S02- 36C26223R0053 0001.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. NUMBER 3. 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)

1 209

MSO-2023-COM-0015

36C262

Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815

Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600

To all Offerors/Bidders

36C26223R0053

11-21-2023

X

See CONTINUATION Page

X 1

This amendment is to answer Vendors questions regarding this solicitation.

Pg. 104 of the PWS is also updated.

Michael Cordeiro Contracting Officer

Table of Contents

SECTION A .................................................................................... Error! Bookmark not defined.

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES ..................................... Error! Bookmark not defined.

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (DEC 2022)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.4 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (JAN 2011)

C.5 52.216-18 ORDERING (AUG 2020)

C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.7 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.8 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.9 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) . 136

C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.11 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.12 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR VERIFIED

SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESSES (NOV 2022)

C.13 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING--

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (NOV 2022)

C.14 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.15 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.16 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.17 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.18 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAR 2023)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 WAGE DETERMINATION

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAR 2023)

E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.3 52.204-20 PREDECESSOR OF OFFEROR (AUG 2020)

E.4 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.5 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (AUG

2020)

E.6 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.7 52.216-1 TYPE OF CONTRACT (APR 1984)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)

E.10 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE

RESOLUTION (OCT 2018)

E.11 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.12 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.13 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (DEC 2022)

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: Michael Cordeiro, Contracting Officer 36C262 michael.cordeiro@va.gov Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600

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

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] 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.

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.”

mailto:michael.cordeiro@va.gov

Post Award Orientation: The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by VAAM M842.5 Post Award Orientation.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

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 instruction.

B.2 SCHEDULE OF SERVICES

This is an indefinite delivery, indefinite quantity, (IDIQ) fixed-price contract. Prices in this Schedule represent an all-inclusive rate including labor, facility, incidental costs, and overhead.

Costs not incorporated into the contractor’s price will not be reimbursed by the Government.

The guaranteed minimum amount for this contract is $1,000.00. The maximum aggregate value of the orders that can be placed under this contract is $12,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum amount.

The previous option year pricing will apply to any extension pursuant to FAR 52.217-8.

*PMPM includes cost of unassigned patient visits, contractor shall not bill separately or propose an additional LIN or bill separately for these costs.” All quantities are estimated, the government will pay for services performed as certified by the COR.

Base Year – 4/1/2024- 3/31/2025

Line Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit

(Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

0001 Primary Care Services at capitation rates per member per month (PMPM)

PMPM

EA

0002 Primary Care Mental Health Services at capitation rates per member per month (PMPM)

PMPM 105 EA

Total for Base Year $________________________

Option Year One – 4/1/2025- 3/31/2026

Line Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit (Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

1001 Primary Care Services at

1002 Primary Care Mental Health member per month (PMPM)

Total for Option Year 1 $________________________

Option Year 2 – 4/1/2026- 3/31/2027

Line Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit (Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

2001 Primary Care Services at

2002 Primary Care Mental Health

Total for Option Year 2 $________________________

Option Year 3 – 4/1/2027- 3/31/2028

Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit (Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

3001 Primary Care Services at

3002 Primary Care Mental Health member per month (PMPM)

PMPM 107 EA

Total for Option Year 3 $________________________

Option Year 4 – 4/1/2028- 3/31/2029

Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit (Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

4001 Primary Care Services at

4002 Primary Care Mental Health member per month (PMPM)

PMPM 108 EA

Total for Option Year 4 $________________________

Option Year 5 – 4/1/2029- 3/31/2030

Line Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit (Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

5001 Primary Care Services at

5002 Primary Care Mental Health member per month (PMPM)

Total for Option Year 5 $________________________

Option Year 6 – 4/1/2030- 3/31/2031

Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit (Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

6001 Primary Care Services at

6002 Primary Care Mental Health member per month (PMPM)

Total for Option Year 6 $________________________

Option Year 7 –4/1/2031- 3/31/2032

Item

Services Unit

(PMPM)

