36C26319R0012-001.pdf

PAGE 1 OF 76 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. DUNS: DUNS+4:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

636-19-1-3027-0001

36C26319R0012

6. SOLICITATION ISSUE DATE

01-24-2019

Andrew Schoenecker 651-293-3038 02-22-2019

3:00PM CST

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Attention: Andrew J. Schoenecker

316 Robert Street N.

St. Paul MN 55101

X

621111

$11 Million

N/A

X

N/A

X

Department of Veterans Affairs

VA Central Iowa Health Care System

3600 30th Street

Des Moines IA 50310

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Attention: Andrew J. Schoenecker

316 Robert Street N.

St. Paul MN 55101

Y

Department of Veterans Affairs

Financial Services Center

PO Box 149971

Austin TX 78714-9971

X

See CONTINUATION Page

Ophthalmology on-call services and off-site patient consultations, to include emergent per procedure CPT codes in accordance with 38 U.S.C. 8153.

The period of performance for the base year is 04-19-2019 to

04-18-2020, with the possibility of four (4) option years.

Reference:

Section B.2 Schedule of Services for pricing.

Section B.3 Performance Work Statement for summary of performance objectives and standards.

Section E.1 for submittal instructions and evaluation factors.

X ONE

Charles A. Hurry Contracting Officer

36C26319R0012

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS.……..…...1

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.2 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.3 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.4 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.5 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

C.6 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND

COMPLIANCE (JUL 2018)

C.7 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(SEP 2018)

C.8 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORATED BY

REFERENCE (JAN 2008)

C.9 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.10 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.11 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(JAN 2008)

C.12 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.13 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.14 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO

BENEFICIARIES (JAN 2008)

C.15 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003)

C.16 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (OCT 2018)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

E.2 PROPOSAL SUBMITTAL INSTRUCTIONS

E.3 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION)

E.4 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.5 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (OCT 2018)

E.6 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.7 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) .. 76

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION

1. CONTRACT ADMINISTRATION DATA

Contractor:

List below the responsible party that may be contacted during the term of this contract for matters pertaining to the contract:

Contractor Name:

Point of Contact:

Address:

Telephone:

Facsimile:

E-mail:

Federal Taxpayer ID Number:

Dun and Bradstreet Number:

Government:

Contracting Officer – Andrew Schoenecker

Network Contracting Office 23

316 Robert Street N, Suite 506

Saint Paul, MN 55101

Phone (651) 293-3038

Fax (651) 293-3060

Andrew.Schoenecker@va.gov

Contracting Officer’s Representative – Samantha Malone

3600 30th Street

Des Moines, IA 50310

Phone (515) 699-5999 x5840

Samantha.Malone@va.gov

2. INVOICES: Invoices shall be submitted in arrears:

[ ] Other [X] Monthly

3. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered and dated as follows:

AMENDMENT NUMBER DATE

4. AVAILABILITY OF FUNDS: The contract is subject to the availability of VA funds. The contractor shall perform no service after the end of the current exercised contract year until the Contracting Officer authorizes such services in writing.

mailto:Andrew.Schoenecker@va.gov mailto:Samantha.Malone@va.gov

POINT OF CONTACT: The Contractor shall provide a point of contact (POC) who shall be responsible for the performance of the work under this contract. The POC shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The POC may be a contract health care provider performing under this contract. An alternate may be designated, but the Contractor shall identify, in writing, those times when the alternate shall act as the POC. The Contractor shall identify the POC and alternate in writing to the Contracting

Officer’s Representative (COR) and Contracting Officer (CO). The Contractor shall give written notification to the

COR and CO of the time when the alternate will act as the POC. The POC shall be available by telephone Monday through Friday, 8:00 AM through 4:30 PM, excluding Federal holidays.

SECURE FAX: VA Handbook 6500 requires the following statement on all fax cover sheets be included: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribute on, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

B.2 SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform Ophthalmology Physician

Services to eligible beneficiaries of the Department of Veterans Affairs Medical Center, Central Iowa (hereinafter referred to as VAMC). The contractor’s physician(s) care shall cover the range of Ophthalmology Services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by the American Academy of

Ophthalmology (AAO) http://one.aao.org/guidelines-browse

Place of Performance: Contractor’s facility for all on-call emergent encounters (per procedure CPT).

