RFP 36C25625R0058 - McComb CBOC - Final.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C25625R0058 08-01-2025

Stephanie Keo 713-791-1414 EXT 26408 08-25-2025

15:00 CDT

36C256 Department of Veterans Affairs Network Contracting Office 16 5075 Westheimer Road, Suite 750

Houston TX 77056-5643

X 100

X

621498

$25.5 Million

N/A

36C586

Department of Veterans Affairs G.V. (Sonny) Montgomery VAMC 1500 E Woodrow Wilson Avenue

Jackson MS 39216

36C256

Department of Veterans Affairs Network Contracting Office 16 5075 Westheimer Road, Suite 750

Houston TX 77056-5643

FSC e-Invoice Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 Invoice must be submitted electronically

1-877-489-6135 512-460-5429

See CONTINUATION Page

Contractor to provide Community Based Outpatient Clinic Services for McComb, Pike County, Mississippi in accordance with the Price/Cost Schedule of Services and Performance Work Statement.

This is a single award solicitation in accordance with Federal Acquisition Regulation (FAR) 12,15, and 16.504.

This is a Service-Disabled Veteran Owned Small Business (SDVOSB)set aside. Offerors must be SDVOSB certified at time of proposal submission and at time of award.

NOTIFICATION TO OFFERORS: Required documents and instruction are on page 152 through page 154 - INSTRUCTIONS TO OFFERORS

X 1(one)

Stephanie Keo

VA-VHA-RPOC-2023-0081

36C25625R0058

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT

B.4 IT CONTRACT SECURITY

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTSAND

COMMERCIAL SERVICES (NOV 2023)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL

(JAN 2011)

C.4 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (NOV 2021)

C.5 52.216-18 ORDERING (AUG 2020)

C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.7 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.8 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.9 52.219-14 LIMITATIONS ON SUBCONTRACTING (OCT 2022)

C.10 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN 1997)

C.11 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.12 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.13 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022) .. 131

C.14 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.15 VAAR 852.204-70 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (MAY 2020)

C.16 VAAR 852.204-71 INFORMATION AND INFORMATION SYSTEMS SECURITY

(FEB 2023)

C.17 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.18 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED SERVICE-

DISABLED VETERAN-OWNED SMALL BUSINESSES (JAN 2023) (DEVIATION)

C.19 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.20 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.21 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.22 VAAR 852.237-72 CRIME CONTROL ACT—REPORTING OF CHILD ABUSE (OCT

2019)

C.23 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019) 146

C.24 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.25 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.26 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.27 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (JAN 2025) ALTERNATE I (FEB 2000) (DEVIATION FEB 2025)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 - QUALITY ASSURANCE SURVEILLANCE PLAN

D.2 - CONTRACTOR CONFLICTS OF INTEREST VA DIRECTIVE 1660.03

D.3 - WAGE DETERMINATION WASHINGTON COUNTY

D.4 - VA NOTICE OF LIMITATIONS ON SUBCONTRACTING

D.5 - REFERENCE CONTRACT WORKSHEET

D.6 - VA RULES OF BEHAVIOR VA HANDBOOK 6500.6

D.7 - COMMUNICATING TEST RESULTS TO PROVIDERS AND PATIENTS

D.8 ANCILLARY TESTING POLICY

D.9 - MEDICATION RECONCILIATION

D.10 - INTENTIONALLY LEFT BLANK

D.11 - WAGE DETERMINATION (DAVIS BACON) WASHINGTON COUNTY

D.12 - TELEHEALTH OPERATIONS MANUAL

D.13 - EOC GUIDE

D.14 - LOCAL POLICY ANCILLARY TESTING

D.15 - INTENTIONALLY LEFT BLANK

D.16 - INTENTIONALLY LEFT BLANK

D.17 - LOCAL PATHOLOGY AND LABORATORY MEDICINE SERVICE

D.18 - CONTRACTOR CERTIFICATION IMMIGRATION AND NATIONALITY ACT

D.19 - MEDICATION RECONCILIATION

D.20 - ANTICOAGULATION THERAPY MANAGEMENT

D.21 - VA SUICIDE PREVENTION SAFETY PLAN AND SBOR

D.22 - REACH VET

D.23 - VETERAN RESIDENT RIGHT AND RESPONSIBILITIES

D.24 - VA SIGNAGE DESIGN MANUAL

D.25 - HEALTH INFORMATION MANAGEMENT AND HEALTH RECORD

DOCUMENTATION -PEN AND INK- POLICY

D26 - SUICIDE PREVENTION POLICY

D.27 - REMOTE PATIENT MONITORING - HOME TELEHEALTH MANUAL

ECTION E - SOLICITATION PROVISIONS

E.1 52.201-1 ACQUISITION 360: VOLUNTARY SURVEY (SEP 2023)

