36C26323R0027_1-updated.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

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. UEI: EFT:

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. NOV 2021)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C26323R0027 07-27-2023

Sara Hanson, Contract Specialist 320-654-7607 08-28-2023

10AM CST

36C263 Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Contract Officer 4801 Veterans Drive St. Cloud MN 56303

X

621498

$25.5 Million

N/A

Department of Veterans Affairs Fargo VA Medical Center 2101 Elm St N

Fargo ND 58102

Department of veterans Affairs Network 23 Contracting Office Attn: Sara Hanson 4801 Veterans Drive Saint Cloud MN 56303

Department of Veterans Affairs Financial Service Center PO Box 149971

Austin TX 78714

512-460-5540

See CONTINUATION Page

Community Based Outpatient Clinic (CBOC)services to be located at two sites; within the city limits of Williston, ND and Dickinson, ND to provide Primary Care Services.

See Section B.2 for Schedule of Services page 6

See Section B.3 for Performance Work Statement page 13

See CONTINUATION Page

Paid via separately issued Task Order

X 1

Travis Johnson Contracting Officer

36C26323R0027

Table of Contents

SECTION A

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

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 ............................................................ PERFORMANCE WORK STATEMENT (PWS)

B.4 IT CONTRACT SECURITY

SECTION C - CONTRACT CLAUSES

C.1 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (JAN 2011)

C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (DEC 2022)

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (NOV 2021)

C.4 52.216-18 ORDERING (AUG 2020)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 ADDENDA TO 52.217-8 EVALUATION OF OPTION TO EXTEND UNDER 52.217-

C.9 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) . 139

C.10 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.11 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.12 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.13 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.14 VAAR 852.204-71 INFORMATION AND INFORMATION SYSTEMS SECURITY

(FEB 2023)

C.15 VAAR 852.211-76 LIQUIDATED DAMAGES - REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023)

C.16 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JAN 2023)

C.17 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.18 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.19 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019)

C.20 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.21 VAAR 852.239-70 SECURITY REQUIREMENTS FOR INFORMATION

TECHNOLOGY RESOURCES (FEB 2023)

C.22 VAAR 852.239-73 INFORMATION SYSTEM HOSTING, OPERATION,

MAINTENANCE, OR USE (FEB 2023)

C.23 VAAR 852.239-74 SECURITY CONTROLS COMPLIANCE TESTING (FEB 2023)

C.24 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.25 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) 160

C.26 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.27 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAR 2023)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

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

COMMERCIAL SERVICES (MAR 2023)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.222-5 CONSTRUCTION WAGE RATE REQUIREMENTS—SECONDARY SITE

OF THE WORK (MAY 2014)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)

E.8 VAAR 852.215-72 NOTICE OF INTENT TO RE-SOLICIT (OCT 2019)

E.9 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.10 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.11 VAAR 852.239-71 INFORMATION SYSTEM SECURITY PLAN AND

ACCREDITATION (FEB 2023)

E.12 VAAR 852.239-75 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY NOTICE (FEB 2023)

E.13 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES

INCORPORATED BY REFERENCE (JAN 2008)

E.14 VAAR 852.273-70 LATE OFFERS (NOV 2021)

E.15 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

E.16 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E17. EVALUATION FACTORS:

E.18 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (DEC 2022)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

System for Award Management (SAM):

SAM Registration: Offeror must be registered in the System for Award Management (SAM).

(SAM includes the functionality of the previous Central Contractor Registration (CCR) and Online Representations and Certifications Applications (ORCA)). No contract will be entered into with an unregistered contractor. Internet access allows registration by completing an electronic on-line registration application at https://sam.gov/content/home.

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: (Name & Address)

Name of Company:

Name:

Title:

Address:

E-mail Address:

Phone No:

Toll Free No:

Fax No:

Tax ID No:

CAGE Code:

DUNS Number:

b. GOVERNMENT: Contracting Officer (90C)

Travis Johnson 2501 W 22nd St Sioux Falls, SD 57105

Travis.Johnson2@va.gov 605-333-6822

c. Contractor and Government points of contact can be changed by written notification to the other party. Notification will be placed in the Contract file and will not require a modification to the Contract.

