36C26224Q1230_1.docx

SUBJECT*

664 - 36C262-24-AP-4043 VASDHS New Escondido CBOC Procurement _ Base plus 9 Option Years

GENERAL INFORMATION

SET-ASIDE

Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815

POINT OF CONTACT*

Contracting Officer Tashodra Rogers Tashodra.Rogers@va.gov

(562) 766-2303

PLACE OF PERFORMANCE

VA San Diego Healthcare System

3350 La Jolla Village Drive

San Diego California

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

AGENCY CONTACT’S EMAIL ADDRESS

EMAIL DESCRIPTION

DESCRIPTION

Sources Sought Notice Sources Sought Notice The U.S. Department of Veterans Affairs (VA) San Diego Healthcare System (VASDHS) requires a Contractor with demonstrated experience in operating Community Based Out-patient Clinics (CBOC) to provide CBOC services in the city of Escondido, CA.

Sources Sought Notice

THIS IS A REQUEST FOR INFORMATION (RFI) – SOURCES SOUGHT

1. Responses to this Sources Sought must be in writing. The purpose of this Sources Sought Announcement is for market research purposes only, to make appropriate acquisition decisions and to gain knowledge of businesses, including Veteran Owned and Service Disabled Veteran Owned Small Business (SDVOSB), interested and capable of providing the following services:

The U.S. Department of Veterans Affairs (VA) Greater San Diego Healthcare System (VASDHS) requires a Contractor with demonstrated experience in operating Community Based Out-patient Clinics (CBOC) to provide CBOC services in the city of Escondido, CA.

2. The NAICS for this requirement is 621498, All other Outpatient Care Centers. The product service code is Q201, Medical – General Health Care.

3. Interested and capable Contractors should respond to this notice not later than 3:00 PM Pacific Daylight Time (PDT) on June 12, 2024, by providing the following via email only to Tashodra.Rogers@va.gov.

(c) business size (e.g., large, small, other than small, VOSB, SDVOSB);

(d) phone and email of primary point of contact

(e) SAM Unique Entity Identifier (UEI) number

(f) A capability statement that addresses the organization’s qualifications and ability to perform as a contractor specifically for the work described in the attached excerpt from the impending solicitation’s DRAFT performance work statement (PWS). To assist the contracting office in making a capability determination, respondents are encouraged to provide specific examples of their company’s experience providing CBOC services including the following information:

(1) Contract number

(2) Place of Performance

(3) The average number of monthly billable patients over the past (or last) year of the contract.

(4) Period of Performance

4. Required Services. **See attached excerpt from DRAFT PWS.

5. The intended contract period of performance will be for 10-years, estimated at November 1, 2024 – October 31, 2034.

--End of Sources Sought Announcement--

EXCERPT from the DRAFT PWS for Escondido CBOC Services

Highlights:

1. Place of Performance – Escondido, CA, Congressional District:50th Congressional district of California.

2. Estimated Billable patients for the base period – 3288

3. Number of estimated Patient Aligned Care Teams (PACT) - 4

4. Contractor shall provide space for mental health services.

5. VASDHS shall provide all mental health staffing, including for Primary Care Mental Health Integration.

B.3 DRAFT PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1 SERVICES REQUIRED: The VA San Diego Healthcare System (VASDHS); requires the following services to be provided in a Community Based Outpatient Clinic (CBOC) dedicated solely to Veterans, primarily residing in the city of Escondido, California. The Contractor shall provide a continuum of care from prevention to diagnosis and treatment, to appropriate referral and follow-up. Those patients needing specialty of follow-up care shall be referred to VASDHS.

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. Mental Health services will be provided by VASDHS staff on-site.

1.2 PLACE OF PERFORMANCE: VA San Diego Healthcare System (VASDHS) has a need for the provision of primary care services for Veterans in the City of Escondido of California off-site in a Community Based Outpatient Clinic. The city of Escondido is located approximately 23 miles from the VASDHS.

1.3 AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of the VA San Diego Healthcare System 3350 La Jolla Village Drive San Diego, California 92161.

1.4 POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the Contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vhapublications/ or at http://www.va.gov/vapubs/. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/Resources.asp.

2. STAFFING AND QUALIFICATIONS –

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

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff). The 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 in ratios to Primary Care Providers of 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 Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA, 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: 3,510.

PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by Contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. 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. May also be credentialed and privileged 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.

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.

2.2 PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor.

2.2.1 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. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. At least two (2) of the primary care providers must be physicians.

OPTION 1: Physician (MD): 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. 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, telehealth, and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications: CRNP’s (including subcontractors) must have a MSN from a NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP 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. 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, telehealth, and telephone 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.

2.2.2 TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP Qualifications: Graduate of a school of professional nursing approved by the appropriate State-accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e., CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

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

2.2.3 TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. Contractor to propose the mix of Clinical Associates from the options below.