Pricing Instructions: Contract Line Item Number (CLIN) and Subline Item Number (SLIN).

The offeror is instructed to edit the number of SLINs to correspond with the number of key personnel submitted for the CLIN. Other commercial health care offerors shall identify by title/position or level of experience the key personnel submitted. Also, re-number SLINs if adding or removing key personnel.

The Contractor shall propose the cost per unit hours for Physician (Ophthalmology) key personnel to be credentialed and be available for scheduling to meet the requirements of the service contract.

One Full-Time Employee (FTE) equivalent is defined by VA as a minimum of 80 hours every two weeks per year and does not include holidays.

SCOPE: Broken down by Contract Line Item Number (CLIN) and Subline Item Number (SLIN) All hourly rate CLINs will be charged to the nearest next higher 15-minute mark (:15, :30, :45, :00) for actual time present, with a one hour minimum paid for on-site consultation. After hours on-call days will be calculated to an hourly rate, with 15.5 hours for weekday after hours on call periods, and 24 hour periods for weekend and holiday on-call.

There are an estimated 10 holidays per twelve 12-month period.

CLIN 0001, 1001, 2001, 3001, 4001 (Weekday After Hours On-call) (Estimated 1565.5 hours base 12 mo, 8-10 days per month, 101 weekdays for twelve (12) months, 40%), (weekday (2 days per week). After hours Call runs from 1630 until 0800 (15.5 hours) the next day. Weekday call runs from 1630 Monday through 0800 Saturday morning.

CLIN 0002, 1002, 2002, 3002, 4002 (Weekend/Holiday On-call) (Estimated 1152 hours base 12 mo, 4-5 weekend days/ holidays per month, 48 days for twelve (12) months, 40%). Weekend call days run from 0800 to 0800 (24 hours) the next day. Weekend call runs from 0800 Saturday through 0800 Monday morning. Holiday call runs from

0800 on the actual holiday date to 0800 the following day.

CLIN 0003, 1003, 2003, 3003, 4003 (Non-Clinical Task (Review/Training) (Estimated 48 hours base 12 months, 1 hours per month times four key personnel, 48 hours for twelve (12) months). Covers required peer reviews and mandatory annual training for key personnel.

CLIN 0004, 1004, 2004, 3004, 4004 (Emergent Encounters (Per Procedure CPT)) An encounter consists of 2-3 per procedure CPT Codes (new visit, exam, and procedure). (Estimated 12 encounters per 12 months, one 1 per month / 12 encounters for twelve (12) months), paid per procedure (CPT code) for off-site). See Attachment A: Per

Procedure CPT (off-site) Pricing Table. An encounter consists of an exam CPT, outpatient visit CPT, and a

Procedure CPT based upon the encounter procedure type.

