREMENTS: Psychiatrists shall execute non-disclosure agreements when they work with sensitive and/or proprietary information.

19.0. RISK CONTROL: Psychiatrists shall comply with safety, patient issues, infection control, and other areas as required.

20. PLACES OF PERFORMANCE: Services under this contract may be performed as needed at VA facilities within VISN20, incorporating the states of Washington, Oregon, and Idaho, as listed below:

State of Washington:

VA Puget Sound Healthcare System-Seattle Division: 1660 S. Columbian Way, Seattle, WA 98108 VA Puget Sound Healthcare System-American Lake Division: 9600 Veterans Dr., Lakewood, WA 98493 Mann-Grandstaff VA Medical Center: 4815 N. Assembly St., Spokane, WA 99205 VA Portland Healthcare System, Vancouver Campus: 1601 E. 4th Plain Blvd., Vancouver, WA 98661 Jonathan M. Wainwright Memorial VA Medical Center: 77 Wainwright Dr., Walla Walla, WA 99362

State of Oregon:

Portland VA Medical Center: 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239 Roseburg VA Healthcare System: 913 NW Garden Valley Blvd., Roseburg, OR 97471-6513 VA Southern Oregon Rehabilitation Center: 8495 Crater Lake Hwy., White City, OR 97503

State of Idaho:

Boise VA Medical Center: 500 West Fort St., Boise ID 83702

Note: The government reserves the right to add or delete facilities from this listing within the VISN20 region as may be necessitated by changing requirements.

21.0. INITIAL PERIODS OF PERFORMANCE: The Boise VAMC has an immediate need for two (2) Psychiatrists under this requirement. Each will be for an initial four (4) month period. Actual start and end dates are dependent upon completion of the Psychiatrists’ background checks and credentialing/ privileging. These services shall be performed at the Boise VA Medical Center (BVAMC), Building 114, 500 W Fort St., Boise, ID. 83702.

22.0. CONTINUIUNG PERFORMANCE: The Government anticipates multiple contractors to be chosen for awards under this solicitation. Individual Orders will be placed against those awards by the various VA facilities where services may be required as listed in Section 20 of this Performance Work Statement. Prior to the placement of each Order, a best and final price competition will determine which Contractor will be awarded an Order to perform a specific location for a specified period. That determination will include best and final pricing for performance of Psychiatrist services, Contract Line Item Number 0001 as well as Travel Expense Reimbursement, Contract Line Item Number 0002.

23.0. TRAVEL EXPENSE REIMBURSEMENT: The Government prefers Contractors to send providers under this contract from the locality in which the VA facility is located. Allowable and allocable travel expense reimbursement will only be paid for providers who travel more than 40 miles from the VA facility where they are required to provide services. The Government agrees to reimburse the Contractor on the same basis as federal employees are reimbursed for travel expenses. The Contractor shall be reimbursed for travel made at the direction of the Government, only. In accordance with Federal Acquisition Regulation (FAR) 31.205-46, reimbursable travel expenses are as follows:

23.1. Costs incurred by contractor personnel on official company business are allowable, subject to the limitations contained in this subsection. Costs for transportation may be based on mileage rates, actual costs incurred, or on a combination thereof, provided the method used results in a reasonable charge. Costs for lodging, meals, and incidental expenses may be based on per diem, actual expenses, or a combination thereof, provided the method used results in a reasonable charge.

23.2. Except as provided in subparagraph 23.3 of this subsection, costs incurred for lodging, meals, and incidental expenses (as defined in the regulations cited in 23.2.a, b, and c of this subparagraph) shall be considered to be reasonable and allowable only to the extent that they do not exceed on a daily basis the maximum per diem rates in effect at the time of travel as set forth in the:

a. Federal Travel Regulations, prescribed by the General Services Administration, for travel in the contiguous United States, available on a subscription basis from the:

Superintendent of Documents U.S. Government Printing Office Washington, DC 20402 Stock No. 922-002-00000-2;

b. Joint Travel Regulation, Volume 2, DoD Civilian Personnel, Appendix A, prescribed by the Department of Defense, for travel in Alaska, Hawaii, and outlying areas of the United States, available on a subscription basis from the:

Superintendent of Documents U.S. Government Printing Office Washington, DC 20402 Stock No. 908-010-00000-1; or

c. Standardized Regulations (Government Civilians, Foreign Areas), Section 925, “Maximum Travel Per Diem Allowances for Foreign Areas,” prescribed by the Department of State, for travel in areas not covered in 23.2.a and b of this subparagraph, available on a subscription basis from the:

Superintendent of Documents U.S. Government Printing Office Washington, DC 20402 Stock No. 744-008-00000-0.

23.3. In special or unusual situations, actual costs in excess of the above-referenced maximum per diem rates are allowable provided that such amounts do not exceed the higher amounts authorized for Federal civilian employees as permitted in the regulations referenced in 22.2.a, b, and c of this subsection. For such higher amounts to be allowable, all of the following conditions must be met:

23.3.1. One of the conditions warranting approval of the actual expense method, as set forth in the regulations referenced in paragraphs 22.2.a, b, and c of this subsection, must exist.

23.3.2. A written justification for use of the higher amounts must be approved by an officer of the contractor’s organization or designee to ensure that the authority is properly administered and controlled to prevent abuse.

