RFP 36C26225R0004 - Amendment 0001 - CBOC Services - El Centro - VASDHS.pdf

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

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AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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1 13

0001 12-12-2024

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 Long Beach CA 90815

To all Offerors/Bidders

36C26225R0004

11-22-2024

X

X X

X 1

This amendment is issued to:

1. Amend the solicitation (pages 2-3).

2. Answer questions received to the solicitation (pages 4-13).

Offerors are advised that the original solicitation ID in Contract Opportunities is 36C26225R0004_1.

All other Terms and Conditions shall remain unchanged.

Alice McGruder Contracting Officer

1. The solicitation is amended as follows:

1. Section B.3 PERFORMANCE WORK STATEMENT, Paragraph 11. SPACE REQUIREMENTS, Telehealth space requirements, is amended to read:

Telehealth space requirements: Four (4) rooms, at least 144 square feet each room. One room for staff and smaller equipment, one room for Teleretinal screening and two rooms for individual encounters and group patient/staff education. The Telehealth rooms shall be located near the Primary Care area. A medical examination table is required for each telehealth room. Each Telehealth room shall have a handwashing station.

2. Section B.3 PERFORMANCE WORK STATEMENT, Paragraph 11. SPACE REQUIREMENTS, Telemental Health Space Requirements, is amended to read:

Telemental Health Space Requirements: One (1) group room that can accommodate at least fifteen Veterans and is at least 300 Square Feet. Three (3) rooms at least 120 square feet each room) for Telemental Health. Each Telemental Health room will be properly lighted and equipped with a telephone. Two storage rooms, each at least 120 square feet to be used as a Veteran’s resource area. All rooms shall be able to support standard office furniture and space for a wheel chairs and shall meet American with Disabilities Act (ADA) requirements. Each Telemental Health room shall have a handwashing station.

3. Section B.3 PERFORMANCE WORK STATEMENT, Paragraph 12. ENVIRONMENT OF CARE (EOC), is amended to read:

ENVIRONMENT OF CARE (EOC): Contractor shall meet VHA standards regarding EOC and shall provide EOC management plans addressing safety, security, hazardous materials, hazardous waste, emergency preparedness, life safety, medical equipment, infection control, and utility systems within 15 calendar days after contract award. The VASDHS safety officer shall approve the EOC documents prior to commencement of patient care activities at the clinic. The EOC management plans shall be updated annually, along with a summary of performance and opportunities for improvement. Environment of care (EOC) rounds will be conducted at least once per fiscal year (FY) in nonpatient care areas and twice per FY in patient care areas. These rounds will be conducted by VA in accordance with VHA Directive 1608 Comprehensive Environment of Care (CEOC) Program using the Comprehensive Environment of Care Assessment and Compliance Rounding Tool. Contractor shall address deficiencies identified during EOC rounds and ensure they are closed within 14-business days or have a documented plan for action (PFA) for deficiencies that take longer than 14 business days to correct.

4. Section B.3 PERFORMANCE WORK STATEMENT, Paragraph 13. EQUIPMENT, OFFICE SUPPLIES AND TECHNICAL SUPPORT, The contractor shall be responsible for, is amended to read:

Having a contingency plan for computer downtime that defines the processes to ensure continuity of patient care and maintenance of the integrity of the patient’s medical record during periods of loss of computer functions. The contingency plan shall be reviewed and approved by the CO after award of the contract. In addition, a contingency plan template that designates criticality of application/system, estimate of impact, locations of equipment, and contact persons will be provided to the contractor for completion after award of the contract.

The contingency plan shall mirror VA OIT DevSecOP’s COOP plan.

5. Section B.3 PERFORMANCE WORK STATEMENT, Paragraph 18. SPECIAL CONTRACT REQUIREMENTS, Contract Start-up Requirements, is amended to read:

The contractor shall have 180 calendar days from contract award to commencement of the provision of medical care to VA parent facility patients. However, the contractor shall have all start-up requirements in place and ready to commence operation NLT 173 calendar days from contract award. The final seven (7) calendar days will be used for training and resolution of any last minute or unexpected technical or personnel related challenges. The contractor shall comply with the following contract requirements prior to commencement of clinical operations:

2. The following are answers to questions received in response to the solicitation:

1. Please confirm, other than the Tele-Mental Health Group Room, does the government require any additional group rooms? If so, how many and what is the size requirement of each?