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor should be mailed to the following address:

3. INVOICES: Invoices shall be submitted in arrears: MONTHLY (in arrears)

4. All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. Government Invoice Address:

All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests. Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA) Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current Invoicing information is located at http://www.fsc.va.gov/einvoice. asp.

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

Post Award Orientation: The Contracting Officer will schedule a post award orientation for contract orientation purposes as required by VA Acquisition Manual, Part M842.502-70.

6. Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at http://www.va.gov/oig/contacts/hotline.asp and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions.

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

Amendment Number Date mailto:Travis.Johnson2@va.gov

B.2 SCHEDULE OF SERVICES

In accordance with Title 38 United States Code (USC) 8153 and FAR 15, the Contractor shall provide continuous delivery of Contractor Operation Primary Care Services, including Primary Care inclusive of space for tele-health services in accordance with the terms, conditions, and provisions stated herein, and to furnish services to eligible veteran beneficiaries enrolled with the VA Fargo Health Care System at the prices specified in the PRICE SCHEDULE AND SERVICES. A contract resulting from this solicitation will be awarded for one year, with the Government having the option to extend the contract for nine (9) additional one-year periods.

This solicitation covers the provision of Primary Care services. The clinic is to be located within the city limits of both Williston, ND and Dickinson, ND. The contractor shall establish two locations to provide the required services specified under this contract. Primary care must be provided at the same site as the primary clinic. Veterans to be serviced under this contract reside primarily in Williston, ND contract reside primarily in the North Dakota Counties of:

Williams, McKenzie, Mountrail, Divide, Burke and Dunn and the Montana Counties of Sheridan, Roosevelt and Richland but are not restricted to those counties. Veterans to be serviced under the Dickinson, ND contract reside primarily in the North Dakota Counties of: Golden Valley, Billings, Starck, Hettinger, Slope, Bowman, Adams and the South Dakota counties of Harding, and Perkins but are not restricted to those counties.

Primary Care services will be provided to patients enrolled to the clinics by the Contractor.

Payment for services will be based on a capitated rate per member per month(PMPM).

Estimated enrollment numbers are stated for the purposed of pricing and evaluating proposals.

Contract performance shall be based upon orders issued against this contract. The guaranteed minimum contract amount is $2,000,000.00.

CBOC ORDERING PROCEDURES: This is a Firm Fixed Price (FFP) Indefinite Delivery/Indefinite Quantity (IDIQ) contract (see FAR 52.216-22). The Task Orders shall specify the quantities of services for each period of performance and shall comply with FAR 52.216-18 and 52.216-19. Any services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the Contracting Officer or Administrative Contracting Officer.

Orders may be issued by facsimile or by electronic commerce methods.

Contract Minimum $2,000,000.00 Contract Maximum 46,500,000.00

*Per Member Per Month (PMPM) includes cost of unassigned patient visits, the Contractor shall not bill separately or propose an additional Line Item Number (LIN) or bill separately for these costs. All quantities are estimated, the government will pay for services performed as certified by the Contracting Officer’s Representative (COR).

BASE YEAR – January 1, 2024, through December 31, 2024

Line Item Services

Unit

Estimated Quantity

Price per Unit

Total

Cost per month

Total Estimated Cost per year

0001 Dickinson, ND Primary Care Services at capitation rates per member per month

(PMPM)

PMPM

0002 Williston, ND Primary Services at capitation rates per member per month

(PMPM)

Total for Base Year $________________________

OPTION YEAR 1 – January 1, 2025, through December 31, 2025 per

Cost per month

Total Estimated Cost per year

1001 Dickinson, ND Primary Care Services at capitation rates per

1002 Williston, ND capitation rates per member per month

(PMPM)

Total for Option Year 1 $________________________

OPTION YEAR 2 – January 1, 2026, through December 31, 2026

Cost per month

Total Estimated Cost per year

2001 Dickinson, ND Primary Care Services at capitation rates per

2002 Williston, ND Primary Services at capitation rates per member per month

(PMPM)

