36C26026Q0296.docx

Sources Sought Notice Sources Sought Notice

GENERAL INFORMATION

SET-ASIDE

ATTN: V4CONT

1601 E. Fourth Plain Blvd Bldg.17, Suite B428 Vancouver WA 98661

POINT OF CONTACT*

Contract Specialist David Hurrell david.hurrell@va.gov

PLACE OF PERFORMANCE

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

DESCRIPTION

A.1 DISCLAIMER

This RFI is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to this RFI that is marked as proprietary will be handled accordingly. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI.

A.2 DESCRIPTION

The U.S. Department of Veterans Affairs, Network Contracting Office 20, in support of the VISN 20 Northwest Network, is currently requesting information to determine the existence of vendors capable of providing Community Based Outpatient Clinic (CBOC) services to the Mann-Grandstaff VA Medical Center (MGVAMC) It is anticipated that a single Indefinite-Delivery Indefinite-Quantity (IDIQ) contract will result from the solicitation. The intended period of performance is 5 years.

Description of Services MGVAMC requires clinic space, equipment, supplies and staff as detailed in the Performance Work Statement (PWS) for Primary Care services for approximately 700 patients in the Lincoln County, MT area. The requirement is a physical location within Lincoln County, MT.

Contractor performing services under a resultant contract shall provide a continuum of care from prevention to diagnosis and treatment, and 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.

Alternatively, the contractor may provide clinic space, equipment, supplies and staff, except physicians, which may be provided by MGVAMC.

The NAICS code assigned is: 621498, All Other Outpatient Care Centers the small business size standard for this NAICS code is $25.5 million.

The Government is not soliciting offers at this time. This is a Sources Sought Notice to gain knowledge of potential qualified sources. A solicitation is not currently available.

Responses to this request will be considered for the purpose of determining how the requirements will be stated and how the procurement will be conducted. This Sources Sought Notice is not to be construed as a commitment by the Government, implied or otherwise, to issue a solicitation or to award a contract. No reimbursement will be made for any costs associated with providing information in response to this notice or any follow-up information requests.

If your business is interested and capable of providing the required services, please complete the Sources Sought Questionnaire following the PWS and email your response to David.hurrell@va.gov no later than 04:30 PM PT on April 17, 2026. Please include a Capabilities Statement. Phone calls will not be accepted. Include any comments or questions you may have.

A.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1 Services Required: The Mann-Grandstaff VA Medical Center (MGVAMC) requires the following services to be provided in a private hospital, office or clinic environment to Veterans, primarily residing in Lincoln County, Montana.

1.2 Site Classification: This site is classified as a Other Outpatient Services Site.

1.3 Place of Performance: Services shall be performed by contractor at Located within Libby, Montana on behalf of MGVAMC, 4815 N. Assembly St. Spokane, WA 99205

1.4 Authority: Title 38 United States Code (USC) 8153 and FAR parts 12 and 15.

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#. A link to the VA Qualifications Standards is also included in this document.

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties ACGME: Accreditation Council for Graduate Medical Education ACIP: Advisory Committee on Immunization Practices 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 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 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 - A 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 substance 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 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.

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: 620.

Physician Director (Mandatory for all sites): FTE Ratio Performance Standard: 0.05 FTE per PACT. Responsible Party: Shall be provided by contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contractor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. The physician director may also be credentialed and privileged to function as a PCP. (If so, authorization for prescriptive authority is required). Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site. Supervises mid-level providers such as physician assistants in compliance with the state of Montana.

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. Contractor to propose mix of PCP from the options below.

Option 1: Physician (MD/DO): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Option 2: Advanced Practice Registered Nurse (APRN): Qualifications: APRN’s (including subcontractors) shall possess a master’s degree from a program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE) and maintain full and current certification as a Certified Nurse Practitioner (CNP) from the American Nurses Association or another nationally recognized certifying body in either Adult Health or Family Practice. Authorization for prescriptive authority is required. CNPs shall prescribe controlled substances in accordance with limitations imposed by the Controlled Substances Act and the CNP’s State licensure on the authority to prescribe or administer controlled substances. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CNP shall have current, full, active, and unrestricted license and 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 qualification standards for Advanced Practice Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Option 3: Physician Assistant (PA): Qualifications: PA’s (including subcontractors) shall be a graduate of a training program which is accredited by the Accreditation Review Commission on Education of PA (ARC-PA) or one of its predecessor organizations. Additionally, PAs shall have a master’s degree in any discipline or a bachelor’s degree in any discipline with one year of experience as a PA. PAs shall have successfully passed the PA National Certifying Exam (PANCE). Authorization for prescriptive authority is required. PA shall have current, full, active, and unrestricted license and registration in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

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 qualification standards for Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. 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 qualification standards for Licensed Practical or Vocation nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. 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. This position will receive training as a back-up for telehealth services.

