PWS_ 36C24821R0017_ CBOC Services.pdf

36C24821R0017

Non-VA Operated CBOC Services, St. Thomas, United States Virgin Islands

B.3 PERFORMANCE WORK SCHEDULE

1. GENERAL:

1.1. SERVICES REQUIRED: The Veterans Affairs Caribbean Healthcare System (VACHS), requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in the United States Virgin Islands (USVIs) of ST. Thomas and St.

John.

1.1.1. Primary Care Outpatient Clinic: offer both medical (physically on-site) and mental health care (either physically on-site or by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care (Community Based Outpatient Clinics)

CBOCs are required to provide both primary care and mental health services. Sites that do not provide both primary care and mental health services are classified as Other

Outpatient Services. Access to specialty care and Integrative Health is not provided on-site but may be available through referral or telehealth. A Primary Care CBOC often provides home-based primary care (HBPC) and home to the population it serves to meet the primary care and mental health needs of Veterans who have difficulty accessing clinic-based care. Primary care in VA includes both medical and mental health care services, as they are inseparable in providing personalized, proactive, patient-centered health care. Primary Care Requirement. A point of service is said to provide primary care services if the registers more than 500 primary care encounters within the primary care stop class within a given fiscal year. Mental Health Requirements. A point of service is said to provide mental health services if the site registers more than 500 mental health encounters within a single mental health clinic stop class within a given fiscal year. Mental health services may be provided using telehealth, if the workload at the point of service would not otherwise justify the presence of mental health providers.

Mental health services will be provided on-site, via Telehealth or by referral.

1.2. PLACE OF PERFORMANCE: The clinic locution must be centrally located in the USVIs of

St. Thomas with easy access to public transportation. The location should provide adequate parking and access to persons with disabilities.

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of VA Caribbean Healthcare System.

1.4. POLICY AND REGULATIONS: The contractor is required to meet the VHA performance, and quality criteria and standards including but not limited to access, satisfaction, prevention index, chronic disease index, 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. Compliance with mandated performance is required as a condition of the resultant contract. The contractor shall comply with all relevant

VA policies and procedures, including those related to quality, patient safety, and performance including but not limited to the following:

1.4.1. Title 21 C.F.R 900.12(c), “Mammography Quality Standards” http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf

1.4.2. Title 21 CFR, “Food and Drugs” Section 1300-end”.

https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html

1.4.3. 38 USC. Section 7332, regarding a timely special consent for any medical treatment for drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus (HIV), or sickle cell anemia, to a Veteran with health insurance. A special consent from the Veteran is needed to allow VA to release bills and medical records associated with the treatment. http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-

2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html

1.4.4. 42 CFR Part 482, “Conditions of Participation” http://www.gpo.gov/fdsys/pkg/CFR-

2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf

1.4.5. 42 CFR 493.15(b), “Laboratories Performing Waived Tests” http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf

1.4.6. Clinical Laboratory Improvement Amendments (CLIA):

http://cms.hhs.gov/Regulations-and-

Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp

1.4.7. VHA Directive 2006-041, “Veterans Health Care Service Standards” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.4.8. VA Directive 1663, “Health Care Resources Contracting – Buying” https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.9. VA Directive 6371, “Destruction of Temporary Paper Records” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2The

1.4.10. VHA Record Control Schedule 10-1 http://www1.va.gov/vhapublications/rcs10/rcs10-

1.pdf

1.4.11. "Patient Medical Records-VA" (24VA19). 24VA19 http://vaww.vhaco.va.gov/privacy/SystemofRecords.htm.

