PWS _QASP Molokai CBOC_.docx

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. SERVICES REQUIRED: The VA Pacific Islands Healthcare System (VAPIHCS) requires the following services to be provided in a private office or clinic environment to Veterans, primarily residing in Molokai, HI: Site of care is (5V21 459QB).

[X] Other Outpatient Clinical Services Site of Care (Less than 500 encounters registered in primary care and mental health stop class within any given fiscal year or does not include MH Services) Clinical services are provided to remote areas through a Telehealth clinic or other arrangement. If any other services are provided in this venue (external to a VA clinic or facility), they must be associated with, attached to, and coordinated by a health care delivery site located in a clinic or facility.

1.2. PLACE OF PERFORMANCE: on the island of Molokai, HI

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of VAPIHCS, 459 Patterson Road Honolulu, HI 96819.

1.4. POLICY AND REGULATIONS: The Contractor is required to meet VHA performance and quality criteria and standards including, but not limited to, access, customer 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 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/vhapublications/ or at http://www.va.gov/vapubs/. 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/Resources.asp.

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. ACPE: American Council on Pharmaceutical Education

1.5.5. ACO: Administrative Contracting Officer

1.5.6. ADE: adverse drug events

1.5.7. AED: Automatic External Defibrillator

1.5.8. AIS: Automated Information Security

1.5.9. ANA: American Nurses Association

1.5.10. AOA: American Osteopathic Association

1.5.11. ARRT: American Registry of Radiologic Technology

1.5.12. ASC: Ambulatory Surgery Clinic

1.5.13. 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.

1.5.14. BAA: Business Associate Agreement

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

1.5.16. BLS: Basic Life Support

1.5.17. BOS: Bureau of Osteopathic Specialists

1.5.18. CAHEA: Committee on Allied Health Education and Accreditation

1.5.19. CAP: College of American Pathologists

1.5.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.21. CBO: VA Central Billing Office.

1.5.22. CDC: Centers for Disease Control and Prevention

1.5.23. CEU: Certified Education Unit

1.5.24. CLIA: Clinical Laboratory Improvement Amendments

1.5.25. CME: Continuing Medical Education

1.5.26. CMS: Center for Medicare and Medicaid Services

1.5.27. CO: Contracting Officer

1.5.28. COPD: chronic obstructive pulmonary disease

1.5.29. COR: Contracting Officer’s Representative

1.5.30. COS: Chief of Staff

1.5.31. CPA: Collaborative Practice Agreement

1.5.32. CPS: Clinical Pharmacy Specialist

1.5.33. CPT: Current Procedural Terminology

1.5.34. CRNP: Certified Registered Nurse Practitioners

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

1.5.36. CPARS: Contractor Performance Assessment Reporting System

1.5.37. CVT: Clinical Video Telehealth

1.5.38. DICOM: Digital Image and Communication in Medicine

1.5.39. DIGMA: Drop in Group Medical Appointment

1.5.40. DRG: Diagnostic Related Group

1.5.41. DSS: Decision Support System

1.5.42. ECC Extended Care Center

1.5.43. 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.

1.5.44. EPRP: External Peer Review Program

1.5.45. FDA: Food and Drug Administration

1.5.46. FSMB: Federation of State Medical Boards

1.5.47. 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.

1.5.48. HHS: Department of Health and Human Services

1.5.49. HCFA: HealthCare Financing Administration

1.5.50. 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.

1.5.51. HT: Home Telehealth

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

1.5.53. ICD 10: International Classification of Diseases 10th edition

1.5.54. INR: International Normalized Ratio

1.5.55. ISO: Information Security Officer

1.5.56. LIP: licensed independent practitioner

1.5.57. MCCR: Medical Care Cost Recovery

1.5.58. 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.

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) Specialty substance abuse treatment services.

1.5.59. MQSA: Mammography Quality Standards Act

1.5.60. MSN: Master of Science in Nursing

1.5.61. NCCPA: National Commission on Certification of Physician Assistants

1.5.62. NLN: National League for Nursing

1.5.63. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

1.5.64. OTC: Over the Counter

1.5.65. PA: Physician Assistant

1.5.66. PACS: Picture Archiving and Communications System

1.5.67. 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.

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

1.5.69. PCMH: Patient-Centered Medical Home

1.5.70. PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

1.5.71. PCP: Primary Care Provider

1.5.72. Phar.D.: Doctor of Pharmacy

1.5.73. POC: Point of Care Testing

1.5.74. 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.

