36C26220R0128 0004 - QandA and PWS Update and Attachments.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

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

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR

ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

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

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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

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

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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

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

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

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

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

(If other than Item 6)

(Specify type of modification and authority)

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

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

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

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

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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

0004 08-21-2020 None

36C262

Department of Veterans Affairs

Network Contracting Office 22

4811 Airport Plaza Drive

Suite 600

Long Beach CA 90815

36C262

Department of Veterans Affairs

Network Contracting Office 22

4811 Airport Plaza Drive

Suite 600

Long Beach CA 90815

To all Offerors/Bidders 36C26220R0128

08-21-2020 X

X

X 1

The purpose of this amendment is to:

1. Provide answers to the questions asked.

2. Provide updated sections of the PWS based on changes made.

All other terms and conditions remain unchaged.

Proposals are due by 9/4/2020 at 4:00pm PST.

Alice McGruder

Questions and Answers

RFP 36C26220R0128 – Escondido CBOC

PATIENT VESTING:

QUESTION: Upon award of the new contract, will the new contractor inherit the patient’s last

Primary Care vesting visit and be allowed to bill for that patient up until their next anniversary date?

ANSWER: Please reference the below Sections/pages of the RFP:

Page 6: “CBOC Ordering Procedures”

Page 28; Section 4.3.1 – Registration and Enrollment

Page 81; Section 6.2.1 – Evaluation and Management and Billable Roster

QUESTION: Will the new contractor inherit the patients’ last vesting visit and be allowed to bill for one year from that date upon contact award?

ANSWER: Please reference the below Sections/pages of the RFP:

Page 6: “CBOC Ordering Procedures”

Page 28; Section 4.3.1 – Registration and Enrollment

Page 81; Section 6.2.1 – Evaluation and Management and Billable Roster

QUESTION: What is the current vested roster as of July 2020?

ANSWER: As of May 2020, there were 3,572 billable patients. There are 4,132 patients assigned to Escondido in PCMM.

QUESTION: How many veterans using the Escondido CBOC are currently on the Primary Care billable roster?

ANSWER: 3,572

QUESTION: Is the current number of veterans on the billable roster an accurate reflection of what the starting billable roster will be under the new contract?

ANSWER: There are 3,572 patients on the most recent billable roster. Patients on that roster who pass their 12-month anniversary will be removed from the billable roster. The number of billable patients changes from month to month. There are currently 4,132 patients assigned to the Escondido CBOC in PCMM.

QUESTION: What was the number of enrollees invoiced for each of the last three months?

ANSWER: Below is the number of enrollees invoiced for the last three (3) months:

March 3599 billable patients

April 3630 billable patients

May 3,572 billable patients

QUESTION: What is the veteran population in the catchment area by zip code?

ANSWER: Please see chart provided below:

QUESTION: What is the current number of enrolled women veterans?

ANSWER: There are 367 women Veterans enrolled at the Escondido CBOC.

QUESTION: How many women veterans are assigned to the clinic?

ANSWER: There are 367 women Veterans assigned to the Escondido CBOC.

QUESTION: Please provide a breakdown of the enrolled veterans by age range

ANSWER:

(5V22) (664GD) Escondido, CA Grand Totals

<25 100 100

25-34 668 668

35-44 776 776

45-54 759 759

55-64 871 871

65-74 1,245 1,245

75-84 605 605

85+ 279 279

Grand Totals 5,303 5,303

QUESTION: Can the government provide the current utilization rates for the clinic?

ANSWER: Please see the below:

QUESTION: On page 58 under 4.10.8.3 The Contractor shall maintain electronic medical records using the computerized patient record system, CPRS, and Vista Imaging making sure they are up-to-date and shall include the enrolled patients’ medical records to all subcontractor providers... After these documents have been scanned, the original hard copies will be mailed weekly via UPS. The UPS delivery service will be at the expense of the Contractor. In the last 12 months, approximately how many deliveries were made to the VA from the Escondido CBOC via UPS to submit the original hard copy medical records?

ANSWER: Per Section 4.10.8.3. “Hard copies of external source documents may be scanned into the electronic medical record by the Contractor or a summary progress note written by an appropriate clinician after a review of the external source documents may be used in lieu of scanning any external source documents. After these documents have been scanned, the original hard copies will be mailed weekly via UPS. The UPS delivery service will be at the expense of the Contractor.” Only hard copies of external source documents are required to be mailed weekly via UPS. There is no past UPS Delivery data from current contract in the last 12 months.

QUESTION: How will PCMHI be provided? In person or via telehealth?

ANSWER: Per Section 4.9.7 of the PWS, “Mid-sized CBOCs, those seeing between 1,500 and

5,000 unique veterans, shall have an on-site presence of mental health services available to primary care patients who need them.”

PRESCRIPTION/VACCINE/PHARMACY REQUIREMENTS:

QUESTION: Pursuant to the Prescription Fulfillment paragraph 4.8.9, 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 a routine medication dispensed through the VA or an urgent/emergent medication dispensed through the contracted local pharmacy.

ANSWER: The Contractor shall purchase, order/prescribe, and administer vaccines and medications that are to be administered in the clinic. The cost of these medications/vaccines shall be included in the PMPM capitated rate.

