Attachment E - DRAFT CPRMP VA1391-L - BLANK.pdf

1. ADMINISTRATION

VA

FY 20XX LEASE PROJECT DATA

2. DATA AS OF

Month DD, YYYY

3. VERSION #

X

4. LOCATION

Alameda, CA

5. PROJECT TITLE

Community Based Outpatient Clinic (CBOC)

6. TOTAL LEASE CONTRACT

VALUE

$X,XXX,XXX

7. SCIP PRIORITY SCORE

FY ASSIGNED

0.XXXX

FY 20XX

VA 1391-L DRAFT 02/07/2024 1

VA 1391-L Summary Page

A. Lease Project Description

A1. PROJECT DESCRIPTION

[Enter Project Description]

B. Information Developed During the Implementation Planning Process

B1. SUMMARY LEASE INFORMATION

Lease Type Existing NUSF Proposed NUSF1

Expansion/Reduction NUSF:

FTE

Existing NUSF per FTE Proposed NUSF per FTE

FY31 Projected Enrollees2

(10 Years) Expiration Dates of Existing Leases3

Current Total Annual Cost4

Proposed Delineated Area North:

East:

South:

West:

Congressional District(s) Proposed Number of Parking Spaces5

1As VA continues the modernization of its leasing program, the intent is for all acquisitions utilizing the Request for Lease Proposals (RLP) method to use a square footage metric better aligned with industry standards. The ABOA SF estimate will be finalized during pre-design.

2 Data reflects the VISN XX, Central Market.

3VA will coordinate with GSA to execute such interim leasing actions as are necessary to ensure continued housing of VA services prior to the effective date of the new lease. It is in the best interest of the Government to avert the financial risk of holdover tenancy.

4Total Annual Cost includes unserviced annual rent and operating expenses.

5VA may pursue structured parking within the lease, instead of surface parking, during lease execution depending on land parcel availability.

C. Information Developed Post-Implementation Planning

C1. BUDGET INFORMATION

Budgetary Scoring XX.XX% Estimated Maximum Lease Term 20 years Proposed Unserviced Annual Rental Rate1 $ Proposed Total Unserviced Annual Rent $ Medical and Other Related Alterations (Lump Sum Payment)2

Total Lease Contract Value3 $

VALUE

$X,XXX,XXX

7. SCIP PRIORITY SCORE

FY ASSIGNED

0.XXXX

FY 20XX

VA 1391-L DRAFT 02/07/2024 2

1Estimated Annual Unserviced Rental Rate includes Base/NNN rent, real estate taxes, insurance, maintenance and repair reserves, and management fees. This estimate may be escalated by 2.1 percent annually to the effective date of the lease to account for inflation. The proposed rental rate is unserviced (taxes, insurance, management, and maintenance and repair reserves included); however, the lease contract may include operating expenses paid by the lessor. VA will conduct a competitive procurement and negotiate with offerors to ensure that lease award is made in the best interest of the Government.

2Represents an estimated lump sum payment to the lessor for the purchase and installation of build-out requirements (tenant improvements) not included in the annual rent. Actual lump sum amount may vary based on offers received.

3Total Lease Contract Value is the sum of total unserviced annual rent and medical and other related alterations. (ORP to provide official definition)

C2. BUDGET AUTHORITY ($000)

Lease Term Request Medical and Other Related Alterations Unserviced Annual Rent

Budget Authority Up to 20 years Not Required - Mid-level Lease $X,XXX $X,XXX

D. Information Developed to Prepare for Lease Execution

D1. EXECUTION PLANNING INFORMATION

Date of Acquisition Plan MM/DD/YYY Budgetary Scoring XX.XX%

Note: Full VA 1391-L Summary Page included as Attachment I of the VA 1391 Package

VALUE

$X,XXX,XXX

7. SCIP PRIORITY SCORE

FY ASSIGNED

0.XXXX

FY 20XX

VA 1391-L DRAFT 02/07/2024 3

E. Supporting Budget Justification Data

E1. DEMOGRAPHIC DATA*

Actual

Projected

Projected

Projected

Change (2021 – 2041)

Veteran Population XXX,XXX XXX,XXX XXX,XXX XXX,XXX X.X% Enrollees XXX,XXX XXX,XXX XXX,XXX XXX,XXX X.X% *Data reflects the VISN 17, Central Market.