Please see Paragraph 11 – SPACE REQUIREMENTS (page 74).

2. For the two telehealth rooms designated for individual encounters and group patient/staff education, what is the maximum group occupancy expected in these rooms?

Please see Paragraph 11 – SPACE REQUIREMENTS (page 74).

3. Please confirm the size and number of small group rooms and large group rooms required in this facility.

See Paragraph 11 – SPACE REQUIREMENTS (page 74).

4. Please confirm the number of procedure rooms and women’s health exam rooms required in this clinic. Can a procedure room count toward the number of required women’s health exam rooms?

No, a procedure room may not count toward the one examination room must be a Women’s Health examination room. See Paragraph 11 – SPACE REQUIREMENTS (page 74) per the PACT Space Module Design Guide.

5. Does the current CBOC meet the government’s space requirements, and if not, will the location be “grandfathered in” and available for rebid “as-is”?

No, the CBOC resulting from this procurement must meet the PACT Space Module Design Guide.

6. Please confirm the new CBOC must be designed with the on/Stage-Off/Stage concept as laid out in the PACT Design Guide.

The CBOC resulting from this procurement must meet the PACT Space Module Design

7. Please provide the number of billable enrollees on the most current invoice.

1,780

8. Please list all VA staff that will be onsite at the clinic and the approximate number of days per week they will be there.

No VA staff will be at the El Centro CBOC.

9. Will the new Contractor inherit the patients’ last vesting visit and be allowed to bill for one year from the date upon contract award?

Yes

10. Will the government be making site visits prior to the award? If so, how much advance notice will the contractor be given?

The government may make site visits prior to award. However, this will not require Offeror's involvement because the interior of the offered site will not be evaluated.

11. How many Mission Act referrals, for Primary Care, were made in the past 12 months for enrolled veterans of the CBOC?

5 Veterans

12. Transcripts are required to be submitted for NP candidates with the proposal. Can these transcripts be submitted after the award?

Yes. This procurement does not require any resumes or transcripts prior to award.

13. Please list the vaccines the contractor is responsible for purchasing and provide information on how many of each vaccine were used at the clinic in the past year.

FY 2024:

14. Please confirm if the VA will supply the telephones and will the existing number be rolled over to the new contractor?

The VA will provide voice and data networks and the physical telephones. The telephone numbers may not be the same with the VA voice network.

15. Will VA be supplying the telephones and telephone system for the clinic? Including fax?

The VASDSH will provide the telephones and telephone system. The contractor will provide a fax machine.

16. Will the government add price realism language to the current solicitation? To prevent contractors from deliberately underbidding this contract?

No

17. Will the government extend this solicitation by 30 days?

18. What are the CLINS for PC and MH over the life of the contract?

Please reference Section B. Schedule of Services and Price and Section D.19 Price

Worksheet for estimated billable quantities (pages 155-157).

19. Please confirm that the build out time is 180 days, and the contractor shall be ready to commence operation on day 173, not 143 as stated on pg. 96.

Please see Solicitation Amendments above.

20. Please confirm if the contractor is responsible for Mental Health services and there will be a separate PMPM.

The contractor shall provide Primary Care Mental Health Integration Services. Please reference Section B. Schedule of Services and Price and Section D.19 Price Worksheet.

21. Please provide the cost of the EKG GE 5500.

Please consult GE price catalog/sales department or other retailers.

22. What is the Mental Health staffing requirement if it is the responsibility of the contractor?

The contractor will provide PCMHI staff. Mental Health services will be provided via telemental health provided by VASDHS staff.

23. Is the contractor responsible for providing a prescribing LIP for mental health? If so, what is the FTE required?

There is no requirement to provide a prescribing LIP for mental health.