http://one.aao.org/guidelines-browse

Period of Performance

BASE YEAR: April 19, 2019 – April 18, 2020

CLIN SLIN

Description

Estimated

Quantity

Unit Unit Cost

Total

Annual Cost

Board Certified/Board Eligible Ophthalmology

Services

1. On-Call (Weekday)

2. On-Call (Weekend, Holiday)

3. Non-Clinical Task (Review/Training)

4. Emergent Encounters (per Procedure CPT)

N/A N/A DO NOT

PRICE

DO NOT

PRICE

0001a On-Call (Weekday) 1,565.5 Hour $ $

0001b On-Call (Weekend, Holiday) 1,152 Hour $ $

0001c Non-Clinical Task (Review/Training) 48 Hour $ $

0001d

Emergent Encounters (Per Procedure CPT – See

Attachment A) 12 Each

DO NOT

PRICE

DO NOT

KEY PERSONNEL

None

Board Certified/Board Eligible Ophthalmologist

NAME:________________________________

TITLE/LEVEL OF

EXPERIENCE:__________________________

NAME:________________________________

NAME:________________________________

NAME:________________________________

TOTAL

OPTION YEAR 1: April 19, 2020 – April 18, 2021

Estimated

Quantity

Unit Unit Cost

Total

Annual Cost

Board Certified/Board Eligible Ophthalmology

Services

1. On-Call (Weekday)

2. On-Call (Weekend, Holiday)

3. Non-Clinical Task (Review/Training)

4. Emergent Encounters (per Procedure CPT)

N/A N/A DO NOT

PRICE

1001a On-Call (Weekday) 1,565.5 Hour $ $

1001b On-Call (Weekend, Holiday) 1,152 Hour $ $

1001c Non-Clinical Task (Review/Training) 48 Hour $ $

1001d

Attachment A) 12 Each

DO NOT

PRICE

DO NOT

NAME:________________________________

NAME:________________________________

NAME:________________________________

NAME:________________________________

OPTION YEAR 2: April 19, 2021 – April 18, 2022

Estimated

Quantity

Unit Unit Cost

Total

Annual Cost

Board Certified/Board Eligible Ophthalmology

Services

1. On-Call (Weekday)

2. On-Call (Weekend, Holiday)

3. Non-Clinical Task (Review/Training)

4. Emergent Encounters (per Procedure CPT)

N/A N/A DO NOT

PRICE

2001a On-Call (Weekday) 1,565.5 Hour $ $

2001b On-Call (Weekend, Holiday) 1,152 Hour $ $

2001c Non-Clinical Task (Review/Training) 48 Hour $ $

2001d

Attachment A) 12 Each

DO NOT

PRICE

DO NOT

NAME:________________________________

NAME:________________________________

NAME:________________________________

NAME:________________________________

OPTION YEAR 3: April 19, 2022 – April 18, 2023

Estimated

Quantity

Unit Unit Cost

Total

Annual Cost

Board Certified/Board Eligible Ophthalmology

Services

1. On-Call (Weekday)

2. On-Call (Weekend, Holiday)

3. Non-Clinical Task (Review/Training)

4. Emergent Encounters (per Procedure CPT)

N/A N/A DO NOT

PRICE

3001a On-Call (Weekday) 1,565.5 Hour $ $

3001b On-Call (Weekend, Holiday) 1,152 Hour $ $

3001c Non-Clinical Task (Review/Training) 48 Hour $ $

3001d

Attachment A) 12 Each

DO NOT

PRICE

DO NOT

NAME:________________________________

NAME:________________________________

NAME:________________________________

NAME:________________________________

OPTION YEAR 4: April 19, 2023 – April 18, 2024

TOTAL (Base Year + Four Option Years): $ .

Description

Estimated

Quantity Unit Unit Cost

Total

Annual Cost

Board Certified/Board Eligible Ophthalmology

Services

1. On-Call (Weekday)

2. On-Call (Weekend, Holiday)

3. Non-Clinical Task (Review/Training)

4. Emergent Encounters (Per Procedure CPT)

N/A N/A DO NOT

PRICE

4001a On-Call (Weekday) 1,565.5 Hour $ $

4001b On-Call (Weekend, Holiday) 1,152 Hour $ $

4001c Non-Clinical Task (Review/Training) 48 Hour $ $

4001d

Attachment A) 12 Each

DO NOT

PRICE

DO NOT

NAME:________________________________

NAME:________________________________

NAME:________________________________

NAME:________________________________

Attachment A

Per Procedure CPT Listing (off-site):

Testing Procedure CPT Estimated

Quantity Unit

Phsyician Fee

Schedule

Estimated

Total Price

Removal of Foreign Body, external eye, conjunctival surficial

65205 2 EA $ $

Removal of Foreign Body, conjunctival embedded, subconjunctival, or scleral non-perforating

65210 2 EA $ $

Removal of Foreign Body, Corneal, without slip lamp

65220 1 EA $ $

Removal of Foreign Body, Corneal, with slip lamp

65222 1 EA $ $

Repair of laceration, conjunctiva, with or without no perforating laceration sclera, direct closure