1.4.12. VHA Handbook 1101.11(3), “Coordinated Care for Traveling Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

1.4.13. VHA Directive 2007-033, "Telephone Service for Clinical Care," https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605

1.4.14. VHA Directive 2008-015, “Public Access to Automated External Defibrillators

(AEDs): Deployment, Training, and Policies for use in VHA Facilities” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1665

1.4.15. VHA Directive 1088, “Communicating Test Results to Providers and Patients” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.16. VHA Directive 2009-038 “VHA National Dual Care Policy” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058Tge

1.4.17. VHA Directive 1033, “Anticoagulation Therapy Management” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129

1.4.18. VHA Directive 1108.08, “VHA Formulary Management Process” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291

1.4.19. VHA Directive 1230 “Outpatient Scheduling Processes and Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

1.4.20. VHA Directive 2010-033, “Military Sexual Trauma (MST) Programming,” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2272

1.4.21. VHA Directive 2010-053, “Patient Record Flags”.

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341 https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2 http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf http://vaww.vhaco.va.gov/privacy/SystemofRecords.htm https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1665 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2272 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341

1.4.22. VHA Directive 2011-012, “Medication Reconciliation”

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2390

1.4.23. VHA Directive 2011-020, “Automated Safety Incident Surveillance and Tracking

System (ASISTS)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407

1.4.24. VHA Directive 1199, “Reporting Cases of Abuse and Neglect”, https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5624

1.4.25. VHA Directive 2012-026, “Sexual Assaults and Other Defined Public Safety

Incidents in VHA” The directive specifically includes contracted sites of care and defines procedures specific to patient disruptive behavior.

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797

1.4.26. VA Handbook 0730, “Security and Law Enforcement”

https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=93&FType=2

1.4.27. VHA Handbook 1003.4, "VHA Patient Advocacy Program,"

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970

1.4.28. VHA Handbook 1004.07, “Financial Relationships between Health Care

Professionals and Industry” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

1.4.29. VHA Handbook 1006.02, “VHA Site Classifications and Definitions” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970

1.4.30. VHA Handbook 1050.01, “VHA National Patient Safety Improvement Handbook” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389

1.4.31. VHA Handbook 1100.17, “National Practitioner Data Bank Reports”-https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.32. VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364The

1.4.33. Querying State Prescription Drug Monitoring Programs (PDMP) http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283

1.4.34. Amendment to VHA Handbook 1100.18, “” Reporting and Responding to State

Licensing Boards” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962The

1.4.35. VHA Handbook 1100.19, “Credentialing and Privileging” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.36. VHA Directive 1306, “Querying State Prescription Drug Monitoring Programs

(PDMP)”

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283

1.4.37. VHA Handbook 1101.10, “Patient Aligned Care Team (PACT)” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977

1.4.38. VHA Handbook 1105.0, “Mammography Program Procedures and Standards” http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2411

1.4.39. VHA Handbook 1106.01, “Pathology and Laboratory Medicine Service (P&LMS)

Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3169

1.4.40. VHA Handbook 1108.05, “Outpatient Pharmacy Services”

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209

1.4.41. VHA Directive 1120.02 Health Promotion and Disease Prevention Core Program

Requirements http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2390 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5624 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797 https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=93&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977 http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2411 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3169 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5965

1.4.42. VHA Handbook, “1330.01 Health Care Services for Women Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332

1.4.43. VHA Handbook 1160.01, “Uniform Mental Health Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762

1.4.44. VHA Handbook 5005, Part 2, Appendix G15, “Licensed Pharmacist Qualification

Standards” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2

1.4.45. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htmThe

1.4.46. Title 38 CFR §17.107, “VA Response to Disruptive Behavior of Patients” (2010) www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdfThe

1.4.47. Title 38 CFR § 1.203, “Information to be reported to VA Police” (2003) https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-

1.4.48. “Guidelines for Preventing Workplace Violence for Health Care and Social Service

Workers,” Occupational Safety and Health Administration (OSHA) OSHA 3148-

01R 2004) https://www.osha.gov/Publications/osha3148.pdf

1.4.49. “Violence: Occupational Hazards in Hospitals, National Institute for Occupational

Safety and Health” (NIOSH) NIOSH 2002-101, April 2002.