24. Section 11, page 74 lists the following space requirements: “A minimum of 3 examination rooms per PACT teamlet and 1 consultation room per teamlet. One examination room must be a Women’s Health examination room. The El Centro clinic will have six (6) primary care examination rooms and three (3) interview rooms, one (1) PCMH integration room.” Please confirm that the second sentence is referring back to the requirements of the first sentence. Specifically, the “six (6) primary care examination rooms” are the same as the “3 examination rooms per PACT teamlet”, and the “three (3) interview rooms” are the same as “1 consultation room per teamlet”.

Yes, and all rooms shall meet the PACT Space Module Design Guide requirements.

25. Will the VA provide the lab specimen tubes?

Yes, VA provides tubes and cups. The contractor would need to supply the collection materials-coban, needles, vacutainers.

26. Regarding Section 5.2, would the VA be willing to provide Well Women’s Health Services

Supplies, including Thin Prep Pap Test, Pap Smear Collection Kits, Cytobrushes, as well as the IFOBT kits? In our experience, these supplies are difficult for the contractor to procure.

Yes, the VASDHS will supply Thin Prep Pap Test, Pap Smear Collection Kits, Cytobrushes, as well as the IFOBT kits.

27. Who is the incumbent contractor for this opportunity and the associated contract number.

Sterling Medical Associates, Inc; Contract Number 36C26223D0038

28. Can you provide the billable history over the last 3 months?

July: 1,779 August: 1,770 September: 1,780

29. Can the VA please provide the historical enrollment for the past five years?

Year: 2020; Number of Patients: 1,712 Year: 2021; Number of Patients: 1,712 Year: 2022; Number of Patients: 1,750 Year: 2023; Number of Patients: 1,755 Year: 2024; Number of Patients: 1,810

30. Please list the vaccines the contractor is responsible for purchasing and provide information on how many of each vaccine were used at the clinic in the past year.

31. The RFP states, "A copy of licenses must be provided with offer and will be updated annually."

Nowhere in the instructions to offer does it mention providing a staffing plan or to provide any licenses. Is a staffing plan and copy of licenses required with the submission of the proposal?

32. The RFP states, "Telephone Access to Clinical Care: The contractor shall make provisions for toll free telephone care, twenty-four (24) hours a day, seven (7) days a week, including evenings, weekends, and holidays, for all Veterans." Is it acceptable to the VA if the Contractor uses the VA's after hours call center to provide after-hours telephone access?

33. The RFP states, "the following minimum space requirements are: A minimum of 3 examination rooms per PACT teamlet and 1 consultation room per teamlet. One examination room must be a Women's Health examination room. The El Centro clinic will have six (6) primary care examination rooms and three (3) interview rooms, one (1) PCMH integration room." Is the Women's Health exam room included in the 6 primary care exam rooms and 1 exam consultation room, or is that an additional exam room? Is the 1 consultation room per teamlet the same room as the interview rooms or are they separate rooms?

The Women’s Health exam room is included in the 6 primary care exam rooms.

Consultation and interview rooms are the same.

34. The RFP states, "ENVIRONMENT OF CARE (EOC): Contractor shall meet VHA standards regarding EOC and shall provide EOC management plans addressing safety, security, hazardous materials, hazardous waste, emergency preparedness, life safety, medical equipment, infection control, and utility systems with the submission of their proposal and within 15 calendar days after contract award." Is it acceptable for the Contractor to provide the EOC within 15 calendar days after contract award?

Yes, please see Solicitation Amendments above.

35. The RFP states, "Having a contingency plan for computer downtime that defines the processes to ensure continuity of patient care and maintenance of the integrity of the patient's medical record during periods of loss of computer functions. The contingency plan shall be reviewed and approved by the CO prior to award of the contract." Nowhere in the instructions to offer does it mention providing a Contingency Plan for Computer Downtime. Is the bidder required to submit the contingency plan for computer downtime with the proposal?

36. Attachment 16 was not provided with the Solicitation in Sam.gov. Will the government provide

Attachment 16?

D.16 is not an attachment. Please reference the bullets points (hyperlinks) in D.16.