1.5.75. PCMHI: Primary Care-Mental Health Integration

1.5.76. PWS: Performance Work Statement

1.5.77. QAPI: Quality Assessment and Performance Improvement

1.5.78. QASP: Quality Assurance Surveillance Plan

1.5.79. RME: reusable medical equipment

1.5.80. SOP (Clinical): Scope of Practice

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

1.5.82. SFT: Store and Forward Telehealth

1.5.83. SMA: Shared Medical Appointments

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 RNs, 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. VA EHR: VA electronic health record

1.5.93. VAMC: Veterans Affairs Medical Center

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

1.5.95. VHA: Veterans Health Administration

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), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed Clinical Social Workers (LCSWs), Registered Dietician/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 in ratios to Primary Care Providers of 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 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: 300.

2.2. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES): FTE Ratio Performance Standard: 0.05 FTE per PACT Responsible Party: Shall be provided by the VAPIHCS.

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

2.3.1. 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 midlevel provider. The VAPIHCS will provide the teamlet member 1. Teamlet member 1 will be a physician provided by VAPIHCS. The physician is a .95 FTE for the VAPIHCS but will only be on-site providing services at the clinic for 30 hours (.75 FTE) per week. The PCP will be off-site on VA National work travel the remaining time. When the physician is sick, all appointments are cancelled for the day. When a physician is on leave, another provider from VAPIHCS Oahu will fly to Molokai island to cover the clinic days

OPTION 1: Physician (MD) (provided by VAPIHCS): The physician will be provided by the VAPIHCS.

2.3.2. TEAMLET MEMBER 2 (provided by VAPIHCS): Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard: 1 FTE. Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2. The Teamlet member 2 will be provided by the VAPIHCS. When the RN is sick on a non-clinic day, all appointments are cancelled. A non-clinic day is defined as a day in which the PCP is not on-site and where veterans have appointments with the RN. When the RN is sick on a clinic day, the Teamlet Member 1 will complete the initial check-in and vitals for the patients.RIMARY CARE STAFFING – CLINICAL ASSOCIATE [X] Mandatory for all sites

2.3.3. TEAMLET MEMBER 3: CLINICAL ASSOCIATE (to be provided by VAPIHCS) FTE Ratio Performance Standard: 1 FTE to be provided by the VAPIHCS.

OPTION 1: Licensed Practical Nurse (LPN): 1 FTE to be provided by VAPIHCS.

PRIMARY CARE STAFFING – CLERICAL ASSOCIATE [X] Mandatory for all sites

2.3.4. TEAMLET MEMBER 4: ADMINISTRATIVE ASSOCIATE: FTE Ratio Performance Standard: 1 FTE (to be provided by Contractor). 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. DISCIPLINE SPECIFIC PACT TEAM MEMBERS (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 staffing will not be provided by the Contractor.

2.4.1. DISCIPLINE SPECIFIC 1: CLINICAL PHARMACY SPECIALIST (CPS) – PACT: FTE Ratio Performance Standard: 1.0 FTE per 3 PACTs Qualifications: Will be provided by the VAPIHCS via telehealth. STA

2.4.2. DISCIPLINE SPECIFIC 2: CLINICAL PHARMACY SPECIALIST (CPS) ANTI-COAGULATION: FTE Ratio Performance Standard: 1.0 FTE per 5 PACTs. Qualifications: Will be provided by the VAPIHCS via telehealth. STAEXPANDED PACT STAFD PACT STAF

2.4.3. DISCIPLINE SPECIFIC 3: LICENSED CLINICAL SOCIAL WORKER (this position provides general/medical social work services): FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Qualifications: Will be provided by the VAPIHCS via telehealth and on-site. The social worker typically flies into Molokai for appointments on an as needed basis which has historically been one to two times per month.

2.4.4. DISCIPLINE SPECIFIC 4: REGISTERED DIETITIAN/NUTRITIONIST: FTE Ratio Performance Standard: 1 FTE per 5 PACTs. Qualifications: Will be provided by the VAPIHCS via telehealth.

2.4.5. DISCIPLINE SPECIFIC 5: PRIMARY CARE MENTAL HEALTH INTEGRATION (PC-MHI):

FTE Ratio Performance Standard - 0.05 FTE to be provided by the VAPIHCS through a psychologist. The psychologist flies to Molokai for clinic days at least once a month and is on-site for one business day.

