36C26225Q0896.docx

SUBJECT*

VAGLAHS - East Los Angeles CBOC - Request For Information - Long Term Contract - 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*

Contract Specialist Haig Altunian Haig.Altunian@va.gov

(562) 760 - 9214

PLACE OF PERFORMANCE

VA Greater Los Angeles Healthcare System

11301 Wilshire Blvd

Los Angeles CA

ADDITIONAL INFORMATION

AGENCY’S URL

URL DESCRIPTION

EMAIL DESCRIPTION

DESCRIPTION

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

Sources Sought Notice

THIS IS A REQUEST FOR INFORMATION (RFI) ONLY – 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 Los Angeles Healthcare System (VAGLAHS) requires a Contractor with demonstrated experience in operating Community Based Out-patient Clinics (CBOC) to provide CBOC services in the city of Commerce, CA.

2. The NAICS code for this requirement is 621498, All other Outpatient Care Centers. The Product Service Code (PSC) 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 23, 2025, by providing the following via email only to Haig.Altunian@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

(5) Point of Contact information (Name, designation, email, phone number) for someone who can verify the work that was done under this contract.

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

5. The intended contract period of performance will be for 10-years, estimated at October 1, 2026 – September 30, 2035.

--End of Sources Sought Announcement--

EXCERPT from the DRAFT PWS for East Los Angeles CBOC Services

Highlights:

1. Place of Performance – Commerce, CA, Congressional District: 42nd Congressional district of California.

2. Estimated Billable patients for the base period – 1,461

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

B.3 DRAFT PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1 Services Required: The VA Greater Los Angeles Healthcare System (VAGLAHS) also known as “the parent facility” requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in East Los Angeles, Los Angeles County, California.

1.2 Site Classification: This site is classified as a [X] Primary Care CBOC.

1.3 Place of Performance: Services shall be performed by contractor at the East Los Angeles CBOC will be located within the city limits of Los Angeles. The Contractor shall provide community-based outpatient clinics dedicated solely to Veterans. This contract is for Primary Care Services and administrative support and space for Mental Health, Tele-Mental and Tele-Health services in the form of a Community Based Outpatient Clinic (CBOC) for Veterans living in East Los Angeles, California, approximately 30 miles from the parent facility. The parent facility for this CBOC is the VAGLAHS. Unless otherwise noted, hereafter within this document, singular terms such as “CBOC”, “clinic” or “Contractor’s facility” shall refer to the East Los Angeles CBOC. Primary Care services will provide a continuum of care from prevention to diagnosis and treatment, to appropriate referral and follow-up. Those patients needing specialty or follow-up care not included in these contracts shall be referred to the VAGLAHS.

1.4 Authority: Title 38 United States Code (USC) 8153 and FAR 12 in combination with 15 and/or VAAR 873.

1.5 Policy and Regulations: The contractor is required to meet VHA performance and quality criteria, policy and standards including, but not limited to, access, quality of care, Veteran satisfaction, coordination of care, 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/vapubs/ or at http://www.va.gov/vhapublications/. Some VA policy documents include Standard Operating Procedures (SOPs) located on internal VA websites that are not available to the public. SOPs relevant to this requirement are provided as attachments under Section D. 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/docs/List-of-contracted-clinic-policy-documents.xlsx#. A link to the VA Qualifications Standards is also included in this document.

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), 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. The total estimated patients assigned to site is: 1461.

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. Contractor’s Physicians performing under this contract shall be board certified 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 qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to assigned 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.

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 mid-level 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.

Option 1: Physician (MD/DO): 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 qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned 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.

Option 2: Advanced Practice Registered Nurse (APRN): Qualifications: APRN’s (including subcontractors) shall possess a master’s degree from a program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing Education (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 qualification standards for Advanced Practice Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned 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.

Option 3: Physician Assistant (PA): Qualifications: PA’s (including subcontractors) shall 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 shall 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 shall 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 qualification standards for Physician Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned 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.

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 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 qualification standards for Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned 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.

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) or 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 qualification standards for Licensed Practical or Vocation nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned 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 ability 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.

Option 2: Unlicensed Assistive Personnel (Health Technician, Nursing Assistant). This staffing is part of the PACT Teamlet, not the primary telehealth clinical technician (TCT): Qualifications: Nursing Assistant qualifications per VA qualification standards for Nursing Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Health Technician qualifications per Health Aid and Technician Series 0640 located at: Health Aid and Technician Series 0640 (opm.gov).

Position Responsibilities: Responsible for the provision of covered services to assigned 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 ability 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.

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 provide clerical support and administrative functions to support site operations. Completion of scheduling training per VA policies and guidance. See VA qualification standards for Medical Support Assistant located in the VA Qualification Standards for additional qualifications. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. Provide clerical support and administrative functions to PACT staff and collaborate 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.