Total for Option Year 2 $________________________

OPTION YEAR 3 – January 1, 2027, through December 31, 2027

Cost per month

Total Estimated Cost per year

3001 Dickinson, ND Primary Care Services at capitation rates per

3002 Williston, ND Primary capitation rates per member per month

(PMPM)

Total for Option Year 3 $________________________

OPTION YEAR 4 – January 1, 2028, through December 31, 2028

Cost per month

Total Estimated Cost per year

4001 Dickinson, ND Primary Care Services at capitation rates per

4002 Williston, ND Primary capitation rates per member per month

(PMPM)

Total for Option Year 4 $________________________

OPTION YEAR 5 – January 1, 2029, through December 31, 2029

Cost per month

Total Estimated Cost per year

5001 Dickinson, ND Primary Care Services at capitation rates per

5002 Williston, ND Primary capitation rates per member per month

(PMPM)

Total for Option Year 5 $________________________

OPTION YEAR 6 – January 1, 2030, through December 31, 2030

Cost per month

Total Estimated Cost per year

6001 Dickinson, ND Primary Care Services at capitation rates per

6002 Williston, ND Primary capitation rates per member per month

(PMPM)

Total for Option Year 6 $________________________

OPTION YEAR 7 – January 1, 2031, through December 31, 2031

Line Item Services Total Estimated

Total Estimated Cost per year

Unit Estimated Quantity

Price

Cost per month

7001 Dickinson, ND Primary Care Services at capitation rates per

7002 Williston, ND capitation rates per member per month

(PMPM)

Total for Option Year 7 $________________________

OPTION YEAR 8 – January 1, 2032, through December 31, 2032

Cost per month

Total Estimated Cost per year

8001 Dickinson, ND Primary Care Services at capitation rates per

8002 Williston, ND capitation rates per member per month

(PMPM)

Total for Option Year 8 $________________________

OPTION YEAR 9 – January 1, 2033, through December 31, 2033

Cost per month

Total Estimated Cost per year

9001 Dickinson, ND Primary Care Services at capitation rates per

9002 Williston, ND capitation rates per member per month

(PMPM)

Total for Option Year 9 $________________________

Total Estimated Contract Amount Dickinson CBOC $____________________

Total Estimated Contract Amount Williston CBOC $_____________________

TOTAL FOR BASE AND OPTION YEAR $___________________________

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. SERVICES REQUIRED: The Fargo, ND Veteran Affairs Health Care System (Fargo VAHCS; requires the following services to be provided in a private hospital, office or clinic environment to Veterans, primarily residing in Williston and Dickinson, North Dakota.

1.1.1. Primary Care CBOC: offers both medical and mental health care (physically on site and by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care CBOCs are required to provide both primary care and mental health services. Mental Health services will be provided using Telehealth, VVC, or phone if the workload at the point of service would not otherwise justify the presence of Mental Health Providers. Mental Health Services will be provided by VA staff via virtual modalities.

1.2. PLACE OF PERFORMANCE: Williston, North Dakota, is located 391 miles north and west of Fargo, North Dakota. Dickinson, North Dakota, is located 293 miles west of Fargo, ND. The Contractor shall provide a primary CBOC facility in Dickinson, ND and Williston, ND within the city limit boundary (as established by the local zoning authority) of these towns so that access is available. Veterans to be serviced under the Williston, ND contract reside primarily in the North Dakota Counties of: Williams, McKenzie, Mountrail, Divide, Burke and Dunn and the Montana Counties of Sheridan, Roosevelt and Richland but are not restricted to those counties. Veterans to be serviced under the Dickinson, ND contract reside primarily in the North Dakota Counties of:

Golden Valley, Billings, Starck, Hettinger, Slope, Bowman, Adams and the South Dakota counties of Harding, and Perkins but are not restricted to those counties. The facility shall have easy access to main roads and highways.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 and FAR 15 and FAR 12 to be furnished by the contractor on behalf of Fargo, ND Veteran Affairs Health Care System (Fargo VAHCS) 2101 Elm St N, Fargo, ND 58102.

