Draft PWS - El Centro - CBOC Services - VASDHS.docx

DRAFT PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1 Services Required: The VA San Diego Healthcare System (VASDHS); requires primary care through a Community-Based Outpatient Clinic (CBOC) dedicated solely to Veterans, primarily residing in El Centro, California located in Imperial County. The parent facility for this clinic is the VA San Diego Health Care System (VASDHS) in La Jolla, California. Unless otherwise noted hereafter within this document, singular terms such as “CBOC” or “Contractor’s facility” shall refer to the El Centro CBOC. The Contractor shall provide a community-based outpatient clinic solely dedicated to Veterans. Primary Care shall provide a continuum of care from prevention to diagnosis and treatment, to appropriate referral and follow-up. Those patients needing specialty or follow-up care shall be referred to VASDHS.

1.2 Site Classification: This site is classified as a [X] Primary Care CBOC.

1.3 Place of Performance: Contractor’s CBOC shall be located within the city limits of El Centro.

The City of El Centro is located approximately 120 miles from the VASDHS.

1.4 Authority: Title 38 United States Code (USC) 8153 and FAR Parts 12 and 15, to be furnished by the contractor on behalf of the VA San Diego Healthcare System 3350 La Jolla Village Drive San Diego, California 92161.

1.5 Policy and Regulations: The contractor is required to meet VHA performance and quality criteria, policy and standards including, but not limited to, access, quality of care, Veteran satisfaction, coordination of care, and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vapubs/ or at http://www.va.gov/vhapublications/. Some VA policy documents include Standard Operating Procedures (SOPs) located on internal VA websites that are not available to the public. SOPs relevant to this requirement are provided as attachments under Section D. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy Document located at https://www.patientcare.va.gov/primarycare/docs/List-of-contracted-clinic-policy-documents.xlsx#. A link to the VA Qualifications Standards is also included in this document.

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties ACGME: Accreditation Council for Graduate Medical Education ACIP: Advisory Committee on Immunization Practices ACLS: Advanced Cardiac Life Support ACO: Administrative Contracting Officer ACPE: American Council on Pharmaceutical Education ADE: Adverse Drug Events AED: Automatic External Defibrillator AIS: Automated Information Security ANA: American Nurses Association AOA: American Osteopathic Association APRN: Advanced Practice Registered Nurse ARRT: American Registry of Radiologic Technology ASC: Ambulatory Surgery Center Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e., CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

Asynchronous Care: Care provided outside of bookable time and includes but is not limited to the following activities: refilling prescriptions, reviewing outside records, huddles and case management, team meetings, processing view alerts, secure messaging and training.

BAA: Business Associate Agreement BI-RADS: Breast Imaging-Reporting and Data System; a quality assurance tool designed to standardize mammography reporting.

BLS: Basic Life Support BOS: Bureau of Osteopathic Specialists CAHEA: Committee on Allied Health Education and Accreditation CAP: College of American Pathologists CARF: Commission on Accreditation of Rehabilitation Facilities CBO: VA Central Billing Office.

CCNE: Commission on Collegiate Nursing Education CDC: Centers for Disease Control and Prevention CEU: Certified Education Unit CLIA: Clinical Laboratory Improvement Amendments CME: Continuing Medical Education CMS: Center for Medicare and Medicaid Services CNP: Certified Nurse Practitioner CNS: Clinical Nurse Specialist CO: Contracting Officer COPD: Chronic Obstructive Pulmonary Disease COR: Contracting Officer’s Representative COS: Chief of Staff CPA: Collaborative Practice Agreement CPARS: Contractor Performance Assessment Reporting System CPP: Clinical Pharmacist Practitioner CPT: Current Procedural Terminology CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org.

CVT: Clinical Video Telehealth DICOM: Digital Image and Communication in Medicine DIGMA: Drop-in Group Medical Appointment DRG: Diagnostic Related Group DSS: Decision Support System ECC: Extended Care Center Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

EPRP: External Peer Review Program FDA: Food and Drug Administration FSMB: Federation of State Medical Boards FTE: Full Time Equivalent HCC: Health Care Center - A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

HCFA: Health Care Financing Administration HHS: Department of Health and Human Services HICPAC: Healthcare Infection Control Practices Advisory Committee - a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the CDC and the Secretary of HHS regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

HPE: Health Professions Education HPT: Health Professions Trainee HT: Home Telehealth ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories ICD: International Classification of Diseases iMED: software used by VA for informed consent.

