S06 - 36C26019R0032 0005.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODECODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 11

0005 05-27-2021 None

Department of Veterans Affairs Network Contracting Office 20 8524 N Wall St Spokane WA 99208

Department of Veterans Affairs Network Contracting Office 20 8524 N Wall St Spokane WA 99208

To all Offerors/Bidders

36C26019R0032

04-01-2021

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 06-10-2021 at 17:00 PST

The purpose of this amendment is to address additional questions and answers, update PMPM quantities and extend the proposal due date from 05-31-2021 at 17:00 PST to 06-10-2021 at 17:00 PST.

Contracting POC for this action is Scott A. Reed at (509) 321-1909 or scott.reed2@va.gov.

All other terms and conditions remain unchanged.

36C26019R0032 0005 Bonner County CBOC

SCHEDULE OF SERVICES

The guaranteed minimum contract amount is $500,000.00 and the maximum contract amount shall not exceed $20,000,000.00.

Ordering Procedures: VA has the sole authority to assign Veterans treated by the contractor into the Primary Care Management Manual (PCMM) software program used to track primary care clinic veteran rosters. Specific billable processes for issuing task orders under the resultant contract includes: determining veteran eligibility, enrollment eligibility, and qualifying encounters is further defined in 6.2.1 (beginning on page 78). Please review in detail section 6.2.1 to ensure compliance for issuance of subsequent task orders and payment processing.

Orders will be placed annually via SF1449, following shortly after the next option being exercised but not later than 30 calendar days prior to expiration of the current period of performance.

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

Total Estimated Cost shall be calculated by multiplying the Estimated Quantity X the Price Per Unit X 12 (Estimated Quantity X Price Per Unit = Monthly Amount X 12 = Total Estimated Amount).

Please reference Attachment 32, Workload History PERIOD OF PERFORMANCE INCLUDING BASE AND ALL OPTIONS: 04/01/2022 – 03/31/2032 (MAY

CHANGE AT AWARD)

Estimated Quantity

Line Item No.

Services Unit Price Per Unit

Total Estimated Cost

0001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Base Year:

POP: 04/01/2022 – 03/31/2023

PMPM 1500 $_______ $_____________________

1001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year One:

POP: 04/01/2023 – 03/31/2024

PMPM 1600 $_______ $_____________________

2001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Two:

POP: 04/01/2024 – 03/31/2025

PMPM 1700 $_______ $_____________________

Line Item No.

Services Unit Estimated Quantity

Price Per Unit

Total Estimated Cost

3001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Three:

POP: 04/01/2025 – 03/31/2026

PMPM 1800 $_______ $_____________________

4001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Four:

POP: 04/01/2026 – 03/31/2027

PMPM 1850 $_______ $_____________________

5001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Five:

POP: 04/01/2027 – 03/31/2028

PMPM 1900 $_______ $_____________________

6001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Six:

POP: 04/01/2028 – 03/31/2029

PMPM 1950 $_______ $_____________________

7001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Seven:

POP: 04/01/2029 – 03/31/2030

PMPM 2000 $_______ $_____________________

8001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Eight:

POP: 04/01/2030 – 03/31/2031

PMPM 2050 $_______ $_____________________

Line Item No.

Services Unit Estimated Quantity

Price Per Unit

Total Estimated Cost

9001 Primary Care Services at Capitation rates per member per month (PMPM) Services shall be provided in Bonner County, Idaho

Option Year Nine:

POP: 04/01/2031 – 03/31/2032

PMPM 2100 $_______ $_____________________

Contract Total: $_____________________________

ADDITIONAL QUESTIONS AND ANSWERS

Solicitation page 18 of 140

2.8. TELEHEALTH SERVICES CLINICAL STAFF: The following telehealth staffing shall be provided by the Contractor: Telehealth Clinical Technician (TCT). FTE Ratio Performance Standard: 1.0 FTE TCT per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM or LPN), depending on size of clinic/clinic workload/clinic telehealth services). All staff providing telehealth related services (primary TCT(s) and back-ups) must be trained in teleretinal imaging, teledermatology, teleaudiology, tele-mental health, teleprimary care, etc. The qualifications, competencies and position responsibilities noted below apply to primary TCT(s) and back-ups. The Telepresenter can be any clinically trained person assisting the provider in the presentation of the Veteran using video conferencing.