2.5. SPECIALTY CARE STAFFING: Specialty care services are not offered at this CBOC. For speciality care services not provided for at the CBOC, the VAPIHCS will refer patients either for local services from private providers (reimbursed through TriWest) or refer patients to Oahu, HI, where the clinic can provide a wide range of services. Referral to the island of Oahu, HI requires the veteran to travel by plane.

2.6 ANCILLARY SUPPORT SERVICES STAFFING: Ancillary support services are not provided for at this CBOC. Radiology and/or phlebotomy services will be provided by local community providers or by referral for a trip to the VA Clinic on Oahu, HI.

2.7 GENERAL AND SPECIALTY MENTAL HEALTH STAFFING: General and mental health staffing will be provided by the VAPIHCS via telehealth and on-site. A VAPIHCS psychologist flies to the island of Molokai at least once a month (1 day trip) to provide services. Any other services that are not provided on site is accomplished through telehealth appointments.

2.7.1 Suicide Prevention Coordinator (SPC): The VA performance standard for sites with 10,000 patients or more is maintaining a Suicide Prevention Coordinator (SPC) with a full-time commitment to suicide prevention activities. In smaller sites serving less than 10,000, this may be a collateral assignment. Will be provided by the VAPIHCS.

2.7.2 Homeless Outreach Specialist: To ensure the availability of outreach and referral services to homeless Veterans, all sites with 10,000 patients or more must designate at least one outreach specialist, usually a clinical social worker, to provide services to homeless Veterans. NOTE: In smaller facilities, this may be a collateral assignment. Will be provided by the VAPIHCS.

2.8 TELEHEALTH SERVICES CLINICAL STAFF: Telehealth Clinical Technician (TCT) FTE Ratio performance standard 1.0 FTE Telehealth Clinical Technician (TCT) per estimated 5,000 patients at clinic, with a trained back-up (e.g., another TCT or a member of the PACT Teamlet (LIP, RNCM, or LPN), depending on size of clinic/clinic workload/clinic telehealth services). All staff providing telehealth related services (primary TCT(s) and back-ups) must be trained in teleretinal imaging, teledermatology, teleaudiology, tele-mental health, teleprimary care etc. The qualifications, competencies, and position responsibilities noted below apply to primary TCT(s) and back-ups. The Telepresenter can be any clinically trained person assisting the provider in the presentation of the Veteran using video-conferencing. Depending on the skills needed for the encounter, the Telepresenter can be a licensed independent provider (LIP), Registered Nurse, LPN, or Telehealth Clinical Technician (TCT). Telepresenters can also serve as TCT back-ups. The number and discipline of Contractor’s staff trained to function as a TCT back-up or Telepresenter will be based on the volume and type of telehealth services provided. The VAPIHCS RN (PACT Teamlet Member #2) will provide TCT and telepresenter services. The Administrative Associate (Teamlet Member #4) shall have the qualifications listed below to be a TCT.

2.8.1 Qualifications: All staff providing telehealth related services into the clinic shall be appropriately credentialed and; where necessary, privileged. All contractor staff who support and manage telehealth services must be working within permitted licensure and scope of practice. Where non-licensed staff is supporting telehealth services the Contractor’s licensed staff must provide appropriate clinical supervision.

2.8.2 Competency – TCTs, Telepresenters, Store and Forward Imagers et al. and their back-ups, shall be expected to provide clinical care in compliance with established clinical protocol. Additional guidelines governing operations will be utilized and provided to Contractor by VA. TCTs, Telepresenters, Store and Forward Imagers and back-ups shall be expected to successfully complete training programs required for certification 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 certification. 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.

2.8.3 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 enrolled 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. The TCT shall be responsible for conveyance of clinically appropriate in-person interaction or on-site observations (e.g., assisting with hearing aid fittings, detection of alcohol use, etc.) with the Veteran patient to the telehealth provider. The TCT shall be responsible for gathering and transmitting telehealth images, sounds, data and all other supporting data to the assigned VA providers or reading centers within time lines established by policy. The TCT shall provide technology education to patients including but not limited to: review of acquired data or images for anatomic and general findings, review of photos, and provision of VA approved handouts. The TCT shall communicate regularly with the Facility Telehealth Coordinator (FTC) to work out any process issues, equipment needs/problems, data collection and any other logistical issues.