INR: International Normalized Ratio LIP: Licensed Independent Practitioner MCCR: Medical Care Cost Recovery Mental Health Services: per VHA Directive 1160.01 is meant to include services for the evaluation, diagnosis, treatment, rehabilitation, suicide prevention and crisis intervention, and coordination of care for both substance use disorders and other mental disorders.

General mental health services include:

(a) Diagnostic and treatment planning evaluations for the full range of mental health problems, including SUD

(b) Treatment services using evidence-based pharmacotherapy, somatic treatments, or primary evidence-based Psychotherapy (EBP) for patients with mental health conditions and substance use disorders

(c) Patient education

(d) Family education, family consultation, family psychoeducation and couples/marriage and family counseling when it is associated with benefits to the Veterans

(e) Referrals as needed to inpatient and residential care programs; and

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder (PTSD) and Military Sexual Trauma (MST)

(g) Suicide Prevention

(h) Referrals and coordination of care between other levels of care and community treatment programs.

Specialty mental health services include:

(a) Consultation and treatment services for the full range of mental health conditions

(b) Evidence-based psychotherapy

(c) Intensive Community Mental Health Integration (ICMHR)

(d) Psychosocial Rehabilitation Services, including: PRRCs, family psycho-education, family education, skills training, peer support, and Compensated Work Therapy (CWT), supported employment and vocational assistance.

(e) PTSD teams or specialists

(f) MST special clinics

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

MQSA: Mammography Quality Standards Act MSN: Master of Science in Nursing NLN: National League for Nursing NLNAC: National League for Nursing Accreditation Commission NP: Nurse Practitioner NSQIP/CICSP: National Surgical Quality Improvement Program/Continuous Improvement in Cardiac Surgical Program OTC: Over the Counter PA: Physician Assistant PACS: Picture Archiving and Communications System PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team-based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

PACT Support staff: PACT staff assisting providers in the actual delivery of care to patients. It consists of RNCMs, clinical associates, and administrative associates.

SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two-way conversation.

Parent Facility: VAMC responsible for performance monitoring and payment for contracted outpatient site of care services.

PBM: Pharmacy Benefits Management PCMH: Patient-Centered Medical Home PCMHI: Primary Care-Mental Health Integration PCMM: Patient Centered Management Module - is an enterprise application that enables users to (1) set up and define health care teams, (2) assign staff and their associated full-time equivalent (FTE) staff to positions within each team, (3) assign patients to the team, and (4) assign patients to specific team members.

PCP: Primary Care Provider Phar.D.: Doctor of Pharmacy PMPM: Per Member Per Month-reimbursement methodology for services provided under the PC and MH LINs based on all-inclusive monthly rate per Veteran that meets qualifying encounter criteria in the previous twelve months of the contract period. This methodology also accounts for costs of unassigned/unenrolled visits based on estimates provided to contractors and it supports the PACT model in increasing coordination, quality, and continuity of care of Veterans receiving services at the Outpatient Site of Care.

POC: Point of Care Testing Primary Care Visit: an episode of care furnished in a clinic or virtually that provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care includes, but is not limited to, diagnosis and management of acute and chronic biopsychosocial conditions, health promotion, disease prevention, overall care management, and patient and caregiver education. The VHA site classification defines primary care as those encounters that occur within the primary care class of encounters.

PWS: Performance Work Statement QAPI: Quality Assessment and Performance Improvement QASP: Quality Assurance Surveillance Plan REACH VET: Recovery Engagement and Coordination for Health Veterans Enhanced Treatment- REACH VET summarizes information from the Veterans Health Record and uses predictive modeling to identify Veterans at statistical risk for suicide and other negative outcomes. This tool supplements clinical strategies used to identify at-risk Veterans and may help providers intervene prior to these negative outcomes occurring.

RME: Reusable Medical Equipment SFT: Store and Forward Telehealth SMA: Shared Medical Appointments SOP (Clinical): Scope of Practice SPD: Sterile Processing Division SPE: Senior Procurement Executive Specialty Care Visit: The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology; emergency; employee health; endocrinology; gastroenterology; general medicine; hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology; amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye; general surgery; gynecology (GYN); neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

STORM: Stratification Tool for Opioid Risk Monitoring SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two way conversation.

