36C26323R0027 0001.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

MSO-2023-COM-0024

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Contract Officer 4801 Veterans Drive St. Cloud

MN

56303

To all Offerors/Bidders

36C26323R0027 07-27-2023

X X X ** HOUR & DATE for Receipt of Offers is EXTENDED to:

September 5, 2023 at 10 AM CDT X The purpose of this amendment is to address the following:

1. Vendor questions (see attached questions)

2. The closing date and time have been extended until September 5, 2023, at 10 AM CDT.

3. Attached is the updated wage determination WD 2015-5381 Rev 20 dated 07/25/2023.

4. All other terms and conditions remain the same.

Travis Johnson Contracting Officer Question: Please explain why the CLINs are flat, and the government does not expect a decline in enrollees at the clinic over the next 10 years, corresponding to Census estimates.

Answer: These are estimates.

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

Answer: July 2023: Williston= 958, Dickinson=856 Question: Is the current number of veterans on the Primary Care billable roster an accurate reflection of what the starting billable roster will be under the new contract?

Answer: Yes

Question: Is the incumbent required to move to either of the current facilities?

Answer: No

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

Answer: Yes

Question: On page 189 of the solicitation the government asks for the latest copies of state or local inspection codes for the building. If these are not available, can they be provided prior to clinic opening?

Answer: Yes before opening we would need a certificate of occupancy and a certificate from the Fire Marshall Question: How many VA staffed personnel will be providing services at the each CBOC? Please list by job title and number of days per month.

Answer: Hud Vash, Mental Health(on site daily)

Question: How many offices will be needed at either CBOC for the VA provided staff (by position/function) identified in question 7?

Answer: We believe this is in reference to question 8. 2 offices please refer to Attachment 9 of Space and Equipment Requirements.

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

Answer: Yes they would inherit the last 12 months

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

Answer: Yes, 24 hours

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

Answer: Dickinson= 42, Williston= 44 Question: Transcripts are required to be submitted for NP candidates with the proposal. Can these transcripts be submitted after the award?

Answer: No

Question: Proof of ACLS and BLS are required to be submitted for Physicians with the proposal. Can these be submitted after the award?

Answer: No

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

a. Pneumovax 23

b. Prevnar 13

c. TDAP

d. TD

e. Zostavax

f. Shingrix

g. HPV

h. PPD

i. Twinrix (Hep A&B)

j. Hep A

k. Hep B

l. Depo

m. Influenza

n. MMR

o. Meningococcal Oligo/DIPH Conj Inj

p. Meningococcal/Diphtheria Tox

Answer: All vaccines would need to be provided by the contractor including Covid 19. No data available on vaccines given last year.

Question: Are there any additional Vaccines, other than those listed in question 18 above.

Answer: Possibly, all vaccines are provided by Contractor. Some additions but not inclusive:

· Prevnar 20 (This replaced Prevnar 13)

· Respiratory Syncytial Virus (RSV) Arexvy -Haemophilus influenzae type b (Hib)

4.6.4.1 PRESCRIPTION FULFILLMENT: Remove language: with the exception of vaccines for COVID-19.

Question: Please advise how mental health will be managed in the clinic (is contractor or VA providing, or will it be referred to VAMC)

Answer: VA Providing

Question: Section 2.8 Telehealth Clinical Services Staff

a. Can the Telehealth technician be a certified medical assistant?

Answer: Yes

Question: Section 4.6.5.4.3 Anticoagulation

a. Will the VA provide the A1C equipment?

Answer: Yes

Question: Section 4.9.1 Space requirements

b. There is a requirement for a manager’s office in the space requirements but no mention of a requirement for a manager being required in the staffing requirements, is a manager required, if so, what are the requirements for a manager?

Answer: Yes, a clinic manager is required for each location. List of duties isn’t all inclusive: Manage QASP, Clinic Assess, Staffing, Facility Maintenance Management, Reports, etc.

Question: Section 4.11.3

a. Who is responsible for providing telephones for the clinic? Please confirm if the VA will supply the telephones and will the existing number be rolled over to the new contractor?

Answer: VA will provide phone and VA intends to use existing number if possible

Question: Section 6.1.2 Start Up Requirements

c. 6.1.2 states the contractor must allow for 7 days of training prior to the start of the contract. Scheduling training is typically two weeks long, will the VA provide reimbursement to the contractor if scheduling staff need to be brought in prior to the start date to complete scheduling training?

