36C26120Q1074.docx

36C26120Q1074

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

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

36C26120Q1074 08-28-2020 Joleo B. Dianala, joleo.dianala@va.gov

(916) 923-4575 09-11-2020 12:00

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) VA Northern California HealthCare System 5342 Dudley Blvd, Bldg 209 McClellan

CA

95652-2609 X X 621498 $22 Million N/A X Reference PWS

612MCP

Department of Veterans Affairs Department of Veterans Affairs VA Northern California HealthCare System 3230 Peacekeeper Way, Bldg. 209 McClellan

CA

95652-1012

Department of Veterans Affairs FMS VA-9(101) Financial Services Center PO Box 149971 Austin

TX

78714-9971 See CONTINUATION Page Contractor shall provide Primary Care Support Services to eligible Veterans for the VA Pacific Island Healthcare System primarily residing in Saipan, Tinian, Rota, and Commonwealth of the Northern Mariana Islands (CNMI).

CBOC shall be located on the island of Saipan.

*See 52.212-1 and 852.273-73 for submission instructions.* See CONTINUATION Page X X Joleo B. Dianala

VA-VHA-2020-378F6FAE

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C261 Department of Veterans Affairs Network Contracting Office 21 VA Northern California HealthCare System 5342 Dudley Blvd, Bldg 209 McClellan, CA 95652-2609

Use NCO21MedicalSharingTeam@va.gov as an alternate contact information should your POC be non-responsive or no longer assigned to NCO 21. Include in subject line, the Contract Number and ATTN: “Individual name attempted to contact”

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

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. 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. Current Invoicing information is located at http://www.fsc.va.gov/einvoice.asp

Department of Veterans Affairs Financial Services Center P.O. Box 149971, Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Award Orientation - The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by Procurement Policy Memorandum (PPM) 2019- 01. https://www.va.gov/oal/docs/business/pps/ppm201901.pdf And:

Secure Fax - Please review VA Handbook 6500 that requires the following statement on all fax cover sheets be included: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

B.2 PRICE/COST SCHEDULE

Proposed Contractor facility must be physically located on the island of Saipan. The Parent Facility is the VA Pacific Islands Health Care System (VAPIHCS), 459 Patterson Road, Honolulu, HI 96819. Payment for primary care services shall be based on a monthly capitated rate, as further explained within this solicitation.

The quantities listed in the Price Schedule below are estimates only and are not to be considered a minimum or maximum.

The Government will order the below specified minimum contract value of services and may order up to and including the below specified maximum contract value of services through task orders under this basic Indefinite Delivery Indefinite Quantity (IDIQ) contract during the duration of the contract inclusive of all option periods. The maximum amount under this contract is not guaranteed.

The guaranteed minimum contract value is $1,000.00 and the maximum value shall not exceed $650,000.00.

ITEM INFORMATION

Primary Care Services at capitation rates per member per month (PMPM) Ordering Period 1: 10/01/2020 - 09/30/2021

Primary Care Services at capitation rates per member per month (PMPM) Ordering Period 2: 10/01/2021 - 09/30/2022

Primary Care Services at capitation rates per member per month (PMPM) Ordering Period 3: 10/01/2022 - 09/30/2023

Primary Care Services at capitation rates per member per month (PMPM) Ordering Period 4: 10/01/2023 - 09/30/2024

Primary Care Services at capitation rates per member per month (PMPM) Ordering Period 5: 10/01/2024 - 09/30/2025

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 required Evaluation and Management Exams. Please review in detail the PWS to ensure compliance for issuance of subsequent task orders and payment processing.

