36C79118R0022-0002000.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

BY

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) 11-09-2018 Department of Veterans Affairs Commodities & Services Acquisition Svc (003B6E) 555 Corporate Circle Golden

CO

80401-5621

To all Offerors/Bidders

36C79118R0022 11-09-2018

X x x 5:00 pm MST 11/26/2018 x The purpose of this amendment is to extend the proposal due date to November 26, 2018 at 5:00 p.m. MST.

Additionally, a set of answers to questions received from potential offerors is provided.

At least one additional amendment is forthcoming to answer the remaining questions.

Contract Specialist/Contracting Officer: Alyssa.Urquhart@va.gov Contracting Officer: David.Little@va.gov

Some of the answers to the questions received regarding this solicitation are provided below. Another amendment will be forthcoming with answers to the additional questions. The answers to the questions below do not modify the text in the solicitation. Therefore an updated solicitation is not required at this time.

1. (Section B.2.2) "VA reserves the right to deviate from the CMS Medicare Program when there is a conflict in policies. Non-ESRD services will not be reimbursed under this contract and must be authorized/coordinated with the VAMC (i.e. vaccines, medications, etc. that are provided during the dialysis session for non-ESRD diagnoses). " -Will Acute Kidney Injury (AKI) Diagnosis Dialysis Treatments be covered or only if ESRD Related? Currently, AKI is covered by Medicare.

Answer: This contract does not cover Acute Kidney Injury (AKI).

2. (Section B.5.4.E.3) "A transient authorization is effective for 60-calendar days or less to cover a patient’s travel beyond the normal support of the regular community dialysis unit. " This seems to say that transient auths are effective for 60 days but we hear that if a patient stays longer or has different days than specifically on the transient auth, we end up with a gap that does not allow us to get paid.

Answer: In the event a Veteran is in transient status for more than 60 days, please reference language included at B.5.4.E.3 "Travel extending beyond 60 calendar days will require a new authorization from the home VAMC’s Ordering Officer."

3. (Section B.5.4.E.3. Note) "Note: The VA may modify authorizations to include the allowance to extend previously expired authorizations or to modify an authorization in the event services were provided without a current authorization. The contractor is still responsible for communicating with the VA regarding missing/expired authorizations." This seems to indicate some flexibility but it seems to be more VAMC dependent. How can we achieve more standardization?

Answer: The VA reserves the right to review all authorizations on a case by case basis and render final determination on when to modify an authorization.

4. (Section B.5.E) – NOTE: Can we modify this note language from “may modify” to “will modify authorizations to include the allowance to extend previously expired…” Answer: This language is not being modified at this time.

5. (Section B.5.7) CHANGE IN OWNERSHIP (CHOW)

In the event a Change in Ownership (CHOW) affects a facility under contract, the contractor shall notify the CO, COR and applicable VAMC at least 30 calendar days prior to the expected effective date.

If the Change of Ownership will result in the facility (facilities) not being Medicare certified as of the date of the sale, the VA may require Veterans to be moved to a contractually compliant facility.

What if the clinic is Medicare certified upon Ownership change, will the current authorization transfer to the new clinic or does a new authorization need to be obtained?

Answer: No, the authorization will not transfer, and a new or amended authorization will be required.

6. (Section B.5.7) "The contractor shall provide:

“• Date facility (facilities) will no longer be available" - Facilities will always remain certified. Can we gain agreement from VA to acknowledge acquired facilities as in-network versus make Veterans change facilities and care teams Answer: If the facility is removed from a NDSC contract, then the Veteran may need to be reassigned to another NDSC contracted provider/facility. VHA retains responsibility to authorize services as best meets Veterans medical needs.

7. (Section B.5.8.B) - Can we move written requirement for a Veteran safety event from 24 hours to 10 days?

Answer: There will be no changes made at this time for the Veteran Safety Event requirement.

8. (Section 5.9.B) "Prescriptions: All routine medications not stipulated to be provided by the contractor in the bundled payment for dialysis treatment will be filled by the local VA Pharmacy unless alternative guidance is provided to the Veteran by VA. Routine medications prescribed will follow the VA formulary referenced at: http://www.pbm.va.gov/PBM/NationalFormulary.asp Questions regarding non-formulary medications may be referred to designated VA personnel for assistance with approval, authorization, or appropriate substitution." - Does Sensipar apply here?

Answer: No. Sensipar is a medication that is now included in the Medicare Bundle for End Stage Renal Disease (ESRD). Sensipar will not be filled by VA nor be paid for separately from the bundle.

