36C26219R0026-0002000.docx

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

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

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

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AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 09-13-2019 None 00262 Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815 00262 Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815 To all Offerors/Bidders

36C26219R0026 08-02-2019

X x x 9/30/2019- 4:00pm (PST) x Amendment 0002 is hereby issued to publish Questions and Answers received in response to the RFP.

The due date for receipt of offers has been extended to 9/30/2019 4:00pm (PST)

CHELSEA BLACK

CONTRACTING OFFICER

CONTINUATION PAGE

QUESTIONS & ANSWERS

36C262-19-R-0026

1. How many VA staffed personnel will be providing services at each CBOC?

2. For the Loma Linda CBOC RFP, do we have to bid on all 5 CBOCs? Or can we bid on a few? Offeror must bid on all 5.

3. Do we also send in separate budgets for the IDIQ fixed price contract versus the leases? Offeror shall complete the price schedules B.2 and F1.07 in accordance with the RFP.

4. The RFP asks for 42” door openings at the exam rooms, is this correct? Yes. 42” doors (or split leaf doors equal to or greater than 42”) to accommodate bariatric patients.

5. Will the exam rooms require sliding doors on patient sides? No.

6. RFP 29.3.1.11 refers to USP 795, 797, & 800 Pharmacopeia. What does this pertain to? These are United States Pharmacopeia regulations for compounding medications (795,797) and handling of hazardous drugs (USP 800).

7. Will all sites be required to have a vestibule at the reception area? No.

8. RFP 29.4.9 refers to USP General Chapter 797 Pharmacopeia Compounds. Where is this required and for what provider? USP standards must be followed any time medications are compounded. They apply to everyone. Please see the FAQ link here: https://www.usp.org/frequently-asked-questions/pharmaceutical-compounding-sterile-preparations.

9. Will GSA guidelines need to be followed with regard to security standards if the building is under 25,000 square feet? The offeror must meet all VHA security guidelines as described in this RFP.

10. RFP 36.2, commissioning of all equipment is called out twice, once at 143 days, and again at 173 days. Which is the correct number of days? 173 days. RFP will be amended to correct this.

11. RFP 36.16, requires two exterior signs. Will one exterior-building mounted sign and one ground-level monument sign meet this design? Yes.

12. Will the five clinics have the same OFB date? No, all CBOCs do not need to be opened on the same day, however all CBOCs shall be activated and opened no later than 180 days after contract award.

13. The VA is providing both its own VA data and phone circuit. Does this include the phone service and physical phones? Yes.

14. For the VA circuits, will the VA or the Contractor be responsible for extending circuits into the IT closet. VA.

15. RFP 30.8.7 states Cat 6. Is this accurate or will it change to Cat 6A? 6A.

16. Please clarify the number of drops required in exam rooms. How many for Telehealth? 1 drop for PCC equipment, 1 drop for tele-retinal camera, 1 drop for telephone, 1 drop for computer, and 1 drop for future equipment.

17. Is the environment Plenum or non-Plenum? (Construction question) Either would be acceptable- at the contractor’s discretion.

18. Page 5, Section B2. Base Year CLINS: What is the source of the data for estimated enrollment in the base year? Some of the numbers differ considerably from the compass data from 5/2019. Historical data maintained by the COR for paid invoices. The PACT Compass data represents patients assigned to PACT teams and does not represent billable enrollment data.

19. What is the current billable enrollment? As of Aug 2019, the current billable enrollment is as follows: Corona-3180, Murrieta-7289, Palm Desert-6994, Rancho-5494, Victorville-4175.

20. Will the new Contractor inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contract award? Yes.

21. Is the Contractor responsible for providing services to traveling Vets? If so, how many are anticipated per year? Yes. The limits are outlined at paragraph 21.5, page 26 of the RFP.

22. Page 19, Hours of Operation: Will the VA consider compressed staffing in four 10-hour days if the staffing supports it? Or will the VA consider late evening hours to coincide with the MH late hours of operations two days per week? The Hours of Operation, as stipulated in the RFP, must be met.

23. Will the Government be doing site visits prior to award? If so, how much advance notice will the Contractor be given? Site visits may be conducted as part of the responsibility check. 2-3 day notice will be provided.