Medications on current Escondido Ward Stock List (excluding MH Ward Stock list):

1. HIV Post-Exposure Prophylaxis Kit

a. Truvada (combination tablet containing emtricitabine 200mg and tenofovir

300mg)

b. Isentress (raltegravir) 400mg tablet

2. Naloxone 4mg/0.1mL Nasal Spray

3. Any additional medications required as based on clinical need of individual patients

QUESTION: (Question 1) In the Prescription Fulfillment paragraph 4.8.9 it states that the

Contractor shall provide all medication, including any necessary vaccines that are to be administered to patients in the clinic. Will the Vaccines and Medications be purchased by the VA and then delivered to the clinic?

ANSWER: No, the Contractor shall purchase, order/prescribe, and administer vaccines and medications that are to be administered in the clinic. The cost of these medications/vaccines shall be included in the PMPM capitated rate.

QUESTION: (Question 2) If the cost of vaccines discussed in (Question 1) are the responsibility of the contractor, please confirm that the following list of Vaccines are the responsibility of the contractor?

ANSWER:

1. TDAP

2. Pneumovax 23

3. Prevnar 13

4. TD

5. Flu, High dose flu

6. Shingrix

7. Twinrix (Hep A&B)

8. Hep A

9. Hep B

10. HPV

QUESTION: (Question 3) 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

(Question 2)?

1. Flu, Standard Dose

2. Typhoid, VICPS

3. Meningococcal B, OMV

4. MMR

5. Varicella

QUESTION: (Question 4) If the cost of vaccines is the responsibility of the contractor…. What is the number of Vaccines, by type as listed in (Question 2) and any additional Vaccines added by the government pursuant to (Question 3), that was provided to the Escondido CBOC Enrolled

Veterans in the last 12 months?

ANSWER: Please see list provided below – contractors are responsible for administering/providing all vaccines listed below, including vaccines that have utilization number of zero.

Vaccine Administration Data – Escondido (previous 12 months)

INFLUENZA, INJECTABLE, QUADRIVALENT, PRESERVATIVE FREE 974

TDAP 187

ZOSTER RECOMBINANT 146

INFLUENZA, TRIVALENT, ADJUVANTED 111

PNEUMOCOCCAL POLYSACCHARIDE PPV23 76

PNEUMOCOCCAL CONJUGATE PCV 13 63

HEP B, ADULT 9

TD (ADULT), 2 LF TETANUS TOXOID, PRESERVATIVE FREE, ADSORBED 4

HEP A, ADULT 3

TYPHOID, VICPS 3

MENINGOCOCCAL B, OMV 1

MMR 1

VARICELLA 1

HPV9 1

Flu, High Dose 0

Twinrix (Hep A & B) 0

Depo (unable to give estimate until we know what this is)

QUESTION: Is the VA or Contractor responsible for contracting with the local pharmacy for the Urgent/Emergent (up to 10 day) medications.

ANSWER: Per section 4.8.9 of the PWS, the VA is responsible for contracting with the local pharmacy for the Urgent/Emergent medications.

QUESTION: On page 38 under 4.8.9 it states: PRESCRIPTION FULFILLMENT- the

Contractor shall provide all medications, including any necessary vaccines that are to be administered to patients in the clinic. Please provide a list of all medications, vaccinations and amounts to be administered in the clinic.

ANSWER: Please see Ward stock list and vaccine list provided above. Contractor also responsible for additional medications based on clinical needs of individual patients

QUESTION: Please provide list and 12-month usage numbers of all vaccines provided by the current contractor

ANSWER: Please see chart provided above.

QUESTION: Page 54 – 4.9.17.4.8Emergency contraception: Who pays Levonorgestrel; Plan B medication?

ANSWER: VA (this is on Heritage list)

QUESTION: Page 39 – 4.8.9 Pharmacy Services: Who pays for the 10-day emergent medications?

ANSWER: VA (this is on Heritage list)

QUESTION: Thin-Prep PAP testing supplies are not available for purchase by contractor, will the VA supply?

ANSWER: VA is not responsible in supplying the Thin-Prep PAP testing supplies, this is the responsibility of the contractor.

SPACE REQUIREMENTS:

QUESTION: Does the current CBOC facility meet the new contract PACT Space Module

Design Guide requirements as stated in the Space Requirements paragraph 4.11 of the solicitation?

ANSWER: No, the PACT Space Module Design Guide is not included in the current

Escondido contract.

QUESTION: Will the Contractors proposed space be required to meet the on-stage/off-stage design with the PACT Zone?

ANSWER: Not required.

QUESTION: Is the PACT model designed required for this opportunity to include on-stage off-stage design?

ANSWER: Not required.

QUESTION: Section 4.11.1.5 requires a 360 square foot conference room. The mental house space requires two 300 square foot conference rooms. Please clarify if these are three separate rooms or if it is a requirement for just two (with the 360 square foot room doing double duty for the mental health requirement).

ANSWER: Section 4.11.1.5 states that Mental Health meeting/conference space can be used for this purpose.

QUESTION: Typically, RFP section state “Setback distance from the face of the Building's exterior to the protected/defended perimeter (i.e., any potential point of explosion). This means the distance from the Building to the curb or other boundary protected by bollards, planters or other street furniture. Such potential points of explosion may be, but are not limited to, such areas that could be accessible by any motorized vehicle (i.e., street, alley, sidewalk, driveway, parking lot).”

a. What is the setback distance of the site to the bollards required for physical security? Typically, it is 25 feet, but most clinics in shopping center etc. … do not have spaces that conform to this requirement?