2.8.4 Telepresenter Position Responsibilities: Include, but are not limited to the following: Assist the primary care or specialty care provider with the Veteran physical exam as needed, provide Veteran education, documentation and assistance with workload capture for the completion of the visit, per scope of practice and manage required screenings and complete clinical reminders, documentation, scheduling and opening and closing the encounter.

2.9 LICENSE AND ACCREDITATION: The Contractor is not required to provide any physician(s) or licensed providers. The qualifications below pertain only to the Teamlet Member #4, if applicable.

2.9.1 Technical Proficiency/Board Certification: Personnel shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently.

2.9.2 The Contractor must ensure that all individuals who provide services and/or supervise services at the Contractor’s Outpatient Site of Care, including individuals furnishing services under contract are qualified to provide or supervise such services.

2.9.3 Position specific competencies shall be completed for all staff annually.

2.9.4 Contractor staff qualifications, licenses, certifications and facility Joint Commission or equivalent accreditation must be maintained throughout the contract period of performance. If Contractor’s staff is not directly employed by the treating facility, documentation must be provided to the COR to ensure adequate certification. All actions required for maintaining certification must be kept up to date always. Documentation verifying current licenses, certifications and facility accreditation must be provided by the Contractor on an annual basis.

2.9.5 The Contractor is responsible for assuring that all persons, whether they be employees, agents, subcontractors, providers or anyone acting for or on behalf of the Contractor, are properly licensed always under the applicable state law and/or regulations of the provider’s license, and shall be subject to credentialing and privileging requirements by VA.

2.9.6 The Contractor shall not permit any employee to begin work at an Outpatient Site of Care prior to confirmation from the VA that the individual’s background investigation has been reviewed and released to the Office of Personnel Management (OPM), by the Security and Investigations Center (SIC).

2.10 CREDENTIALING AND PRIVILEGING: This section is N/A. The Contractor is not required to provide any physician(s) or licensed providers.

2.11 TRAINING (ACLS/BLS/VA MANDATORY): This section is N/A. The Contractor is not required to provide any physician(s) or licensed providers. The RN provided by the VAPIHCS is trained in BLS and the physician provided by the VAPIHCS is trained in ACLS.

2.12 ACCESS TO PATIENT INFORMATION: In performance of official duties, Contractor’s provider(s) have regular access to printed and electronic files containing sensitive data, which must be protected under the provisions of the Privacy Act of 1974 (5 U.S.C. 552a), and other applicable laws, Federal Regulations, Veterans Affairs statutes and policies. Contractor’s provider(s) are responsible for (1) protecting that data from unauthorized release or from loss, alteration, or unauthorized deletion and (2) following all applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in a computer access agreement which contract provider(s) signs.

2.12.1 Contractor staff shall complete required security training and sign a VA Computer Access Agreement prior to having access to the VA computer system. Security Training will be accomplished annually. Contractor staff shall select training modules for Privacy Training and Information Security Training. Upon completion of the training, please email or fax training certificates to the Contracting Officer when determined.

2.12.2 In addition, if providing clinical services, Contractor staff will attend VA EHR training prior to providing any patient care services. Contractor staff shall document patient care in the VA EHR to comply with all VA and equivalent TJC standards.

2.12.3 All contract personnel requiring access to PHI / Encrypted information must obtain a PIV card to ensure secure communications to and from the VA (e.g. Clinical staff, contract billing staff requiring patient lists with PHI/PII and Contract management personnel requiring PHI/PII information).

2.13 RULES OF BEHAVIOR FOR AUTOMATED INFORMATION SYSTEMS: Contractor staff having access to VA Information Systems are required to read and sign a Rules of Behavior statement which outlines rules of behavior related to VA Automated Information Systems. The COR will provide, through the facility ISO, the Rules of Behavior to The Contractor for the respective facility. A copy of the Rules of Behavior may also be found in the attachments section of this solicitation (Section D).

2.14 STANDARD INFECTION CONTROL MEASURES (PPD, IMMUNIZATIONS, ETC.): Contractor shall provide statement that all required infection control testing and immunizations for their personnel are current and that the contractor is compliant with OSHA regulations concerning occupational exposure to blood borne pathogens. All clinic staff are required to receive annual influenza vaccination. Staff unable or unwilling to be vaccinated are required to wear a face mask throughout the influenza season. The Contractor shall also notify the VA of any significant communicable disease exposures and the VA will also notify the contractor of the same, as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in Health Care Personnel (as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for infection control in their personnel. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.15 NATIONAL PROVIDER IDENTIFICATION (NPI): N/A as there are no provided physicians or clinical staff provided by the contractor.