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index and clinical guidelines.

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

1.5. DEFINITIONS/ACRONYMS:

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

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e. CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

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

1.5.15. BAA: Business Associate Agreement

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

1.5.17. BLS: Basic Life Support

1.5.18. BOS: Bureau of Osteopathic Specialists

1.5.19. CAHEA: Committee on Allied Health Education and Accreditation

1.5.20. CAP: College of American Pathologists

1.5.21. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.22. CBO: VA Central Billing Office.

1.5.23. CDC: Centers for Disease Control and Prevention

1.5.24. CEU: Certified Education Unit

1.5.25. CLIA: Clinical Laboratory Improvement Amendments

1.5.26. CME: Continuing Medical Education

1.5.27. CMS: Center for Medicare and Medicaid Services

1.5.28. CO: Contracting Officer

1.5.29. COPD: chronic obstructive pulmonary disease

1.5.30. COR: Contracting Officer’s Representative

1.5.31. COS: Chief of Staff

1.5.32. CPA: Collaborative Practice Agreement

1.5.33. CPS: Clinical Pharmacy Specialist

1.5.34. CPRS: Computerized Patient Record System

1.5.35. CPT: Current Procedural Terminology

1.5.36. CRNP: Certified Registered Nurse Practitioners

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

1.5.38. CPARS: Contractor Performance Assessment Reporting System

1.5.39. CVT: Clinical Video Telehealth

http://www.cswe.org/

1.5.40. DICOM: Digital Image and Communication in Medicine

1.5.41. DIGMA: Drop in Group Medical Appointment

1.5.42. DRG: Diagnostic Related Group

1.5.43. DSS: Decision Support System

1.5.44. ECC Extended Care Center

1.5.45. Enrollment: The process of establishing eligibility for VA’s “Medical Benefits

Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

1.5.46. EPRP: External Peer Review Program

1.5.47. FDA: Food and Drug Administration

1.5.48. FSMB: Federation of State Medical Boards

1.5.49. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

1.5.50. HHS: Department of Health and Human Services

1.5.51. HCFA: HealthCare Financing Administration

1.5.52. HICPAC: Healthcare Infection Control Practices Advisory Committee- a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

1.5.53. HT: Home Telehealth

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

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

1.5.56. iMED: software used by VA for informed consent

1.5.57. INR: International Normalized Ratio

1.5.58. ISO: Information Security Officer

1.5.59. LIP: licensed independent practitioner

1.5.60. MCCR: Medical Care Cost Recovery

1.5.61. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education when it is associated with benefits to the Veterans;

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST).

Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions;

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psycho-education, family education, skills training, peer support, and Compensated Work Therapy (CWT) and supported employment;

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.62. MQSA: Mammography Quality Standards Act

1.5.63. MSN: Master of Science in Nursing

1.5.64. NCCPA: National Commission on Certification of Physician Assistants

1.5.65. NLN: National League for Nursing

1.5.66. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing

Improvement in Cardiac Surgical Program

1.5.67. OTC: Over the Counter

1.5.68. PA: Physician Assistant

1.5.69. PACS: Picture Archiving and Communications System

1.5.70. PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

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

1.5.72. PCMH: Patient-Centered Medical Home

1.5.73. PCMM: Primary Care Management Module- a software program used to track

Primary Care Clinic Veteran rosters.