Q: Will the Government please confirm if both a contracted Telehealth Clinical Technician (TCT) and the contracted Telepresenter are both required by the VA? If both are required, what is the full time equivalent (FTE) requirement for each?

A: The TCT and Tele presenter are not both required.

Solicitation page 31 of 140

4.6.2.4.9. Emergency contraception

Q: Emergency contraception (e.g., Levonorgestrel (Plan B), etc.) must be available to all women veteran patients in a timely manner. Will the Government please confirm who pays Levonorgestrel; Plan B medication, the VA, or the Contractor?

A: The Government will pay for emergency contraception. At this time, the Government has a contract with Heritage and the formulary option is Ella (Ulipristal) as it has a longer effective window of 120 hours.

Solicitation page 31 of 140

4.6.2.4.10. Contractor shall provide all equipment necessary to provide comprehensive women’s health services.

Q: The RFP states contractor will provide supplies for PAP testing; however, the Contractor is not able to purchase Thin Prep. Will the Government please confirm that the VA will supply Thin Prep?

A: The Government will provide ThinPrep® or SurePath ™ Collection vials, brushes and spatulas.

Solicitation page 32 of 140

4.6.3.1. Prescription Fulfillment - The Contractor will provide all medications (including any necessary vaccines, with the exception of vaccines for COVID-19 as indicated in section 4.6.3.4) that are to be administered to patients in the clinic…. Urgent/Emergent medications needed will be filled via VA contracted local pharmacy for up to 10 days.

Q: Will the Government please confirm who pays for the 10-day emergent medications?

A: The Government will pay for the 10-day emergent medications.

Solicitation page 32 of 140

4.6.3.1. Prescription Fulfillment - The Contractor will provide all medications.

Q: Will the Government please provide a list of all medications, vaccinations and amounts to be administered in the clinic?

A: The amount of vaccinations to be administered will be dependent upon the patient clinical criteria and the provider’s scope of practice. TD, Tdap, Shingles, PCV13, MMR, Hep A, Hep B, and any other required vaccines not provided by the VA that are to be administered to patients in the clinic. The contractor is only required to provide medications to patients that are to be administered to patients in clinic.

Vaccines and medications provided to the current contract clinic over fiscal year 20.

OCT 1,2019 TO SEP 30,2020

DIPHTHERIA/TET TOX/PERTUSSIS VACCINE INJ 34

HEPATITIS B VACCINE, 20MCG, 1 ML 5

INFLUENZA VAC,QUAD (AGE 65+) SYR 0.7ML 50

INFLUENZA VACCINE,QUAD,(AGE<65) SYR 232

MEASLES, MUMPS & RUBELLA II 1

NALOXONE HCL 4MG/SPRAY SOLN NASAL SPRAY 1

PNEUMOCOCCAL 13-VALENT CONJ VACCINE 80

PNEUMOCOCCAL 23-VALENT POLYSAC VACCINE 60

ZOSTER VACCINE,RECOMBINANT INJ 274

zzINFLUENZA VACC TRI,ADJUV (AGE 65+) SYR 150

TOTAL 887

Solicitation page 35 of 140

4.6.3.4. Redistribution of COVID-19 Vaccine to Contracted Outpatient Sites of Care (i.e., CBOCs): VA will provide COVID-19 vaccines in accordance with the January 12, 2021 memorandum from the Assistant Undersecretary for Health for Patient Care Services on the Storage of Vaccines and Medications in Pharmaceutical Grade Purpose-Built Refrigerators and Freezers at Veterans Affairs Medical Facilities and Redistribution of COVID-19 Vaccines to Contracted Community Based Outpatient Clinics. Contractor is responsible for: Storage, Security, Administration and Monitoring of Requirements of COVID-19 Vaccine:

4.6.3.4.1. Storage:

4.6.3.4.1.1. Ensure all COVID-19 vaccine is properly stored and handled in accordance with the U.S. Department of Health and Human Services Centers for Disease Control (CDC) Vaccine Storage and Handling Toolkit that may be accessed at https://www.cdc.gov/vaccines/hcp/admin/storage/index.html.

Q: Will the Government please confirm which COVID vaccine is being administered at the CBOC? What are the specific storage specifications required to store the COVID vaccine?

A: Moderna and Johnson and Johnson. Please see the link provided above and/or the following specifications:

STORAGE

• Ensuring all COVID-19 vaccine is properly stored and handled in accordance with the U.S. Department of Health and Human Services Centers for Disease Control (CDC) Vaccine Storage and Handling Toolkit that may be accessed at: https://www.cdc.gov/vaccines/hcp/admin/storage/index.html.

• Ensuring a plan is in place for the contracted CBOC that is compliant with the Department of Veterans Affairs (VA) COVID-19 Vaccine Redistribution plans

• Ensuring vaccines and medications exposed to temperature excursions are not used for patient care and are returned to Pharmacy Services for appropriate disposal if necessary, and that a written summary is prepared and submitted to the VA contracting officer describing the events that contributed to the loss of COVID-19 vaccine.

• Ensuring a plan is in place that is consistent with CDC’s Interim Clinical Considerations for Use of mRNA COVID- 19 Vaccines Currently Authorized in the United States that may be accessed at:

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html.

SECURITY

• Ensure a plan is in place to ensure the security of the COVID-19 Vaccine. The pharmaceutical grade refrigerator with the COVID-19 vaccine shall be stored:

o in a locked room with access to the room limited to the staff involved in administering vaccines or medications to patients; OR o in a locked pharmaceutical grade refrigerator with access to the unit limited to the staff involved in administering vaccines to patients.

• Ensure a plan is in place for the CBOC manager to reconcile the COVID-19 vaccines administered compared to on-hand inventory to monitor for inventory shrinkage. o COVID-19 vaccine inventory shrinkage shall be reported to the VA Contracting Officer that at a minimum includes the number of COVID-19 vaccine doses that cannot be reconciled, a brief summary of the review, and corrective actions.

Solicitation page 35 of 140

4.6.3.4.3. Administration and Monitoring:

Q: Will the Government please specify if there are any additional COVID-19 related services that will be required outside those delineated in the Performance Work Statement (PWS) such as CAMI report review and management, COVID-19 testing, weekly COVID calls with the VAMC, etc.?

A: Contractor will need to report doses administered and doses wasted, which have to be reported to VA Pharmacy by 1500 daily in order to enter into the PBM reporting site, refrigerator monitoring and reporting on demand, any excursion of temperature events (temp tracking, how long, movement of vaccine to alternative storage, waste, incident report), and back-up power plan in case of power outage (required).

Solicitation page 37 of 140

4.6.4.3.1. – Specimens

Q: Will the Government please confirm if the Contractor is required to provide a refrigerated centrifuge?

A: Not required

Solicitation page 42 of 140

4.6.5.3 Mental Health Support services states: Contractor shall provide the following clerical support services for mental health providers at the CBOC.

Q: Will the Government please confirm the number of clerical and clinical support staff are required for all VA support services and the level of effort (FTE) for each?

A: 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 mid-level 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 in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of, and access to, appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing and nature-related events (e.g., extreme weather conditions, natural disasters).

A TCT or Telepresenter .5 FTE.

Staffing is dependent upon the number of active patients as identified above.

Solicitation page 51 of 140

4.6.6. SPECIALTY CARE SERVICES:

Q: Will the Government please specify the types of specialty services needed by number of patients over the previous two (2) years?