Option 2: Unlicensed Assistive Personnel (Health Technician, Nursing Assistant). This staffing is part of the PACT Teamlet, not the primary telehealth clinical technician (TCT): Qualifications: Nursing Assistant qualifications per VA qualification standards for Nursing Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Health Technician qualifications per Health Aid and Technician Series 0640 located at: Health Aid and Technician Series 0640 (opm.gov).

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. This position will receive training as a back-up for telehealth services.

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. See VA qualification standards for Medical Support Assistant located in the VA Qualification Standards for additional qualifications. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. 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.

Discipline Specific 1: Clinical Pharmacist Practitioner (CPP) PACT: Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Discipline Specific 2: Clinical Pharmacist Practitioner (CPP) Anti-Coagulation - Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Discipline Specific 3: Licensed Social Worker (this position provides general/medical social work services): Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Discipline Specific 4: Registered Dietitian/Nutritionist: Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

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

Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Option 1: Psychologist: Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Option 2: Licensed Social Worker (Mental Health) (this position provides mental health services as part of the PCMHI team): Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Option 3: Licensed Professional Mental Health Counselor (LPMHC): Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Option 4: Psychiatrist: Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Option 5: Advanced Practice Registered Nurse (APRN): Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Option 6: Mental Health Clinical Pharmacist Practitioner (CPP): Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Option 7: Registered Nurse (RN): Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

2.4 Specialty Care Staffing:

Podiatrist: Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

Physical Therapist: Services shall be provided by VA staff via telehealth and/or telephone to enrolled and unassigned patients presenting for care.

2.5 Ancillary Support Services Staffing: The following ancillary support staffing shall be provided by the contractor. The contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to these services during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters).

Phlebotomist: Medical Laboratory Technician Qualifications: Successful completion of (a) an associate-degree course of study of which the 2nd year of the 2-year program included successful completion of a training course of approximately a year's duration in a certified laboratory assistant school approved by a nationally recognized accrediting agency; (b) 1 year of study that included 6 semester hours in chemistry and/or the biological sciences, plus Successful completion of (a) a full-time training course of approximately a year's duration in a medical or clinical laboratory assistant (or technician) school that included instruction in chemistry, hematology, blood banking, and microbiology (including serology) and that, in addition, included supervised laboratory practice incident to the diagnostic process and the treatment of patients; or (b) 1 year of study that included at least 6 semester hours in chemistry and/or biological science; or (c) 2 years of study that included at least 12 semester hours of chemistry and/or biological science course work that must have been directly related to the specialization of the position

2.6 General and Specialty Mental Health Staffing Requirements and Options: The following mental health staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

General MH Staffing FTE Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Specialty MH Staffing FTE Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Required: Administrative Support Staff: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Required: For the additional 8.0 FTE of clinical staff per 1000 Veterans receiving General and Specialty MH services, shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 1: Psychiatrist Qualifications: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 2: Advanced Practice Registered Nurse (APRN): Qualifications: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 3: Physician Assistant: Qualifications: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 4: Mental Health Clinical Pharmacist Practitioner (CPP): Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 5: Psychologist: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 6: Licensed Social Worker (Mental Health): Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 7: Licensed Professional Mental Health Counselor (LPMHC): Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 8: Marriage and Family Therapist (MFT): Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 9: Registered Nurse (RN): Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Option 10: Addiction Therapist: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

a. Addiction Therapist (bachelor’s level) (AT). Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

b. Addiction Therapist (Licensed Master’s Level) (LMAT). Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Additional General and Specialty Mental Health Staffing Requirements: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Suicide Prevention Coordinator (SPC): Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

Homeless Outreach Specialist: Staffing shall be provided by the VA for enrolled and unassigned veterans presenting for care utilizing telehealth, care in the community, or a VA facility.

