Attachment D.6 - Deliverables-Reports Table.pdf

Attachment D.6 – Deliverables / Reports

The Contractor and TVHS are responsible for complying with all reporting requirements established by the contract. Contractor and TVHS are responsible for the accuracy and completeness of all reports and documentation as well as the timely submission of each.

The following table is provided as a guide for the Contractor’s convenience. If an item is listed within the Performance Work Statement but not listed within the table, the Contractor still remains responsible for the delivery of that item.

Submit as noted What Submit To Compliance With proposal A minimum of three (3) past performance references, utilizing the Past Performance Questionnaire

CO/CS Technical Evaluation Factor III

With proposal Description of offeror’s experience in healthcare operations CO/CS Technical Evaluation

Factor II, With proposal Proposed facility information, to include (but not limited to), physical address, map of facility and immediate area, basic floor plan, design & location plan, photos, inspection reports, and proposed hours of operation.

CO/CS

Technical Evaluation Factor I, Subfactor B

With proposal Management of clinic, to include (but not limited to), management approach, quality control plans, staffing capabilities, back-up staffing plan, background check process, quality assurance plans, performance measurement process, reporting documentation, and outreach program.

CO/CS

Technical Evaluation Factor I, Subfactor C

With proposal Continuity of Care, to include (but not limited to), equipment downtime contingency plan, laboratory information, plan for continuity, and transition plan.

CO/CS

Technical Evaluation Factor I, Subfactor E

With proposal and upon renewal of licenses

Copies of all certifications and licenses for staff members providing CBOC services

CO/CS

TechnicalEvaluation Factor I, Subfactor f;

B.2.6 of PWS

With proposal Names for all staff (clinical and administrative) intended to work at/for the proposed facility, to include titles and roles, such as the Medical Director and the Licensed Independent Practitioner (LIP)

CO/CS

Technical Evaluation Factor I, Subfactor f;

B.2.6.4.

With proposal Subcontracting Plan CO/CS Technical Evaluation Factor IV

With proposal Contractor and subcontractor verification of VOSB and SDVOSB status through Vendor Information Pages (VIP)

CO/CS

VAAR 852.215-70

With proposal All-inclusive pricing, utilizing the Pricing Schedule within the solicitation CO/CS Technical

Evaluation Factor V With proposal and new hires

Certification that staff have been compared to OIG List CO/CS Section A, Contract

Administration Data With proposal;

and renewals

Laboratory information / accreditation certificates CO/CS B.4.6.4.3. of PWS

36C24925R0056 Dyersburg CBOC

With proposal;

and renewals

Indemnification and Medical Liability Insurance CO/CS VAAR 852.237-7

Before receiving a VA Network Account (NT Account) and annual training

Certificates of completion for Cyber Security, Privacy Training, and any other training required by the VAMC

CO AND

Contracting Officer Representative

(COR)

B.2.10.1. of PWS

With proposal Separate pricing and technical proposals organized in accordance with solicitation specifications

CO/CS

FAR 52.212-1

Addendum

Upon incident Summary of patient complaints COR B.4.7.8.3. of PWS Upon award Reports of grievance procedures and resolutions COR B.4.7.8. of PWS

Within five (5) days after award

Submit to a background investigation for each contract and subcontract employee

VSC Personnel Security Office

B.2.6.6. of PWS

Upon completion of Background Investigation

Obtain (and maintain active status of) PIV cards for providers and other personnel who are required to utilize VA computer systems and programs

Security Office, COR

B.2.10.3.of PWS

Upon incident Adverse events relating to patient safety VA TVHS Patient Safety Office and Patient Safety Reporting System

B.4.7.8.2. of PWS

Upon award Joint Commission accreditation letter CO/CS Upon incident Malpractice claims involving VA patients against Contractor Chief of Staff B.4.11.3. of PWS

Upon enrollment and/or request of each patient

Patient Handbook Patients of the Cookeville

CBOC

B.4.4. of PWS

Upon opening of clinic

VA TVHS Mental Health Liaison Work Space

Chief of Mental Health

Prior to seeing Patients; & as revised

Emergency policy or SOP

COR

4.11.1 of PWS

Upon submission of invoice

Time and attendance logs COR or designated VA personnel

6.23.1. of PWS

Upon award, and updated annually

Dually signed QASP (Contractor and COR) CO/CS Section D, Attachment 1 of the Contract

Upon award Signed Statement of Understanding CO/CS Section D, Attachment 3 of the Contract

Upon award Rules of Behavior CO/CS Section D, Attachment 4

Upon award; for all new personnel after award; and as necessary for employee renewals

Commencement of credentialing and privileging of clinic personnel

TVHS

Credentialing

B.2.7.of PWS

Page 2 or 3

36C24926D0006 Holly Springs CBOC

Upon award and as updated

Plan for establishing an experienced, proficient Women Veteran Champion COR

Annually at the time of contract renewal

Subcontracting performance and compliance reports CO/CS

FAR 52.219-9

Alternate II

Annually at the time of contract renewal

Workload Report

CO/CS & COR

Monthly AED Device Checks COR 4.6.10.7. of PWS Quarterly TJC Standards audits HIMS Program

Manager

4.11.5. of PWS

36C24926D0006 Holly Springs CBOC