TCT: Telehealth Clinical Technician TIU: Text Integration Utility TJC: The Joint Commission TMS: Talent Management System VA: Veterans Affairs VA ECHO: VA Extension for Community Health Outcomes VA EHR: VA electronic health record VAMC: Veterans Affairs Medical Center VAST: VHA Site Tracking database VetPro: a federal web-based credentialing program for healthcare providers.

VHA: Veterans Health Administration VSSC: VHA Support Service Center VVC: VA Video Connect WHEN: Weekend- Holiday- Every- Night

2. STAFFING AND QUALIFICATIONS

2.1 Minimum Patient Aligned Care Team (PACT) Staffing Requirements:

PACTs comprise the patients, the patients’ personal support persons, teamlets (Primary Care Providers (PCPs), Registered Nurse Care Managers (RNCMs), Clinical Associates, Administrative Associates), discipline specific team members (Clinical Pharmacist Practitioners (CPPs), Licensed Social Workers, Registered Dietitian/Nutritionists, and Primary Care-Mental Health Integration (PCMHI) staff). The contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio to meet VA standards. Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management Module (PCMM) for Primary Care. The staffing standard for support staff shall be at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacist Practitioner (CPP) shall be provided the same support staffing when they are working in the capacity of an advanced practice provider. The contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the contractor shall communicate to the VA, the contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. The total estimated patients assigned to site is: 1,829.

Physician Director (Mandatory for all sites): FTE Ratio Performance Standard: 0.05 FTE per PACT. Responsible Party: Shall be provided by contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Contractor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. The physician director may also be credentialed and privileged to function as a PCP. (If so, authorization for prescriptive authority is required). Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site.

2.2 Primary Care Teamlet Staffing (Mandatory for all sites): All primary care teamlet staffing shall be provided by contractor.

Teamlet Member 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time mid-level provider. Contractor shall propose quantity of FTE to meet standard FTE ratio to panel size. Contractor to propose mix of PCP from the options below. At least one of the primary care providers must be a physician.

Option 1: Physician (MD/DO): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Option 2: Advanced Practice Registered Nurse (APRN): Qualifications: APRN’s (including subcontractors) shall possess a master’s degree from a program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE) and maintain full and current certification as a Certified Nurse Practitioner (CNP) from the American Nurses Association or another nationally recognized certifying body in either Adult Health or Family Practice. Authorization for prescriptive authority is required. CNPs shall prescribe controlled substances in accordance with limitations imposed by the Controlled Substances Act and the CNP’s State licensure on the authority to prescribe or administer controlled substances. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Advanced Practice Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Teamlet Member 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or the commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, virtual care, view alerts management, shared medical appointments, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and virtual care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

Teamlet Member 3: Clinical Associate FTE Ratio Performance Standard: Current standard is 1.0 FTE clinical associate per 1.0 FTE PCP. Contractor to propose the mix of Clinical Associates from the options below.

Option 1: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN): Qualifications: Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Licensed Practical or Vocation nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. The LPN is to serve in the PACT teamlet clinical associate role, not as primary TCT. May be trained as a TCT back-up, but not as the primary TCT.

Option 2: Unlicensed Assistive Personnel (Health Technician, Nursing Assistant). This staffing is part of the PACT Teamlet, not the primary telehealth clinical technician (TCT): Qualifications: Nursing Assistant qualifications per VA qualification standards for Nursing Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Health Technician qualifications per Health Aid and Technician Series 0640 located at: Health Aid and Technician Series 0640 (opm.gov). Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. The HT, NA is to serve in the PACT teamlet clinical associate role, not as a primary TCT. May be trained as a TCT backup, but not as the primary TCT.

Teamlet Member 4: Administrative Associate: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to provide clerical support and administrative functions to support site operations. Completion of scheduling training per VA policies and guidance. See VA qualification standards for Medical Support Assistant located in the VA Qualification Standards for additional qualifications. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. Provide clerical support and administrative functions to PACT staff and collaborate with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans. Provide guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA. Provide scheduling services in accordance with VA policies and guidance.