http://www.cdc.gov/niosh/docs/2002-101/default.html

1.4.50. VA Assistant Secretary OSP Memo, Clarification of Policy for Sexual Assault

Reporting, June 2011.

http://www.diversity.va.gov/products/files/DAW/v10i05.docx

1.4.51. VHA Directive 1231 Outpatient Clinic Practice Management https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296

1.4.52. Access to VHA Clinical Programs for Veterans Participating in State-Approved

Marijuana Programs https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711The

1.4.53. VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary

Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

1.4.54. Provision of Medical Statements and Completion of Forms by VA Health Care

Providers https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300

1.4.55. Seasonal Influenza Prevention Program for VHA Health Care Personnel https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.56. Center Memorandum 116A-18-01 Management of Suicidal Behavior

1.4.57. VHA Directive 2008-052, Smoke-Free Policy for VA Health Care Facilities

1.5. DEFINITIONS/ACRONYMS

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACGME: Accreditation Council for Graduate Medical Education

1.5.4. ACOS: Associate Chief of Staff

1.5.5. ACPE: American Council on Pharmaceutical Education

1.5.6. ACO: Administrative Contracting Officer

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5965 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762 http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm http://www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdf https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203 https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203 https://www.osha.gov/Publications/osha3148.pdf http://www.cdc.gov/niosh/docs/2002-101/default.html http://www.diversity.va.gov/products/files/DAW/v10i05.docx https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300 https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.5.7. ADE: Adverse Drug events

1.5.8. AED: Automatic External Defibrillators

1.5.9. AIS: Automated Information Security

1.5.10. ANA: American Nurses Association

1.5.11. AOA: American Osteopathic Association

1.5.12. ARRT: American Registry of Radiologic Technology

1.5.13. ASC: Ambulatory Surgery Clinic

1.5.14. 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.

1.5.15. BAA: Business Associate Agreement

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

1.5.17. BLS: Basic Life Support

1.5.18. BOS: Bureau of Osteopathic Specialists

1.5.19. CAHEA: Committee on Allied Health Education and Accreditation

1.5.20. CAP: College of American Pathologists

1.5.21. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.22. CBO: VA Central Billing Office

1.5.23. CDC: Centers for Disease Control and Prevention

1.5.24. CEU: Certified Education Unit

1.5.25. CLIA: Clinical Laboratory Improvement Amendments

1.5.26. CME: Continuing Medical Education

1.5.27. CMS: Center for Medicare and Medicaid Services

1.5.28. CO: Contracting Officer

1.5.29. COPD: Chronic Obstructive Pulmonary Disease

1.5.30. COR: Contracting Officer’s Representative

1.5.31. COS: Chief of Staff

1.5.32. CPA: Collaborative Practice Agreement

1.5.33. CPS: Clinical Pharmacy Specialist

1.5.34. CPT: Current Procedural Terminology

1.5.35. CRNP: Certified Registered Nurse Practitioners

1.5.36. CSWE: The Council on Social Work Education. The CSWE website is http://www.cswe.org/.

1.5.37. CPARS: Contractor Performance Assessment Reporting Systems

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

1.5.39. CVT: Clinical Video Telehealth

1.5.40. DICOM: Digital Image and Communications in Medicine

1.5.41. DIGMA: Drop-in Group Medical Appointment

1.5.42. DRG: Diagnostic Related Group

1.5.43. DSS: Decision Support System

1.5.44. ECC: Extended Care Center

1.5.45. 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 http://www.cswe.org/

“enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

1.5.46. EPRP: External Peer Review Program

1.5.47. FDA: Food and Drug Administration

1.5.48. FSMB: Federation of State Medical Boards

1.5.49. FTE: Fulltime Equivalent

1.5.50. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least five (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.

1.5.51. HHS: Department of Health and Human Services

1.5.52. HCFA: Healthcare Financing Administration

1.5.53. 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.