B.3 MANDATORY WRITTEN DISCLOSURES

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

Patient Rights and Responsibilities

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. SERVICES REQUIRED: The VA Pacific Islands Health Care System (VA PIHCS); requires the following services to be provided in a private office or clinic environment to Veterans, primarily residing in Saipan, Tinian and Rota, the Commonwealth of the Northern Mariana Islands (CNMI): The CBOC is located on the island of Saipan. Saipan is 140 miles from the Guam VA CBOC, about 45 minutes flight time from Saipan and 3800 miles from Honolulu VA Medical Center, about 7 hours flight time from Guam. Site of Care is (Saipan 5V21 459GH)

1.1.1. [X] Other Outpatient Clinical Services Site of Care (Less than 500 encounters registered in primary care and mental health stop class within any given fiscal year or does not include MH Services) Clinical services are provided to remote areas through a Telehealth clinic or other arrangement. If any other services are provided in this venue (external to a VA clinic or facility), they must be associated with, attached to, and coordinated by a health care delivery site located in a clinic or facility.

1.2. PLACE OF PERFORMANCE: The CBOC must be located on the island of Saipan.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of VA Pacific Islands Health Care System (VA PIHCS).

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index 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/vhapublications/ or at http://www.va.gov/vapubs/. 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/Resources.asp.

1.5. DEFINITIONS/ACRONYMS:

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. 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.

1.5.14. BAA: Business Associate Agreement

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

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: chronic obstructive pulmonary disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

1.5.35. CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org/ .

1.5.36. CPARS: Contractor Performance Assessment Reporting System

1.5.37. CVT: Clinical Video Telehealth

1.5.38. DICOM: Digital Image and Communication in Medicine

1.5.39. DIGMA: Drop in Group Medical Appointment

1.5.40. DRG: Diagnostic Related Group

1.5.41. DSS: Decision Support System

1.5.42. ECC Extended Care Center

1.5.43. 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.

1.5.44. EPRP: External Peer Review Program

1.5.45. FDA: Food and Drug Administration

1.5.46. FSMB: Federation of State Medical Boards

1.5.47. 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.

1.5.48. HHS: Department of Health and Human Services

1.5.49. HCFA: HealthCare Financing Administration

1.5.50. 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.

1.5.51. HT: Home Telehealth

1.5.52. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.53. ICD 10: International Classification of Diseases 10th edition

1.5.54. INR: International Normalized Ratio

1.5.55. ISO: Information Security Officer

1.5.56. LIP: licensed independent practitioner

1.5.57. MCCR: Medical Care Cost Recovery

1.5.58. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of 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;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education 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).

Specialty mental health services include:

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

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

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

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.59. MQSA: Mammography Quality Standards Act

1.5.60. MSN: Master of Science in Nursing

1.5.61. NCCPA: National Commission on Certification of Physician Assistants

1.5.62. NLN: National League for Nursing

1.5.63. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.5.64. OTC: Over the Counter

1.5.65. PA: Physician Assistant

1.5.66. PACS: Picture Archiving and Communications System

1.5.67. 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.

1.5.68. Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.69. PCMH: Patient-Centered Medical Home

1.5.70. PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.5.71. PCP: Primary Care Provider

1.5.72. Phar.D.: Doctor of Pharmacy

1.5.73. POC: Point of Care Testing

1.5.74. PRIMARY CARE VISIT: an episode of care furnished in a clinic 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.

1.5.75. PCMHI: Primary Care-Mental Health Integration

1.5.76. PWS: Performance Work Statement

1.5.77. QAPI: Quality Assessment and Performance Improvement

1.5.78. QASP: Quality Assurance Surveillance Plan

1.5.79. RME: reusable medical equipment

1.5.80. SOP (Clinical): Scope of Practice

1.5.81. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.82. SFT: Store and Forward Telehealth

1.5.83. SMA: Shared Medical Appointments

1.5.84. SPD: Sterile Processing Division

1.5.85. SPE: Senior Procurement Executive

1.5.86. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care, and is only provided through a referral.” These services are generally divided into two sub-categories: medicine specialties and surgery specialties. 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.