Answer: No

Question: 4.6.4 PHARMACY SERVICES: 4.6.4.1 PRESCRIPTION FULFILLMENT- The Contractor will provide all medications that are to be administered to patients in the clinic …

a. Question: Please provide a specific list of all medications that the contractor is responsible to provide (not just the list of vaccines)

Answer: Contractor needs to provide any and all medications administered/used in the clinic. Any routine outpatient meds will use our mail order system provided by the VA. Vaccines will all be purchased and administered by contractor including Covid 19. Historical usage is unable to be provided.

Question: 4.6.3.4.7 Contractor shall provide all equipment necessary to provide comprehensive women’s health services.

a. Question: Will the VA supply the pap kits?

Answer: VA will provide Thin Prep, paddle/brush Contractor will provide disposable speculums and any other items needed.

Question: 2.2.1PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by Contractor.

a. Question: is the contractor required to have an on-site medical director at 0.05 FTE. If so, does the physician have to be on-site or can this be a remote physician? Another question: in lieu of a physician director, could a LIP NP be the director instead?

Answer: 1FTE MD must be on site at one of the locations.

Director must be an MD and can be remote.

Question: 2.2.3 Medical Assistant

a. Question: are medical assistants permitted to administer immunizations? If so, which immunizations?

Answer: No

Question: OPTION 4: Health Care Technician (HCT)

a. Question: are HCT permitted to administer immunizations? If so, which immunizations?

Answer: No

Question : Is a full-time Clinic Manager required in each site and if so, do they need to be a Registered Nurse?

Answer: Yes full time clinic manager is needed at each site and they need to be RN.

Question: Does the VA want 1 FTE Physician to cover both Dickinson and Williston CBOCs, or does the VA want 1 FTE Physician in each CBOC?

Answer: A minimum of 1 FTE MD in person is required between the two locations. Other providers can be NP or PA.

Question: Will the VA allow a 1 FTE Nurse Practitioner or Physician Assistant to work independently on-site with an off-site Physician providing oversight? If so, given the rural area, the socioeconomic conditions, the local talent pool, and the labor market, will the VA allow the Medical Director to collaborate with the mid-level provider remotely and see patients remotely via telemedicine?

Answer: If a PA is provided they would fall under the contracted MD supervision. A provider needs to be present on site during normal business hours.

Question: Will all CPS Anti-Coagulation services be provided by VA staff?

Answer: contractor will provider INR testing and VA will provider anticoage adjustments from CPS.

Question: RFP states Providing one small desktop color printer for printing patient education information. Will the Government please confirm that the VA will supply the small desktop color printer for patient education documents?

Answer: OIT will provide the desktop colored printer.

Question: Will the VA provide a list of all medications and vaccines that are to be provided by the Contractor and their historical usage?

Answer: Contractor need to provide any and all medications administered in the clinic. Any routine outpatient meds will use our mail order system provided by the VA. Vaccines will all be purchased and administered by contractor including Covid 19. Historical usage is unable to be provided.

Question: Will the new Contractor inherit the patient's last vesting visit and be allowed to bill for one year from that date upon contract award?

Answer: yes Question: Is the Contractor required to submit a CAD drawing with the proposal or is the CAD (or other acceptable file type) drawing required after contract award? If it is to be submitted with the proposal, what other file types are acceptable? Is PDF acceptable?

Answer: Initial drawing can be done in another program than CAD as long as it can show plan meets space requirements. If contracted a CAD drawing would be required as industry standard.

Question: Will the Government please confirm if CAT 6A cabling is preferred and not CAT 6e?

Answer: 6A is acceptable.

Question: VA IT Closet - Will the Government please confirm the 170 sq. ft. is a typo and should be 100 sq. ft.?

Answer: 170 SF is the new requirement.

Question: RFP states: VA IT Closet Power Requirements - four (4) L6-20 receptacles one (1) L6-30 receptacle. Will the Government please confirm the Power Requirements and if two or four 20-amp dedicated receptacles are acceptable?

Answer: Power to the network racks is 3-phase 208V. No 120V single-phase power distribution is specified. Note that IEC 60320 C13/14 and C19/20 power cords are required for all installed active equipment. For TRs with only one network rack: A/B redundant L21-20 circuits, with A/B redundant Rack PDUs to distribute power in the rack. See OIT Design Guide Templates (2) L6-30 receptacle four (4) L6-20.

Question: Should the proposal be emailed to Sara.hanson@va.gov?

Answer: Yes Question: Does the VA want the Subcontracting Plan to be submitted in Part II - Technical Proposal?

Answer: Yes Question: With the two page limitation, is it acceptable to the VA if we attach all the letters, metrics, customer surveys, independent surveys, etc., and not have it count towards the 2-page limitation?