2.7 Telehealth Services Clinical Staff: The following telehealth staffing shall be provided by the contractor. For CBOCs with fewer than 1050 synchronous and/or asynchronous encounters anticipated per year, one Telehealth Clinical Technician (TCT) FTE is required; for CBOCs with 1051-1479 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, 1.5-2 TCT FTE are required; for CBOCs with over 1480 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, greater than 2 TCT FTE are required. Each TCT shall have a trained back-up, e.g., another TCT or a member of the PACT Teamlet such as (PCP, RNCM, or clinical associate) who is able to perform all telehealth duties of the designated telehealth TCT. Qualifications: All staff providing telehealth related services in the clinic shall be appropriately credentialed and where necessary, privileged. See section 2.9 for additional information regarding credentialing and privileging for contracted telehealth providers. All contractor staff who support and manage telehealth services shall be working within permitted licensure and scope of practice. Where non-licensed staff are supporting telehealth services the contractor’s licensed staff shall provide appropriate clinical supervision.

Competency: TCTs, telepresenters, store and forward imagers and back-ups shall be expected to successfully complete training programs and skill assessments required for competency as a TCT, telepresenter and/ or store and forward imager and back-up including VA required training and any VA training mandated for TCT, telepresenter, teleretinal imagers. TCTs, telepresenters, and store and forward imagers shall be responsible for maintaining imager and/or other required competencies or appropriate certifications. TCTs, telepresenters, and store and forward imagers and back-ups shall be expected to demonstrate competency on the function and use of the telehealth equipment including digital retinal and dermatology imaging system, teleaudiology hardware and software. VA will provide training to TCTs, telepresenters, store and forward imagers and back-ups and document competency.

Training: Contractor’s TCTs, RNs, LPNs, LIPs and support staff providing telehealth services shall complete all telehealth required training and skill assessments both virtual and in-person. Contractor’s telehealth staff shall be required to attend conference calls intended to support and maximize delivery of care as required by the VA.

Telehealth Clinical Technician (TCT) Position Responsibilities: TCT manages the telehealth services offered by the clinic (i.e., presenting, equipment management, training, imaging, audiology services, etc.) and is responsible for the provision of covered services to assigned and unassigned patients presenting for care. The contractor’s telehealth services shall include but are not limited to coordinating telehealth clinic set up, scheduling, equipment management, provision of data on request, attendance on VA or Network Telehealth Team calls, maintaining records required for quality control processes, and participating in performance improvement activities. The TCT shall be responsible for conveyance of clinically appropriate in-person interaction or on-site observations (e.g., assisting with hearing aid fittings, detection of alcohol use, etc.) with the patient to the telehealth provider. The TCT shall be responsible for gathering and transmitting telehealth images, sounds, data and all other supporting data to the assigned VA providers or reading centers within timelines established by policy. The TCT shall provide technology education to patients including but not limited to review of acquired data or images for anatomic and general findings, review of photos, and provision of VA approved handouts. The TCT will provide basic telehealth education to patients who receive telehealth services (i.e., TRI, TDI imaging process, when to expect results, etc.), as well as basic education related to the patient’s condition as requested by the telehealth provider (i.e., hand-outs). The TCT shall communicate regularly with the facility telehealth coordinator (FTC) to work out any process issues, equipment needs/problems, data collection and any other logistical issues.

Telepresenter Position Responsibilities: Include but are not limited to the following: Assist the primary care or specialty care provider with the Veteran physical exam as needed, provide Veteran education, documentation, and assistance with workload capture for the completion of the visit, per scope of practice and manage required screenings and complete clinical reminders, documentation, scheduling and opening and closing the encounter.

2.6 2.7

2.8 License and Accreditation: All contract licensed providers assigned by the Contractor to perform the services covered by this contract shall have a current license to practice in the state where the outpatient clinic is located. If the state where the outpatient clinic is located recognizes multistate licensure through a compact and a contract licensed provider’s home state is a party to such compact, and no other restrictions apply, then the provider’s compact licensure status in the state where the outpatient clinic is located may be acceptable as long as the provider complies with all licensure requirements of the multistate compact for the entirety of the provider’s performance of…