2.3 Discipline Specific PACT Team Member (Required for all sites): Discipline-specific team members are designated in PCMM for one or more PACT(s). Discipline-specific team members provide continuity of direct discipline-specific care to all patients assigned to PACT(s) for which the team member is designated.

Discipline Specific 1: Clinical Pharmacist Practitioner (CPP) – PACT: VASDHS PACT Pharmacy services are available through chart referral (co-signing one of the VA San Diego Clinical Pharmacy PACT Practitioners to the CPRS note). PACT CPP clinics are also open to direct patient scheduling without a referral.

Discipline Specific 2: Clinical Pharmacist Practitioner (CPP) Anti-Coagulation – PACT: The VASDHS shall provide clinical pharmacy telehealth services. Anticoagulation management services are available through a CPRS Anticoagulation Consult.

Discipline Specific 3: Licensed Social Worker (this position provides general/medical social work services): Contractor shall provide a Licensed Social Worker. FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Qualifications: Social Workers providing general social work services under this contract shall have a master’s degree in social work (MSW) from a school accredited by the Council on Social Work Education (CSWE). Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Social Worker located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned Veterans presenting for care. Covered services include, but are not limited to, conducting bio-psychosocial assessments to determine needs of Veterans, Veteran’s family members and caregivers. Provide a full range of clinical social work services within established standards of social work practice which includes treatment planning, individual, family and group counseling, VA and community-based resource referrals, case management and other services as appropriate. Providing tailored interventions for a wide range of psychosocial issues to include housing/homelessness, food, finances, family/caregiver support, home care/placements, legal, education, employment, disability, mental health/addiction, medical and reporting of abuse/neglect. Participate in treatment planning with interprofessional teams, members, and other programs. Assist with long term care placement, discharge planning, hand off communication and transitions between levels of care and arranging for in home services to ensure care is timely and appropriate.

Discipline Specific 4: Registered Dietitian/Nutritionist: FTE Ratio Performance Standard: 1 FTE per 5 PACTs. The VASDHS will provide Dietitian services via telehealth.

Discipline Specific 5: Primary Care Mental Health Integration (PCMHI): Contractor shall provide PCMHI staffing. PCMHI is a required component of PACT, providing mental health expertise for Veterans whose conditions can be managed collaboratively in primary care. Where primary care services are offered, PCMHI services shall include Co-located Collaborative Care (CCC) providers who attend PACT huddles and provide consultative advice, brief assessment and problem-focused treatment, and Mental Health Collaborative Care Managers (CoCM) who use the evidence-based Mental Health Collaborative Care Management Model to provide longitudinal follow-up and decision support for specific mental health conditions.

FTE Ratio Performance Standard - The following ratios are the minimum necessary to adequately provide required PCMHI services.

· Co-located Collaborative Care (CCC): 0.5 FTE CCC per 1200 primary care patients. This ratio includes PCMHI Behavioral Health Consultants (Licensed Independent Providers such as the providers included in options 1-3 below), as well as Providers with Prescribing Privileges (PwPP) (such as the providers included in options 4-6 below (depending on the provider’s scope of practice)).

· Collaborative Care Management: 0.17 FTE Collaborative Care Managers per 1200 primary care patients. (Typically options 2-5 below) per PACT. Collaborative Care Managers will also require a consulting PwPP (options 4 - 6 depending on the provider’s scope of practice). Collaborative Care Managers (CoCMs) have specialized training in behavioral health and are typically RNs but could also be other Licensed Practitioners (LP) of varying disciplines.

(See the VHA Directive 1160.01, Uniform Mental Health Services for more information on PCMHI requirements).

A mix of the following disciplines shall be selected to meet the PCMHI FTE ratio performance standard and PCMHI service requirements. Staffing ratio outlined is “minimum” and may be increased by the VA to provide appropriate integrated mental health care.

Option 1: Psychologist: Qualifications: Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Psychologist located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. A doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association (APA), the Psychological Clinical Science Accreditation System (PCSAS), or the Canadian Psychological Association (CPA) at the time the program was completed and successfully completed a professional psychology internship training program that has been accredited by APA or, if they an internship that was not accredited by APA or CPA at the time the program was completed may be considered eligible for hire only if they are currently board certified by the American Board of Professional Psychology in a specialty area that is consistent with the assignment for which the applicant is to be employed and they maintain their board certification. Position Responsibilities: Responsible for collaboration with PACT team for the provision of mental health services to assigned and unassigned patients presenting for care per VHA Directive 1160.01 and the requirements of this contract.