2.3 Discipline Specific PACT Team Member (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.

Discipline Specific 1: Clinical Pharmacist Practitioner (CPP) – PACT: FTE Ratio Performance Standard: 1.0 FTE per 3,600 Veterans Qualifications: A CPP is a licensed pharmacist who is a graduate of an Accreditation Council for Pharmacy Education (ACPE) accredited College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or a Doctor of Pharmacy (PharmD) degree and shall have at least 1 year of pharmacy equivalent experience performing the activities of the position. The CPP shall have a current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; and meet the requirements for a Clinical Pharmacy Specialist position as outlined in VA qualification standards for Licensed Pharmacist located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. . Authorization for a VA scope of practice is required in accordance with VHA Handbook 1108.11 Clinical Pharmacy Services, or subsequent policy release, and adheres to pharmacy practice acts within the state of licensure. In addition to the requirements listed above, the CPP shall have post-graduate experience performing comprehensive medication management and chronic disease state management (e.g., post-graduate residency, direct patient care under collaborative practice agreement or similar equivalent experience). If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. CPP shall be scheduled with bookable appointments and scheduled grid to provide comprehensive medication management to patients functioning in the capacity of an advanced practice provider utilizing a scope of practice or collaborative practice agreement.

Discipline Specific 2: Clinical Pharmacist Practitioner (CPP) Anti-Coagulation - PACT: FTE Ratio Performance Standard: 1.0 FTE per 3,600 Veterans Qualifications: A CPP is a licensed pharmacist who is a graduate of an Accreditation Council for Pharmacy Education (ACPE) accredited College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or a Doctor of Pharmacy (PharmD) degree and shall have at least 1 year of pharmacy equivalent experience performing the activities of the position. The CPP shall have a current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; and meet the requirements for a Clinical Pharmacy Specialist position as outlined in VA qualification standards for Licensed Pharmacist located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. . Authorization for a VA scope of practice is required in accordance with VHA Handbook 1108.11 Clinical Pharmacy Services, or subsequent policy release, and adheres to pharmacy practice acts within the state of licensure. In addition to the requirements listed above, the CPP shall have post-graduate experience performing comprehensive medication management and chronic disease state management (e.g., post-graduate residency, direct patient care under collaborative practice agreement or similar equivalent experience). If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. CPP shall be scheduled with bookable appointments and scheduled grid to provide comprehensive medication management (i.e., anticoagulation therapy management) to patients functioning in the capacity of an advanced practice provider utilizing a scope of practice or collaborative practice agreement. EX

PANDED PACT STAF

Discipline Specific 3: Licensed Social Worker (this position provides general/medical social work services): The contractor will connect the veteran to services via referral to VAGLHS.

Discipline Specific 4: Registered Dietitian/Nutritionist: FTE Ratio Performance Standard: 1 FTE per 5 PACTs. Qualifications: Meet state qualification requirements in the state of the outpatient site of care (i.e., CBOC). Bachelor’s degree from a U.S. regionally accredited college or university and completed a didactic program in dietetics accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND), formerly known as the Commission on Accreditation for Dietetic Education (CADE). Completed an ACEND accredited or approved supervised practice program. Supervised practice programs are post-baccalaureate degree programs that provide supervised practice experiences which meet the eligibility requirements and accreditation standards of ACEND. Completion of a coordinated program in dietetics fulfills the requirements of a supervised practice program. Time spent in a dietetic internship or supervised practice program does not qualify as creditable experience. Dietitian shall be registered with the Commission on Dietetic Registration (CDR), the credentialing branch of the Academy of Nutrition and Dietetics formerly known as the American Dietetic Association (ADA). Advanced Level Practice Dietitians shall possess a minimum of one advanced practice credential relevant to the area of practice, (e.g., Certified Nutrition Support Clinician (CNSC), Board Certified Specialist in Renal Nutrition (CSR), Board Certified Specialist in Gerontological Nutrition (CSG), Certified Diabetes Educator (CDE), or Board-Certified Specialist in Oncology Nutrition (CSO)). 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 qualification standards for Dietician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Serves as the medical nutrition expert. Is autonomous in their work in applying evidence-based nutrition practice guidelines for all patients, including those with complex medical and nutritional needs. Coordinates nutritional care of Veterans with other health care providers, the Veteran, the Veteran’s caregiver, and the community. Interprets research and utilizes whole health principles to develop patient-centered goals and improve outcomes. Conducts comprehensive nutrition assessments using the Nutrition Care Process (NCP), including nutrition focused physical examinations, to establish a nutrition diagnosis and determine risk and/or degree of malnutrition. Develops and implements Medical Nutrition Therapy (MNT) to address the nutrition diagnosis and evaluates and monitors the effectiveness and outcomes of MNT interventions. Modifies the plan as needed to achieve positive patient outcomes. Actively participates in formal and informal interdisciplinary team meetings. Utilizes virtual care technology to improve access to care. Responsible for the provision of covered services to assigned and unassigned patients presenting for care. Responsible for meeting VA scheduling requirements and mandates.