65270 2 EA $ $

Repair of eye socket wound 65290 1 EA $ $

Repair eyelid wound 67930 2 EA $ $

Repair eyelid wound 67935 1 EA $ $

Exam (low to Mod) 92002 3 EA $ $

Exam (moderate to High) 92004 3 EA $ $

Exam (low to moderate) 92012 3 EA $ $

Exam (moderate to high) 92014 3 EA $ $

Office/outpatient visit new 99201 1 EA $ $

Office/outpatient visit new 99202 3 EA $ $

Office/outpatient visit new 99203 4 EA $ $

Office/outpatient visit new 99204 3 EA $ $

Office/outpatient visit new 99205 1 EA $ $

NOTE: Per procedure CPT rates shall be based upon current year physician fee schedule i.e., 2019 procedures will be paid based upon 2019 physician fee schedule, 2020 procedures will be paid based upon 2020 physician fee schedule, etc.

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1. Services Provided: The Contractor shall provide Board Certified Ophthalmology Physician Services for on-call and off-site patient consultations during hours outside normal Ophthalmology hours at the

Department of Veterans Affairs Medical Center (hereinafter referred to as VAMC) in Des Moines, IA.

The contractor’s physician(s)’ care shall be of a quality, meeting or exceeding currently recognized national standards as established by the American Academy of Ophthalmology (AAO) http://one.aao.org/guidelines-browse.

1.2. Place of Performance: Contractor’s facility for all on-call emergency procedures located at:

Street Address:

City, State, Zip Code:

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority. VAAR Part 873

Simplified Acquisition Procedures for Health-Care Resources will be utilized.

1.4. Policy/Handbooks:

1.4.1. VA Directive 1663: Health Care Resources Contracting - Buying http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

1.4.2. VHA Directive 2006-041 Veterans’ Health Care Service Standards (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.3. VHA Directive 2010-018 Facility Infrastructure

www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2227

1.4.4. VHA Directive 1192 Seasonal Influenza Prevention Program https://www.publichealth.va.gov/docs/flu/VHA_Directive_1192_Sep

1.4.5. VHA Handbook 1100.17 National Practitioner Data Bank Reports http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.6. VHA Handbook 1100.18 Reporting And Responding To State Licensing Boards http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.7. VHA Handbook 1100.19 Credentialing and Privileging

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.8. VHA Handbook 1121.01 Eye Care

www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2394

1.4.9. VHA Handbook 1400.01 Resident Supervision

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2847

1.4.10. VHA Handbook 1907.01 Health Information Management and Health Records http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791

1.4.11. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.5. Definitions/Acronyms – terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

http://one.aao.org/guidelines-browse http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2227 https://www.publichealth.va.gov/docs/flu/VHA_Directive_1192_Sep http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2394 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2847 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.5.1. AAO: American Academy of Ophthalmology http://www.aao.org/

1.5.2. ABO: American Board of Ophthalmology http://abop.org/board-certification/

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACLS: Advanced Cardiac Life Support

1.5.5. AOD: Admitting Officer of the Day

1.5.6. BLS: Basic Life Support

1.5.7. CCNE: Commission on Collegiate Nursing Education: www.aacn.nche.edu/accreditation

1.5.8. CDC: Centers for Disease Control and Prevention

1.5.9. CDR: Contract Discrepancy Report

1.5.10. CEU: Certified Education Unit

1.5.11. CME: Continuing Medical Education

1.5.12. CMS: Centers for Medicare and Medicaid Services

1.5.13. Contracting Officer (CO): the person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings.

1.5.14. Contracting Officer’s Representative (COR): a person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken.

1.5.15. COS: Chief of Staff

1.5.16. CPARS: Contractor Performance Assessment Reporting System

1.5.17. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the

VA.

1.5.18. Credentialing: credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.5.19. DEA: Drug Enforcement Agency

1.5.20. ED: Emergency Department

1.5.21. FSMB: Federation of State Medical Boards

1.5.22. Full Time Equivalent (FTE): VA’s definition for full time- working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included.

1.5.23. HHS: Department of Health and Human Services

1.5.24. HIPAA: Health Insurance Portability and Accountability Act

1.5.25. HR: Human Resources

1.5.26. ISO: Information Security Officer

1.5.27. Medical Emergency: a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in:

Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

http://www.aao.org/ http://abop.org/board-certification/ http://www.aacn.nche.edu/accreditation

1.5.28. MOD: Medical Officer of the Day

1.5.29. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by

HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.5.30. NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org

1.5.31. Non-Contract Provider: any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors

1.5.32. NP: Nurse Practitioner

1.5.33. NPPES: National Plan and Provider Enumeration System

1.5.34. PA: Physician Assistant

1.5.35. PALS: Pediatric Advanced Life Support

1.5.36. POP: Period of Performance

1.5.37. PPD: Purified Protein Derivative

1.5.38. PWS: Performance Work Statement

1.5.39. Privileging (Clinical Privileging): privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

1.5.40. QA/QI: Quality Assurance/Quality Improvement

1.5.41. QM/PI: Quality Management/Performance Improvement

1.5.42. QASP: Quality Assurance Surveillance Plan

1.5.43. Veterans Health Administration (VHA): the central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.5.44. Veterans Integrated Services Network (VISN): the regional oversight for the VA medical centers.

1.5.45. VISTA (Veterans Integrated Systems Technology Architecture): a PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

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

1.5.47. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA

Medical Center, for purposes of this contract, this term shall mean the Central Iowa VA Medical

Center or VA-Central Iowa Health Care System.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License – The Contractor’s physician (s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or

Commonwealth of the United States or the District of Columbia when services are performed.

All licenses held by the personnel working on this contract shall be full and unrestricted licenses.

Contractor’s physician (s) who have current, full and unrestricted licenses in one or more states, but http://www.nlnac.org/ 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.

2.1.2. Board Certification – All contract physician(s) shall be Board Certified by the American Board of

Ophthalmology (ABO) http://abop.org/board-certification/, and be currently certified in Basic Life

Support (BLS) Advanced Cardiac Life Support (ACLS). All continuing education courses required for maintaining certification must be kept up to date at all times. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.1.3. Credentialing and Privileging – Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed physician(s) possesses the requisite credentials enabling the granting of privileges.

No services shall be provided by any contractor’s physician(s)prior to obtaining approval by the Des

Moines, IA, VAMC Professional Standards Board, Medical Executive Board and Medical Center

Director.

2.1.3.1. If a contractor’s physician(s)is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.1.4. Technical Proficiency - Contractor’s physician(s) 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. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contractor’s physician(s)and contractor’s physician(s)shall be responsible for abiding by the Facility's Medical

Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.1.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. Contractor’s physician(s)registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging.

Failure to provide shall result in loss of privileges for contract physician(s).

2.1.6. Training (ACLS, BLS, CPRS and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contract physician (s) as required by the VA. VA CPRS training is required, as well as TMS

Courses to be conducted annually (TMS 10176 Privacy and Information Security, TMS 10203

Privacy and HIPAA).

Training (the following training is mandatory per VHACO for Contracted Physicians)

Frequency (once a year, etc.)

Annual Hours

VA Privacy and Information Security

Awareness and Rules of Behavior (VA 10176) Once a year 1 hour

Privacy and HIPAA Training

(VA 10203)

Once a year 1 hour

ACLS/BLS Once every 2 years 6 hours

2.1.7. University of Iowa Resident Supervision: Physicians that indirectly supervise residents will be credentialed by the VAMC in Des Moines, IA, and approved by Chief of Surgery and Associate

Chief of Staff-Education.

http://abop.org/board-certification/

2.1.8. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift to the

COR and Contracting Officer. Tests shall be current within the past year.

2.1.8.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative Tuberculosis Skin

Test (TST) or interferon-gamma release assays (IGRA) for all Contractor’s physician (s) {This is applicable to all health care workers}. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results. The TST or IGRA testing shall be repeated annually.

2.1.8.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.1.8.3. VARICELLA: Contractors shall provide proof of immunity for all Contractor physicians {This is applicable to all health care workers}.

2.1.8.4. ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor physicians {This is applicable to all health care workers}.

2.1.8.5. INFLUENZA: Contractors shall provide proof that all Contractor physicians have received the annual Influenza vaccine unless it is contraindicated. If the Contractor physician has a medical contraindication to the vaccine they shall be required to wear a mask during the Influenza season. {This is applicable to all health care workers}.