2.16 PRESCRIPTION DRUG MONITORING PROGRAM: VAPIHCS providers will be registered with the state prescription drug monitoring program in accordance with VHA Directive 1306, Querying State Prescription Drug Monitoring Programs (PDMP).

2.17 CONFLICT OF INTEREST: The Contractor is responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or sub-Contractors who shall provide services. The Contractor must also provide relevant facts that show how its organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest in accordance with VA Directive1660.03. See attachment in Section D.

2.18 CITIZENSHIP RELATED REQUIREMENTS:

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

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

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

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

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

2.19 ANNUAL OFFICE OF INSPECTOR GENERAL (OIG) STATEMENT: In accordance with The Health Insurance Portability and Accountability Act (HIPAA) and the Balanced Budget Act (BBA) of 1977, the VA OIG has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

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

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

2.20 NON-PERSONAL SERVICES: The parties agree that The Contractor, contract staff, agents and sub-Contractors shall not be considered VA employees for any purpose. All individuals that provide services under this resultant contract and are not employees of the Contractor shall be regarded as subcontractors. The Contractor shall be responsible and accountable for the quality of care delivered by all its subcontractors. The Contractor shall be responsible for strict compliance of all contract terms and conditions without regard to who provides the service.

2.21 CONTRACT PERSONNEL: The Contractor shall be responsible for protecting all Contractor personnel furnishing services. To carry out this responsibility, The Contractor shall provide or certify that the following is provided for all contract staff providing services under the resultant contract:

Workers’ compensation Professional liability insurance Health examinations Income tax withholding, and Social security payments

2.22 INHERENTLY GOVERNMENTAL FUNCTIONS PROHIBITED. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees, selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

2.23 TORT: The Federal Tort Claims Act does not cover Contract staff. When a contract staff member has been identified as a provider in a tort claim, The Contractor’s staff member shall notify the Contractor’s legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s provider’s action or non-action is the responsibility of The Contractor and/or insurance carrier.

2.24 RYAN HAIGHT ACT: In support of providing Veterans access to comprehensive Telehealth services, including the provision of controlled substances in compliance with the Ryan Haight Act, Contractor shall apply for DEA registration if this option is available under state law. If DEA registration is not available under state law or the contractor is unable to obtain DEA registration, Contractor shall ensure a DEA registered provider can be present in the room with the patient during discussions of controlled substances prescriptions, at telehealth visits in which controlled substances are prescribed, if the patient has not had at least one prior in-person medical assessment with the prescribing provider.

3 HOURS OF OPERATION: The following outlines the required hours of operation:

3.1 BUSINESS HOURS: Monday through Friday, 8am-4:30pm. (RNCM, clinical associate, and administrative associate are present during these hours but Primary Care Provider only 3 days a week 0.75 FTE.). The Primary Care Provider is a .95 Government FTE but will only have open office hours for veterans .75 FTE. The Primary Care Provider travels for National VA work the remaining time.

3.2 EVENING HOURS: None

3.3 WEEKEND HOURS: None

3.4 FEDERAL HOLIDAYS: The following holidays are observed by the Department of Veterans Affairs: New Year’s Day, Washington’s Birthday, Martin Luther King’s Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving, Christmas,Any day specifically declared to be a national holiday. Services are not provided on any federal holidays.

4 CONTRACTOR RESPONSIBILITIES:

4.1 GENERAL: Contractor performing services under this contract shall provide administrative support services. The Contractor shall provide services solely dedicated to Veterans regardless of gender or age. Those patients needing specialty care shall be referred to VA.

4.2 REGISTRATION AND FINANCIAL ASSESSMENTS

4.2.1 REGISTRATION AND ENROLLMENT: Enrollment is the acceptance of an eligible Veteran into the VA Health Care System and assignment to an enrollment priority group. Not all Veterans are required to enroll in the VA health care system to receive health care services. Veterans enroll once into VA’s health care system and are continuously enrolled. Enrolled Veterans may seek care at any VA facility without being required or requested to reestablish eligibility for VA health care enrollment purposes. Veterans enrolled at one VA medical facility wishing to register for care at a VA medical facility where the patient has never before presented for care are not required to re-enroll.

This section does not apply. Veterans are enrolled and registered with the VAPIHCS and not with the contractor. The VAPIHCS provides all medical services. This requirement is only for medical space and administrative support (administrative associate) services.