9. (Section B.10.D) "Appropriate Billing Requirements: The contractor shall bill the VA utilizing the current CMS Medicare Program guidelines for separate line item billing as contained in Chapters 8 and 25 of the Medicare Claims Processing Manual. The contractor will be reimbursed according to current CMS Medicare Program billing guidelines at the applicable percentages found in B.2, Schedule of Services."

Will the VA still follow CMS regulations on QIP, Low Volume, On Set and Training Add On? What about TDAPA? Will they pay separately, Sensipar for example?

Answer: Please see Section B.2.2 “Schedule of Services”: The CMS Medicare End Stage Renal Disease (ESRD) PPS is the basis from which all claims will be submitted and paid.

10. (Section B.10.H) Billing the Veteran: Under no circumstances shall the contractor ever seek any monetary recompense from a Veteran for services provided under this contract. Please clarify. If the Veteran needs to go to the VA in order to get an authorization issued and never does – are they truly considered a VA patient?

Answer: Reference Section B.2.4.A: Contractors shall not perform any services under this contract without prior authorization.

11. (Section B.11) "The contractor shall provide requisite security information when they sign up for access to the VA web Provider Portal, which allows the contractor to view authorizations and EOB. Contractors should contact the FSC Help Desk for registration information." A new clinic EOB cannot be pulled in the Portal. Need the EOB information to sign up to pull EOB’s in the Portal. How will we request the initial EOB?

Answer: Contactors may contact the Enterprise Help Desk at VA Financial Services Center (FSC) Customer Service Help Desk at 877-353-9791 or vafsccshd@mail.va.gov for assistance.

12. (Section B.4.3.13) "The Contractor/ subcontractor shall notify within one business day notify the COR and simultaneously, the designated ISO and Privacy Officer for the contract in writing of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the Contractor/ subcontractor has access." - Can we extend to 5 business days?

Answer: No. The reporting period is not being changed.

13. (Section C.1.d) "Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, "This refers to another clause regarding disputes which I do not find in the document. The dispute process probably needs to be more formal. Please advise.

Answer: There are many clauses that are incorporated by reference in this solicitation, refer to section C.9 for more information on clauses incorporated by reference. This quote is directly from clause 52.212-4 Contract Terms and Conditions- Commercial Items. Please pull the language directly from FAR 52.233-1 and you will see the formal disputes process outlined.

14. (Section C.11) – N/A to service provider as business subcontracting does not occur under this contract. Can this be removed along with the Small Business Subcontracting attachment?

Answer: Small Business Subcontracting Plans are required for large businesses. Subcontracting Plans are required in solicitations expecting to exceed $700,000. If large business offeror does not submit a subcontracting plan in Volume 3, they must explain why no small business subcontracting opportunities exist. Reviews of the Small Business Subcontracting Plan will be reviewed by many participants to include a member of the Small Business Administration (SBA).

15. (Attachment 1 – QASP Table A #4) Typically, the patient satisfaction measures are reported through ICH CAHPS performance at the facility level, versus patient satisfaction being reported only as complaints received. We presently report ICH CAHPS patient experience performance to other payers. Would this be an acceptable reporting standard?

Answer: No. See QASP Table A #4: "All complaints must be sent to the CO and CORs within 5 business days via email with read receipt".

16. I noticed there was a question regarding JV and subcontractors in attachment #6 – is there a broader consideration that includes disclosure if which clinics are JVs?

Answer: No. At this time the only question/consideration of Joint Ventures (JVs) is in Attachment 6 – Past Performance Questionnaire.

17. (Attachment 6)– Past Performance Questionnaire- Wouldn’t this only apply to new Offerors with which VA has no previous business experience? Do we need to provide references in connection with this questionnaire? If inapplicable, can we delete this questionnaire?

Answer: The VA Recognizes that an offeror may have past experience with the VA. However, an offeror may want to highlight other past performance experience that does not pertain to the prior Nationwide Dialysis Services Contract (NDSC) with the VA. Attachment 6, Past Performance Questionnaire is not intended to be part of the proposal submission back to the VA from the offeror. Within E.2 SUBMISSION AND CONTACT INFORMATION, the solicitation states, “If the offeror does not have any recent or relevant past performance, they may submit a signed statement explaining why they do not have any recent and/or relevant experience to with their proposal.”

18. Attachment #7 for “Non-VA Care Programs” - what does that mean? Is this related to VA patients treating in locations not included under the proposal? (Would an example be a VA patient at a SNF o Long term Care facility where we are providing Home or Acute services?)

Answer: Non-VA Care means all authorized care outside VA Medical Centers.

19. Attachment # 8 makes a distinction between the modalities and then lists “Home Training”. If a patient is on any home modality – it is presumed that there will be a training as part of that choice. I am not sure what is being captured (or the intent in that question). Wouldn’t we be repeating the numbers of the same home population?

Answer: CLIN 0004 is for “Training for Home-Based Modalities”. Therefore, in accordance with Medicare Payment Methodology, a separate CLIN for “Training for Home-Based Modalities” is included to ensure payment to the contractor.

20. May an extension be provided beyond November 8th to allow more time to develop the response?

Answer: Yes, the solicitation due date is now November 26, 2018, 5:00 p.m. MST.

21. According to the submission requirements for hard copy and CD, may the Offeror submit the proposal via electronic email using the required Excel and Adobe PDF files instead of and/or in addition to mailing via US Mail hard copies and a CD?

Answer: Solicitation Section E.2 states, “Submission and Contact Information”, “The only authorized means of proposal submission is one (1) hard copy and (1) compact disc (CD)”, emphasis added to “and”. Submission of the proposal via email is not acceptable.

22. COMPANY NAME REDACTED intends to submit a proposal on behalf of all its current contracted facilities, which are representative of multiple DUNS numbers. Will each respective DUNS number require its own Excel pricing proposal sheet?

Answer: Since contracts are awarded based on DUNS (Data Universal Numbering System), an offeror must submit a proposal with separate pricing for each DUNS.

23. In Attachment 2 – Facility List – FY19, Columns K & M: Please explain the type of contact you are looking for in each facility. Is the contact a financial contact, contact for referrals, clinical contact or overall program contact?

Answer: Column K “Point of Contact (Business Hours)” and Column M “Point of Contact (After Hours) is an individual(s) that the VAMC can contact to discuss all aspects of veteran patient care, unusual circumstances, and authorizations.

24. Our organization is looking to respond to the RFP as a new entrant to the network. Is there an opportunity to provide a narrative about our organization and our proposal, and if so, where would this be placed in our response?

Answer: Thank you for your interest in the solicitation. The best place to include a short narrative about your organization and proposal would be in “Volume 1 – Executive Summary”.

25. The directions asked that we include a CD of the files; however, we do not have the hardware to move our files to a CD. Would a USB stick be acceptable?

Answer: Unfortunately, the VA is unable to accept USB sticks due to potential security threats of this hardware.

26. In section E.2 Submission and Contact information, notes that the only authorized means to submit our response is by hard copy and CD. We do not have the capability to burn the documents on to a CD. Would a USB drive be acceptable?

Answer: Unfortunately, the VA is unable to accept USB drives due to potential security threats of this hardware.

27. Does the VA require a specific small business (or other business) subcontracting goal, given it is unlikely that services specific to this contract are not anticipated to be subcontracted?

Answer: Small Business Subcontracting Plans are required for large businesses. Subcontracting Plans are required in solicitations expecting to exceed $700,000. If large business offeror does not submit a subcontracting plan in Volume 3, they must explain why no small business subcontracting opportunities exist. Reviews of the Small Business Subcontracting Plan will be reviewed by many participants to include a member of the Small Business Administration (SBA).

28. Will you be issuing an updated SF 1449 with the new offer due date?

Answer: No, a new 1449 will not be issued updating the new offer due date. Instead amendments including the new offer due date (if any) will be tracked and updated on an SF 30 and annotated in Block 11 and/or 14.

29. [No section reference]

a. What is the VA’s timeline to answer submitted questions?

Answer: The VA is working through questions received and is trying to publish answers as amendments to the solicitation on FBO.gov as quickly as possible. In addition to the amendment being published today, the VA plans to publish at least one additional amendment with the remainder of the questions next week.

30. Section B.2.2

a. Provides that “VA reserves the right to deviate from the CMS Medicare Program when there is a conflict in policies” in relation to payment rates for dialysis services. What are the specific deviations in Medicare pricing methodology that are potentially impacted by a “conflict in policies” as this would potentially materially affect a bid submission?

Answer: The VA reserves the right to deviate from the CMS Medicare Program when there is a conflict in policies in relation to payment rates for dialysis services.

31. B.5.10.E

a. Does this 90 calendar day window also apply to rejected claims and resubmissions?

b. Is a resubmission considered a corrected claim (i.e., bill type 727)?

Answer:

a. Yes, a resubmission is considered a corrected claim.

b. The contractor has 90 days to resubmit a rejected claim. This language has been updated in the solicitation.

32. Section 8 Customer Service and Veteran Safety

a. What does the VA define as “sentinel”? Is this the same definition and requirement as either CMS or Joint Commission?

Answer: Yes, the same definition as CMS.

33. The VA received questions relating to specific contract administration and business-to-business arrangements with contractors and related facilities. These questions will not be addressed relating to the new RFP at this time, but may be addressed directly with future contractors during contract administration.

No answer provided for this question, as it is a statement.