2.1.8.6. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all contractor’s physician(s); provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel (as published in American Journal for Infection

Control- AJIC 1998; 26:289-354

2.1.8.7. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel (as published in American Journal for Infection Control- AJIC 1998;

26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.9. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by

HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.10. DEA: Contractor shall provide copy of current DEA certificate in the state of Iowa.

2.1.11. Conflict of Interest: The Contractor and all contractor’s physician(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment 1 in Section D of the solicitation document.

2.1.12. Citizenship related Requirements:

2.1.12.1. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to

Department of Veterans Affairs patient referrals.

2.1.12.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order

12989” and any related pertinent Amendments, as well as applicable Federal Acquisition

Regulations.

2.1.12.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans

Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.1.12.4. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.1.12.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment 2 in

Section D of the solicitation document.

2.1.13. Annual Office of Inspector General (OIG) Statement: in accordance with HIPAA and the Balanced

Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of

Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.1.13.1. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the

HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contractor’s physician(s)are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.1.13.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded

Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

http://oig.hhs.gov/exclusions/index.asp

2.2. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA

Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the

Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

2.3. Non Personal Healthcare Services: the parties agree that the Contractor and all contractor’s physician(s)shall not be considered VA employees for any purpose.

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the

Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Prohibition Against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s) for permanent, long term care.

2.6. Inherent Government Functions: Contractor and Contractor’s physician(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of

Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.7. No Employee status: The Contractor shall be responsible for protecting Contractor’s physician(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.7.1. Workers’ compensation

2.7.2. Professional liability insurance

2.7.3. Health examinations

2.7.4. Income tax withholding, and

2.7.5. Social security payments.

2.8. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract physician(s). When a

Contractor or contractor’s physician(s)has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract physician(s)) action or non-action shall be the responsibility of the

Contractor and/or insurance carrier.

2.9. Key Personnel:

2.9.1. Contract Physicians shall be available for on-call and off-site consultations at contractor’s facility for hours outside normal VA-CIHCS Ophthalmology clinic hours.

2.9.2. The contractor shall provide sufficient staff to cover all on-call and off-site consultations as defined in paragraph Hours of Operation in this section.

2.9.3. The contractor will be paid only for the amount of time covered, no guaranteed minimum payments are included.

2.9.4. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 15 calendar day (s) after the occurrence of any of these events and provide the information required below. After

90 days, the Contractor shall submit the information required below to the CO at least 15 calendar days prior to making any permanent substitutions.

2.9.4.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 15 calendar days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel.

2.9.4.2. For temporary substitutions where the key person shall not be reporting to work for three (3) consecutive work days or more, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person. Any period exceeding two weeks will require the procedure as stated above.

2.9.4.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA

COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s physician (s), s/he may request, without cause, immediate replacement of said Contractor’s physician (s). The CO and COR shall deal with issues raised concerning Contractor’s physician (s) conduct. The final arbiter on questions of acceptability is the CO.

2.9.4.4. Contingency Plan: because continuity of care is an essential part of VAMC’s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor’s physician (s) leaves Contractor’s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.

3. VA HOURS OF OPERATION/SCHEDULING:

3.1. VA Business Hours: Contract Physicians shall be available for on-call and off-site consultations at contractor’s facility for hours outside normal VAMC Ophthalmology clinic hours based upon the agreed upon schedule. Precise on-call responsibility will be based upon the on-call schedule generated monthly.

The contractor shall provide sufficient staff to cover the following (Note: the below amounts are estimated minimum quantities. The contractor may be requested to cover additional nights/weekends of on-call based on the needs of the medical center):

3.1.1. Weeknight on-call coverage: will be provided between the hours from 4:30pm to 8:00am (the following day).

3.1.2. Weekend on-call coverage: will be provided between the hours from 8:00am on Saturday to 8:00am on Monday.

3.1.2.1. Estimated Eight to Ten (8 - 10) weeknights of call per month.

3.1.2.2. Estimated Four to Six (4-6) weekend day/nights of call per month.

3.1.2.3. Estimated One (1) emergency encounter (per procedure CPT) per month.

3.2. After Hours On-Call Work Schedule (on-call coverage hours):

3.2.1. The weekday on-call hours will be provided between the hours of 4:30pm on and 8:00am, Monday through Saturday. Weekday after-hours on-call periods are a 15.5-hour blocks of time from 4:30pm to 8:00am the next day.