1.5.54. HT: Home Telehealth

1.5.55. HUD-VASH: Housing and Urban Development-VA supported housing.

1.5.56. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.5.57. INR: International Normalized Ratio

1.5.58. ISO: Information Security Officer

1.5.59. LIP: Licensed Independent Practitioner

1.5.60. MCCR; Medical Care Cost Recovery

1.5.61. Mental Health Services: per VHA Handbook 1160.01 is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of both substance use disorders and other mental disorders.

1.5.62. VACHS: Veterans Administration Caribbean Healthcare System

General mental health services include:

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

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education 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).

Specialty mental health services include:

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

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

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

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) SN: Master of Science in Nursing

1.5.63. NCCPA: National Commission on Certification of Physician Assistant

1.5.64. NLN: National League for Nursing

1.5.65. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing

Improvement in Cardiac Surgical Program

1.5.66. OTC: Over the Counter

1.5.67. PA: Physician Assistant

1.5.68. PACS: Picture Archiving and Communications System

1.5.69. 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.

1.5.70. Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.71. PCMH: Patient-Centered Medical Home

1.5.72. PCMM: Primary Care Management Module- a software program used to track Primary

Care Clinic Veteran rosters.

1.5.73. PCP: Primary Care Provider

1.5.74. Phar D.: Doctor of Pharmacy

1.5.75. POC: Point of Care Testing

1.5.76. Primary Care Visit: an episode of care furnished in a clinic 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.

1.5.77. PCMHI: Primary Care-Mental Health Integration

1.5.78. PWS: Performance Work Statement

1.5.79. QASP: Quality Assurance Surveillance Plan

1.5.80. RME: Reusable Medical Equipment

1.5.81. SOP (clinical): Scope of Practice

1.5.82. Self-Referral: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.83. SMA: Shared Medical Appointment

1.5.84. SPD: Sterile Processing Division

1.5.85. SPE: Senior Procurement Executive

1.5.86. Specialty Care Visit: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care and is only provided through a referral.” These services are generally divided into two sub-categories:

medicine specialties and surgery specialties. 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.

1.5.87. Support Staff: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of Registered Nurses (RNs) , license Practitioner Nurses

(LPNs) , Medical Assistants, Health Technicians, and Medical Clerks in the clinic.

1.5.88. TJC: The Joint Commission

1.5.89. TIU: Text Integration Utility

1.5.90. TCT: Telehealth Clinical Technicians

1.5.91. VA: Veterans Affairs

1.5.92. VAMC: Veterans Affairs Medical Center

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

1.5.94. VHA: Veterans Health Administration

1.5.95. VISTA: Veterans Health Information Systems and Technology Architecture

2. STAFFING AND QUALIFICATONS

2.1. MINIMUM PATIENT ALIGNED CARE TEAM (PACT) STAFFING REQUIREMENTS:

The Contractor shall provide PACT staffing in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract, modeled after the Primary Care Medical Home. The Contractor shall provide a sufficient number of primary care providers so that each primary care provider has a caseload ratio that meets the demand to meet VA standards. Panel size shall be determined by the

Contractor, based on available staffing, productivity, efficiency, access and clinical outcomes. The Current standards are 1200 active patients per full time physician and 900 active patients per full time midlevel provider The Contractor may use as reference the VA guidelines in accordance with PCMM Handbook

1101.02. The PACT model requires an assigned RN Care Coordinator, a Clinical Associate and a Clerical

Associate, for each PACT teamlet. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must 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. Total

Estimated Patients enrolled/assigned to site 890.

2.2. 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 and/or Family Practice. Contractor’s Physicians performing under this contract shall be board certified or board eligible by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff does not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar day. May also be credentialed and privileged as a PCP. (if so, authorization for prescriptive authority is required). Position Responsibilities: Serve as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care of this site.

2.3. PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES) All primary care teamlet staffing shall be provided by the Contractor.