1.5.87. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.88. TJC: The Joint Commission

1.5.89. TIU: Text Integration Utility

1.5.90. TCT: Telehealth Clinical Technicians

1.5.91. VA: Veterans Affairs

1.5.92. VA EHR: VA electronic health record

1.5.93. VAMC: Veterans Affairs Medical Center

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

1.5.95. VHA: Veterans Health Administration

1.5.96. iMED: software used by VA for informed consent

1.5.97. VVC: VA Video Connect

1.5.98. WHEN: Weekend, Holiday, Every Night

1.5.99. Reporting of Test Results, VA PIHCS No. 11-18-029

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), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI)staff). The VAPIHCS shall provide PACT support staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The VA shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards pro-rated to serve the small catchment in Saipan. Note that the contractor provides PCP on a Fee basis arrangement separate from this contract. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider, whereas Saipan catchment is currently 282 patients corresponding to 0.25 FTE. 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 pro-rated to this population would consist of the combined equivalent of 0.25 FTE RNCM, 0.25 FTE Clinical Associate, 0.25 FTE Administrative Associate) for each 0.25 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 VAPIHCS shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. 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). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA to collaborate on a future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: 282

2.2 PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party:

Qualifications: Responsible Party to VAPIHCS provided physician PCP will also serve as the Physician Director.

Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

2.3 PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor, except teamlet member 1.

2.3.1 TEAMLET MEMBER 1: Primary Care Provider (PCP): VA is providing the PCP. 0.5 FTE Ration Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full midlevel provider. The VAPIHCS will provide the teamlet member 1. Teamlet member 1 will be a Fee Basis physician provided by VAPIHCS. The physician is a 0.5 FTE Fee Basis provider for the VA PIHCS.

2.3.2 OPTION 1: Physician (MD): (provided by the VA PIHCS Fee Basis provider): the physician will be provided by the VAPIHCS.. This Physician will be Fee Basis VA provider, credentialed and privileged by VA PIHCS

2.3.3 TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP. The VAPIHCS will provide 1.0 FTE RNCM staff member. Due to the small population of this catchment and panel, RN will perform duties of Clinical Associate position hence the increased FTE. The contractor will provide 1.0 FTE RNCM as back up support in the event that VAPIHCS RNCM is on leave. Reference VA Handbook 5005, Appendix G6 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and 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 of the Outpatient Site of Care (i.e. CBOC). Position Responsibilities: Responsible for the provision of covered services to enrolled 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, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, 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 telephone 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. PRIMARY CARE STAFFING – CLINICAL ASSOCIATE [X] Mandatory for all sites

2.3.4 TEAMLET MEMBER 3 CLINICAL ASSOCIATE: Due to the small Veteran population on Saipan and the current panel size being 282 requiring only 0.05 FTE PCP, the PACT staffing model has been adjusted to consist of 1.0 FTE VAPIHCS RN CM (see 2.3.3) to fulfill the clinical PACT duties of both RN and Clinical Associate. In addition, a 1.0 Administrative Officer (AO) fulfills the administrative PACT and non-clinical Telehealth duties (scheduling appointments, arranging specialist and Mental Health schedules and connecting Veterans ) AO duties also include time keeping, contracting officer representative, service level advocate, benetravel, coordination of Veteran Care in the Community (CITC) appointments, and liaison with VAPIHCS services on Oahu such as enrollment and eligibility, CITC, etc.

PRIMARY CARE STAFFING – ADMINISTRATIVE ASSOCIATE [X] Mandatory for all sites

2.3.5 TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. VAPIHCS will provide 1.0 FTE administrative officer. 0.25 FTE of this position will be dedicate to administrative PACT duties and 0.75 FTE to non-clinical Telehealth duties (scheduling appointments, arranging specialist and Mental Health schedules and connecting Veterans ) AO duties also include time keeping, contracting officer representative, service level advocate, benetravel, coordination of Veteran Care in the Community (CITC) appointments, and liaison with VAPIHCS services on Oahu such as enrollment and eligibility, CITC, etc. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations .Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.4 DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES):. The VA Pacific Islands Health Care System (VA PIHCS) will provide for the following disciplines on site or via telehealth. Contractor will have to enter a consult for referral in VA EHR or a warm hands off to the VA Staff on site.