24. Page 164, Section 10.01.3 States: Two (2) individual therapy rooms for the UCR Psychiatry Residency Program, 10x12 (120 square feet), and large enough to me the Americans with Disability Act requirements, office space for therapist, wheel chair bound patient and a family member.

a. Is there an affiliation with UCR? No.

25. Are existing employees under a collective bargaining or contractual agreement? The VA is unable to comment on current contract employees.

26. Page 22 #5 – Training (ACLS/BLS/VA Mandatory): 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.

a. Does the VA require providers and nurses to be ACLS trained and certified? No. Only a minimum BLS certification requirement for this facility for all clinical staff. RFP will be amended to reflect that.

27. Page 32 Section 22.13.2: The Contractor shall be responsible to subcontract with an entity near the CBOCs that shall provide diagnostic X-rays and shall be interpreted by VA Radiologist.

a. Does the VA prefer to have radiology onsite versus subcontracting to a local facility? These services shall be subcontracted as stipulated in the RFP.

28. Page 35, 22.18.2 Clinical Pharmacy Services: Direct patient care activities are essential to the role of the CPS in impacting comprehensive medication management and optimal patient care outcomes in PACT. The CPS shall have an appropriate amount of bookable appointment time per week, spending 75-80% of their time in direct patient care.

a. Does the VA require support staff to the CPS? If so, which roles? RN, LVN, Administration Clerk? Yes. As with other providers, they may require the same support that we provide for ACC Pact Pharmacists. Generally, our Pharmacists do not do their own scheduling for example. However, it would be at the discretion of the contractor to assign non-clinical task as long as they meet FTE ratio and clinical requirements.

29. Will the VA or the Contractor be financially responsible for the cost of 10-day bridge medications? The contractor will be responsible for supplying any VHA formulary medication given in the clinic. Outpatient prescriptions would not be the responsibility of the contractor. 10-day bridge medication is currently handled through a retail pharmacy PBM VISN contract.

30. Does the VA require the contractor to purchase a refrigerated centrifuge? Is an industrial strength refrigerator required? The clinic would need adequate equipment to properly store medications meeting all applicable regulations, guidelines, and standards.

31. Page 40, 22.21.9 Mental Health Support Services: The Contractor shall provide the following clerical support services for Mental Health and other Specialty Care providers during normal and extended business hours as outlined in Section 19.

a. Does the VA require designated MH support staff or can this support staff be shared with Primary Care? Mental Health requires separate support staff.

32. Page 41, Telephone Access to Clinical Care: The VA Loma Linda Healthcare System’s VA communication Center will be responsible for incoming calls related to the communication with the Patient Aligned Care Teams (PACT) (i.e. scheduling appointments, medications refills, medication renewals requested and messages to the care teams).

a. Will VA Communication Center be handling incoming calls for all five clinics? Yes.

33. Page 42, section 22.23.2 Tele-retinal services: Will the VA be providing the TCT staff for tele-retinal services? Yes.

34. Page 146, Factor 1 – Activation and Transition Plan: This factor will be used to assess the offeror’s plan to transition services from the previous contract and activate five (5) CBOCs simultaneously to achieve opening the clinics within 180 days after contract award.

a. Please define “simultaneously”. Does the VA require all five clinics to open on the same day, week, month? If not, please provide schedule of opening dates. No, all CBOCs do not need to be opened on the same date, however all CBOCs shall be activated and opened no later than 180 days after contract award.

35. Section 22.24.1.11 says all CBOCs must have at least two WH-PCPs. Does the VA or the Contractor provide Women’s Health PCP? The contractor must ensure this requirement is met at all CBOC sites.

36. Who provides telehealth services? 22.23 says the Contractor shall support and provide telehealth services. But 22.23.1.1 says the VA will provide staff and telehealth equipment for telehealth services at all outpatient sites of care. The VA TCT will support all telehealth services.

37. Does the VA require the tele-health tech to be a Medical Assistant or LPN? The VA will provide the TCT in support of all telehealth services.

38. Does the VA wish to use a security guard? Armed or unarmed? There is no requirement for a security guard, using panic alarms that are routed to local authorities is the minimum requirement.

39. What is the make-up of a mental health PACT team? Does this conflict with Pg. 19, B.3, 2.5.5? The reference cited in the schedule considers price for administrative support for MH services at all CBOCs which is factored into the capitated rate.

40. Will the home-based primary care service be attached to the CBOCs? Is this program included under this contract in any way; would it be potentially included down the road? Please clarify. No, this is a VA sponsored program separate from the primary care services in CBOC and there are no plans to add to the contract in the future.