23.3.3. If it becomes necessary to exercise the authority to use the higher actual expense method repetitively or on a continuing basis in a particular area, the contractor must obtain advance approval from the contracting officer.

23.3.4. Documentation to support actual costs incurred shall be in accordance with the contractor’s established practices, subject to paragraph 23.7 of this subsection, and provided that a receipt is required for each expenditure of $75.00 or more. The approved justification required by paragraph 23.3.2 and, if applicable, paragraph 23.3.3 of this subsection must be retained.

23.4. Paragraphs 23.2 and 23.3 of this subsection do not incorporate the regulations cited in subdivisions 23.2.a, b and c of this subsection in their entirety. Only the maximum per diem rates, the definitions of lodging, meals, and incidental expenses, and the regulatory coverage dealing with special or unusual situations are incorporated herein.

23.5. An advance agreement as outlined in Federal Acquisition Regulation, Part 31.109, with respect to compliance with subparagraphs 23.2 and 23.3 of this subsection may be useful and desirable.

23.6. The maximum per diem rates referenced in subparagraph 23.2 of this subsection generally would not constitute a reasonable daily charge:

a. When no lodging costs are incurred; and/or

b. On partial travel days (e.g., day of departure and return). Appropriate downward adjustments from the maximum per diem rates would normally be required under these circumstances. While these adjustments need not be calculated in accordance with the Federal Travel Regulation or Joint Travel Regulations, they must result in a reasonable charge.

23.7. Costs shall be allowable only if the following information is documented:

a. Date and place (city, town, or other similar designation) of the expenses;

b. Purpose of the trip; and

c. Name of person on trip and that person’s title or relationship to the contractor.

23.8. Airfare costs in excess of the lowest priced airfare available to the contractor during normal business hours are unallowable except when such accommodations require circuitous routing, require travel during unreasonable hours, excessively prolong travel, result in increased cost that would offset transportation savings, are not reasonably adequate for the physical or medical needs of the traveler, or are not reasonably available to meet mission requirements. However, in order for airfare costs in excess of the above standard airfare to be allowable, the applicable condition(s) set forth above must be documented and justified.

23.9. “Cost of travel by contractor-owned, leased, or chartered aircraft,” as used in this paragraph, includes the cost of lease, charter, operation (including personnel), maintenance, depreciation, insurance, and other related costs.

23.9.1. The costs of travel by contractor-owned, leased, or chartered aircraft are limited to the allowable airfare described in paragraph 23.8 of this subsection for the flight destination unless travel by such aircraft is specifically required by contract specification, term, or condition, or a higher amount is approved by the contracting officer. A higher amount may be agreed to when one or more of the circumstances for justifying higher than allowable airfare listed in paragraph 23.8 of this subsection are applicable, or when an advance agreement under subparagraph 23.9.2 of this subsection has been executed. In all cases, travel by contractor-owned, leased, or chartered aircraft must be fully documented and justified. For each contractor-owned, leased, or chartered aircraft used for any business purpose which is charged or allocated, directly or indirectly, to a Government contract, the contractor must maintain and make available manifest/logs for all flights on such company aircraft. As a minimum, the manifest/log shall indicate:

a. Date, time, and points of departure;

b. Destination, date, and time of arrival;

c. Name of each passenger and relationship to the contractor;

d. Authorization for trip; and

e. Purpose of trip.

23.9.2. Where an advance agreement is proposed (see Federal Acquisition Regulation, Part 31.109), consideration may be given to the following:

a. Whether scheduled commercial airlines or other suitable, less costly, travel facilities are available at reasonable times, with reasonable frequency, and serve the required destinations conveniently; and

b. Whether increased flexibility in scheduling results in time savings and more effective use of personnel that would outweigh additional travel costs.

23.10. Costs of contractor-owned or leased automobiles, as used in this paragraph, include the costs of lease, operation (including personnel), maintenance, depreciation, insurance, etc. These costs are allowable, if reasonable, to the extent that the automobiles are used for company business. That portion of the cost of company-furnished automobiles that relates to personal use by employees (including transportation to and from work) is compensation for personal services and is unallowable as stated in Federal Acquisition Regulation, Part 31.205-6(m)(2).

APPENDIX A – CONTRACTOR CERTIFICATION OF EMPLOYEE LEGAL STATUS

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

While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

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

The Contractor agrees to obtain a similar certification from its subcontractors.

Signature: ____________________________________________ Date: ____________________________________________ Typed Name and Title: ___________________________________ Company Name: ______________________________________ This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

APPENDIX B – ORGANIZATIONAL CONFLICT OF INTEREST

In accordance with solicitation provision 852.209-70, Organizational Conflicts of Interest (Jan 2009), Contractors shall provide the following signed response with their offer/proposal:

Reference Solicitation No. 36C26018Q0119

Contractor Name and Address: _____________________________________________

Contractor Conflict of Interest Certification Statement (Check one and sign):

[ ] (Contractor name)_______________________________________________ _________________ represents that the individuals listed in Section D.1, Quality Assurance Surveillance Plan, paragraph 3.0, Contractor Representatives, have no present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or organizational conflicts of interest relating to the services to be provided to the Veterans Administration, Veterans Integrated Services Network 20, under the referenced solicitation.

None of the individuals listed in the solicitation Provider Pool (see Section E.2, Basis of Award, paragraph 7.1.4.1) have a…