Answer: Yes Question: Will the VA please provide the historical billed enrollment for the Dickinson and Williston CBOCs for the past five years?

Answer:

Question: Will the Government please confirm if the VA will provide the phone circuit and physical phones?

Answer: OIT will provide phone circuit.

Question: Do the existing Dickinson and Williston CBOC facilities meet the requirements of this solicitation?

Answer: The terms of this solicitation represent the VA’s requirements for CBOC services in this region upon expiration of the existing contracts and is not an indication of the terms of the existing contracts.

Question: If so, how does the VA intend to ensure that evaluations can be done fairly if the incumbent has a competitive advantage?

Answer: All offers will be evaluated in accordance with the terms of the solicitation.

Question: Can the cost of the facilities be provided separately and not be included in the evaluation factors which would create a level playing field for all bidders?

Answer: Per FAR 52.212-1(e) Multiple Offers, offerors may submit alternate price proposals for consideration, which may include alternative line items for buildout of space. The evaluation factors include price, which necessitates evaluation of any alternate price proposals.

Question: The Dickinson, ND and Williston, ND contract clinic sites shall be ONE PROVIDER/TEAMLET PACT spaces, not the ONE PACT MODULE noted in the VA PACT Design Criteria. This equates to less required space and staff at these VA contract clinics. It is expected that the contractor’s layout shall meet VA PACT Design Criteria, but it shall be modified to a ONE PROVIDER/TEAMLET PACT set up. Where do we find the design specifications for the ONE PROVIDER/TEAMLET PACT space?

Answer: Sufficient back up staff would need to be provided for any leave, absences, vacancies. Please see section 4.9 Space requirements: PACT Space Module Design Guide at http://www.cfm.va.gov/til/dGuide/dgPACT.pdf design specifications Section 4.0 page 21.

Question: NOTE: ALL WALLS AROUND THE PERIMETER AND WITHIN THE CLINIC (ALL ROOM WALLS) SHALL BE CONSTRUCTED FROM STRUCTURAL FLOOR SLAB/DECK TO STRUCTURAL DECK ABOVE WITH ALL WALL PERIMETERS AND PENETRATION SEALED. THE WALL CAVITY SHALL BE FILLED FULL HEIGHT, WIDTH AND DEPTH WITH MINERAL WOOL INSULATION. MINIMUM ROOM TO ROOM STC SHALL BE 45. Do the existing Dickinson and Williston CBOC facilities meet this requirement?

Answer: Yes Question: For the Veteran’s Self Service Kiosks and Education areas: Our standard is 1 data/1 phone jacks per computer station. Will the VA please confirm if this is acceptable?

Answer: 3 Data and 1 Voice is the current Fargo VA Standard.

Question: For the Reception desk and Staff work area: Our standard is 1 data/1 phone jacks per computer station. Will the VA please confirm if this is acceptable?

Answer: 3 Data and 1 Voice is the current Fargo VA Standard.

Question: For the Reception desk and Staff work area: Will the VA please confirm if the contractor is supplying the computer system?

Answer: Dual Screen is not a requirement. Fargo OIT will provide all OIT equipment.

Question: For the Reception desk and Staff work area: Our standard is 1 data/1 phone jacks per computer station. Will the VA please confirm if this is acceptable? Our standard has been no phone jack next to each of the following - printer, fax, and copier. Will the VA please confirm if this is acceptable?

Answer: 3 Data and I Voice is the current Fargo VA Standard.

Question: For the PACT Exam Room: Our standard is 1 data jack on two walls in all Exam Rooms with no phones. Will the VA please confirm if this is acceptable?

Answer: 3 Data and I Voice is the current Fargo VA Standard.

Question: For the Telehealth Rooms: Our standard is 1 data/1 phone jacks per computer station. Will the VA please confirm if this is acceptable? Our standard is 2 data jacks for Telehealth equipment. Will the VA please confirm if this is acceptable?

Answer: 3 Data and I Voice is the current Fargo VA Standard.

Question: For the Alcove height/weight station, handicap accessible: Our standard is no data/phone jacks in height/weight station area. Will the VA please confirm if this is acceptable?

Answer: 3 Data and I Voice is the current Fargo VA Standard.

Question: For the Multipurpose Group Conference Room: Our standard is 1 data/1 phone jacks with HDMI Connection per computer station for presentations onto a TV. Will the VA please confirm if this is acceptable?

Answer: 3 Data and I Voice is the current Fargo VA Standard.