2.3.1. TEAMLET MEMBER ONE (1): Primary Care Provider (PCP): The PACT model requires an assigned PCP, an assigned RN Care Coordinator, a Clinical Associate and a

Clerical Associate for each PACH Teamlet. The Contractor shall propose quantity of

FTE (s) to meet the expected PACT Teamlet composition. The contractor shall propose mix of PCP from the options below.

2.3.1.1. Option one (1): Physician (MD) Qualification: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family

Practice Physicians performing under this contract shall be board certified or board eligible by the ABMS in Internal Medicine and/or Family Practice or the BOS in

Internal Medicine and/or Family Practice. Physician shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute, acceptable personnel within five (5) calendar days. Position Responsibilities:

Responsible for the of covered services to enrolled, and unassigned patients presenting for care, providing health care, providing health are 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 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 od critical team processes. Ensuring the patient has same-say access for face-to-face and telephone 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.

2.3.1.2. OPTION TWO (2): Certified Registered Nurse Practitioner (CRNP)

Qualifications: CRNP’s (including subcontractors) must have an Master of Science

(MSN) and National League for Nursing (NLN) accredited nursing program and have a American Nurses Association (ANA) certification as a Nurse Practitioner in either Adult Health or Family Practice. Authorization for prescriptive authority is required. Three (3) years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred).

Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state of the Outpatient Site of Care

(i.e. CBOC); Reference VA Handbook 5005, Appendix G6.

http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2. Position

Responsibilities: Responsible for the provision of covered services to enrolled 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 telephone 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.

http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=763&FType=2.

Position Responsibilities: Responsible for the provision of covered services to enrolled 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 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2 http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=763&FType=2 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 telephone 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.

2.3.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio

Performance Standard: Current standard is 1.0 FTE RN Case Manager (RNCM) per 1.0 FTE PCP. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2.

Qualifications: Graduate of a school of professional nursing approved by the appropriate

State – accrediting agency and 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 of the Outpatient Site of Care (i.e. CBOC). Position Responsibilities:

Responsible for the provision of covered services to enrolled 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 telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, 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 CPRS for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face, and telephone 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.

2.3.3. TEAMLET MEMBER THREE (3): CLINICAL ASSOCIATE FTE Ratio

Performance Standard Current standards is 1.0 FTE clinical associate per 1.0 FTE

PCP. Contractor to propose the mix of Clinical Associate from the options below.

2.3.3.1. OPTION ONE (1): Licensed Practical Nurse Qualifications: VA HANDBOOK

5005.3 PART II APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL

NURSE QUALIFICATION STANDARD

http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e.

CBOC)Position Responsibilities: Responsible for the provision of covered services to enrolled 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.

2.3.3.2. OPTION TWO (2): Licensed Vocational Nurse (LVN); Qualifications: VA

HANDBOOK 5003/3 PART II APPENDIX G13 LICENSED PRACTICAL OR

VOCATIONAL NURSE QUALIFICATION STANDARD

http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf

Current, full, active, and unrestricted license in the state of the Outpatient Site of

Care (i.e. CBOC) Position Responsibilities: Responsible for the provision of covered services to enrolled 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 http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf http://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005.pdf 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.

2.3.3.3. OPTION 3: Medical Assistant (MA) Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of

Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health

Education Schools (ABEHS), or by any accrediting agency recognized by the United

States Department of Education or a current and active Certified Medical Assistant

(CMA) or Registered Medical Assistant (RMA) from The American Association of

Medical Assistants (AAMA) or the American Medical Technologist (AMT). Other credentials such as completion of a medical services training program of the Armed

Forces of the United States may be accepted based on the Chief of Staff determination. Position Responsibilities: Responsible for the provision of covered services to enrolled 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 nor 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, polices, 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.