41. How does the Contractor handle the potential financial impact of performance/quality standards during the contract? Are the goals based on the national average, VISN, Loma Linda? How would they rate? What benchmarks will be used to establish compliance? All performance standards are outlined in the QASP; national standards will be applied according to VA guidelines. Regarding the financial impact of failing to meet contract performance standards, if the contractor fails to perform at the levels specified in the contract, VA will exercise its remedies under the contract, which could include monetary claims against the contractor.

42. Clarify the difference between the Medical Director and Physician Director. The Physician Director is .05 (two hours); is that a supervisor to oversee NPs and Pas? There is no difference between the two terms physician/medical director. This FTE will supervise all providers and is consistent with the formula provided (.05x26 or more PACTs = 1.0 FTE).

43. If proposed staff do not meet VA credentialing requirements, Contractor is supposed to propose a substitute within five calendar days. Is five calendar days a realistic expectation in which to procure a provider replacement? Yes, this is consistent with all other contracted clinics throughout the VA.

44. Will current providers that are board eligible be grandfathered in or will they need to be board certified by the start of the new contract? Any current CBOC providers will be grandfathered in for their credentials and privileges. The current CBOC providers two-year credentials and privileges will be reviewed and renewed on their appropriate anniversary dates.

45. Is there a required ratio of physicians to NPs/Pas? There needs to be at least (1) MD in each CBOC.

46. It says we can have a licensed LPN, LVN, MA or Healthcare Technician. Can any one of those options fulfill the requirement for Teamlet Member 3? Yes

47. Confirm our responsibility to recruit and include the salaries for the pharmacist(s) and their PACT team in this budget, noting the other specific disciplines are paid for through the VA. It is the contractor’s responsibility to recruit and fill this position requirement.

48. Currently NPs and Pas are licensed independent practitioners (LIPs). Section B.3, 4.3 indicates the VA does not consider them as independent and they have to be under physician supervision. Please clarify whether or not they are considered LIPs. They are recognized as LIPs. Language in the solicitation will be amended to reflect this.

49. Currently Friday business hours are 8:00am to 2:30pm. Is there flexibility with the 4:30pm closing time? No

50. For mental health it indicates hours until 7:30pm a minimum of two times per week. Is it anticipated that during this contract term the requirement could exceed two times per week? No.

51. B.3, 21.5. Clarify whether this is 10 per clinic or 10 per provider per month. 10/month per clinic.

52. Contract says the Contractor is responsible for scheduling initial and follow up visits for primary care and mental health services, but the VA call center will be scheduling appointments. How can the Contractor be responsible for the initial visits when they are not answering the calls? When a patient calls in will the call center schedule the appointment, or will they transfer it to clinic staff to handle? Does this conflict with the language on pg. 19, B.3, 2.5.5? The facility Communication Call Center will schedule appointments generated from inbound calls, however, the contractor will schedule for walk-in patients.

53. How much space is required for Telepharmacy support? VA telehealth service shall require its own space. We need one standard exam room for patient care.

54. Are additional social workers needed for homeless Veterans? If so, does the VA provide them or is the Contractor responsible? The VA will provide the staff for this program.

55. B.3, 22.21.5.1. If the Contractor is not scheduling appointments, how is this requirement to be met? Please clarify. The facility Communication Call Center will be responsible for scheduling generated inbound calls, but walk-in requests are scheduled in the clinic.

56. How much support staff does mental health need in addition to PSR? Based on the current workload at each site, it’s recommended that at least two clerical support staff should be assigned to each clinic.

57. Will current CBOCs need to be modified to meet the space requirements of this contract? Offerors are required to propose CBOC facilities that meet the space requirements specified in the solicitation. Each offeror must determine on its own how to meet those requirements. Please refer to the space requirements at section F and Section B.3 paragraph 29, starting at page 55 for space requirements.

58. Contract says the patient corridor must be a “minimum of (8) six feet wide” Please clarify whether it needs to be eight or six feet wide. Six (6) feet.

59. Lobbies/Mailrooms shall not share return air systems with clinics. Please clarify. Lobbies, mailrooms, and loading docks shall be on separate HVAC systems. This is to protect personnel in the building from airborne threats such as anthrax, dangerous chemicals, etc.