Answer: Please see Attachment: Real Property Policy Memorandum 2018-02 Physical Security

Standards for leased Facilities (Existing Space and Lease Construction Projects) (VAIQ

7866496)

QUESTION: Does the government require any office space for expanded PACT members? For example, Social Worker or Dietitian? If so, how many office spaces?

ANSWER: One (1) office space is required for expanded PACT members.

QUESTION: Does the government require any bathrooms in the leased space? If so, how many?

ANSWER: Yes. Please follow local code requirements at a minimum. The final number of bathrooms will be determined based on the space layout proposed by the offeror.

QUESTION: Will the government allow the “Property Improvements” of the proposed space to be calculated in CLIN 001? Said differently, can vendors price CLIN 001 with the total cost of the property/ clinical site improvement?

ANSWER: Section B.2 – Price Schedule – CLIN 001 the contractor shall charge a fully loaded price, included in the PMPM rate. For Section F – VA Space Requirement – CLIN 001-the contractor shall charge by square footage of the particular space that the VA will occupy.

QUESTION: Does the VA require a separate entrance for the VA leased space?

ANSWER: Yes, Mental Health Clinic shall have a separate entrance and only be accessible from the outpatient clinic area by authorized personnel. Please see 1.01.7 of Section F – VA

Space Requirement – Real Property Lease.

QUESTION: Does the VA require a contiguous space between the contractor's primary care and

VA leased space?

ANSWER: Yes

QUESTION: Does the VA lease space require contractor provided administrative staff for the required reception desk, or will the VA provide such staffing?

ANSWER: No, the VASDHS will provide all staffing for the Mental Health leased space.

QUESTION: How many offices will be needed at the Escondido CBOC for the VA provided staff (by position/function) identified in question 11?

ANSWER: The VA provided staff will occupy the Mental Health space. Please see the RFP for the Mental Health space requirements in attachment D21 – Section F Lease - Escondido.

QUESTION: Does the Escondido CBOC need to comply with California’s Office of Statewide

Health Planning and Development (OSHPD) Codes and Regulations for Primary Care Clinics?

ANSWER: The contractor is required to comply with the terms and conditions of its contract with VA when providing CBOC services to VA. To the extent the contractor has questions about its obligations with respect to California state law, the contractor should seek guidance from its legal counsel or guidance from the State of California.

QUESTION: Are sliding doors required for the CBOC? Does the VA require or prefer swinging doors or sliding doors on Primary Care Exam Rooms? Is a sliding door required on offstage side of the exam room?

ANSWER: Sliding doors are the model for the setup of the examination rooms. Swing doors are also possible, but the space layout needs to be carefully reviewed to ensure clearances and access are not compromised. Please reference section 4.11 – Space Requirements, of the PWS and

Section F – VA Space Requirement – Real Property lease of the RFP for further details.

QUESTION: Section 4.11.1.6 says “patient corridor must be a minimum of (8) six feet wide.”

Please clarify six or eight.

ANSWER: The patient corridor must be (6) six feet wide.

QUESTION: We understand the government requires three exam rooms and one exam/consult room per PACT teamlet. Will the government revise to require the more standard two exam rooms and one exam/consult room per PACT teamlet?

ANSWER: No, the government requires three exam rooms and one consult room per PACT teamlet.

QUESTION: Can the women’s health exam be included in one of these or is it in addition to the three exam rooms and one consult per PACT?

ANSWER: The Women’s Health exam rooms may be included in the total PACT examination room count.

QUESTION: How many telehealth rooms are required in the primary care area?

ANSWER: Two (2); one (1) PC Telehealth and one (1) teleretinal room.

QUESTION: How many women’s health exam rooms are required in total and can they be counted as regular exam rooms in the overall PACT exam room requirements?

ANSWER: Two (2) Women’s Health examination rooms are required, and they can be counted as regular examination rooms in the overall PACT examination room requirements.

QUESTION: How many small group rooms are required in the primary care section of the clinic and how many in the mental health section?

ANSWER: Primary Care - Per Section 4.11.1.5 Group Care Room/Meeting/Conference Space:

Another carpeted room of approximately 360 square feet sufficient to accommodate up to 15 individuals, inclusive of any group facilitators, and one (1) Tele-health real-time video unit shall be made available.

Mental Health - Per Section F 1.01.13 Two (2) group therapy rooms are required and shall be 300 square feet each.

QUESTION: Can the government clarify how many telehealth rooms are required for primary care and mental health?

ANSWER: Two (2). One PC Telehealth and one teleretinal room are required in primary care.

Mental Health will use the space requested to accommodate mental health telehealth. Please see attachment D21 – Section F Lease – Escondido of the RFP for the Mental Health space requirements.

QUESTION: The RFP states the location must be within the city limits of Escondido, California. Will the government expand the location requirements to include areas within and/or near the city limits of Escondido?

ANSWER: No

EQUIPMENT:

QUESTION: Is the VA supplying the phones and phone system for the CBOC or is the contractor to provide?