2.3.3.4. OPTION FOUR (4): Health Care Technician (HCT) as part of PACT Teamlet not for other Telehealth: Qualifications: Completion of an approved medical assistant training program accredited by the Commission on Accreditation of Allied

Health Education Programs or the Accrediting Bureau of Health Education Schools

(ABHES), or by any accrediting agency recognized by the United States Department of Education or a current and active Certified Medical Assistant or Registered

Medical Assistant from The American Association of Medical Assistants (AAMA) or the American Medical Technologist (AMT) . Other credential such as completion of a medical services training program of the Armed Forces of the United Stated may be accepted based on Chief of Staff determination. Position Responsibilities:

Responsible for the provision of covered services to enrolled and unassigned patients presenting 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 ro develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination room 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 healthcare providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical area.

2.3.4. TEAMLET MEMBER 4: CLERICAL ASSOCIATE: FTE Ratio Performance

Standard: Current standard is 1.0 FTE clerical associate per 1.0 FTE PCP.

Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations .Position Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing clerical support and administrative functions to PACT staff, collaborating with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans, providing guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA, and coordinating care for patients assigned to the PACT.

2.4. DISCIPLINES SPECIFIC PACT TEAM MEMBERS (REQURIED FOR ALL SITES):

Discipline-specific team members are designate in PCMM for one (1) 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.

2.4.1. DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) –

PACT: FTE Ratio Performance Standard: 1.0 FTE per 3 PACTs. Qualifications:

Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. CPS who is a licensed pharmacist who is a graduate of an Accreditation Council for Pharmacy Education (ACPE) accredited College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or a Doctor of

Pharmacy (Phar.D.) degree and has at least 1 year of pharmacy equivalent experience at the next lower level at time of employment. In addition to the requirements listed above, the CPS must meet licensed qualification standards to include a graduate of a degree program in pharmacy from an approved college or university and have post-graduate experience performing chronic disease state and medication management services (e.g., post-graduate residency, direct patient care under collaborative practice agreement or similar equivalent experience). The CPS has duties and responsibilities as defined in VHA Handbook 5005, Part 2, Appendix G15, Licensed Pharmacist

Qualification Standards. Current, full, active, and unrestricted license in the state of the

Outpatient Site of Care (i.e. CBOC) http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2 . Authorization for a VA scope of practice is required, in accordance with VHA Directives 2008-043 and

2009-014 or subsequent policy release, and must adhere to pharmacy practice acts within that state. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Position

Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care. Clinical Pharmacy Specialists shall be scheduled to sufficiently provide the needs of enrolled patients functioning in the capacity of a mid-level provider (under SOP or collaborative practice agreement) as their primary duty is to assist providers with comprehensive medication management (anticoagulation and chronic primary care disease management).

http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2 http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1732.

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1852

2.4.2. DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-

COAGULATION: FTE Ratio Performance Standard: 1.0 FTE per 5 PACTs.

Qualifications: Required education and experience demonstrating skills and abilities to perform duties ensuring smooth site operations. CPS who is a licensed pharmacist who is a graduate of an Accreditation Council for Pharmacy Education (ACPE) accredited

College or School of Pharmacy with a baccalaureate degree in pharmacy (BS Pharmacy) and/or a Doctor of Pharmacy (Phar.D.) degree and has at least 1 year of pharmacy equivalent experience at the next lower level at the time of employment. In addition to the requirements listed above, the CPS. Pharmacists must meet licensed qualification standards to include a graduate of a degree program in pharmacy from an approved college or university and have post-graduate experience performing chronic disease state and medication management services (e.g., post-graduate residency, direct patient care under collaborative practice agreement or similar equivalent experience). The degree program must have been approved by the ACPE. Current, full, active, and unrestricted license in the state of the Outpatient Site of Care (i.e. CBOC). The CPS has duties and responsibilities as defined in VHA Handbook 5005, Part 2, Appendix G15, Licensed

Pharmacist Qualification Standards http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2 . Authorization for a VA scope of practice is required, in accordance with VHA Directives 2008-043 and

2009-014 or subsequent policy release, and must adhere to pharmacy practice acts within that state. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute…