ATTACHMENT D.1 - HEMATOLOGY ONCOLOGY PERFORMANCE WORK STATEMENT.docx

36C24923R0100-Onsite Board Certified/Eligible Hematology Oncology Physician – Robley Rex VA Medical Center Performance Work Statement Onsite & On-call Hematology/Oncology Services

1. GENERAL:

1.1. Services Provided: The Contractor shall provide Board Certified /Board Eligible Hematology/Oncology Physician Services on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Robley Rex VA Medical Center in Louisville, Kentucky. The Contractor’s qualified Hematology and Oncology physician(s) shall provide 24/7 call coverage; inpatient coverage (approximately 20 inpatients per month), and outpatient services, with a minimum of (3) 6-hour clinic session days per week and a maximum of (4) 6-hour clinic sessions per week as need is identified by VA; each clinic with a minimum of (25) patient slots; focusing on breast, lung and GI. Clinic session days will be negotiated and mutually agreed upon between Contractor and Medical Center, to provide coverage for other Hematology/Oncology outpatient clinics during times of staffing shortages or absences and emergencies as needed. Services will be rendered at the Robley Rex Veterans Affairs Medical Center (VAMC), 800 Zorn Avenue, Louisville, KY 40206. Contract physicians shall meet or exceed currently recognized national standards as established by The Joint Commission (TJC), and the standards of the American Hospital Association (AHA). In addition, physicians shall comply with all Veterans Health Administration’s (VHA) regulations and directives. The Contractor shall provide sufficient personnel who meet all requirements herein and who can be relied on to perform in strict accordance with the contract. The Contractor shall provide physicians who are competent, qualified, and adequately trained to perform assigned duties.

1.1.1. The Contractor will provide 24/7 call coverage; and provide the on-call information, including contact numbers, to the VA’s Medical Service Office no later than (3) working days prior to the end of each month. This information will be published on the VA’s monthly call schedule.

1.1.2. The Contractor shall be available to provide inpatient consultation services for the diagnosis and treatment of Hematology and Oncology diseases. For inpatient services, the contractor will be available seven (7) days per week, 24 hours a day.

1.1.3. The Contractor shall be available to provide outpatient consultation services for the diagnosis and treatment of Hematologic and Oncology diseases. Outpatient services should be offered as needed to meet demand, with a minimum of (3) 6-hour clinic sessions day per week and a maximum of (4) 6-hour clinic sessions per week as need is identified by VA; each clinic with a minimum of (25) patient slots. It is expected that a provider will be designated for each clinic for the life of the contract to provide continuity of care, when possible, unless circumstances beyond their control necessitate a change. The goal is for all new appointments for outpatient services to be scheduled and seen within 28 days or sooner if clinically indicated. Follow-up clinic appointments are to be seen per established guidelines.

1.1.4. Committee/conference attendance is required in this contract, totaling 132 hours each year, to include the committees/conferences list with this contract.

1.1.5. The Contractor will provide both inpatient and outpatient consultation services for the diagnosis and treatment of Hematology and Oncology diseases. Contractor staff will work with VA leadership in an advisory manner on tumor board and their composition in order to improve care for our veterans.

The following table below identifying the current demand for each diagnosis type:

1.2. Place of Performance: Contractor shall furnish services at the Robley Rex Department of Veterans Affairs (VA) Medical Center (VAMC) (also known as the Louisville VAMC) located at 800 Zorn Avenue, Louisville, KY 40206.

1.3. Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority. In combination with FAR Part 13 Simplified Acquisition Procedures

1.4. Policy/Handbooks: The contractor shall be subject to the following policies, including any subsequent updates during the period of performance.

1.4.1. VA Directive 1663: Health Care Resources Contracting – Buying: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.2. VHA Handbook 1100.17: National Practitioner Data Bank Reports: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.3. VHA Handbook 1100.18: Reporting And Responding To State Licensing Boards:

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9174

1.4.4. VHA Handbook 1100.19: Credentialing and Privileging: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.5. VHA Directive 1003.04: VHA Patient Advocacy: https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

1.4.6. VHA Directive 1088: Communicating Test Results to Providers and Patients: https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.7. VHA Directive 1192.01: Seasonal Influenza Prevention Program: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8948

1.4.8. VHA Directive 1400.01: Supervision of Physician, Dental, Optometry, Chiropractic, and Podiatry Residents: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8579

1.4.9. VHA Directive 1907.01: VHA Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235

1.4.10. VHA Directive 1100.20 Credentialing of Health Care Providers: https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=9444

1.4.11. Privacy Act of 1974 (5 U.S.C. 552a) as amended: http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

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

1.5.1. ACOS/E: Associate Chief of Staff/Education; pertaining to the education department of medical residents, fellows and students.

1.5.2. ASCO: American Society of Clinical Oncology ASCO Hub – American Society of Clinical Oncology

1.5.3. ASH: American Society of Hematology American Society of Hematology - Hematology.org

1.5.4. ACGME: Accreditation Council for Graduate Medical Education

1.5.5. ACLS: Advanced Cardiac Life Support

1.5.6. AOD: Admitting Officer of the Day

1.5.7. BLS: Basic Life Support

1.5.8. CDC: Centers for Disease Control and Prevention

1.5.9. CDR: Contract Discrepancy Report

1.5.10. CEU: Certified Education Unit

1.5.11. CME: Continuing Medical Education

1.5.12. CMS: Centers for Medicare and Medicaid Services

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

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

1.5.15. COS: Chief of Staff

1.5.16. COVID-19: Coronavirus Disease 2019

1.5.17. CPARS: Contractor Performance Assessment Reporting System

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

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

1.5.20. DEA: Drug Enforcement Agency

1.5.21. ED: Emergency Department

1.5.22. EHR: Electronic Health Record - electronic health record system used by the VA

1.5.23. FSMB: Federation of State Medical Boards

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

1.5.25. HHS: Department of Health and Human Services

1.5.26. HIPAA: Health Insurance Portability and Accountability Act

1.5.27. HR: Human Resources

1.5.28. ISO: Information Security Officer

1.5.29. Medical Emergency: a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.5.30. MOD: Medical Officer of the Day

1.5.31. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

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

1.5.33. NPPES: National Plan and Provider Enumeration System

1.5.34. POP: Period of Performance

1.5.35. PPD: Purified Protein Derivative

1.5.36. PWS: Performance Work Statement

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

1.5.38. QA/QI: Quality Assurance/Quality Improvement

1.5.39. QM/PI: Quality Management/Performance Improvement

1.5.40. QASP: Quality Assurance Surveillance Plan

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

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

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

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

1.5.45. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean the Robley Rex (Louisville, KY) Medical Center.

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. License: The Contractor’s physician(s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia) when services are performed onsite on VA property.

All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2. Board Certification: All contract Hematology provider (s)shall be Board Certified /Board Eligible by the American Board of Internal Medicine (ABIM) in Hematology American Society of Hematology-Hematology.org and be currently certified in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) or equivalency. All contract Oncology provider(s) shall be Board Certified /Board Eligible by the American Board of Internal Medicine (ABIM) in Oncology ASCO Hub – American Society of Clinical Oncology , and be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) or equivalency. All continuing education courses required for maintaining certification must always be kept up to date. Documentation verifying current certification shall be provided by the Contractor to the VA COR on an annual basis for each year of contract performance.

2.1.3. Credentialing and Privileging: Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 and VHA Directive 1100.20 referenced above. The Contractor is responsible to ensure that proposed provider (s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any contract provider (s)prior to obtaining approval by the Robley Rex VAMC Professional Standards Board, Medical Executive Board and Medical Center Director.

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

2.1.3.2. The Robley Rex VAMC prohibits a provider being credentialed as a part-time/full-time staff physician here at the facility, as well as a contractor on this contract if the same functions performed on this contract coincide with the functions of their staff appointment.

2.1.4. Technical Proficiency: Contractor’s physician(s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor’s physicians shall have knowledge of professional care theories, principles, practices, and procedures to perform assignments of Oncology patient/critically ill patient population. Contractor’s physician shall demonstrate knowledge of growth and development, and pathophysiology of disease processes specific to the critical care/Oncology population Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for Contractor’s physician(s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

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

2.1.6. Training (ACLS, BLS, EHR and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor’s physician(s) as required by the VA. Other training may become required. VA will communicate any changes to the training requirement to the contractor.

2.1.7. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for physicians within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year.

2.1.7.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all contract physician(s). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually.

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

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

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

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

2.1.7.6. COVID-19: Contractors shall comply with VHA Supplemental Contract Requirements for Combatting COVID-19 {This is applicable to all health care workers}. – See Section D attachment.

2.1.7.7. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all contract physician(s); provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.1.7.8. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel (as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.1.8. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal.

2.1.9. DEA: Contractor shall provide copy of current DEA certificate.

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

2.1.11. Citizenship related Requirements:

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

2.1.11.2. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.1.11.3. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

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

2.1.11.5. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.1.12. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

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

2.1.12.2. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.2. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19 and VHA Directive 1100.20. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract.

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

2.4. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.

2.5. Prohibition against Self-Referral: Contractor’s physicians are prohibited from referring VA patients to contractor’s or their own practice(s).

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

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

2.7.1. Workers’ compensation

2.7.2. Professional liability insurance

2.7.3. Health examinations

2.7.4. Income tax withholding, and

2.7.5. Social security payments.

2.8. Tort Liability: The Federal Tort Claims Act does not cover Contractor or contract provider(s). When a Contractor or contract provider (s)has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract physician(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.9. Key Personnel:

2.9.1. The VA Full Time Equivalency (FTE) for the services required is 4. FTE is defined by VA as a minimum of 80 hours every two weeks and does not include holidays.

2.9.2. The minimum number of Board Certified /Board Eligible Hematology/Oncology providers required to be on site daily is (1) provider, but only when called or scheduled, as time as defined in paragraph Hours of Operation in this section.

2.9.3. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor’s personnel due to sick leave, personal leave, vacations, and additional coverage as required. In the event a scheduled physician is unable to complete an assigned shift, the contractor shall provide the VA with a 90-day notice to provide replacement physician coverage and notify the Contracting Office Representative (COR) at the Robley Rex VAMC immediately of the schedule change.

2.9.4. Personnel Substitutions: During the entirety of performance, the Contractor shall make NO unplanned substitutions of key personnel as credentialing/privileging is required. If a substitution is necessitated by illness, death or termination of employment, temporary emergency privileges may be granted on a case-by-case basis, with approval of the Medical Center Director. If an emergency substitution is necessary the Contractor shall notify the CO, in writing, before the occurrence of any of these events and provide the information required below. For planned substitutions, the Contractor shall submit the information required below to the CO at least 180 calendar days prior to making any permanent substitutions.

2.9.4.1. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor once the background investigation and privileging processes have been completed. The contract will be modified to reflect any approved changes of key personnel.

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

2.9.4.3. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor’s physician(s), s/he may request, without cause, immediate replacement of said Contractor’s physician(s). The CO and COR shall deal with issues raised concerning Contractor’s physician(s) conduct. The final arbiter on questions of acceptability is the CO.

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

3. VA HOURS OF OPERATION/SCHEDULING:

3.1. VA Business Hours: 8:00 am to 4:30 pm

3.2. Clinic Schedule: A minimum of (3) 6-hour clinic sessions day per week and a maximum of (4) 6-hour clinic sessions per week, between the hours of Monday-Friday, 8:00 am to 4:00 pm

3.3. Contractor’s physician(s) shall be available and present in clinic during normal Robley Rex VAMC clinic hours, which will be established, and may be revised, as deemed appropriate for patient care by the Chief of Medicine Service.

3.4. The Contractor shall provide qualified Hematology/Oncology physicians to provide inpatient (approximately 20 inpatients per month), and outpatient services, with a minimum of (3) 6-hour clinic session days per week and a maximum of (4) 6-hour clinic sessions per week as need is identified by VA; each clinic with a minimum of (25) patient slots; focusing on breast, lung and GI. Patients must be seen by a Contractor’s physician(s) on-site at the Robley Rex VAMC in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure.

3.4.1. Inpatient: Inpatient Consults will be the responsibility of the contractor and services are expected to be provided within 24 hours of the initiation of the consult or sooner if the condition warrants. The requesting provider is responsible for contacting the Contractor about the need for inpatient services. The contractor will provide on-call coverage 24 hours a day, including holidays. Coverage will include inpatient follow-up visits for any unstable inpatient, and for consultation with the Robley Rex VAMC’s medical staff regarding the appropriate medical care of veterans presenting with Hematology and/or Oncology diseases. Response to initial call is expected within 30 minutes. For all inpatient consultations an on-site visit is required. Documentation and coding will be in accordance with documentation guidelines published by the Centers for Medicare and Medicaid Services (CMS), and all applicable coding standards. The consultation will be completed using an inpatient consult note in CPRS that directly links the response to the original consult, and the completion of an event capture card; hand delivered to the Medicine Administration office. Contracting staff will work with the Robley Rex VAMC staff, to coordinate care from the inpatient setting to the outpatient setting. The contracting staff will alert the Hematology/Oncology nurse navigators, via in-person or CPRS, of all inpatient consult/follow-up plans.

3.4.2. Outpatient: Outpatient services will be rendered/scheduled as needed and determined by the VA Medical Center, with a minimum of (3) 6-hour clinic sessions day per week and a maximum of (4) 6-hour clinic sessions per week as need is identified by VA; each clinic with a minimum of (25) patient slots, focusing on breast, lung and GI. Clinic session days will be negotiated and mutually agreed upon between Contractor and Medical Center, to provide coverage for other Hematology/Oncology outpatient clinics during times of staffing shortages or absences and emergencies as needed.

3.4.2.1. Outpatient consults will be received and reviewed by the Robley Rex VAMC Hematology/Oncology staff within (2) working days of the consult file date. The goal is for all new and follow-up appointments, for outpatient services to be scheduled and seen within 28 days or sooner (of Patient’s Preferred Date), if clinically indicated. Documentation will be in accordance with documentation guidelines published by the Centers for Medicare and Medicaid Services (CMS), and all applicable coding standards. Outpatient consults will be completed using a consult note in CPRS that directly links the response to the original consult and completing the associated encounter form within 24 hours of patient visit. Follow-up visits will be completed using a follow-up note and completing the associated encounter form within 24 hours of patient visit.

3.4.2.2. It is required by the Medical Center policy, that cancellation of clinics must be made with 90-day notice, and submitted to the VA’s Medical Service Administrative Office, at the Robley Rex VAMC. Cancellation of clinics with less than a 90-day notice shall occur only due to weather, acts of war, or national disasters that are out of control of the VHA or the contract physician. All clinic reduction and cancellation requests shall be in compliance with Medical Center Policy.

3.4.3. Off-hours Coverage: Contractor must make the Contractor’s physician(s) available on-call during all hours when the Robley Rex VAMC clinic is closed, including evenings, weekends, and holidays. Holidays are defined as the period from 8:00 am to 4:30 pm on the Holiday. Weekends are defined as being from 8:00 am on Saturday until 8:00 am on the following Monday. Evenings are defined as being Monday through Friday from 4:30 pm until 8:00 am the next morning.

3.4.3.1. On-call Contractor’s physician(s) must always be available for phone consultations with VA residents and physicians.

3.4.3.2. On-call providers must be available within 30 minutes by phone and on-site within 60 minutes.

3.4.3.3. The Contractor will provide an on-call consultative coverage schedule during the day, evenings, weekends, and Federal holidays. The Contractor will provide on-call information, including contact numbers, to the VA’s Medical Service Office via email no later than three (3) working days prior to the end of each month. This information will be published on the VA’s monthly call schedule. Any non- emergent change in the on-call schedule must be communicated during normal administrative hours to the Louisville VAMC Medicine Service office in advance. The physician on call be available by phone/pager during this time. He/she is required to respond telephonically within 30 minutes of receiving a call and must be prepared to provide on-site consultation and/or assistance at the VAMC.

3.5. Committee/Conference Attendance: Committee/conference attendance is required in this contract, totaling 132 hours each year, to include the committees/conferences listed below. Committee assignments of the Hematology/Oncology contractor sub-specialists shall be made in a collaborative manner. However, once assigned, attendance is mandatory as it helps provide expert consultation on policies and procedures that help our veterans.

3.5.1. When attending a meeting, the contractor provider will document their presence, entering start/end times of their clinic time, on the designated “attendance log.”

3.5.2. Meeting include:

* In absence of staff provider, contractor must attend committee as a back-up, when notified in advance. Contractor will receive a minimum of a 2-week notice.

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

· New Year’s Day

· President’s Day

· Martin Luther King’s Birthday

· Memorial Day

· Juneteenth

· Independence Day

· Labor Day

· Columbus Day

· Veterans Day

· Thanksgiving

· Christmas

· Any day specifically declared to be a national holiday.

3.7. Cancellations: Unless a state of emergency has been declared, the Contractor shall be responsible for providing services or a cancellation of clinics must be submitted/made with 90-day notice, and submitted to the VA’s Medical Service Administrative Office, at the Robley Rex VAMC. Cancellation of clinics with less than a 90-day notice shall occur only due to weather, acts of war, or national disasters that are out of control of the VHA or the contract physician. All clinic reduction and cancellation requests shall be in compliance with Medical Center Policy.

4. CONTRACTOR RESPONSIBILITIES

4.1. Clinical Personnel Required: The Contractor shall provide contractor’s physician(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

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

4.2.1. American Society of Hematology: American Society of Hematology - Hematology.org

4.2.2. American Society of Oncology (ASCO): ASCO Hub – American Society of Clinical Oncology

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

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

4.2.5. The requirements contained in this PWS

4.3. MEDICAL RECORDS

4.3.1. Authorities: Contractor’s physician(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the 5 U.S.C.552a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

4.3.2. HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment of VA patients. Based on this exception, a BAA is not required for this contract. Health records generated by this contract or provided to the Contractors by the VA are covered by the VA Privacy Act system of records entitled ‘Patient Medical Records-VA’ (24VA10A7). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services provided to VA patients are captured in the VA electronic health record system as required by VA policy as discussed in 4.4.4. 4.4.3.

4.3.3. Disclosure: Contractor’s physician(s) may have access to patient medical records for the purpose of providing medical care and services to VA patients and performing services under the contract. VA authorizes the Contractor to discuss patient health information for coordination of care with community health care providers in compliance with VA regulations, HIPAA and VHA Directive 1605.01, Privacy and Release of Information. The VA will provide the Contractor with a copy of VHA Handbook 1907.01, Health Information Management and Health Records and VHA Directive 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor.

4.3.4. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235 and all guidelines provided by the VAMC.

4.3.5. Release of Information: The VA shall maintain control of releasing any copies of patient health information or health records and will follow policies and standards as defined, but not limited to Privacy Act requirements. Contractor will not release or disclose copies of records and will refer all such requests to the Release of Information Department at the VA facility were assigned.

4.3.6. Management for Medical Records: National Archives and Records Administration record disposition requirements are found in RCS 10-1 Chapter 6, 6000 series.

4.4. Direct Patient Care: estimated 95% of the time involved in direct patient care.

4.4.1. Per the qualification section of this PWS, the Contractor shall provide the following staff:

4.4.1.1. Board Certified /Board Eligible Hematology and Oncology Physicians

4.4.1.2. The Contractor shall provide treatment for Hematologic and Oncologic disorders in the outpatient services, with a minimum of (3) 6-hour clinic sessions day per week and a maximum of (4) 6-hour clinic sessions per week as need is identified by VA; each clinic with a minimum of (25) patient slots. The Contractor shall be available to provide consultative services in Hematology and Oncology for inpatients 7 days per week, 24 hours a day including Holidays.

4.4.1.3. The Contractor will provide on-call consultative coverage during the day, evenings, weekends, and Federal holidays. The Contractor will provide on-call information, including contact numbers, to the VA’s Medical Service Office via email no later than three working days prior to the end of each month. This information will be published on the VA’s monthly call schedule. Any non-emergent change in the on-call schedule must be communicated during normal administrative hours to the Louisville VAMC Medicine Service office in advance. The physician on call be available by phone/pager during this time. He/she is required to respond telephonically within 30 minutes of receiving a call and must be prepared to provide on-site consultation and/or assistance at the VAMC.

4.4.1.4. Hematology and Oncology services provided in satisfaction of this contract provide no less than:

4.4.1.4.1. Inpatient and ER consultation service as needed; approximately 20 patients a month

4.4.1.4.2. Approximately 240+ outpatients per month at minimum, and 480 outpatients per month at maximum.

4.4.1.5. The Contract physician is fully responsible for all care rendered to the patient, as well as the clinical outcome. Contract physicians are required to utilize Computerized Patient Record System (CPRS) and Veterans Health Information Systems and Technology Architecture (VISTA) for retrieval of information and documentation of services. The Contractor shall provide physicians who shall:

4.4.1.5.1. Sign notes at the time of the clinic visit, no later than 24 hours of the visit. Perform all documentation requirements, per VHA Handbook 1400.01, dated December 19, 2012.

4.4.1.5.2. Perform requested consultations for inpatients within twenty-four (24) hours of request or sooner as dictated by the acuity of the patient’s medical condition. Contractor will document inpatient encounters to assure that billing at the attending level can be performed.

4.4.1.5.3. Assure that outpatient encounters and/or inpatient event captures are documented and completed in CPRS at the time of the visit.

4.4.1.5.4. Be in compliance with all VA National and VISN directives concerning consult management and clinic scheduling practices as noted.

4.4.1.5.5. Adhere to documentation levels that are standard in the medical community (CMS).

4.4.1.5.6. Perform Tort, peer, and other reviews as assigned by the Chief, Medical Services, or his/her designated representative.

4.4.1.5.7. Participates in the review and response to the patient complaints and/or congressional inquiries.

4.4.1.5.8. They are responsible for the timely review and signature of chemotherapeutic agents and narcotics.

4.4.2. Scope of Care: Contractor’s physician(s) (as appropriate and within scope of practice/privileging) shall be responsible for providing Hematology/Oncology care, including, but not limited to :

4.4.2.1. Clinic and Surgical Care: Contractor’s physician(s) shall provide clinical Hematology/Oncology services. Contractor’s physician(s) shall be present on time for any scheduled clinics as documented by physical presence in the clinic at the scheduled start time.

4.4.2.2. Medications: Contractor’s physician(s) shall follow all established medication policies and procedures. No sample medications shall be provided to patients. All recommendations for FDA-approved agents and diagnostics that are recommended in NCCN guidelines will be presented appropriately by the Hematology/Oncologist to the chemotherapy review committee.

4.4.2.3. Discharge education: Contractor’s physician(s) shall provide discharge education and follow up instructions that are coordinated with the next care setting for all Hematology/Oncology clinical patients.

4.4.3. ADMINISTRATIVE: estimated 5% of time not involved in direct patient care

4.4.3.1. Quality Improvement Meetings: The Contractor’s physician(s) shall participate in continuous quality improvement activities and meetings with committee participation as required by the VAMC Chief of…