Option 2: Licensed Social Worker (Mental Health) (this position provides mental health services as part of the PCMHI team): Qualifications: Social Workers providing PCMHI services under this contract shall have a MSW from a school accredited by the Council on Social Work Education (CSWE). Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Social Worker located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for collaboration with PACT team for the provision of mental health services to assigned and unassigned patients presenting for care per VHA Directive 1160.01 and the requirements of this contract. Covered services include, but are not limited to, conducting bio-psychosocial assessments to determine needs of Veterans, Veteran’s family members and caregivers. Provide a full range of clinical social work services within established standards of social work practice which include treatment planning, individual, family and group counseling, VA and community-based resource referrals, case management and other services as appropriate.

Option 3: Licensed Professional Mental Health Counselor (LPMHC): Qualifications: Hold a full, current, and unrestricted license to independently practice in the state in which the outpatient site of care (i.e., CBOC) is located as a Licensed Professional Mental Health Counselor, which includes diagnosis and treatment. Hold a master’s or doctoral degree in: Clinical Mental Health Counseling; Clinical Rehabilitation Counseling; Clinical Mental Health Counseling and Clinical Rehabilitation Counseling; or a related field, from a program accredited by the Council on Accreditation of Counseling and Related Educational Programs (CACREP). Examples of related mental health counseling fields include but are not limited to Addiction Counseling; Community Counseling; Gerontology Counseling; Marital, Couple, and Family Counseling. CACREP defines the date when graduates are considered to have graduated from a CACREP accredited program. Additional information may be obtained from http://www.cacrep.org/directory/. NOTE: Traditional Rehabilitation counseling programs that are accredited by CACREP do not meet the LPMHC qualification standards as Traditional Rehabilitation counseling differs from Clinical Rehabilitation counseling per VA qualification standards for Licensed Professional Mental Health Counselor located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Covered services include, but are not limited to, conducting bio-psychosocial assessments to determine needs of Veterans, Veteran’s family members and caregivers. Provide a full range of mental health services within the established scope of practice for this licensure, which include treatment planning, brief individual, family and group counseling, Collaborative Care Management, and other services as appropriate. Responsible for collaboration with PACT team for the provision of mental health services to assigned and unassigned patients presenting for care per VHA Directive 1160.01 and the requirements of this contract.

Option 4: Psychiatrist: Qualifications: Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for collaboration with PACT team for the provision of mental health services to assigned and unassigned patients presenting for care per to VHA Directive 1160.01 and the requirements of this contract.

Option 5: Advanced Practice Registered Nurse (APRN): Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The National League for Nursing Accrediting Commission (NLNAC) or the commission on Collegiate Nursing Education (CCNE). Requirements include current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located with certification as a Psychiatric Mental Health NP or CNS and authorization for prescriptive authority; otherwise; qualifications as per VA qualification standards for Advanced Practice Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for collaboration with PACT team for the provision of mental health services to assigned and unassigned patients presenting for care per to VHA Directive 1160.01 and the requirements of this contract.

Option 6: Registered Nurse (RN): Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or the commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for disease-specific care management for assigned and unassigned patients presenting for care per VHA Directive 1160.01 and the requirements of this contract.

2.4 Specialty Care Staffing: All Specialty care will be referred to the VASDHS by submitting a specialty care consult.

2.5 Ancillary Support Services Staffing: The following ancillary support staffing shall be provided by the contractor. The contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to these services during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters).

X-Ray Diagnostic Radiologic Technologist (DRT): The contractor is not responsible for providing a DRT. The Contractor is responsible for entering requests for radiology procedures into the VA EHR. All imaging orders shall be clinically appropriate. Contractor shall place a community radiology consult with SEOC and preferred provider/facility, using the consult toolbox. The Contractor clinical or administrative staff will instruct the patient to call the El Centro Regional Medical Center within 24 to 48 hours after their clinic visit. Patients will call (760) 482-5000 option 2 to schedule their radiology appointment at the El Centro Regional Medical Center. The VASDHS Community Care Team will receive and process the consult. The VASDHS Community Care team will fax the authorization to the El Centro Regional Medical Center.