3.2.2. Weekend on-call starts at 8:00am on Saturday and ends at 8:00am on Monday. Weekend on-call is broken into two 24-hour periods from 8:00am to 8:00am.

3.2.3. Holiday call runs from 8:00am on the actual holiday date to 8:00am the following day.

3.3. Patients must be seen by a contractor’s physician(s) in a timely manner in accordance with VA Rules and

Regulations on clinic wait times and consult completion.

3.3.1. On-Call Coverage: Contractor must make the contractor’s physician(s) available on-call during all hours when the VAMC Ophthalmology Clinic is closed, including evenings, weekends and holidays. On-call physicians must return a call within 30 minutes of the page attempt, and see the patient within 30 minutes when medically indicated. The contractor shall notify the COR about any obstacles to meeting this performance measure.

3.3.1.1. On-call contractor’s physician (s) who are scheduled must be available during on-call periods for phone consultations with VA residents and physicians.

3.3.1.2. Patients must be seen within 30 minutes of the page when medically indicated.

3.4. Federal Holidays: the following holidays are observed by the Department of Veterans Affairs

• New Year’s Day

• President’s Day

• Martin Luther King’s Birthday

• Memorial Day

• Independence Day

• Labor Day

• Columbus Day

• Veterans Day

• Thanksgiving

• Christmas

• Any day specifically declared by the President of the United States to be a national holiday.

3.5. Cancellations of scheduled on-call coverage:

3.5.1. The contractor will be responsible for providing on-call coverage for the amount of time specified above. The schedule will be coordinated with the COR and reviewed on a monthly basis if needed.

3.5.2. Unless a state of emergency has been declared, the Contractor shall be responsible for providing services.

4. CONTRACTOR RESPONSIBILITIES

4.1. On-Call Personnel Required: The Contractor shall provide contract physician (s) who are competent, qualified per this performance work statement, and adequately trained to perform assigned duties per the published on-call schedule.

4.1.1. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor’s invoices. On-call days will be calculated to a daily rate, with 15.5 hours for weekday after hours on-call periods, and 24-hour periods for weekend and holiday on-call.

4.2. Standards of Care: The contractor’s physician(s)’ care shall cover the range of Ophthalmology services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting, or exceeding currently recognized TJC, VA and national standards as established by:

4.2.1. American Academy of Ophthalmology(AAO) Guidelines and Preferred Practice Patterns

4.2.2. VHA Handbook 1121.01 Eye Care

www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2394

4.2.3. VA Standards: VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision)

4.2.4. The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx

4.2.5. The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

4.2.6. The requirements contained in this PWS.

4.3. Resident Supervision and Teaching: Indirect supervision while on-call.

4.3.1. Resident Supervision/Teaching: According to the guidelines dictated by the Residency Review

Committee of ACGME, the contractor’s physician(s) performing the services may provide guidance to residents via telephone. Contract physician (s) may be responsible for indirect (distance) supervision of Ophthalmology Residents that are located at VAMC Des Moines, IA.

4.3.1.1. Academic environment: Not required for this contract.

4.3.1.2. Clinical Direction and Oversight: Contract physician (s) shall provide clinical direction to and oversight of residents consistent with current community standards of care. The contracting physician is responsible for indirect (distance) resident supervision in accordance with the national VHA Handbook 1400.01, Resident Supervision, dated December 19, 2012.

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2847

4.3.2. Attending Physician: Clinics/Ophthalmology procedures may be performed by the resident under the supervision of the contractor’s physician based on the Resident’s level of training and current competency. Patients requiring care beyond the Resident’s level of skill will be referred to the contractor’s physician’s office for patient management.

4.4. MEDICAL RECORDS

4.4.1. Authorities: Contractor’s physician(s)providing healthcare services to VA patients shall be considered as part of the…