37. The RFP states, "UEI Number. Provide the Unique Entity Identifier Number assigned to your firm in the space provided in section B.1 Contract Administration." There is no space provided in Section B.1. Where in Section B.1 Contract Administration should the UEI number be placed?

Please provide UEI Number next to Contractor “Company Name” (does it need to have a line in the amendment)

38. The RFP states in Volume 2 Factor 1 - Experience, to use the form provided in D.1 Reference

Contract Worksheet. Is there a limit on the number of D.1 Reference Contract Worksheets the Government like to see to show contractor's and subcontractor's experience?

39. The RFP states: Collaborative Care Management: 0.17 FTE Collaborative Care Managers per 1200 primary care patients. (Typically options 2-5 below) per PACT. Is the intent to have 0.17 FTE Collaborative Care Managers per 1200 primary care patients or 0.17 FTE per PACT team?

0.17 FTE per 1,200 primary care patients.

40. Will the VA accept a board eligible physician?

41. There was no enrollment numbers listed for base or each option year for either PC or MH?

Please reference Section B. Schedule of Services and Price and Section D.19 Price

Worksheet for estimated billable quantities (pages 155-157).

42. Are contractors allowed to bid on certain areas of this RFP? As it states that multiple bids are accepted.

Per the solicitation, section E.4 Addendum to FAR 52.212-1 Instructions to offerors, last paragraph on page 166, reminds Offerors that, "they are required to submit at least one proposal that exactly conforms to the solicitation terms and conditions, including the Schedule of Services and Price as presented in the solicitation section B.2 and D.19 Price Worksheet, with no deviations. OFFERORS WHO FAIL TO MEET THIS

SOLICITATION REQUIREMENT WILL HAVE ALL PROPOSALS REJECTED".

43. Is there a facility currently being used for this RFP and if so can I as the contractor use the same facility?

The current El Centro CBOC is located at 1115 South 4th Street, El Centro, CA 92243- 4741. Any facility offered must meet all terms and conditions of the solicitation and resulting contract.

44. Are there multiple bids being awarded for this RFP?

45. Does the current CBOC facility meet all the operational and space requirements per the PACT

Space Module Design Guide?

No, the CBOC resulting from this procurement must meet the PACT Space Module Design

46. Is the facility lease transferable if the contract is awarded to a new vendor? Are there any restrictions on subleasing or transferring the lease?

This information is not available from the government.

47. Does the current facility offer enough space to meet the needs of the patient population?

This information is not available from the government.

48. What are the current staffing levels at the CBOC and are they adequate to meet patient demand?

Yes, the incumbent meets the staffing requirements required by the current contract.

49. What is the current number of Telehealth Clinical Staff in place, to include number of Telehealth Clinical Technicians? Has this coverage been adequate to meet telehealth demand?

There is one telehealth clinical technician and coverage is adequate.

50. The RFP provides estimated billable number of patients in the base period of this contract of 1,829.

What is the 12-month historical average number of patients included in the monthly billable PC LIN roster?

1,707

51. Please provide the 12-month billable roster.

October 2023: 1,638 November 2023: 1,640 December 2023: 1,642 January 2024: 1,655 February 2024: 1,675 March 2024: 1,689 April 2024: 1,702 May 2024: 1,752 June 2024: 1,765 July 2024: 1,779 August 2024: 1,770 September 2024; 1,780

52. Provide historical average number of patients included in the monthly billable MH LIN roster.

Mental Health is not included in the current El Centro CBOC.

53. What is the estimated billable number of patients for the MH LIN in the base period of this contract?

Please see D.19 Price Worksheet for estimated billable quantities of Mental Health Veterans (pages 155-157).

54. Please provide the number of historical qualifying encounters completed by a PCP with the primary stop codes and secondary credit codes as defined on pages 98-99 of the RFP.

55. Please provide the number of historical encounters that fall within the primary care-mental health integration (PCMHI) and/or general/specialty MH service by professional MH staff under a 500 series stop coded clinic.

PCMHI is not included in the current El Centro CBOC.

56. Please confirm that the government will accept a Physician Assistant in place of a Nurse

Practitioner if a Physician is present?