ANSWER: No, the VA is not supplying the phones and phone system. The contractor shall provide the phones and phone system.

QUESTION: Page 69 – 4.16.1.5 Procurement of printers, scanners, fax, copiers. This section says that Contractor is responsible for the items listed above however, VA typically will not connect Contractor equipment to the VA network. Please advise the type of office equipment VA will supply for the daily operation

ANSWER: Contractor equipment will not be connected to the VA network. The contractor is responsible for providing the office equipment needed to conduct normal clinic business. Fax and copiers do not need to be connected to the VA network. The VASDHS will provide printers and scanners as needed to connect to the VA network.

QUESTION: Page 71 – Telephone equipment - Will the VA or the contractor be responsible for providing and maintaining the Telephone circuit and Telephone system?

ANSWER: The contractor is responsible for providing and maintaining the telephones, telephone circuit and system.

QUESTION: Will the VA be using WIFI on their network?

ANSWER: There will be two separate WiFi systems, the secure VA network and an open guest wireless network. Please see Attachment: VA OIT Standards and Criteria.

QUESTION: P38, 4.8.8 – Who will bear the cost of changing from a MUSE compatible EKG to one that is compatible with Cerner software after the conversion from CPRS (and Vista

Imaging)?

ANSWER: Per section 4.8.8 of the PWS - The contractor shall bear the cost of changing from a

MUSE compatible EKG to one that is compatible with Cerner software

QUESTION: Does the VA require the contractor to purchase a refrigerated centrifuge?

ANSWER: A refrigerated centrifuge is not required.

QUESTION: Please confirm that the contractor is responsible for providing a copier for the government’s mental health section. If so, please provide specifications for the size of copier needed (at least the number of copies per month). Who will be responsible for the maintenance of the copier? Who will be responsible for copier supplies and paper?

ANSWER: Per Section F - 1.01.12 - The contractor is responsible for providing a separate color copier in the Mental Health space for use by VA Mental Health staff. The contractor is responsible for maintenance, copier supplies and paper.

QUESTION: Will the government provide phones for the clinic?

ANSWER: The contractor is responsible for the telephones and the telephones service/system.

STAFFING:

QUESTION: How many VA staffed personnel will be providing services at the Escondido

CBOC? Please list by job title and number of days per month.

LVN – 16 days

LCSW – 20 days

LCSW – 20 days

Psychologist – 20 days

Psychologist – 16 days

Psychologist 12 days

ADTP Counselor – 20 days

Psychiatrist – 8 days

Psychiatrist – 8 days

Psychiatrist – 12 days

Psychiatrist – 12 days

Psychiatrist – 4 days

PCHMI Nurse – 20 days

MSA – 20 days

MSA – 20 days

LCSW Intern – 12 days

LCSW Intern- 12 days

Non-VA Security officer – 20 days

QUESTION: What is the number of FTEE Physicians currently working in the clinic?

ANSWER: The current physician FTEE is not relevant to this solicitation. The contractor shall staff the clinic according to the PACT Team model.

QUESTION: What is the number of FTEE NP’s and/or PA’s currently working in the clinic?

ANSWER: The current NP/PA FTEE is not relevant to this solicitation. The contractor shall staff the clinic according to the PACT Team model.

QUESTION: How many times per year does the VA anticipate that the Contractor staff will be required to travel to and attend VA mandated meetings on-site at the VAMC or other VA

Facility?

ANSWER: The number of times staff will be required to travel to the VASDHS for training will vary as new requirements can affect the number.

QUESTION: On page 42 under 4.8.11.2 it states: Contractor shall provide clerical support, including scheduling, and ancillary support for VA tele pharmacy services as appropriate. The support services should be consistent for each scheduled clinic to include but not limited to intake vitals by LVN/LPN, Unlicensed Assistive Personnel (health tech or nursing assistant), or similar, downloading of blood sugar from meters, POC INR testing and downloading, teaching patients how to use BP monitors at home, calling patients for lab reminders, scheduling patient visits and contacting patients who no-show for rescheduling. How many clerical and clinical support staff are required for telepharmacy support services?

ANSWER: No additional staff are required. It is a collateral duty for other clinic staff. Please review Section 2 – Staffing and Qualifications for more details.

QUESTION: On page 43 4.9.2.8 To ensure the availability of outreach and referral services to homeless veterans, all contractor sites shall designate at least one outreach specialist, usually a clinical social worker, to provide services to homeless veterans. Who will provide this specialist the VA or contractor?

ANSWER: The VA will provide outreach specialists.

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

ANSWER: Per section 4.9.7 - VASDHS will provide all staff for Mental Health at the

Escondido CBOC including clerical support.

QUESTION: How many VA staffed personnel will be providing services at the CBOC? Please list job title and number of days per month.

LCSW – 20 days

Psychologist – 20 days

Psychologist – 16 days

Psychologist 12 days

ADTP Counselor – 20 days

Psychiatrist – 8 days

Psychiatrist – 8 days

Psychiatrist – 12 days

Psychiatrist – 12 days

Psychiatrist – 4 days

PCHMI Nurse – 20 days

MSA – 20 days

MSA – 20 days

LCSW Intern – 12 days

QUESTION: P46 - Will CBOC be staffed with a LCSW on site? Is LCSW provided by VA or

Contractor?