2.4.1 DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) –PACT: FTE Ratio Performance Standard: 1.0 FTE per 3 PACTs Qualifications: Will be provided provided by the VA PIHCS via Telehealth.

2.4.2 DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-COAGULATION: Will be provided by the VAPIHCS via Telehealth.

2.4.3 DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER (this position provides general/medical social work services): Will be provided by VAPIHCS via Telehealth.

2.4.4 DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST: Will be provided by VAPIHCS via Teleheath.

2.4.5 DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH INTEGRATION (PC-MHI):

FTE Ratio Performance Standard – 1.0 FTE LCSW to be provided by VAPIHCS on site. Psychiatrist or Pyschologist via Telehealth.

OPTION 1: Psychiatrist: Qualifications: Will be provided by VAPIHCS via Telehealth.

OPTION 2:Psychologist:Qualifications: Will be provided by VAPIHCS via Telehealth or on site when a psychologist is on island.

OPTION 3: Advanced Practice Nurse: Qualifications: Will be provided by VAPIHCS via Telehealth.

OPTION 5: Licensed Clinical Social Worker (this position provides mental health services as part of the PC-MHI team): Qualifications: Will be provided by VAPIHCS on site or Telehealth when the assigned LCSW is on leave.

2.5 SPECIALTY CARE STAFFING: Specialty Care services are provided by the VAPIHCS either by travelling Oahu based specialists or by community specialists. Contractor shall be responsible for entering consult in VA EHR which will then be processed and scheduled by VAPIHCS Care in the Community (CITC) staff according to VA MISSION Act legislation. Results generate view alert to ordering Fee basis PCP who is responsible for follow up.Some specialty care services not available on Saipan may require travel off island to access. VAPIHCS is responsible for Benetravel program for assisting Veterans during these eventualities.

2.6 ANCILLARY SUPPORT SERVICES STAFFING: Ancillary Supprot services are not provided at this clinic. Radiology and/or phlebotomy services will be provided by local community providers.

2.6.1 DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: Fee basis provider will enter Consult in VA EHR for any Radiologic needs. Consult will then be processed and scheduled by VAPIHCS CITC staff according to VA MISSION Act legislation. Results generate view alert to ordering Fee basis PCP who is responsible for follow up.

2.6.2 PHLEBOTOMIST/LABORATORY TECHNICIAN: Fee basis provider will enter a VA EHR a consult for any Phlebotomist/Laboratory request. Consult will then be processed and scheduled by VAPIHCS CITC staff according to VA MISSION Act legislation. Results generate view alert to ordering Fee basis PCP who is responsible for follow up.

2.7 GENERAL AND SPECIALTY MENTAL HEALTH STAFFING: General and Mental Health staffing will be provided by the VAPIHCS via telehealth and on site. A VAPIHCS LCSW is on site and the contractor will enter EHR consults for MH services. VAPIHCS Mental Health service will process consults and arrange appropriate appointments. The contractor may call VAPIHCS MH at 670-322-0035 for any questions or assistance.

OPTION 5: Mental Health Licensed Clinical Social Worker: Qualifications: VAPIHCS will provide on site and Telehealth.

2.7.1 Suicide Prevention Coordinator (SPC): The VA performance standard for sites with 10,000 patients or more is maintaining a Suicide Prevention Coordinator (SPC) with a full-time commitment to suicide prevention activities. In smaller sites serving less than 10,000, this may be a collateral assignment. Will be provided by the VAPIHCS.

2.7.2 Homeless Outreach Specialist: To ensure the availability of outreach and referral services to homeless Veterans, all sites with 10,000 patients or more must designate at least one outreach specialist, usually a clinical social worker, to provide services to homeless Veterans. NOTE: In smaller facilities, this may be a collateral assignment. Will be provided by VAPIHCS.

2.8 TELEHEALTH SERVICES CLINICAL STAFF: VAPIHCS AO shall provide scheduling and logistical support for Telehealth visits by Oahu based Specialty Care and Mental Health. The small site does not have capability of Teledermatology, Teleretinal imaging, or Teleaudiology at the current time and these services are provided by VAPIHCS on a specialty consult basis through CITC. VA PIHCS shall provide TCT and Telepresenter on site. VA PIHCS shall also provide training to VA Staff in the rare event that coverage is required.

2.9 LICENSE AND ACCREDITATION: Contract physician(s) and all other 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 site is located. All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contract providers who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.9.1 Technical Proficiency/Board Certification: Personnel shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently.

2.9.2 The Contractor must ensure that all individuals who provide services and/or supervise services at the Contractor’s Outpatient Site of Care, including individuals furnishing services under contract are qualified to provide or supervise such services.

2.9.3 Position specific competencies shall be completed for all staff annually.

2.9.4 Contractor staff qualifications, licenses, certifications and facility Joint Commission or equivalent accreditation must be maintained throughout the contract period of performance. If Contractor’s staff is not directly employed by the treating facility, documentation must be provided to the COR to ensure adequate certification. All actions required for maintaining certification must be kept up to date always. Documentation verifying current licenses, certifications and facility accreditation must be provided by the Contractor on an annual basis.

2.9.5 The Contractor is responsible for assuring that all persons, whether they be employees, agents, subcontractors, providers or anyone acting for or on behalf of the Contractor, are properly licensed always under the applicable state law and/or regulations of the provider’s license, and shall be subject to credentialing and privileging requirements by VA.

2.9.6 The Contractor shall not permit any employee to begin work at an Outpatient Site of Care prior to confirmation from the VA that the individual’s background investigation has been reviewed and released to the Office of Personnel Management (OPM), by the Security and Investigations Center (SIC), and that credentialing and privileging requirements have been met. A copy of licenses must be provided with offer and will be updated annually. Any changes related to the providers' licensing or credentials will be reported immediately to the VA Credentialing Office. Failure to adhere to this provision may result in one or more of the following sanctions, which shall remain in effect until the deficiency is corrected:

2.9.6.1.1 The VA will not pay the capitation payment due on behalf of an enrolled patient if service is provided or authorized by unlicensed personnel, without regard to whether such services were medically necessary and appropriate.

2.9.6.1.2 The VA may refer the matter to the appropriate licensing authority for action, as well as notify the patient that he/she was seen by a provider outside the scope of the contract and may pursue further action.

2.9.7 The Contractor shall notify COR, Contracting Officer, and the VA Chief of Staff when any provider furnishing services under this contract is reported to the National Practitioner Data Bank. This notification shall include the name, title, and specialty of the provider.

2.10 CREDENTIALING AND PRIVILEGING: Credentialing and privileging of all health care professionals who are permitted by law and the facility to practice independently will be done in accordance with the provisions of VHA Handbook 1100.19. Credentialing for all health care professionals who claim licensure, certification, or registration, as applicable to the position and who are not currently credentialed in accordance with VHA Handbook 1100.19, must be credentialed in accordance with VHA Directive 2012-030. This VHA Handbook and VHA Directive provide updated VHA procedures regarding credentialing and privileging, to include: VHA policy concerning VetPro; the Expedited Medical Staff Appointment Process; credentialing during activation of the facility Disaster Plan; requirements for querying the FSMB; credentialing and privileging requirements for Telemedicine and remote health care; clarifications for the Summary Suspension of Privileges process in order to ensure both patient safety and practitioner rights; and the credentialing requirements for other required providers.

2.10.1 Contractor shall ensure that all health care professionals who are permitted by law and the facility to practice independently participate in the Credentialing and Privileging process through VHA’s electronic credentialing system, “VetPro”. No services are to be provided by any contract provider requiring credentialing and privileging until the parent VA Medical Executive Board and Director have granted approval. The Contractor shall be provided copies of current requirements and updates as they are published.