1.5.74. PCP: Primary Care Provider

1.5.75. Phar.D.: Doctor of Pharmacy

1.5.76. POC: Point of Care Testing

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

1.5.78. PCMHI: Primary Care-Mental Health Integration

1.5.79. PWS: Performance Work Statement

1.5.80. QAPI: Quality Assessment and Performance Improvement

1.5.81. QASP: Quality Assurance Surveillance Plan

1.5.82. RME: reusable medical equipment

1.5.83. SOP (Clinical): Scope of Practice

1.5.84. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.85. SFT: Store and Forward Telehealth

1.5.86. SMA: Shared Medical Appointments

1.5.87. SPD: Sterile Processing Division

1.5.88. SPE: Senior Procurement Executive

1.5.89. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care, and is only provided through a referral.” These services are generally divided into two sub-categories:

medicine specialties and surgery specialties. The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine;

allergy; cardiology; dermatology; emergency; employee health; endocrinology;

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

nephrology; neurology; outreach; pulmonary or respiratory disease;

rheumatology; amputation follow-up; amputation; anesthesia; cardio-thoracic;

ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN);

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

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

1.5.91. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.92. TJC: The Joint Commission

1.5.93. TIU: Text Integration Utility

1.5.94. TCT: Telehealth Clinical Technicians

1.5.95. VA: Veterans Affairs

1.5.96. VA EHR: VA electronic health record

1.5.97. VAMC: Veterans Affairs Medical Center

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

1.5.99. VHA: Veterans Health Administration

1.5.100. VVC: VA Video Connect

1.5.101. WHEN: Weekend- Holiday- Every Night

2. STAFFING AND QUALIFICATIONS

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

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff). The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be in ratios to Primary Care Providers of at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the Contractor shall communicate to the VA the Contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. Total Estimated Patients enrolled/assigned to site: Williston 1100 and Dickinson 1000.

PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by Contractor.

Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contactor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. May also be credentialed and privileged as a PCP. (If so, authorization for prescriptive authority is required).

Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e.

CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G2 located at: https://www.va.gov/vapubs/index.cfm. Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

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

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

Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Contractor shall propose quantity of FTE to meet Standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. Contractor is required to provide at least 1 FTE Physician.

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 Handbook 5005, Appendix G2 located at: https://www.va.gov/vapubs/index.cfm. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face, telehealth, and telephone care visits during regular clinic hours, and collaborating with PACT staff to develop personal health https://www.va.gov/vapubs/index.cfm plans that incorporate care management and care coordination appropriate to the patient’s needs.

OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications:

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

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

OPTION 3: Physician Assistant (PA):Qualifications: PA’s (including subcontractors) must meet one of the three following educational criteria: a) A bachelor’s degree from a PA training program which is certified by the CAHEA;

or b) Graduation from a PA training program of at least twelve (12) months duration, which is certified by the CAHEA and a bachelor’s degree in a health care occupation or health related science; or c) graduation from a PA training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician. The duration of approved academic training and health care experience must total at least five (5) years.

Authorization for prescriptive authority is required. PA shall have current, full, active, and unrestricted license and registration in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per

VA HANDBOOK 5005 APPENDIX G8 PHYSICIAN ASSISTANT

QUALIFICATION STANDARD located at: https://www.va.gov/vapubs/index.cfm.

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

2.2.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or The commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G6 located at:

https://www.va.gov/vapubs/index.cfm. Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients.

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

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

2.2.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP.

Contractor to propose the mix of Clinical Associates from the options below.

OPTION 1: Licensed Practical Nurse (LPN): Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005

APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE

QUALIFICATION STANDARD located at: https://www.va.gov/vapubs/index.cfm.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment.

Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. This staff member will receive training as back-up for telehealth services.

OPTION 2: Licensed Vocational Nurse (LVN):Qualifications: Current, full, active, and unrestricted license in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA HANDBOOK 5005

APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE

QUALIFICATION STANDARD located at: https://www.va.gov/vapubs/index.cfm.

Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment.

Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. This staff member will receive training as back-up for telehealth services.

OPTION 3: Medical Assistant (MA):Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination.Position Responsibilities:

Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the aability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas.

OPTION 4: Health Care Technician (HCT) (as part of PACT teamlet, not primary telehealth technician) : Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting

Bureau of Health Education Schools (ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant (CMA) or Registered Medical Assistant (RMA) from The American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Other credentials such as completion of a medical services training program of the Armed Forces of the United States may be accepted based on Chief of Staff determination. Position Responsibilities:

Responsible for the provision of covered services to enrolled and…