E2. WORKLOAD*

Actual

Projected

Projected

Projected Change

(2021 – 2041) Ambulatory Procedures XXX,XXX XXX,XXX XXX,XXX XXX,XXX -XX.X% Ambulatory Services XXX,XXX XXX,XXX XXX,XXX XXX,XXX -XX.X% Mental Health Stops XXX,XXX XXX,XXX XXX,XXX XXX,XXX -XX.X% Mental Health Services XXX,XXX XXX,XXX XXX,XXX XXX,XXX -XX.X% Acute Inpatient Beds XX XX XX XX -XX.X% Acute Mental Health Beds XX XX XX XX -XX.X% *Data reflects the VISN 17, Central Market, and excludes Pharmacy and Laboratory and Pathology stops.

E3. JUSTIFICATION FOR CHANGES

Scope Changes:

[Enter Justification for Scope Changes if applicable]

Budget Changes:

[Enter Justification for Budget Changes if applicable]

Schedule Changes:

[Enter Justification for Schedule Changes if applicable]

E4. PROJECT JUSTIFICATION

[Enter Project Justification]

E5. ANALYSIS OF BENEFITS/IMPACT IF NOT FUNDED

[Enter Analysis of Benefits/Impact if not Funded]

E6. SCHEDULE*

Milestone Schedule Baseline Estimated Date Current Estimated Date Award Lease XX months after requirement finalization Month YYYY Month YYYY Complete Construction XX months after lease award Month YYYY Month YYYY Activation/Occupancy XX months after construction Month YYYY Month YYYY *For leases with an annual unserviced rent exceeding the GSA prospectus threshold, the schedule above is dependent on passage of committee resolutions by the House Committees on Veterans' Affairs and Transportation and Infrastructure and the Senate Committees on Veterans' Affairs and Environment and Public Works.

E7. ANALYSIS OF ALTERNATIVES (MAJOR AND MID-LEVEL LEASES ONLY)

Status Quo:

[Enter Status Quo description]

Alternative 1: Lease (Preferred Alternative) [Enter Alternative 1 description]

VALUE

$X,XXX,XXX

7. SCIP PRIORITY SCORE

FY ASSIGNED

0.XXXX

FY 20XX

VA 1391-L DRAFT 02/07/2024 4

Alternative 2: New Construction [Enter Alternative 2 description]

Alternative 3: Renovation [Enter Alternative 3 description]

Alternative 4: Contract Out [Enter Alternative 4 description]

Alternative 5: Acquisition of an Existing Facility through Purchase [Enter Alternative 5 description]

Alternative 6: Collaboration with DoD for a Joint Project [Enter Alternative 6 description]

E8. ANALYSIS OF ALTERNATIVES (MAJOR AND MID-LEVEL LEASES ONLY) – 30-YEAR COSTS IN DISCOUNTED DOLLARS ($000)

Acquisition* Ancillary Services**

Equipment and Other Items Total Life Cycle Total # of

FTEE

Net New

FTEE

Net Present

Value Status Quo 0 $XXX,XXX $XXX,XXX $XXX,XXX XXX N/A N/A Lease $XXX,XXX $XXX,XXX $XXX,XXX $XXX,XXX XXX XX $XXX,XXX New Construction $XXX,XXX $XXX,XXX $XXX,XXX $XXX,XXX XXX XX $XXX,XXX Renovation N/A N/A N/A N/A N/A N/A N/A Contract Out $XXX,XXX $XXX,XXX $XXX,XXX $XXX,XXX XXX (XXX) $XXX,XXX Acquire an Existing Facility

N/A N/A N/A N/A N/A N/A N/A

VA/DOD

Collaboration

N/A N/A N/A N/A N/A N/A N/A

Other (if applicable) N/A N/A N/A N/A N/A N/A N/A *This is the total estimated cost for construction/renovation projects or build-out (special purpose renovations) for leases, in discounted dollars.