ANSWER: The VA will provide a LCSW.

QUESTION: P17, 2.2 - Can Board Eligible physicians meet VA credentialing requirements?

ANSWER: Please reference Section 2– Staffing and Qualifications and Section 2.5 –

Credentialing and Privileging, of the PWS. The contractor shall submit the Curriculum Vitae and other information for their physician candidates to the VASDHS. The VASDHS Medical Staff

Office will provide the physician with VetPro instructions to begin the credentialing process.

Each physician is credentialed and privileged individually to determine if they meet VA credentialing requirements.

QUESTION: Will the VA require a clinic manager?

ANSWER: Yes, VA requires a Nurse Clinic Manager.

QUESTION: Is the contractor responsible for providing a primary care LMSW??

ANSWER: No.

QUESTION: Is the contractor responsible for providing a Registered Dietician??

ANSWER: No.

QUESTION: Does the VA wish to use a security guard? Armed or Unarmed?

ANSWER: The VA will provide a security guard for the Mental Health leased space.

QUESTION: How many VA staffed personnel will be providing services at the CBOC? Please list by job title and number of days per month.

LCSW – 20 days

Psychologist – 20 days

Psychologist – 16 days

Psychologist 12 days

ADTP Counselor – 20 days

Psychiatrist – 8 days

Psychiatrist – 8 days

Psychiatrist – 12 days

Psychiatrist – 12 days

Psychiatrist – 4 days

PCHMI Nurse – 20 days

MSA – 20 days

MSA – 20 days

LCSW Intern – 12 days

QUESTION: Can the government clarify who will provide the expanded PACT members

(Social Work, Dietitian, and Pharmacist)?

ANSWER: The VA will provide the expanded PACT members.

QUESTION: Can the PACT level teamlet support the VA provided mental health staff or does the government require additional PACT level support for mental health?

ANSWER: No additional PACT level support for Mental Health is required. Primary Care resources or staff will be used to support Mental Health.

EVALUATION/CONTRACTING:

QUESTION: Due to the challenges associated with COVID and property searches during this time, please consider providing a 30-60-day extension to the RFP.

ANSWER: The RFP response due date has been extended to 9/4/2020 at 4:00pm PST.

QUESTION: Can the government extend the proposal due date by two weeks to allow vendors adequate time to respond to the solicitation requirements and allow time for answers to questions?

ANSWER: The RFP response due date has been extended to 9/4/2020 at 4:00pm PST.

QUESTION: With reference to ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO

OFFERORS—COMMERCIAL ITEMS, 1. Information Required for Proposal Evaluations: f.

FACTOR 6- PAST PERFORMANCE. 4. General Responsibility Determination. 3.) Provide evidence of proper zoning for the proposed site. Page 141 of 171 – Question: Should the zoning information be placed with the staffing information in General Responsibility Determination or should it be moved to Special Standard of Responsibility with the facility leasing information?

ANSWER: Please provide a separate writeup for each General Responsibility (1-4).

OFFERORS—COMMERCIAL ITEMS, FACTOR 1 –ACTIVATION AND TRANSITION

PLAN, (page 139/140 of 171), item #1, Describe the offeror’s plan to transition services from the current contract and the activation plan separately. Question: Can the Government define the difference between Transition Plan and Activation Plan?

ANSWER: Transition Plan – transfer all services from current contracted location to new contracted location. Activation Plan – to make the new Escondido CBOC fully functional.

QUESTION: With reference to Attachment 2: Immigration and Nationality Act of 1952

Certification and all other forms requiring signature not listed in the ADDENDUM to FAR

52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS, b. Requirements for

Proposal Submittal, (2) Past Performance and Price/Cost Proposal and Responsibility (page 138 of 171). Question: Can the Government specify in which proposal these forms should be included?

ANSWER: Per Page 138, b. (2) of FAR 52-212-1 “Offerors shall submit a separate binder with the information the solicitation requires offerors to provide.”

OFFERORS—COMMERCIAL ITEMS, f. FACTOR 6- PAST PERFORMANCE, (2) Offerors shall provide their references with a copy of the Past Performance Survey (Attachment D3) and have it returned to the Contracting Officer by the response date (page 141 of 171). Question:

Can the Government specify how many references are required in addition to the completed contracts that must be provided in item (1)?

ANSWER: Past Performance Survey for each contract listed in item (1).

OFFERORS—COMMERCIAL ITEMS, f. FACTOR 6- PAST PERFORMANCE, 3. Special

Standard of Responsibilities, sub section a. Sub Lease Terms- Offeror shall provide evidence that the 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 (page 141 of 171). Question: Would the Government clarify if this should be included in the Past Performance Proposal; the Lease Proposal; or both?

ANSWER: Special Standards of responsibility shall be addressed separately as “special

Standard of responsibility – Sub Lease Terms”

QUESTION: Will the government be doing site visits prior to award? If so, how much advance notice will the contractor be given?

ANSWER: The Government is not conducting a site visit as part of the evaluation for award. Please see Factor 2 – Facility Layout and Factor 3 – Proposed site of the evaluation factors.

QUESTION: Will a site visit be conducted? If so, will the site visit be used as part of the source selection evaluation criteria?

ANSWER: The Government is not conducting a site visit as part of the evaluation for award. Please see Factor 2 – Facility Layout and Factor 3 – Proposed site of the evaluation factors.