Discipline Specific 5: Primary Care Mental Health Integration (PCMHI):

PCMHI services to be provided by VA Mental Health staff on location at the Contract Clinic. Contract Primary Care provider places a CONSULT for same-site mental health services. The Primary Care staff are to provide a warm handoff for patients who need acute care. Contract staff will assist with the scheduling and rooming of patients in PCMHI.

accredited by APA or CPA at the time the program was completed may be considered eligible for hire only if they are currently board certified by the American Board of Professional Psychology in a specialty area that is consistent with the assignment for which the applicant is to be employed and they maintain their board certification. Position Responsibilities: Responsible for collaboration with PACT team for the provision of mental health services to assigned and unassigned patients presenting for care per VHA Directive 1160.01 and the requirements of this contract.

2.4 Specialty Care Staffing:

Podiatrist: FTE Ratio Performance Standard: Podiatry services to be provided by the VAGLAHS. The Contractor shall request a Podiatry CONSULT electronically through the VA EHR and include consult service requested, urgency, diagnosis (when required), and reason for request. Any and all additional information required must be entered by the referring CBOC Primary Care Provider via the consult template.

Physical Therapist: FTE Ratio Performance Standard: Physical Therapy services to be provided by the VAGLAHS. The Contractor shall request a CONSULT electronically through the VA EHR and include consult service requested, urgency, diagnosis (when required), and reason for request. Any and all additional information required must be entered by the referring CBOC Primary Care Provider via the consult template.

2.6 Ancillary Support Services Staffing: The following ancillary support staffing shall be provided by the contractor. The contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to these services during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters).

X-Ray Diagnostic Radiologic Technologist: Diagnostic Radiology services to be provided by the VAGLAHS. The contractor shall request a Diagnostic Radiology CONSULT electronically through the VA EHR and include consult service requested, urgency, diagnosis (when required), and reason for request. Any and all additional information required must be entered by the referring CBOC Primary Care Provider via the consult template.

Phlebotomist: The contract laboratory person in charge of technical operations in hematology/coagulation must have education and experience equivalent to a Medical Technologist with a certification with the American Society for Clinical Pathology (MT (ASCP)) National Credentialing Agency (NCA), American Medical Technologists (AMT) or American Association of Bioanalysts (AAB) and at least 4 years’ experience, one of which is in clinical hematology, under a qualified director. Any contract site performing phlebotomy will have oversight by VA laboratory.

Waived Testing Personnel: The VA will provide the test systems/instruments and reagents for contractor waived testing except for fecal occult blood testing cards and developer. The Contractor must contact the VA Ancillary Testing staff prior to purchasing fecal occult blood test kits to ensure consistency of methodology/ manufacturer. If the VA changes fecal occult blood testing methodology/ manufacturer, the Contractor must comply with the change to maintain the same standard of care. These test systems/instruments are from manufacturers that have received 510(K) clearances from the FDA. The VA will provide test procedures and training materials, initial training, and annual competency assessment. The Ancillary Testing staff will make periodic visits to the Contractor’s site and monitor the quality control and test results to ensure accuracy and, consistency, and adherences to VA policies and requirements. All ancillary testing at the Contractor’s site will be under the oversight of the VA Ancillary Testing Program. The Contractor is required to use the same test systems/instruments; quality control and reagent lot numbers used for ancillary testing performed at the VA. When the VA Ancillary Testing Program upgrades waived test systems/instruments, the VA will furnish the Contractor with the new test systems/instruments to maintain the same standard of care. The Ancillary Testing staff will arrange for repair/maintenance in the event of system/instrument failure. If required, the Contractor shall provide a courier to transport instruments and/or reagents to the Contractor or the VA Ancillary Testing staff for linearity/correlation studies and minor repairs. The VA will purchase proficiency testing materials for the Contractor, and the Contractor must comply with the Pathology and Laboratory Medicine, CAP and TJC requirements/regulations for testing proficiency materials and submitting results. The identified staff shall meet facility defined requirements of the VA Ancillary Testing Program, receive training specific to the testing activity, receive orientation specific to the needs of the service, and have been documented to be competent to perform the test. Staff that has not completed a medical laboratory certification program shall have documented comprehensive training commensurate with the test system to ensure proficiency. It is the contractor’s responsibility to ensure staff performing testing is following procedure manual and manufacturer’s guidelines, performs and document quality control as defined, document results, participates in mandatory competency, and performs proficiency testing.