2.10.2 Credentials and Privileges shall require renewal annually in accordance with VA and TJC requirements. Credentialed providers assigned by the Contractor to work at the site shall be required to report specific patient outcome information, such as complications, to the VA. Quality improvement data provided by the Contractor and/or collected by the VA will be used to analyze individual practice patterns. The Service Chief, Primary Care Service Line will utilize the data to formulate recommendations to the Medical Executive Board when clinical privileges are being considered for renewal.

2.10.3 Contractor shall ensure that all health care professionals who claim licensure, certification, or registration, as applicable to the position and who are not currently credentialed in accordance with VHA Handbook 1100.19 participate in the Credentialing process through VA’s “VetPro,” in accordance with VHA Directive 2012-030. No services are to be provided by any contract provider requiring credentialing until the parent facility has granted approval. The Contractor shall be provided copies of current requirements and updates as they are published. Since Contracted Nurse Practitioners, Clinical Pharmacy Specialists, and Physician Assistants are not recognized by the VA as independent practitioners, they function under a VA Scope of Practice (not Clinical Privileges). The VA Scope of Practice must adhere to applicable practice acts within that state. The credentials and scope of practice for Nurse Practitioners, Clinical Pharmacy Specialists, and Physician Assistants are reviewed at the time of the initial appointment and at least every two years thereafter by an appropriate VA discipline-specific Professional Standards Board.

2.11 CME/CEU: Contractor staff registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. CME hours shall be reported to the credentials office for tracking. These documents are required for both privileging and re privileging. Failure to provide will result in loss of privileges.

2.12 TRAINING (ACLS/BLS/VA MANDATORY): The RN provided by the VAPIHCS is trained in BLS and the physician by the VAPIHCS is trained in ACLS. Contractor staff shall complete VA mandatory training as requested and complete ACLS/BLS training and keep ACLS/BLS certifications current throughout the life of the contract. Copies of current certifications shall be provided to the COR. ACLS certification is required for health care personnel that order, administer, monitor, or supervise moderate sedation, monitored anesthesia care, or general anesthesia, according to current VHA policy. The contractor shall coordinate and cover contract staff travel expenses in accordance with General Services Administration (GSA) rates. https://www.gsa.gov/portal/category/100000.

2.13 ACCESS TO PATIENT INFORMATION: In performance of official duties, Contractor’s provider(s) have regular access to printed and electronic files containing sensitive data, which must be protected under the provisions of the Privacy Act of 1974 (5 U.S.C. 552a), and other applicable laws, Federal Regulations, Veterans Affairs statutes and policies. Contractor’s provider(s) are responsible for (1) protecting that data from unauthorized release or from loss, alteration, or unauthorized deletion and (2) following all applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in a computer access agreement which contract provider(s) signs.

2.13.1 Contractor staff shall complete required security training and sign a VA Computer Access Agreement prior to having access to the VA computer system. Security Training will be accomplished annually. Contractor staff shall select training modules for Privacy Training and Information Security Training. Upon completion of the training, please email or fax training certificates to the Contracting Officer at NCO21MedicalSharingTeam@va.gov.

2.13.2 In addition, if providing clinical services, Contractor staff will attend VA EHR training prior to providing any patient care services. Contractor staff shall document patient care in the VA EHR to comply with all VA and equivalent TJC standards.

2.13.3 All contract personnel requiring access to PHI / Encrypted information must obtain a PIV card to ensure secure communications to and from the VA (e.g. Clinical staff, contract billing staff requiring patient lists with PHI/PII and Contract management personnel requiring PHI/PII information).

2.14 RULES OF BEHAVIOR FOR AUTOMATED INFORMATION SYSTEMS: Contractor staff having access to VA Information Systems are required to read and sign a Rules of Behavior statement which outlines rules of behavior related to VA Automated Information Systems. The COR will provide, through the facility ISO, the Rules of Behavior to The Contractor for the respective facility.