Estimated Quantity

(EA)

Price per Unit (Monthly)

Total Estimated Cost per month

Total Estimated Cost per year

7001 Primary Care Services at

7002 Primary Care Mental Health

Total for Option Year 7 $________________________

TOTAL FOR BASE AND OPTION YEARS $___________________________

ORDERING PROCEDURES: VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management Model (PCMM) software program used to track primary care clinic Veteran rosters. Specific billable processes for issuing task orders under the resultant contract include: determining Veteran eligibility, enrollment eligibility, and at least one qualifying encounter by the Contractor’s primary care provider (PCP) within the previous 12 months.

The Contractor will be provided a list of all enrolled patients at the beginning of the contract and will be able to bill for these patients immediately. In order to remain enrolled in the clinic, patients must have a qualifying visit within 12 months of their last visit. Qualifying encounters are further defined in PWS Section 6.2.1.

Any services to be furnished under this contract shall be ordered by issuance of task orders by the Contracting Officer. Orders may be issued by facsimile or by electronic commerce methods.

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. SERVICES REQUIRED: The New Mexico VA Healthcare System (NMVAHCS); requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in Espanola New Mexico: Espanola CBOC.

1.1.1. [X] Primary Care CBOC: offers both medical and mental health care (physically on site and by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray.

Primary Care CBOCs are required to provide both primary care and mental health services.

Primary Care-Mental Health Integration services will be provided on-site and via tele-health by the Contractor.

1.2. PLACE OF PERFORMANCE: Within the city limits of Espanola, New Mexico which is approximately 94 miles from the NMVAHCS parent facility.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153, FAR Parts 12 and 15 to be furnished by the contractor on behalf of the New Mexico VA Healthcare System at 1501 San Pedro Dr, SE Albuquerque, New Mexico 87108.

1.4. POLICY AND REGULATIONS: The Contractor shall 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. The 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 Center

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. ASYNCHRONOUS CARE: Care provided outside of bookable time and includes but is not limited to the following activities: refilling prescriptions, reviewing outside records, huddles and case management, team meetings, processing view alerts, secure messaging and training.

1.5.15. BAA: Business Associate Agreement

http://www.va.gov/vhapublications/ http://www.va.gov/vapubs/ https://www.patientcare.va.gov/primarycare/Resources.asp

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

1.5.17. BLS: Basic Life Support

1.5.18. BOS: Bureau of Osteopathic Specialists

1.5.19. CAHEA: Committee on Allied Health Education and Accreditation

1.5.20. CAP: College of American Pathologists

1.5.21. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.22. CBO: VA Central Billing Office.

1.5.23. CDC: Centers for Disease Control and Prevention

1.5.24. CEU: Certified Education Unit

1.5.25. CLIA: Clinical Laboratory Improvement Amendments

1.5.26. CME: Continuing Medical Education

1.5.27. CMS: Center for Medicare and Medicaid Services

1.5.28. CO: Contracting Officer

1.5.29. COPD: chronic obstructive pulmonary disease

1.5.30. COR: Contracting Officer’s Representative

1.5.31. COS: Chief of Staff

1.5.32. CPA: Collaborative Practice Agreement

1.5.33. CPP: Clinical Pharmacist Practitioner

1.5.34. CPT: Current Procedural Terminology

1.5.35. CRNP: Certified Registered Nurse Practitioners

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

1.5.37. CPARS: Contractor Performance Assessment Reporting System

1.5.38. CVT: Clinical Video Telehealth.

1.5.39. DICOM: Digital Image and Communication in Medicine

1.5.40. DIGMA: Drop in Group Medical Appointment

1.5.41. DRG: Diagnostic Related Group

1.5.42. DSS: Decision Support System

1.5.43. ECC Extended Care Center

1.5.44. 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.