No, Physician Assistant is not acceptable as a primary care provider.

57. What is the security process for onboarding staff and how long is the expected timeline for completion?

Staff must submit the VA background check form completed correctly. Staff must be fingerprinted and have proper identification to be fingerprinted. Background checks can be completed as quickly as two to three weeks if staff complete all requirements timely.

Background checks can take up to three months if staff do not obtain fingerprints, or complete paperwork properly.

58. Projections indicate that the eligible population in this county will decrease 1%-2% each year over the contract term. Based on historical enrollment at this clinic, is it expected that the CBOC billable patients will decline at this same rate?

Please see D.19 Price Worksheet for estimated billable quantities of Mental Health Veterans (pages 155-157).

59. Increasing the start-up time to 180 days will help reduce construction costs by minimizing overtime requirements for Davis-Bacon related trades, it would also help to minimize supply chain issues.

Would the government consider extending the start-up time to 180 days?

Please see Paragraph 18, Contract Start-up Requirements, which indicates 180 days.

60. To ensure compliance with the solicitation requirements for administering vaccines and medications in a primary care setting, could you please confirm that the scope of required medications and vaccines is limited to those typically administered for preventive and routine purposes? Specifically, we are seeking to confirm that this includes vaccinations such as influenza, COVID-19, pneumococcal, and routine adult immunizations, as well as medications for primary care-managed conditions like hypertension, diabetes, and cholesterol management. Additionally, can you confirm that this does not include medications or vaccines typically managed in specialty or hospital settings, such as advanced cancer therapies, high-risk biologics, or specialty immunizations not usually administered in primary care (e.g., travel vaccines or rare disease treatments)?

Please see Pharmacy Services (page 40).

61. Will the VA please verify that courier services will be provided once a day.

Yes, the VASDHS will provide the courier service once per day.

62. Since the VA handles the anticoagulation with VA staffed PharmD’s will the VA be responsible for completing and submitting these reports to the VA?

Yes

63. Since this procurement is set-aside for a SDVOSB, would the Government consider an initial fixed price contract, with a cost reimbursement line item, for a six-month construction/transition period?

RFP would require the contractor to provide all necessary facilities, maintenance, staffing, supplies, and equipment for the CBOC. RFP would list contract required services and supplies in the form of contract line items (CLINs). The first CLIN would correspond to facility development/construction, equipment, furnishings, and other start-up during a six-month transition period (reimbursable).

During the six-month startup period, monthly progress payments would be reimbursed. Upon completion of start-up and commencement of services, contractor would be paid PMPM for enrolled Veteran population (Fixed Price IDIQ).

Per Section E.4 (page 166), VA will consider alternative proposals that meet the requirements of FAR Clause 52.212-1, paragraph (e) Multiple Offers, included in the solicitation. However, Offerors are reminded that they are required to submit at least one proposal that exactly conforms to the solicitation terms and conditions, including the Schedule of Services and Price as presented in the solicitation section B.2 and D.19 Price Worksheet, with no deviations. OFFERORS WHO FAIL TO MEET THIS

SOLICITATION REQUIREMENT WILL HAVE ALL PROPOSALS REJECTED.

64. Do the women’s health exam rooms and procedure exam room required count towards the required 3 exam rooms per PACT?

Yes.

65. Will the VA provide the lab specimen tubes?

Yes, VA provides tubes and cups. The contractor would need to supply the collection materials-coban, needles, vacutainers.

66. Who will provide the centrifuge machine?

Per Section 5.4, Laboratory Services (page 44), the Contractor is responsible for Providing and utilizing the appropriate centrifuge in accordance with the VA San Diego Healthcare System (VASDHS) Department of Pathology and Laboratory Medicine recommendation to separate serum/plasma from blood cells were indicated within the specified time period according to the current standard operation manual.

67. Please verify the number of Female veterans currently enrolled.

114 female Veterans

68. Please provide the number of synchronous and/or asynchronous encounters are anticipated for the clinic so that the contractor can determine the right staffing levels for the TCT positions.