A:

FY 19 Consults Total FY20 Consults Totals Acupuncture 77 Acupuncture 73 Anticoag 37 Anticoag 39 Audiology 39 Audiology 39

BH 88 BH 105

Cardiology 254 Cardiology 272 Chiropractic 101 Chiropractic 139 Derm 188 Derm 188 Endocrinology 18 Endocrinology 32

ENT 88 ENT 54

GI 223 GI 235

GYN 8 GYN 12

Hematology 13 Hand 8 Home Care 75 Hematology 21 Imagining 615 Home Care 128 Infectious Disease 7 Imaging 290 Nephrology` 13 Infectious Disease 2 Neurology 99 Nephrology 17 Neurosurgery 49 Neurology 67

Nutrition 16 Neurosurgery 34 Oncology 40 Nutrition 22 Ophthalmology 63 Oncology 31 Optometry 109 Ophthalmology 46 Ortho 208 Optometry 127 OT 11 Ortho 161 Pain 105 OT 32 Pharmacy 157 Pain 112 Podiatry 175 Pharmacy 128 Prosthetics 229 Podiatry 189 PT 215 Prosthetics 299 Pulmonology 156 PT 221 Radiology Vascular 8 pulmonology 246 Renal 1 Renal 3 Rheumatology 38 Rheumatology 8 Social Work 73 Social Work 53 Speech 3 Speech 3 Surgery 70 surgery 48 Urology 136 Urology 132 Vascular Surgery 36 Vascular Surgery 31 Wound 2 Wound 1

3843 3648

Solicitation page 51 of 140

4.6.6. SPECIALTY CARE SERVICES:

Q: Will the Government please specify how many of the referrals were for primary care patients?

A: All referrals made by the contract clinic would be on behalf of primary care patients. Referrals are for specialty care only.

Solicitation page 66 of 140

4.11 EQUIPMENT, OFFICE SUPPLIES AND TECHNICAL SUPPORT:

In accordance with VA and VHA directives, policies and handbooks, all equipment attaching to a VA network will be owned and controlled by the VA. No other equipment will be connected to this network.

4.11.1.5. The procurement, installation and maintenance of all printers, copiers, scanners, fax machines*, shredders or other peripheral office equipment, and all related and ongoing supplies (paper, toner, ink cartridges) required to operate the equipment in support of the facility under the specifications of this contract.

Q: This section says that Contractor is responsible for the items listed above however, VA typically will not connect Contractor equipment to the VA network. Will the Government please confirm the list of contractor-supplied equipment that cannot be connected to the VA network? Will the Government please confirm the list of contractor-supplied equipment that can be connected to the VA network?

A: No contractor-owned equipment can be connected to the VA network.

Solicitation page 66 of 140

4.11.1.9. One small desktop color printer for printing patient education information.

Q: Will the Government please confirm that VA will supply small desktop color printer for patient education documents since contractor owned equipment is not permitted on VA network?

A: Yes. Government will supply a color laserjet printer for patient education information

Solicitation page 17 of 140; 51 of 140; 64 of 140

2.3.4. TEAMLET MEMBER 4: Administrative Associate: FTE Ratio Performance Standard: Current standard is

1.0 FTE Administrative Associate per 1.0 FTE PCP.

4.6.5.3. Mental Health Support Services: The Contractor shall provide the following clerical support services for mental health providers at the CBOC:

4.6.5.5. General and Specialty Mental Health Services: …. The Contractor shall provide clerical support including scheduling and ancillary support staff at the clinic who can arrange appropriate time and space for the veterans and staff who can provide technical support as required.

4.6.7.3. Telepharmacy Services: The Contractor shall provide support for VA provided clinical pharmacy telehealth services. The Contractor shall provide clerical support including scheduling and ancillary support for VA telepharmacy services.