Question: For the PACT Team Work Area: Our standard is 1 data/1 phone jacks per computer station. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.. Multi-functional devices won’t be provided by VA and need to be supplied by Contractor.

Question: Is the Contractor responsible for the fax machine?

Answer: Contractor is responsible for the fax machine.

Question: Is the Contractor responsible for the Colored Printer?

Answer: Contractor is responsible for colored printer.

Question: Will the government allow a non PIV card reader badge system?

Answer: No Question: For the Laboratory: Our standard is 1 data/1 phone jacks per computer station. Will the VA please confirm if this is acceptable? Our standard is one or two station plates with 4 data jacks each for lab equipment and printers. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: For the Blood Specimen Collection Area: Our standard is no data or phone jacks behind collection chairs. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: Our standard is 3 data/1 phone jacks per computer station in the Manager’s office. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: For the Homeless Program Social Work Office: Our standard is 1 data/1 phone jacks per computer station. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: For the Mental Health Provider: Our standard is 1 data/1 phone jacks per computer station. Please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: Our standard is 3 data/1 phone jacks in Medication room. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: Our standard is no data/phone jacks in Storage Room, unless used to upload EKG. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: Our standard is no data/phone jacks in Clean Storage Room. Will the VA please confirm if this is acceptable?

Answer: At least one phone/data outlet shall be provided.

Question: Our standard is no data/phone jacks in Soiled Utility Room. Will the VA please confirm if this is acceptable?

Answer: At least one phone/data outlet shall be provided.

Question: For the Staff Break and Locker Room: Our standard is 1 wall jack for phone. Will the VA please confirm if this is acceptable?

Answer: 3 data and 1 voice is the current Fargo VA Standard.

Question: Telehealth staffing ratio is 1/5000. Will the VA require a 1.0 FTE TCT?

Answer: Yes 1.0 FTE and a trained back up Question: RFP states contractor will provide all equipment necessary to perform Pap Smears. If the contractor is unable to purchase Thin Prep, will the VA provide?

Answer: VA will provide Thin Prep and Paddle/brush. Contractor provides Disposable speculums.

Question: Can the government provide a list of medications they expect Contractors to provide along with quantities/ frequency?

Answer: Contractor only needs to provide medications that they need while patient is in clinic. Any routine meds (vet will use at home) will use the Mail order system provided by the VA. No formulary as these are provided by the Contractor.

Question: For submittal, are Offerors required to submit any hard copies or just electronically via email.

Answer: Please submit all documents electronically.

Question: Which vaccines are Contractors responsible for providing?

Answer: All Vaccines including covid 19 Question: Are Contractors responsible for paying for any patients individualized treatment/medication/injectables?

Answer: If the medication is administered in the clinic, the contract CBOC would be responsible to supply. We do NOT mail medications directly to patients that are administered in clinic.

Question: Are Contractors responsible for mental health medication or injectables?

Answer: Yes – if they are administered in clinic, contract CBOC would be responsible for providing.

Question: Are Contractors responsible for administering medication/ paying for medication prescribed by non contracted providers?

Answer: No, these meds would be ordered by the Contract PCP through the VA mail order process, or use the different authorized VA local contract pharmacy programs.

Question: Are Contractors responsible for any procedures?

Answer: Yes Contractor should perform procedures that is common in Primary care. The list you provided below and others should be conducted by the contractor. List below isn’t all inclusive

0. If so, who pays for materials?

Answer: Contractor pays for all clinical supplies.

0. Examples- skin biopsies, joint injections, wound care, battlefield acupuncture, inserting/removing foley catheters, cryotherapy.

Answer: superficial abscesses, tick removal, tapping a joint, Women’s health procedures. Etc.

Question: Are Contractors responsible for having medication on site?

Answer: Contractor only needs to provide medications that they need while patient is in clinic. Any routine meds (vet will use at home) will use the Mail order system provided by the VA. No formulary as these are provided by the Contractor.

Question: Are there any VA training mandates that require any staff to travel to the VAMC ?

Answer: Yes Question: Will the VA continue to provide VA courier services?

Answer: Yes Question: Are Contractors responsible for preparing slides for the VAMC lab?

Answer: Yes. Current process does require peripheral slides to be made. See attachment PC-16.SOP.1106(page 14) included in section D attachments. If technology changes, the process will need to be revaluated.

Question: What lab specimen tubes/containers is contractor responsible for purchasing vs the VA?

Answer:

Question: What specific lab specimen tubes is the contractor required to purchase?

Answer:

See attached document: S02 - Attachmnet 8 - WD 2015-5381 Rev 20 dated July 25 2023.

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