QUESTION: Can the government clarify the contract transition timeline? Instruction to offers states 180 days but Section 6.1.2 states 90 days.

ANSWER: Section 6.1.2 – total of (83 days to have all start-up requirements in place + 90 days for the commencement of medical care +7 days raining & resolution of any last-minute challenges = 180 days)

The Following Sections Have Been Updated in the PWS.

Changes Are Highlighted in Yellow.

1. Section 4.8.9 PHARMACY SERVICES (PRESCRIPTION FULFILLMENT)

PHARMACY SERVICES (PRESCRIPTION FULFILLMENT)- the Contractor shall provide all medications, including any necessary vaccines that are to be administered to patients in the clinic. Routine prescriptions will be dispensed by the VA and mailed via VA Centralized Mail Out Pharmacy (CMOP) to the Veteran following appropriate Contractor’s provider order entry in CPRS. The VA will review all submitted non-formulary restricted, and prior authorization medication consults in a timely manner in accordance with VHA Handbook 1108.08. VA Pharmacy Service will require Contractor clinic management or designee to conduct routine inspections of medication storage areas monthly and provide documentation per local VA Pharmacy policy to the VASD Pharmacy Designee Chief of Pharmacy.

Urgent/Emergent medications needed will be filled via contracted local pharmacy for up to 10 days. All other prescribed medications will be via CPRS, faxed, or mailed to VA pharmacy for filling. The

Contractor shall abide by all Joint Commission (or equivalent accreditation body) and VA policy on the storage, security, handling and disposal of all medications held in their clinic and comply with all monthly clinic inspections and the recommendations generated from those inspections, as conducted by

VA Pharmacy Service.

2. Section 4.8.10 PHARMACY SERVICES

PHARMACY SERVICES: The Contractor shall be responsible for prescribing medications as medically indicated. Prior to prescribing any medications, the Contractor shall review medication profiles in CPRS for duplicate therapy, drug-disease complications, drug-drug, drug-food, drug-lab interferences, appropriateness of dose, frequency and route of administration, drug allergy, clinical abuse/misuse, and documentation of medications obtained outside of the VA in CPRS “Non-VA” medications list, including over-the-counter and herbal agents and known allergies. The Contractor providers shall also query State

Prescription Drug Monitoring Programs (PDMPs) before prescribing controlled substances per VHA

Directive 1306 Querying State Prescription Drug Monitoring Programs (PDMP). The Contractor is required to enter all prescription orders using the CPRS outpatient medication order entry option. The

Contractor shall include complete directions for the prescription (“PRN” alone is not acceptable), the indication for the medication use (whenever possible), the appropriate quantity, and subsequent refills for the medication. iMED consents Relevant consents and/or authorizations shall be obtained by clinic staff prior to prescribing or dispensing medications requiring consent including prescriptions for controlled substances to Veterans or medications with REMS requirements.

3. Section 4.8.10.6

In accordance with TJC standards, the Contractor shall actively participate in routine inspections in collaboration with the local VA Pharmacy on a VA-specified regular basis. All medication storage sites will be inspected to ensure that medications are being stored properly (e.g., under appropriate refrigeration, and USP800 compliant if required; externals separated from internals; expiration dates checked, etc.) and VA Medication Inspection Form (VA Form 10-0053) will be completed, signed by the inspecting contractor Pharmacy personnel and the Clinic Nurse Manager. This information will be used in conjunction with the COR’s quarterly evaluation of the Contractor’s performance. Follow-up on all recommendations identified and resolution of all identified discrepancies on the Medication Inspection

Form will be completed in a timely manner- by Clinic Personnel, as directed or requested by the VA

Chief of Pharmacy.

4. Section 4.8.10.15

Reports of Adverse Drug Events (ADEs) will be documented in the patients’ medical record (under the

Allergy/Adverse Drug Reaction tracking option in CPRS), with the specifics of the event documented as outlined in local VA policy. and forwarded to VA Pharmacy as they occur via encrypted E-mail to

Elizabeth.Gramer@va.gov

5. Section 4.8.10.16

All medication errors and medication-related incidents shall be reported immediately to the Chief, Pharmacy Service or designee and submitted to the local VA Patient Safety on the local VA-approved

Incident Report form through the Joint Patient Safety Reporting (JPSR) or equivalent system.

mailto:Elizabeth.Gramer@va.gov

VA OIT Standards and Criteria

VA Engineering and all contractors will ensure that all construction projects at any VA facility adhere to the standards and criteria set forth in this document. OIT may deem any infrastructure that does not meet these requirements as unfit to support VA network services.

A. CABLE REQUIREMENTS

1. The cabling contractor shall be responsible for all parts and labor required to completely install and test the new cable infrastructure.

2. No cable shall terminate on equipment located in the interstitial at the Medical Center.

3. Fiber

a. Contractor is responsible for providing all closet connector housing units and required components to terminate fiber on both ends.

b. All fiber will be aqua OM4. The minimum pull shall be 24 strands.

c. Contractor will terminate at both ends with LC-LC connectors unless otherwise directed by a designated OIT representative.

d. At the primary Medical Center, all installations will be direct connections from the new IDF to the existing fiber rack in room BB102A.

e. At offsite locations, contractor must install fiber backbone linking all IDFs directly back to the ground floor primary IDF.

4. Voice feed cable

a. Quantity of CAT 3 cable pairs will be determined by an OIT representative prior to installation. A minimum of 50 telephone feed cable pairs will be pulled to the new

IDF.

b. Installations in existing buildings located at the primary Medical Center

i. Cable must be terminated on 110 blocks at the MDF in room B167.

ii. Only interior gray cable shall be installed, no innerduct or exterior cable will be accepted.

iii. In new IDF, cable must be terminated on modular patch panels on the rack, one pair per jack. Pairs 24 and 25 will be a single two pair jack in position 24.

c. Installations in new buildings constructed on the primary Medical Center campus

i. Cable must be terminated on 110 blocks at the MDF in room B167.

ii. In the new building, terminate cable at ground floor IDF and branch cables evenly to all other IDFs.

iii. All cables run outside of a building must have gas tube protection at each end to protect it from the environmental elements.

d. Installations in buildings other than on the primary Medical Center campus

i. Contractor must provide minimum 25 pair CAT3 feed cable from the MPOE to the primary ground floor IDF.

ii. At MPOE end, feed cable must use terminations that match and are integrated into the network service provider (telco) provided existing cable environment.

iii. In MDF (ground floor primary IDF), feed cable must be terminated on eight position jacks in modular patch panels on the rack, one pair per jack on pins 4 and 5. Pairs 24 and 25 will be a single two pair jack. Pair 24 on pins 4 and 5, pair 25 on pins 3 and 6.

iv. In subsequent IDFs, feed cable must be terminated on eight position jacks in modular patch panels on the rack, one pair per jack on pins 4 and 5. Pairs 24 and 25 will be a single two pair jack. Pair 24 on pins 4 and 5, pair 25 on pins 3 and 6. Follow same scheme for any additional binder groups.

5. Workstation requirements

a. Copper cable runs must not exceed a distance of 100 meters (~328 feet).

b. Cable shall be CAT 6A, four pair, unshielded (UTP). Superior Essex or equivalent brand will be used unless otherwise specified by an OIT representative.

6. All cable runs shall follow the cable trays that are above the drop ceilings.

7. Cables shall not be attached to removable ceiling grid supports or laid directly on the ceiling grid. Cables shall not be attached to or supported by fire sprinkler heads, delivery systems or any environmental sensor in the ceiling air space.

8. All cable runs inside walls will be pulled by the contractor and shall be enclosed in Electrical Metallic Tubing (EMT) and single gang boxes.

9. The cabling contractor will be responsible for ensuring that the fire-rated structures (core walls) retain their existing fire-rating by installing proper sleeves and fire stops at all the accesses from the core area once the cabling effort has been completed.

10. All previously abandoned voice and/or data cable in the construction area shall be removed completely from end to end by the contractor once verified by VA OIT representative.

B. JACK CONFIGURATIONS

1. Data drops will be in a three jack configuration on a four port faceplate mounted on a single gang box or mud ring.

2. Wireless Access Point jacks must be a single port biscuit box.

3. Contractor will install VA OIT provided mounting hardware for all wall mount telephones.

4. All drops shall be wired to a T568a standard.

5. Only white, four gang, flush mount vertical classic series faceplates will be used.

6. Faceplates will be labeled in accordance with VA specifications

a. Numbering convention

i. Building number (where applicable)

ii. Floor, to include wing designation if applicable

iii. Panel

b. Jacks are to be labeled as: building – IDF – patch panel – jack port number. For example, in a typical 3 jack faceplate building 1, IDF room number B116, patch panel C, jack location 07 is to be identified as 1-B116-C-07. From this it will be assumed that the blue and white jacks are C-08 and C-09 respectively.

c. Prior to labeling, contractor shall obtain approval from OIT representative to ensure proposed numbering scheme meets OIT standards.

7. Contractor will terminate the workstation end with Panduit gray, blue, and white keystone jacks, and terminate the IDF end with the corresponding gray, blue, or white RJ45 port on the patch panel.

8. Each station will be tested and certified with full documentation provided to the VA representative.

9. Contractor will provide “as built” documentation identifying all jack locations and their associated labels.

10. There will be a minimum of one triple data drop location installed on every wall in all rooms regardless of the room designation or purpose.

C. WIRELESS NETWORKS

1. Areas with an existing wireless network

a. OIT is to be notified prior to the start of construction to allow for the removal of all wireless access points (WAPs).

b. VA Engineering or contractor must provide CAD drawings for OIT to design the wireless network a minimum of 90 days prior to cable installation.

c. Contractor will install new green CAT 6A cable to each WAP location and terminate on green jacks on the patch panel in the new IDF.

d. Contractor will install WAPs in locations designated by OIT representative.

2. Wireless network installation in new buildings

a. VA private wireless network

i. All new construction must include cabling for the VA wireless network using green CAT 6A cable.

ii. VA Engineering or contractor must provide CAD drawings for OIT to design the wireless network a minimum of 90 days prior to cable installation.

iii. OIT will provide the WAPs and associated hardware.

iv. Contractor will install WAPs in all locations identified on the predictive drawing provided by OIT.

v. Contractor should assume one WAP per approximately every 700sf.

vi. For locations greater than 12,000sf, VA OIT may elect to procure a separate contract for design and installation of the wireless network in conjunction with building construction. Contractor must confirm their wireless network responsibilities with VHA and OIT in projects of this size.

3. Guest (public) wireless network

a. New construction must also include cabling for the guest wireless network separate from the VA network.

b. OIT has no involvement with or responsibility for the public network. All cabling, hardware, network equipment, and transport circuits are to be provided by VA Engineering, Healthcare Technology Management (HTM), or their designated contractor.

c. All components of the guest network are required to reside outside of OIT rooms.

D. ELECTRICAL REQUIREMENTS

1. The cabling contractor is responsible for grounding and bonding the entire infrastructure provided in the project.

a. Use #6 grounding conductors and two-hole irreversible compression connectors to bond racks to the room’s telecommunications grounding bus-bar (TGB).

b. The contractor shall provide and install the proper grounding kits for the voice terminations and patch panels as required by manufacturer.

c. The contractor shall ground and bond the telecommunications rack.

d. Contractor is also responsible to ensure grounding bus bar is properly grounded per

NEC section 606.

2. A dedicated 120VAC 20A circuit equipped with NEMA 5-20R receptacle shall be mounted directly above each rack. The two 120V 20A circuits will have a dedicated uninterruptible power supply (UPS) plugged into the receptacles. The equipment rack will require two 6’ multiple outlet power strips mounted at the back of the rack. Each individual power strip will be plugged into a separate UPS.

3. Each receptacle must be powered by a separate electrical panel.

4. A minimum of one electrical receptacle connected to E-power in all locations within the Medical Center campus or where otherwise available is required.

5. The National Electrical Code (NEC) will be adhered to for all installations in addition to any site-specific requirements.

E. DATA CLOSETS

1. Contractor will extend the telco circuit to the MDF or IDF as applicable.

2. Physical Requirements

a. IT closets shall house nothing other than IT equipment. Nurse call, panic alarms, access controls, CCTV and similar systems must not reside in IT closets.

b. Space must be a minimum of 120 sq. ft.

c. The IT closet is required to be enclosed with a hard lid ceiling.

d. Doors need to be fire rated in accordance with specifications required by VA

Engineering management.

e. The closet requires a dedicated Environmental Control Unit (air conditioning) not part of the facility system.

f. In addition to the quantity of 4-inch conduit stubs contractor requires to terminate all cables in the IDF, two empty 4-inch conduit stubs must be made available for future expansion.

g. Conduits shall lead to the nearest accessible drop ceiling location, preferably in a hallway.

h. Contractor shall install an 8ft, ¾” fire rated plywood backboard on one wall in IDF.

Board must be painted but allow for fire rating labels to be visible.

i. Data and phone closets are to be cleaned of all dust and debris from racks, walls, and floor.

3. Racks

a. Two 45U 7’ x 19” two-post racks will be provided and installed by the contractor

b. Minimum three feet of clearance is required on all sides of racks, also accounting for the 26” depth of the UPS.

c. Cable managers will be provided by the contractor

i. Vertical cable management will be provided on both ends of each rack (including between racks) from the floor to top of rack.

ii. Racks shall be separated only by vertical cable managers.

iii. 2U dual sided horizontal cable managers (Panduit WMP1E) will be placed between each patch panel with a corresponding number of managers provided, but not installed, for the opposite rack (12 total).

d. Cable management will include ladder racks above the racks and on both sides of racks, extending to the wall where cables enter the closet.

e. Racks must be securely mounted to the floor.

4. Patch Panels

a. Fiber panel must be mounted in the highest position on the left rack .

b. A modular patch panel for CAT 3 copper feed cable termination will be installed directly under the fiber panel, separated only by a 2U horizontal cable manager.

c. Contractor will provide and install a minimum of six 48-port patch panels in the right rack.

d. Patch panels shall be labeled alphabetically in sequential order from the top position down, starting with “A.”

e. Jacks on the patch panels do not need to be individually labeled, provided they follow the three jack sequence numbering scheme stated above (B.4.b) and correspond to the faceplates in which they are connected.

f. Single cable drops (wall phones or POTS lines, etc.) should be terminated at the bottom of the last panel, so as to not disrupt the three jack consecutive numbering scheme.

g. Standard rack layout depicting contractor responsibilities is diagramed below.

5. UPS

a. Two uninterruptible power supply (UPS) units will be provided by and installed in each IT closet by the contractor.

b. One UPS will be installed in each rack.

c. UPS must be in the bottom position of the rack.

d. The model to be installed will be a rack mountable APC SMART-UPS X 2200VA

LCD 100-127V with NIC (model SMT2200RM2UC) or equivalent.

e. UPS must also include the compatible network management card (model AP9630).

F. VA (NON-IT) PROVIDED SYSTEMS

1. A scramble pad compatible with the existing VA access control system must be installed on all

IT closet doors.

2. A security camera monitored by VA Police must be placed in the vicinity of the IT closet to record video footage of all who enter and exit the room.

3. Wireless temperature sensor will be installed as part of the existing VA Engineering monitoring system.

Fiber panel

Modular patch panel for feed cable

Vertical cable manager

2U horizontal cable manager

48-port patch panel

UPS

CONTRACTOR PROVIDED COMPONENTS