1.5.45. EPRP: External Peer Review Program

1.5.46. FDA: Food and Drug Administration

1.5.47. FSMB: Federation of State Medical Boards

1.5.48. HCC: Health Care Center an 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.

1.5.49. HHS: Department of Health and Human Services

1.5.50. HCFA: HealthCare Financing Administration

1.5.51. 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.

1.5.52. HT: Home Telehealth

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

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

1.5.55. iMED: software used by VA for informed consent

1.5.56. INR: International Normalized Ratio

http://www.cswe.org/

1.5.57. ISO: Information Security Officer

1.5.58. LIP: licensed independent practitioner

1.5.59. MCCR: Medical Care Cost Recovery

1.5.60. 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.

1.5.61. TMS: Talent Management System

1.5.62. VA ECHO: VA Extension for Community Health Outcomes

1.5.63. VSSC: VHA Support Service Center

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.

1.5.64. MQSA: Mammography Quality Standards Act

1.5.65. MSN: Master of Science in Nursing

1.5.66. NLN: National League for Nursing

1.5.67. NSQIP/CICSP: National Surgical Quality Improvement Program/ Continuous

Improvement in Cardiac Surgical Program

1.5.68. OTC: Over the Counter

1.5.69. PA: Physician Assistant

1.5.70. PACS: Picture Archiving and Communications System

1.5.71. 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.

1.5.72. PACT Support staff: PACT staff assisting providers in the actual delivery of care to patients. It consists of RNCMs, clinical associates, and administrative associates.

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

1.5.74. PCMH: Patient-Centered Medical Home

1.5.75. PCMM: Patient Centered Management Module- a software program used to track

Primary Care Clinic Veteran rosters.

1.5.76. PCP: Primary Care Provider

1.5.77. Phar.D.: Doctor of Pharmacy

1.5.78. POC: Point of Care Testing

1.5.79. PRIMARY CARE VISIT: an episode of care furnished in a clinic or virtually that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

1.5.80. PCMHI: Primary Care-Mental Health Integration

1.5.81. PWS: Performance Work Statement

1.5.82. QAPI: Quality Assessment and Performance Improvement

1.5.83. QASP: Quality Assurance Surveillance Plan

1.5.84. RME: reusable medical equipment

1.5.85. SOP (Clinical): Scope of Practice

1.5.86. SFT: Store and Forward Telehealth

1.5.87. SMA: Shared Medical Appointments

1.5.88. SPD: Sterile Processing Division

1.5.89. SPE: Senior Procurement Executive

1.5.90. SPECIALTY CARE VISIT: The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology;

dermatology; emergency; employee health; endocrinology; gastroenterology;

general medicine; hematology or oncology; infectious disease; nephrology;

neurology; outreach; pulmonary or respiratory disease; rheumatology;

amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery;

orthopedics; plastic surgery; urology; or vascular clinic stops.

1.5.91. SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two way conversation.

1.5.92. TJC: The Joint Commission

1.5.93. TIU: Text Integration Utility

1.5.94. TCT: Telehealth Clinical Technicians

1.5.95. VA: Veterans Affairs

1.5.96. VA EHR: VA electronic health record

1.5.97. VAMC: Veterans Affairs Medical Center

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

1.5.99. VHA: Veterans Health Administration

1.5.100. VVC: VA Video Connect

1.5.101. WHEN: Weekend- Holiday- Every Night

2. STAFFING AND QUALIFICATIONS:

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS:

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacist Practitioners (CPPs), Licensed Social Workers, Registered Dietitian/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff). The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacist Practitioner (CPP) shall be provided the same support staffing when they are working in the capacity of an advanced practice provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA, the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: 675.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance

Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by Contractor.

2.2.1. Qualifications: The Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice.

If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. The physician director may also be credentialed and privileged to function as a PCP. (If so, authorization for prescriptive authority is required). Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA Handbook 5005, Appendix G2.

2.2.2. 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 the Contractor.

2.3.1. TEAMLET MEMBER 1: Primary Care Provider (PCP): FTE Ratio Performance

Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. The Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. The Contractor to propose mix of PCP from the options below:

2.3.1.1. OPTION 1: Physician (MD/DO):

2.3.1.1.1. Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice.

Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e., CBOC) is located;

otherwise, qualifications as per VA Handbook 5005.

2.3.1.1.2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.1.2. OPTION 2: Advanced Practice Registered Nurse (APRN):

2.3.1.2.1. Qualifications: APRN’s (including subcontractors) must possess a master’s degree from a program accredited by the NLNAC or CCNE and maintain full and current certification as a Certified Nurse Practitioner (CNP) from the American Nurses Association or another nationally recognized certifying body in either Adult Health or Family Practice. Authorization for prescriptive authority is required. CNPs shall prescribe controlled substances in accordance with limitations imposed by the Controlled Substances Act and the CNP’s State licensure on the authority to prescribe, or administer controlled substances. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6.

2.3.1.2.2. Position Responsibilities: Responsible for the provision of covered providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.1.3. OPTION 3: Physician Assistant (PA):

2.3.1.3.1. Qualifications: PA’s (including subcontractors) must be a graduate of a training program which is accredited by the Accreditation Review Commission on Education of PA (ARC-PA) or one of its predecessor organizations. Additionally, PAs must have a Master’s degree in any discipline or a Bachelor’s degree in any discipline with one year of experience as a PA. PAs must have successfully passed the PA National Certifying Exam (PANCE). Authorization for prescriptive authority is required. PA shall have current, full, active, and unrestricted license, and registration in the state in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA HANDBOOK 5005 APPENDIX G8.

2.3.1.3.2. Position Responsibilities: Responsible for the provision of covered providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

2.3.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio

Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP.

2.3.2.1. Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or the commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA Handbook 5005, Appendix G6.

2.3.2.2. 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, virtual care, view alerts management, shared medical appointments, face to face visits, etc. , as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and virtual care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team.

Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

PRIMARY for all sites

2.3.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard:

Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. The Contractor to propose the mix of Clinical Associates from the options below.

2.3.3.1. OPTION 1: Licensed Practical Nurse (LPN):

2.3.3.1.1. Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA HANDBOOK 5005 APPENDIX G13.

2.3.3.1.2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Staff will be assigned telehealth trainings in TMS by the Office of Connected Care Service Section. Staff will receive face-to-face training once all trainings are completed in TMS. One backup is required per OCC; Staff will provide TCT back up.

2.3.3.2. OPTION 2: Licensed Vocational Nurse (LVN):

2.3.3.2.1. Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA HANDBOOK 5005 APPENDIX G13.

2.3.3.2.2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Staff will be assigned telehealth trainings in TMS by the Office of Connected Care Service Section. Staff will receive face-to-face training once all trainings are completed in TMS. One backup is required per OCC; Staff will provide TCT back up.

2.3.3.3. OPTION 3: Health Technician (Medical Assistant) This staffing is part of the

PACT Teamlet, not the primary telehealth clinical technician (TCT):

2.3.3.3.1. Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on VA Chief of Staff determination.

2.3.3.3.2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Staff will be assigned telehealth trainings in TMS by the Office of Connected Care Service Section. Staff will receive face-to-face training once all trainings are completed in TMS. One backup is required per OCC; Staff will provide TCT back up.

2.3.4. TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio

Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0

FTE PCP.

2.3.4.1. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. Completion of scheduling training per VA policies and guidance.

2.3.4.2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care. Provide 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. Provide guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA. Provide scheduling services in accordance with VA policies and guidance..

2.4. DISCIPLINE SPECIFIC PACT TEAM MEMBERS (REQUIRED FOR ALL SITES):

Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated.