4.2.2 FINANCIAL ASSESSMENTS: Financial assessment is the process known as a Means Test (MT) used by VA to assess a Veteran’s attributable income and assets. The MT determines a Veteran’s copayment responsibilities, assists in determining enrollment priority group assignment, and assists in evaluating requirements for determining beneficiary travel benefits. Not all Veterans are required to make copayments. The VA will provide this service.

4.2.3 The VAPIHCS shall provide at no additional cost approximately 2/month nurse-only visits and 2/month provider visits to Veterans who are not assigned for care at the Contractor’s outpatient site of care. These visits occur when an unassigned Veteran eligible for VA health care comes to the clinic seeking limited episodic care that cannot be provided by the Veterans assigned primary care provider/team at their preferred facility. The clinic shall ensure that the Veteran is triaged by an appropriate clinical staff member and that any basic care that can be provided by the nurse and/or provider is provided. Contractor shall provide care for traveling Veterans in accordance with VHA Handbook 1101.11(2), “Coordinated Care for Traveling Veterans” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

4.2.4 Telehealth support for Patients Not Assigned at the Outpatient Site of Care— At no additional cost the VAPIHCS shall provide approximately 2/month telehealth visits with the VAMC parent for Veterans who are not assigned for care at the Contractor’s outpatient site of care. These visits occur when an unassigned Veteran eligible for VA health care requires a telehealth visit with the parent VAMC (vs. requiring the patient traveling to the parent VAMC). The VAPIHCS and Contractor (TCT services) shall support the scheduling and visit management as per requirements and normal routine as defined in the PWS.

4.3 PATIENT HANDBOOK: The VA shall provide each patient with a copy of a patient handbook. The handbook shall include: Address of Contractor’s Outpatient Site of Care, names of providers, telephone number(s), and office hours; Description of services provided; Procedures for obtaining services; Procedures for obtaining emergency services; and notice to the patient that they have the right to grieve eligibility related decisions directly to the VA.

4.4 STANDARDS OF PRACTICE: Contractor shall be responsible for meeting or exceeding VA and TJC (or equivalent) standards.

4.5 DIRECT PATIENT CARE. The VAPIHCS will provide all direct patient care services.

4.5.1 PRIMARY CARE SERVICES: The VAPIHCS will provide all primary care services.

4.6.1.1 PRIMARY CARE TASKS SUMMARY: VA employs the patient centered medical home model of primary care, which in VA is called the Patient Aligned Care Team. VHA HANDBOOK 1101.10 “Patient Aligned Care Team” outlines complete requirements for the PACT model. The PACT delivery model is predicated on a foundation of delivering care that is patient centered, team based and continuously striving for improvement. Important components of the model include Patient Centered Care, Access, Care Management and Coordination as well as redesigning the team and work. Contractor shall provide all services in accordance with Handbook 1101.10. Information provided below summarizes the PACT model and Contractor requirements. See Handbook 1101.10 for more comprehensive information and requirements.

4.6.1.1.1 ENHANCE PATIENT CENTERED CARE (PCC): Establishing a patient centered practice environment and philosophy as a core principle of PACT requires a knowledgeable staff and an engaged, activated patient and family. Contractor staff shall be required to complete the following tasks to begin to implement PCC:

4.6.1.1.1.1 Engage the patient/family in self-management and personal goal setting

4.6.1.1.1.2 Provide education pertinent to care needs and document the provision of that education.

4.6.1.1.1.3 Provide support on site to enroll patients in MyHealtheVet & Secure Messaging

4.6.1.1.1.4 Ensure staff is trained in self-management techniques, motivational interviewing, shared decision making as made available by VA.

4.6.1.1.1.5 Clinic patients will be notified of all test results requiring action within 7 days and all test results not requiring action within 14 days. For critical results that represent an imminent danger to the patient, the Contractor shall notify the patient immediately.

4.6.1.1.2 ENHANCE ACCESS TO CARE: PACT strives for superb access to care in all venues including face to face and virtual care. Contractor is expected to enhance access to care by offering care in the following modalities:

4.6.1.1.2.1 Face to Face Visit Access: Provide same day access for patients and increase (or establish) group visits and shared medical appointments

4.6.1.1.2.2 Virtual Access- the contractor shall provide the following virtual access:

4.6.1.1.2.2.1 Telephones: Phones should be answered by a “live” person with a focus on achieving first call resolution. First call resolution is taking care of the Veteran’s issue/request during that call. This approach requires thoughtful planning and strategy

4.6.1.1.2.2.2 MyHealtheVet (MHV): Provide support to enroll Veterans into (MHV) to include full authentication for use of premium services (such as secure messaging).