60. How is the Contractor to handle VA requirement vs. building allowable requirements for signage? The signage requirements in the RFP must be met as outlined.

61. Please clarify the five CBOC names will continue to be referred to as “clinic” for signage purposes. The signage requirements in the RFP must be met as outlined.

62. Please clarify if the VA will lease the five CBOC sites, and if so, does the Contractor sub-lease from the VA? The contractor shall lease all space consistent with the requirements indicated in Section B.3, paragraph 29 and Section F. To meet the requirements of the solicitation, the contractor will either lease or sub-lease the space allocated for VA staff to the Government, as identified in Section F. The contractor must ensure that whatever arrangement it makes with the owner of the CBOC facility that there is no restriction on issuing a fully-enforceable sub-lease to the Government that meets the requirements identified in Section F.

63. For the Murrieta requirement, if an audiologist is available in the immediate area, can the Contractor arrange with them to provide services? No, this will be a VA operated and staffed program. Contractor is responsible for the purchase and installation of the sound booths.

64. Will the new Contractor inherit the patient’s last primary care vesting visits and be allowed to bill for one year from that date upon contract award? Yes.

65. How many Choice or Mission Act referrals occurred in the past 12 months for enrolled Veterans in each of the 5 Loma Linda CBOCs included in the solicitation?

66. The solicitation clearly states in paragraph 2.5.2 that the VA will provide the staff and support for the Clinical Pharmacy Specialist (CPS) Anti-Coagulation. Will the VA be providing the Clinical Pharmacy Specialist identified in paragraph 2.5.1? No, the contractor will provide this FTE (para 2.5.1)

67. In paragraph 22.13.2 it states that the Contractor shall be responsible to “subcontract” with an entity near the CBOCs that shall provide diagnostic X-rays. Historically, clinics of this size offer on-site X-ray. Please confirm that the VA does not want on-site X-ray services. There are no requirements for X-ray services at any of the (5) CBOCs. These services will be subcontracted as stipulated.

68. In paragraph 22.16 it states that the Contractor will provide all medications, including any necessary vaccines that are to be administered to patients in the clinic. Will the medications and vaccines be provided to the clinic at the cost of the Contractor or the VA? If the cost of vaccines is the responsibility of the Contractor, please confirm that the following list of vaccines are the responsibility of the Contactor?

a. TDAP

b. Pneumovax 23

c. Prevnar 13

d. TD

e. Flu, High dose flu

f. Shingrix

g. Twinrix (Hep A&B)

h. Hep A

i. Hep B

j. HPV

k. Depo The contractor will provide all medications, including any necessary vaccines, that are to be administered to patients in the clinic and will bear the cost of those medications and vaccines. Under para 22.16, page 33, the above list is of vaccines is the responsibility of the contractor.

69. If the cost of vaccines is the responsibility of the contractor…are there any additional vaccines required to be supplied by the contractor other than those listed in the question above? No.

70. If the cost of vaccines is the responsibility of the contractor… what is the number of vaccines provided to enrolled Veterans during the past 12 months, by type as listed in question 68 and any additional vaccines added by the government pursuant to question 69, in each of the five Loma Linda CBOCs listed in this solicitation?

71. If the cost of medications is the responsibility of the contractor….please provide a list of Medications the Government expects the contractor to dispense (at the cost of the contractor) from the clinic that would not be routine medication dispensed through the VA or an urgent/emergent medication dispensed through the VA’s PBM contract. Medications must be consistent with the VA National Formulary (https://www.pbm.va.gov/nationalformulary.asp).

72. What are the types and quantities of medications provided to enrolled Veterans during the past 12 months in each of the 5 Loma Linda CBOCs included in this solicitation? The CBOCs do not provide or dispense medications to the veterans other than those used for point of care treatment. VALL does not track the medications used by the current contractor for POC treatments.

73. Does the VA require the contractor to supply medications that are available as over the counter (without a prescription) at the cost of the contractor? Yes.

74. Does the current Corona CBOC facility meet the new contract PACT Space Module Design Guide requirements as stated in paragraph 29 of the solicitation? The VA is unable to comment on the current CBOC facility as it relates to the current RFP.

75. Does the current Murrieta CBOC facility meet the new contract Pact Space Module Design Guide requirements as stated in paragraph 29 of the solicitation? The VA is unable to comment on the current CBOC facility as it relates to the current RFP.

76. Does the current Palm Desert CBOC facility meet the new contract PACT Space Module Design Guide requirements as stated in paragraph 29 of the solicitation? The VA is unable to comment on the current CBOC facility as it relates to the current RFP.

77. Does the current Rancho Cucamonga CBOC facility meet the new contract PACT Space Module Design Guide requirements as stated in paragraph 29 of the solicitation? The VA is unable to comment on the current CBOC facility as it relates to the current RFP.

78. Does the current Victorville CBOC facility meet the new contract PACT Space Module Design Guide requirements as stated in paragraph 29 of the solicitation? The VA is unable to comment on the current CBOC facility as it relates to the current RFP.

79. There is a typo error in paragraph 23.2.6 which states that the patient corridors must be a minimum of (8) six feet wide. Please clarify if the corridors must be six or eight feet wide. Six (6) feet wide.

80. How many VA staffed personnel will be providing services at the Corona CBOC? Please list by job title and number of days per month. Please refer back to question 1.

81. How many offices will be needed at the Corona CBOC for VA provided staff (by position/function). Please refer back to Section F.

82. How many VA staffed personnel will be providing services at the Murrieta CBOC? Please list by job title and number of days per month. Please refer back to question 1.

83. How many offices will be needed at the Murrieta CBOC for VA provided staff (by position/function). Please refer back to Section F.

84. How many VA staffed personnel will be providing services at the Palm Desert CBOC? Please list by job title and number of days per month. Please refer back to question 1.

85. How many offices will be needed at the Palm Desert CBOC for the VA provided staff (by position/function.? Please refer back to Section F.

86. How many VA staffed personnel will be providing services at the Rancho Cucamonga CBOC? Please list by job title and number of days per month. Please refer back to question 1.

87. How many offices will be needed at the Rancho Cucamonga CBOC for the VA provided staff (by position/function).? Please refer back to Section F.

88. How many VA staffed personnel will be providing services at the Victorville CBOC? Please list by job title and number of days per month. Please refer back to question 1.

89. How many offices will be needed at the Victorville CBOC for the VA provided staff (by position/function).? Please refer back to Section F.

90. How many Veterans using the Corona CBOC are currently on the primary care billable roster? 3180

91. How many Veterans using the Murrieta CBOC are currently on the primary care billable roster? 7289

92. How many Veterans using the Palm Desert CBOC are currently on the primary care billable roster? 6994

93. How many Veterans using the Rancho Cucamonga CBOC are currently on the primary care billable roster? 5494

94. How many Veterans using the Victorville CBOC are currently on the primary care billable roster? 4175

95. How many times per year does the VA anticipate that the contractor staff will be required to travel to attend VA mandated meetings on-site at the Loma Linda VAMC or other VA facility? 12-15 times a year.

96. Section E.15 52.212-2 Evaluation – Commercial Items: Item 1.b states that the special standard of responsibility applies to this procurement Sub-Lease terms. Is this requirement connected to the clinic specific request for lease proposals for each of the 5 Loma Linda CBOCs? This special standard of responsibility applies to the space required for VA staff as detailed under Section F

97. Is the VA intending to “sublease” the requested space indicated in the clinic specific request for lease proposals from the contractor? Or does the VA intend to lease the space directly from the landlord? The VA intends to sublease the space from the successful offeror.

98. In the request for lease proposals under section 1, it states that the VA requires a 180-day termination rights. Is this the notice period that the VA requires at the end of the term of the 5-year lease (give notice to landlord 180 days before the end of lease)? Or does the VA expect to have the ability to terminate the lease with 180-day notice at any time during the lease (not customary in the industry). The Government will have the right to terminate the lease or sub-lease for the VA-occupied space five years after the date the lease or sub-lease is executed. To exercise this termination right, the Government will provide a 180-day notice to the contractor. This 180-day notice may be given at any time starting at the fourth year, sixth month of the lease or sub-lease with the termination to be effective 180 days thereafter.

99. With regard to the general responsibility determination (page 138) where should the information be included in our submission? Please refer back to the RFP- page 134, section b, (2).

100. With regard to the general responsibility determination (page 138), are resumes/CV’s or a list of names of the proposed staff required with this submission? Please refer back to page 138 of the RFP- the requirement is to provide a narrative describing the offeror’s staffing plan for each clinic in accordance with the requirements in Section 2 of the PWS. Resumes/CVs are not requested with the submission; however, in accordance with FAR 9.104, the Government reserves the right to request additional information prior to award to assist the contracting officer with making the responsibility determination.

101. Is it acceptable to use 8in x 14in fold out pages for the Gannt Charts and floor plans? Yes

102. Are there any page restrictions to any section/volume of this submission? No

103. Can the VA please confirm what the “Distance from the Facility” and “Estimated Travel Time” columns are in reference to in the table located on Pg. 10 section B.3 1.2? The tables reflect that the clinics must remain in their congressional districts and estimates the distance and time to the main VA Medical Center. The tables reflect that the clinics must remain in their congressional districts and estimates the distance and time to the VA Medical Center.

104. Will the VA please provide the VA-provided personnel at each clinic including positions and number of FTEs for each position? Please refer back to question 1.

105. Does the VA require offerors to use the on-stage, off-stage Patient Aligned Care Team (PACT) concept in accordance with the PACT Space Module Design Guide? VHA PACT Handbook 1101.10 should be reviewed for the basic requirements to facilitate clinical operations within PACT. Design shall be consistent across the clinic- VA staffed space shall be consistent with the contractor occupied space.

106. How was the estimated RSF calculated for the VA space requirements for each clinic? The calculated total usable square feet of the required rooms for mental health and audiology for the Corona and Rancho Cucamonga clinics are less than the minimum estimate in section 1.07; and greater than the minimum estimate in section 1.07 for the Murrieta, Victorville, and Palm Desert Clinics. Section F will be amended to clarify his information. The schedule has been updated to reflect Net Square Feet (NSF).

107. Do the RSF estimates for the VA space requirements include load factor and circulation in addition to the total usable square footage of the required rooms? Section F will be amended to clarify this information. The schedule has been updated to reflect Net Square Feet (NSF).

108. Under the mental health space requirements for Victorville, the solicitation includes requirements that the PCMHI space should be embedded within the primary care clinic. How many PCMHI rooms does the VA required for Victorville? Should these rooms be included in the total square footage of the VA leased space? Each CBOC must have 4 rooms at 120 square feet each for individual treatment rooms (ITR) a total of 480 square feet at each CBOC for the PCMHI/PACT/DCM program. Section F will be amended to clarify the requirement.

109. Does each clinic require PCMHI integration rooms embedded with the primary clinic? If so, how many rooms are required for each of the other 4 clinics? And, should these rooms be included in the total square footage of the VA leased space for each clinic? Each CBOC must have 4 rooms at 120 square feet each for individual treatment rooms (ITR) a total of 480 square feet at each CBOC for the PCMHI/PACT/DCM program. Section F will be amended to clarify the requirement.

110. Under the mental health space requirements for Victorville, the solicitation states: “1.01.22 each of the five CBOCs shall have two individual therapy rooms, 10x12 (120 square feet), embedded in the primary care clinic, and large enough to meet the Americans with Disability Act requirements”. For each clinic can the VA confirm the number of individual therapy rooms that should be included in the primary care clinic and the number of individual therapy rooms that should be included in the mental health space? Can the VA confirm if the two individual therapy rooms that are embedded in the primary care clinic are to be included in the total square footage of the VA leased space for each clinic? Section F has been amended to reflect and clarify this requirement. Each CBOC must have 4 rooms at 120 square feet each for individual treatment rooms (ITR) a total of 480 square feet at each CBOC for the PCMHI/PACT/DCM program. Section F will be amended to clarify the requirement.

111. Can the VA provide the staff and administrative area space requirements for Palm Desert’s clinic audiology clinic space? Section F has been amended to provide this information.

112. Will the new contractor inherit the patient’s last vesting visit and be allowed to bill for one year from that date upon contract award? Yes

113. Is the current facility designed to meet the VA’s standards to accommodate the PACT Model; is the current facility using the on-stage, off-stage Patient Aligned Care Team (PACT) concept in accordance with the PACT Space Module Design Guide? The VA is unable to comment on the current CBOC facility as it relates to the current RFP.

114. Is the current facility adequate to meet the size requirements for the current solicitation. The VA is unable to comment on the current CBOC facility as it relates to the current RFP.

115. Can the VA please indicate what activities/tasks should be included in the transition plan; and what activities/tasks should be included in the activation plan? The contractor shall provide an activation and transition plan that depicts and describes the activities/tasks the contractor will accomplish to ensure successful activation and transition of services and space.

116. Can the VA confirm that the Sub Lease terms requirement/evaluation factor should be included in the Lease Proposals/Request for Leasing Proposals (RLPs) volume? Reference: Special Standard of Responsibilities. To assist the contracting officer in determining if the special standards of responsibility applicable to this procurement are met, offerors are asked to provide the following information with their proposals. Failure to include this information could result in a contracting officer’s determination that an otherwise successful offeror is not eligible for contract award.

l. Sub Lease Terms- Offeror shall provide evidence that each site allows for the sub-lease of space to the VA for the space occupied by VA staff for the purposes described in the solicitation Information provided for Responsibility matters shall be included in accordance with the requirement in the RFP- page 134, section b, (2).

117. Are the items listed under “General Responsibility Determination” a separate evaluation factor to be included in the Technical Proposal? How is the VA evaluating the items listed under “General Responsibility Determination” in the Instructions to Offerors? These do not appear to be part of the evaluation factors listed in section E.15. Reference: General Responsibility Determination. To assist the contracting officer in making the responsibility determination, offerors are asked to provide the following information with their proposals. Failure to include this information could result in a contracting officer’s determination that an otherwise successful offeror is not eligible for contract award.

1.) Provide a narrative describing the offeror’s ability to recruit adequate staffing and retain quality personnel to meet the needs of this contract. Describe the offeror’s process of completing background checks on employees providing services.

2.) Provide a narrative describing the offeror’s contingency plan for staffing clinics in the event of absence (planned or unplanned) of regularly scheduled staff.

3.) Provide evidence of proper zoning for each of the five (5) proposed sites.

4.) Provide a narrative describing the offeror’s staffing plan for each clinic in accordance with the requirements in Section 2 of the PWS.

A responsibility determination under FAR Part 9.104 is separate and different from the evaluation of proposals described in Solicitation Section E.15. The information requested to assist the contracting officer in making the responsibility determination are not “proposal evaluation factors” and will not considered as part of proposal evaluations. The general responsibility determination will be conducted in accordance with the procedures described in FAR 9.104.

Information provided for Responsibility matters shall be included in accordance with the requirement in the RFP- page 134, section b, (2).

The contracting officer will review this information as part of the responsibility determination for the successful offeror.

118. What will the VA do if a proposed location becomes unavailable prior to award? The offeror shall guarantee availability of the proposed facilities.

119. Most leases have a component of Common Area Maintenance charges, among others, that vary from year to year. Landlords typically provide an endo of year reconciliation with the additional cost provided. How would the VA like to account for these types of variable, and unknown expenses if we are to provide rates for the entire length of the contract? The VA is looking for a full-service gross lease. Contractor shall factor in all costs into the offered pricing. There will be no end-of-year price adjustments made for the space contract line items.

120. These requirements for VA space within the locations does not seem to account for the common areas within the overall space and is the VA expecting to, in essence, pay two CAM charges? The VA is looking for a full-service gross lease. Contractor shall factor in all costs into the offered pricing.

121. The cost to build out space specific to the VA can vary from proposal to award time. Will the VA allow for some overages that almost always happen, post award? No

122. In the event of a change order during construction, how would the government review and approve them? If construction change orders are required, the VA shall work with the contractor to review and approve.

123. As a sub-tenant, the landlord will expect to see all main lease clauses flow down to sublet. Is the VA prepared to accept such conditions? The VA lease is between the VA and Offeror. What the offeror agrees to with the landlord is between those two parties. Offeror must agree to all the terms and conditions in the VA lease proposal published in the solicitation. The Government cannot accept in its lease or sub-lease for VA-occupied space any terms or conditions that are not currently included in the lease portion of the solicitation. The lease or sub-lease for the VA-occupied space will be a Government-provided lease instrument that contains only the terms and conditions for the leased space published in the solicitation. Offerors must ensure that the space the offeror proposes to lease or sublease to the Government for the VA-occupied space can be sublet to the Government in accordance with these restrictions.

124. As a sub-tenant, the VA will be expected to have their own insurance to cover damage caused by them, their patients, etc. Does the VA have that in place already, and/or will the VA be ready to provide their own certificates of insurance? The Government is self-insured. The Government’s liability for property damage is governed by the Federal Tort Claims Act.

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