2.7 General and Specialty Mental Health Staffing Requirements and Options:

General MH Staffing FTE to be provided by VA Mental Health staff on location at the Contract Clinic. Contract Primary Care provider places a CONSULT for same-site mental health services. The Primary Care staff are to provide a warm handoff for patients who need acute care. Contract staff will assist with the scheduling and rooming of patients in PCMHI.

Specialty MH Staffing Contractor shall request specialty consultations electronically through the VA EHR and include consult service requested, urgency, diagnosis (when required), and reason for request. Any and all additional information required by some Specialty Sections must be entered by the referring CBOC Primary Care Provider via the CONSULT template.

Required: Administrative Support Staff: FTE Ratio Performance Standard: Current minimum standard is 1.0 FTE administrative staff per 1000 Veterans receiving General and Specialty MH services: Qualifications: Required education and experience demonstrating skills and abilities to provide clerical support and administrative functions to support site operations. Completion of scheduling training per VA policies and guidance. See VA qualification standards for Medical Support Assistant located in the VA Qualification Standards for additional qualifications. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for completing administrative tasks to support the General MH and Specialty MH teams and Veterans presenting for care, providing clerical support and administrative functions to support timely access to high quality care that is coordinated. 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.

Required: For the additional 8.0 FTE of clinical staff per 1000 Veterans receiving General and Specialty MH services, a mix of the following disciplines listed below shall be selected to meet general and specialty MH FTE ratio performance standard and general and specialty MH service requirements. The staffing ratio outlined above is the “minimum” necessary to adequately provide evidence-based treatment, medication management and other indicated services, care coordination and proactive population management. This staffing ratio may be increased by the VA to provide mental health care. See the Uniform Mental Health Services Directive 1160.01 for General and Specialty Mental Health requirements.

Additional General and Specialty Mental Health Staffing Requirements:

Suicide Prevention Coordinator (SPC): Services to be provided by VA Mental Health staff on location at the Contract Clinic. Contract Primary Care provider places a CONSULT for same-site mental health services. The Primary Care staff are to provide a warm handoff for patients who need acute care. Contract staff will assist with the scheduling and rooming of patients in PCMHI.

Homeless Outreach Specialist: Services to be provided by VA staff on location at the Contract Clinic.

2.8 Telehealth Services Clinical Staff: The following telehealth staffing shall be provided by the contractor. For CBOCs with fewer than 1050 synchronous and/or asynchronous encounters anticipated per year, one Telehealth Clinical Technician (TCT) FTE is required; for CBOCs with 1051-1479 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, 1.5-2 TCT FTE are required; for CBOCs with over 1480 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, greater than 2 TCT FTE are required. Each TCT shall have a trained back-up, e.g., another TCT or a member of the PACT Teamlet such as (PCP, RNCM, or clinical associate) who is able to perform all telehealth duties of the designated telehealth TCT. Qualifications: All staff providing telehealth related services in the clinic shall be appropriately credentialed and where necessary, privileged. See section 2.9 for additional information regarding credentialing and privileging for contracted telehealth providers. All contractor staff who support and manage telehealth services shall be working within permitted licensure and scope of practice. Where non-licensed staff are supporting telehealth services the contractor’s licensed staff shall provide appropriate clinical supervision.

Competency: TCTs, telepresenters, store and forward imagers and back-ups shall be expected to successfully complete training programs and skill assessments required for competency as a TCT, telepresenter and/ or store and forward imager and back-up including VA required training and any VA training mandated for TCT, telepresenter, teleretinal imagers. TCTs, telepresenters, and store and forward imagers shall be responsible for maintaining imager and/or other required competencies or appropriate certifications. TCTs, telepresenters, 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, teleaudiology hardware and software. VA will provide training to TCTs, telepresenters, store and forward imagers and back-ups and document competency.

Training: Contractor’s TCTs, RNs, LPNs, LIPs and support staff providing telehealth services shall complete all telehealth required training and skill assessments 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.

Telehealth Clinical Technician (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 assigned 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 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 will provide basic telehealth education to patients who receive telehealth services (i.e., TRI, TDI imaging process, when to expect results, etc.), as well as basic education related to the patient’s condition as requested by the telehealth provider (i.e., hand-outs). 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.

Telepresenter 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.

2.6 2.7

2.8 License and Accreditation: All 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 clinic is located. If the state where the outpatient clinic is located recognizes multistate licensure through a compact and a contract licensed provider’s home state is a party to such compact, and no other restrictions apply, then the provider’s compact licensure status in the state where the outpatient clinic is located may be acceptable as long as the provider complies with all licensure requirements of the multistate compact for the entirety of the provider’s performance of services under the contract.

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.

Contractor staff 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.

The contractor shall 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.

Position specific competencies shall be completed for all staff annually.

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

The contractor is responsible for assuring that all persons, whether they be staff, 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.

The contractor shall not permit any staff 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 shall 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.