4.9.14. “VETERANS ONLY” CLINIC REQUIREMENTS FOR CO-LOCATED FACILITIES: To meet the VA’s requirements for a “Veterans Only” clinic in a co-located facility, the Contractor’s site must have separate signage, a separate waiting room and dedicated staff for the site. The clerical/administrative personnel who check patients into and out of the clinic, respond to questions and resolve issues for veterans must be working with veterans only.

Q: How many contracted clerical support staff are required for the VA staff on-site?

A: One (1) clerical support per PACT team. Enough staff to cover for staff absences as well as provide clerical support for telehealth clinics. Based on current clinic enrollment

Telehealth MH Services has been under one (1) percent utilization by patients.

Solicitation

General - Staffing

Q: Will the Government please confirm if a Clinic Manager is required?

A: PWS indicates there needs to be a program manager for the contract. This individual would be the point of contact for the COR and CO. There is a Clinical Director requirement. The Clinical Director’s role is equivalent to a clinic manager.

Solicitation

General - Prescriptions

Q: Will the VA provide Naxolone for veterans who require it as a precaution?

A: Yes

Q: We note a significant discrepancy between the estimated patient panel increases for the Bonner County CBOC actual current enrollment at the current Bonner County Clinic.

The estimated patient panel significantly affects the price submitted by respective offerors. With the awarded contractor only able to bill for the actual patient panel size, an estimated patient panel that is higher than the actual patient panel can result in significant budgeting issues for an awarded contractor.

The VA’s response of “The number of enrollees would have been much higher if clinic consistently contacted Veterans to schedule their required annual appointment” is helpful.

However, based upon the significant potential budgeting impact of an estimated panel that significantly differs from an actual panel, which can significantly affect the care of Veterans, would the VA please consider providing additional clarification on the discrepancy between actual panel sizes and projected panel sizes?

A: Please see the explanation below with the graph.

Q: We would like to respectfully request clarification as to why the current panel size based upon the Questions and Answers in 0002 is “March 1445” when the estimated panel size in the first year of the pricing schedule states “1600”.

Even when the awarded contractor is to consistently contact Veterans to schedule annual appointments, the new patients’ vesting onto the current enrollment would not occur immediately and we would respectfully submit that the awarded contractor would have a budgeting shortfall between the 1600 estimated panel in the first year and the current panel of 1445 in March.

We would respectfully ask if the VA will consider amending the estimated panel size in the base year of the schedule to be closer to the current roster as given in the answer to Question 0002?

A: The current enrollment as of April is 1453. The quantity for each year of the contract is being changed. Please see the Schedule of Services included in this amendment.

Q: Additionally, Question two of the Q&A 0002 shows a declining number of enrollees from January (1449) to March (1445). Furthermore, the Historical Workload provided in Attachment 32 showed a Veteran population of 1,554 as of 9/5/2018. This means that from September 2018 to March 2021, there was a decrease of 109 patients in the span of two and a half years. However, very notably, the current schedule shows that the number of enrollees is actually estimated to increase by 200 from the base year to option year two.

We would respectfully ask if the VA will consider amending the schedule to bring the estimated Veteran enrollment closer to the historical experience data provided by the VA?

If the VA will not amend the schedule to bring the bring the estimated Veteran enrollment closer to the historical escalations provided by the VA, we would respectfully request for clarification as to why the estimated panel is projected to increase by such an amount when all prior experience data provided to responsible offerors, by the VA, instead shows a decline in panel size?

A: The base year quantity is being changed to 1500 pmpm. Quantity will increase by 100 patients for Option Years 1-3, and will increase by 50 every year after that based on the projected eligible veterans from the Veteran Population Projection Model 2016 (BetPop 2016). This is developed by the VA Office of Enterprise Integration, Data Governance and Analytics, Predictive Analytics and Actuary. Based on the projected eligible Veterans (BY19). Results below highlighting the projected growth for Bonner and Boundary Counties. Please see the Schedule of Services in this amendment for the updated quantities.