Phlebotomist: 1.00 FTEE, other clinic staff will need to be trained to provide coverage as needed. Must have knowledge of legal requirements of blood drawing, fluid sample handling and relevant medical equipment and material. This position also requires the ability to use computers to enter patient information, excellent communication skills, and attention to detail. The Phlebotomist must be able to properly identify patients and use correct phlebotomy methods (venipuncture, skin puncture) to obtain patient samples. The Phlebotomist is relied on to preserve patient health and the quality of samples. The Phlebotomist must have a National Phlebotomy License or a California Phlebotomy License. Any contract site performing phlebotomy will have oversight by VA laboratory.

Waived Testing Personnel: Waived testing personnel will be determined by contractor, and approved by VASDHS, as needed for patient care. The FTE will be included as part of the PACT teamlet and/or laboratory staff and will be trained and deemed competent by VA San Diego Ancillary Testing Coordinator. The identified staff shall meet facility defined requirements necessary to meet laboratory accreditation requirements as directed by the Ancillary Testing Coordinator. Contractor staff will receive training specific to the testing activity by VASDHS laboratory staff and they will receive orientation specific to the needs of the service, and have been documented to be competent to perform the test. All staff performing waived testing shall have documented comprehensive training commensurate with the test system to ensure proficiency. It is the contractor’s responsibility to ensure staff performing testing is following procedure manual and manufacturer’s guidelines, performs and document quality control as defined, document results, participates in mandatory competency, and performs proficiency testing.

2.6 General and Specialty Mental Health Staffing Requirements. Mental Health Services will be provided by the VASDHS via telehealth.

2.7 Telehealth Services Clinical Staff: The following telehealth staffing shall be provided by the contractor. For CBOCs with fewer than 1050 synchronous and/or asynchronous encounters anticipated per year, one Telehealth Clinical Technician (TCT) FTE is required; for CBOCs with 1051-1479 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, 1.5-2 TCT FTE are required; for CBOCs with over 1480 annual synchronous and/or asynchronous encounters anticipated, or those with an expansion plan target in this range, greater than 2 TCT FTE are required. Each TCT shall have a trained back-up, e.g., another TCT or a member of the PACT Teamlet such as (PCP, RNCM, or clinical associate) who is able to perform all telehealth duties of the designated telehealth TCT. Qualifications: All staff providing telehealth related services in the clinic shall be appropriately credentialed and where necessary, privileged. See section 2.9 for additional information regarding credentialing and privileging for contracted telehealth providers. All contractor staff who support and manage telehealth services shall be working within permitted licensure and scope of practice. Where non-licensed staff are supporting telehealth services the contractor’s licensed staff shall provide appropriate clinical supervision.

Competency: TCTs, telepresenters, store and forward imagers and back-ups shall be expected to successfully complete training programs and skill assessments required for competency as a TCT, telepresenter and/ or store and forward imager and back-up including VA required training and any VA training mandated for TCT, telepresenter, teleretinal imagers. TCTs, telepresenters, and store and forward imagers shall be responsible for maintaining imager and/or other required competencies or appropriate certifications. TCTs, telepresenters, and store and forward imagers and back-ups shall be expected to demonstrate competency on the function and use of the telehealth equipment including digital retinal and dermatology imaging system, teleaudiology hardware and software. VA will provide training to TCTs, telepresenters, store and forward imagers and back-ups and document competency.

Training: Contractor’s TCTs, RNs, LPNs, LIPs and support staff providing telehealth services shall complete all telehealth required training and skill assessments both virtual and in-person. Contractor’s telehealth staff shall be required to attend conference calls intended to support and maximize delivery of care as required by the VA.

Telehealth Clinical Technician (TCT) Position Responsibilities: TCT manages the telehealth services offered by the clinic (i.e., presenting, equipment management, training, imaging, audiology services, etc.) and is responsible for the provision of covered services to assigned and unassigned patients presenting for care. The contractor’s telehealth services shall include but are not limited to coordinating telehealth clinic set up, scheduling, equipment management, provision of data on request, attendance on VA or Network Telehealth Team calls, maintaining records required for quality control processes, and participating in performance improvement activities.