OPTION 1: Licensed Practical Nurse (LPN): 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. 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. The LPN is to serve in the PACT teamlet clinical associate role, not as primary TCT. May be trained as a TCT back-up, but not as the primary TCT.

OPTION 2: Licensed Vocational Nurse (LVN): Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005 APPENDIX G13. 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. The LVN is to serve in the PACT teamlet clinical associate role, not as primary TCT. May be trained as a TCT back-up, but not as the primary TCT.

OPTION 3: Medical Assistant (MA):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 Chief of Staff determination.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. The MA is to serve in the PACT teamlet clinical associate role, not as a primary TCT. Can be trained as a TCT backup, but not as the primary TCT.

OPTION 4: Health Care Technician (HCT) (as part of PACT teamlet, not primary telehealth technician) : 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 Chief of Staff determination. 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. The HCT is to serve in the PACT teamlet clinical associate role, not as a primary TCT. Can be trained as a TCT backup, but not as the primary TCT.

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

2.2.4 TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations .Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.3 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. The following discipline specific staffing shall be provided by the Contractor.

2.3.1 DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) –PACT: FTE Ratio Performance Standard: VASDHS PACT Pharmacy services are available through chart referral (co-signing one of the VA San Diego Clinical Pharmacy PACT Practitioners to the CPRS note). PACT CPP clinics are also open to direct patient scheduling without a referral.

EXPANDED PACT STAF

2.4 ANCILLARY SUPPORT SERVICES STAFFING:

2.5.1 DIAGNOSTIC RADIOLOGIC TECHNOLOGIST: The Contractor shall be responsible for entering requests for Radiology procedures into VA EHR. All imaging orders shall be clinically appropriate. VASDHS will provide radiological examinations. The Contractor shall refer all imaging studies to the parent VAMC. The Contractor shall be financially liable for any cost associated with any radiological examinations or imaging studies where prior authorization or concurrence was not granted by the parent VAMC. X-rays performed at VA can be viewed by the Contractor through VISTA Imaging and the PACS.

2.5.2 PHLEBOTOMIST/LABORATORY TECHNICIAN 2.00 FTEE: Contractor shall provide laboratory Phlebotomist staff. Staff shall have knowledge of legal requirements of blood drawing, fluid sample handling and relevant medical equipment and material. This position also requires the ability to use computers to enter patient information, excellent communication skills, and attention to detail. The Phlebotomist shall be able to properly identify patients and use correct phlebotomy methods (venipuncture, skin puncture) to obtain patient samples. The Phlebotomist is relied on to preserve patient health and the quality of samples. The Phlebotomist shall have a National Phlebotomy License or a California Phlebotomy License.

2.6 TELEHEALTH SERVICES CLINICAL STAFF: The following telehealth staffing shall be provided by the Contractor. Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services). All staff providing telehealth related services (primary TCT(s) and back-ups) must be trained in tele-retinal imaging, tele-dermatology, tele-audiology, tele-mental health, tele-primary care etc. The qualifications, competencies, and position responsibilities noted below apply to primary TCT(s) and back-ups. The Tele-presenter can be any clinically trained person assisting the provider in the presentation of the Veteran using videoconferencing. Depending on the skills needed for the encounter, the Tele-presenter can be a licensed independent provider (LIP), Registered Nurse, LPN, or Telehealth Clinical Technician (TCT). Tele-presenters can also serve as TCT back-ups. The number and discipline of Contractor’s staff trained to function as a TCT back-up or Tele-presenter will be based on the volume and type of telehealth services provided.

2.6.1 Qualifications: All staff providing telehealth related services into the clinic shall be appropriately credentialed and where necessary, privileged. All contractor staff who support and manage telehealth services must be working within permitted licensure and scope of practice. Where non-licensed staff is supporting telehealth services the Contractor’s licensed staff must provide appropriate clinical supervision.

2.6.2 Competency – TCTs, Tele-presenters, Store and Forward Imagers et al. and their back-ups, shall be expected to provide clinical care in compliance with established clinical protocol. Additional guidelines governing operations will be utilized and provided to Contractor by VA. TCTs, Tele-presenters, Store and Forward Imagers and back-ups shall be expected to successfully complete training programs required for certification as a TCT, Tele-presenter and/ or Store and Forward Imager and back-up including VA required training and any VA training mandated for TCT, Tele-presenter, Tele-retinal Imagers. TCTs, Tele-presenters, and Store and Forward Imagers shall be responsible for maintaining imager and/or other required certification. TCTs, Tele-presenters, and Store and Forward Imagers and back-ups shall be expected to demonstrate competency on the function and use of the telehealth equipment including digital retinal and dermatology imaging system, tele-audiology hardware and software. VA will provide training to TCTs, Tele-presenters, Store and Forward Imagers and back-ups and document competency.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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