4.6.1.1.2.2.3 Secure Messaging (SM): Encourage & educate patients to use SM as a non-synchronous mode of communication; establish SM as a communication method in clinic and increase Veteran participation in SM.

4.6.1.1.2.3 Telemedicine & Telehealth:

4.6.1.1.2.3.1 Improve access to scarce medical services via telemedicine

4.6.1.1.2.3.2 Increase Veteran enrollment in telehealth modalities

4.6.1.1.3 ENHANCE CARE MANAGEMENT & COORDINATION OF CARE: Improving systems and processes associated with critical patient transitions, managing populations of patients and patients at high risk has proven to have a positive impact on quality, patient satisfaction and utilization of high cost services such as acute inpatient admissions, skilled nursing facility stays, and emergency department visits. Clinic staff shall take the following actions to achieve improvements:

4.6.1.1.3.1 Improve Critical Transitions Processes: Inpatient to Outpatient: develop systems to identify admitted primary care patients; provide follow up care either by face to face visit or telephone visit within 2 days’ post discharge and document the follow up care in the VA EHR and communicate among the team.

4.6.1.1.3.2 Enhance Primary Care to Specialty Care Interface:

4.6.1.1.3.3 Participate in electronic virtual consults & SCAN ECHO as available

4.6.1.1.3.4 Develop resource listing of specialty care points of contact for nursing and medical care

4.6.1.1.3.5 Participate in VAMC sponsored medical educational activities to enhance networking with specialty staff

4.6.1.1.3.6 Enhance VA & Community Interfaces in Caring for Veterans

4.6.1.1.3.7 Develop a list of community points of contact

4.6.1.1.3.8 Develop mutually agreeable interface systems with community facilities and providers

4.6.1.1.4 IMPROVE SYSTEMS FOR MANAGING THE CARE OF PATIENT POPULATIONS

4.6.1.1.4.1 Enhance Management of Patients with Chronic Illness

4.6.1.1.4.2 Identify patients with suboptimal chronic disease indices from VHA databases (registries)

4.6.1.1.4.3 Develop plans including staff roles and responsibilities in addressing care needs. Include all team members in delivering care as license allows. Use face to face and virtual care delivery methods such as pharmacy/nurse clinics, telephone clinic etc.

4.6.1.1.5 ENHANCE HEALTH PROMOTION & DISEASE PREVENTION FOCUS IN CARE DELIVERY

4.6.1.1.5.1 Identify patients with preventive care needs from VHA databases (registries)

4.6.1.1.5.2 Develop & implement plans including staff roles and responsibilities in addressing care needs. Include all team members in delivering care as license allows. Use face to face and virtual care delivery methods such as pharmacy/nurse clinics, telephone clinic etc.

4.6.1.1.6 ENHANCE MANAGEMENT OF HIGH RISK VETERANS (such as Veterans with frequent emergency department visits, frequent inpatient admissions for ambulatory sensitive conditions, and severely injured/disabled, frail elderly).

4.6.1.1.6.1 Identify high risk patients from VHA databases (registries)

4.6.1.1.6.2 Develop plans including staff roles and responsibilities in addressing care needs. Include all team members in delivering care as license allows.

4.6.1.1.6.3 Use face to face and virtual care delivery methods such as pharmacy/nurse clinics, telephone clinic etc.

4.6.1.1.7 IMPROVE PRACTICE DESIGN & FLOW TO ENHANCE WORK EFFICIENCY & CARE DELIVERY

4.6.1.1.7.1 Maximize functioning of all team members through role and task clarification for work flow processes.

4.6.1.1.7.2 Ensure all team members work to their maximum ability/skill/license

4.6.1.1.7.3 Develop a plan to improve work flow process for visit or virtual care.

4.6.1.1.7.4 Conduct daily teamlet huddles to focus on operational needs for that day

4.6.1.1.7.5 Conduct weekly team meeting to focus on systems and process improvements, review and use data to monitor processes, etc.

4.6.1.2 PRIMARY CARE SERVICES SCOPE OF CARE: Contractor shall use the PACT model to provide primary care services supporting a continuum of care from prevention to diagnosis and treatment, to…