2.4.1. DISCIPLINE SPECIFIC 1: Clinical Pharmacist Practitioner (CPP): Provided by

NMVAHCS; The Contractor responsible for placing consult in VA EHR and appropriate level of follow-up.

2.4.2. DISCIPLINE SPECIFIC 2: Clinical Pharmacist Practitioner (CPP): ANTI-

COAGULATION: Provided by NMVAHCS; The Contractor responsible for placing consult in VA EHR and appropriate level of follow-up.

2.4.3. DISCIPLINE SPECIFIC 3: LICENSED SOCIAL WORKER (this position provides general/medical social work services): FTE Ratio Performance Standard: 1 FTE per 2 PACTs.

2.4.3.1.1. Qualifications: Social Workers providing general social work services under this contract must have a master’s degree in Social Work (MSW) from a school accredited by Council on Social Work Education (CSWE). Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise, qualifications as per VA HANDBOOK

5005/120 PART II APPENDIX G39 SOCIAL WORKER QUALIFCATION

STANDARD GS-0185.

2.4.3.1.2. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned Veterans presenting for care. Covered services would include, but are not limited to, conducting bio-psychosocial assessments to determine needs of Veterans, Veteran’s family members and caregivers.

Provide a full range of clinical social work services within established standards of social work practice which includes treatment planning, individual, family and group counseling, VA and community-based resource referrals, case management and other services as appropriate. Providing tailored interventions for a wide range of psychosocial issues to include, housing/homelessness, food, finances, family/caregiver support, home care/placements, legal, education, employment, disability, mental health/addiction, medical and reporting of abuse/neglect. Participate in treatment planning with interprofessional teams, members, and other programs.

Assist with long term care placement, discharge planning, hand off communication and transitions between levels of care and arranging for in home services to ensure care is timely and appropriate.

2.4.4. DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST will be by NMVAHCS. The Contractor responsible for placing consult in VA EHR and appropriate level of follow-up.

DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH

INTEGRATION (PC-MHI) To be provided by the contractor: PCMHI is a required component of PACT, providing mental health expertise for Veterans whose conditions can be managed collaboratively in primary care. Where primary care services are offered, PCMHI services must include Co-located Collaborative Care (CCC) providers who attend PACT huddles and provide consultative advice, brief assessment and problem-focused treatment, and Mental Health Collaborative Care Managers (CoCM) who use the evidence-based Mental Health Collaborative Care Management Model to provide longitudinal follow-up and decision support for specific mental health conditions.

FTE Ratio Performance Standard - The following ratios are the minimum necessary to adequately provide required PCMHI services.

• Co-located Collaborative Care (CCC): 0.5 FTEE CCC per 1200 primary care patients. This ratio includes PCMHI Behavioral Health Consultants (Licensed Independent Providers such as the providers included in options 1- 3 below) as well as Providers with Prescribing Privileges (PwPP) (such as the providers included in options 4-6 below (depending on the provider’s scope of practice)).

• Collaborative Care Management: 0.17 FTEE Collaborative Care Managers per 1200 primary care patients. (typically options 2-5 below) per PACT.

Collaborative Care Managers will also require a consulting PwPP(options 4 - 6 depending on the provider’s scope of practice). Collaborative Care Managers (CoCMs) have specialized training in behavioral health and are typically RNs, but could also be other Licensed Practitioners (LP) of varying disciplines.

(See the VHA Directive 1160.01, Uniform Mental Health Services for PCMHI requirements in the policy spreadsheet).

A mix of the following disciplines shall be selected to meet the PCMHI FTE ratio performance standard and PCMHI service requirements. Staffing ratio outlined is “minimum” and may be increased by the VA to provide appropriate integrated mental health care.

2.4.4.1. OPTION 1: Psychologist:

2.4.4.1.1. Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, PART II APPENDIX G18.

A doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association (APA), the Psychological Clinical Science Accreditation System (PCSAS), or the Canadian…