**This is defined as operating expenses and supplies (recurring costs from the cost-effectiveness analysis template included in Project Definition)

E9. ADDITIONAL INFORMATION

N/A

VALUE

$X,XXX,XXX

7. SCIP PRIORITY SCORE

FY ASSIGNED

0.XXXX

FY 20XX

VA 1391-L DRAFT 02/07/2024 5

F. Capital Program Requirements Management Process (CPRMP) This section will be completed only if a CPRMP submission is necessary due to requested changes after SCIP Approval.

F1. SPACE CHANGES (NUSF) IN SUPPORT OF CPRMP REQUEST

Space Types – Enter Current and Proposed Changes by SCIP Baseline

Latest Externally Communicated Baseline

Project Total Post-Requested Changes

Inpatient Mental Health CLC/Hospice Administration Research Support/ Infrastructure Ancillary/ Diagnostic Mental Health Primary Care Specialty Care Acute Inpatient Medicine & Surgery Acute Special Programs Common/Swing/ Construction Total If Change in Space, provide justification for the change. Attach additional supporting documents if needed. VHA must provide demographic information for all proposed changes.

F2. UTILIZATION CHANGES IN SUPPORT OF CPRMP REQUEST

Utilization Categories SCIP Baseline Latest Externally

Communicated Baseline Project Total Post-Requested

Changes Inpatient Medicine (BDOC) Inpatient Mental Health

(BDOC)

Dental Clinic (Procedures) Laboratory and Pathology (Clinic Stops) Medical & Other Non-Surg Specialties (Clinic Stops) Mental Health Programs (Clinic Stops) Primary Care-Geriatrics- Urgent Care (Clinic Stops) Surgical Specialties (Clinic Stops) Inpatient Residential Rehab Mental Health Programs

(BDOC)

Long Term Care (LTC)Non- Institutional (Clinic Stops) Blind Rehab (BDOC) Inpatient LTC (BDOC) Spinal Cord Injury (BDOC) If Change in Utilization, provide justification for the change. Attach additional supporting documents if needed. VHA must provide demographic information for all proposed changes.

VALUE

$X,XXX,XXX

7. SCIP PRIORITY SCORE

FY ASSIGNED

0.XXXX

FY 20XX

VA 1391-L DRAFT 02/07/2024 6

F3. BED COUNT CHANGES (INPATIENT PROJECTS) IN SUPPORT OF CPRMP REQUEST

Bed Categories SCIP Baseline Latest Externally

Communicated Baseline Project Total Post-Requested

Changes Inpatient Medical Inpatient Surgical Acute Inpatient Mental Health Blind Rehab CLC/Hospice Residential Rehab Mental Health Spinal Cord Polytrauma Hotel Total If Change in Inpatient Beds, provide justification for the change. Attach additional supporting documents if needed. VHA must provide demographic and workload information for all proposed changes.

VALUE

$X,XXX,XXX

7. SCIP PRIORITY SCORE

FY ASSIGNED

0.XXXX

FY 20XX

VA 1391-L DRAFT 02/07/2024 7

G. Attachments G1. Implementation Planning Output

I. Service Delivery Plan II. Gap Mitigation Plan

III. Functional Program IV. Project Definition

G2. Attachments to Support Budget Submission and Lease Execution Planning Summary I. Acquisition Plan II. Pre-Procurement Scoring Report

G3. GREX Requirements for GSA Delegation (Post-SCIP) I. Acquisition Plan II. Market Research III. Agency Labor Cost Worksheet IV. Rural Development Act V. FEMA Floodplain Map VI. Delineated Map VII. Original Lease/SF2 VIII. Needs Assessment Questionnaire