E.2 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

E.3 ADDENDUM TO FAR 52.212-1 INSTRUCTIONS TO OFFERORS -COMMERCIAL

ITEMS

E.4 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.5 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.6 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT ORDERS—

REPRESENTATION AND DISCLOSURES (DEC 2023)

E.7 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) .. 168

E.8 52.216-1 TYPE OF CONTRACT (APR 1984)

E.9 52.222-5 CONSTRUCTION WAGE RATE REQUIREMENTS—SECONDARY SITE OF

THE WORK (MAY 2014)

E.10 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.11 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)

E.12 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.13 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.14 VAAR 852.239-75 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY NOTICE (FEB 2023)

E.15 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (NOV 2021)

E.16 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.17 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

POC: ___________________________

Address: ________________________ Phone: __________________________ Email: ___________________________

SAM UEI Number: ____________________

TAX ID: __________________________

b. GOVERNMENT:

Stephanie Keo, Contracting Officer (CO) Department of Veterans Affairs Network Contracting Office 16 (NCO 16) 5075 Westheimer Road, Suite 750 (90C) Houston, TX 77056 Email: stephanie.keo@va.gov

Marissa Staten, Contracting Officer Representative (COR) Department of Veterans Affairs G.V. (Sonny) Montgomery VAMC 1500 E Woodrow Wilson Avenue Jackson, MS 39216 Email: marissa.staten@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [x] Monthly in arrears mailto:stephanie.keo@va.gov mailto:%20marissa.staten@va.gov

3. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission.

4. INVOICE REQUIREMENTS AND SUPPORTING DOCUMENTATION: Reference Performance Work Statement under Billing for additional information.

5. SECURE FAX: The following statement on all fax cover sheets be included: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

6. EMPLOYMENT REPORTS ON SPECIAL DISABLED VETERANS OF THE VIETNAM ERA,

AND OTHER ELIGIBLE VETERANS (VETS 4212): Offerors in accordance with FAR clause 52.222- 37, Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans, which is incorporated in this solicitation by reference, and Public Law 105-359, section 1354 (enacted October 31, 1998), the successful offeror must meet the reporting requirement as required by the clause. The contracting officer may require the successful offeror to furnish evidence that it has complied with requirements to file a VETS-4212 Federal Contractor Report (formerly VETS-100) with the Department of Labor for the preceding fiscal year (30 SEP) until Title 38 Section 4212(d) (weblink http://www.dol.gov/vets/vets4212.htm). For questions and information on filing VETS-4212 reports, contract the VETS-4212 Processing Center at (866) 237-0275 or visit the Department of Labor’s web site at http://www.dol.gov/vets/contractor/main.htm. and/or for further assistance or questions VETS4212-customersupport@dol.gov.

7. SYSTEM AWARDS MANAGEMENT SYSTEM (SAM): Federal Acquisition Regulations require all contractors conducting business with the Government be registered in the System Awards Management System (SAM) online database for the provision of basic information relative to contract awards (see FAR Clause 52.212-4(t)). This may be accomplished at http://www.sam.gov. It is the responsibility of the contractor to renew this registration annually.

8. E-VERIFY: The contractor in accordance with FAR clause 52.222-54, Employment Eligibility Verification are required to enroll in and use the Department of Homeland Security (DHS), United States Citizenship and Immigration Services’ (USCIS) electronic employment eligibility verification program (E-Verify). The Federal government has a long-standing policy to only contract with businesses and other entities that abide by the immigration laws of the United States and to employ only individuals who are authorized to work. E-Verify is the best means to electronically confirm identity and employment authorization of employees working under covered Federal contracts, as required by clause 52.222-54.

USCIS has enhanced the E-Verify website with resource information and outreach materials to assist with enrollment and use of eVerify. USCIS routinely hosts free public webinars on E-Verify and has a detailed E-Verify.

9. SERVICE CONTRACT REPORTING: In accordance with FAR 52.204-15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts, the contractor is required to report the total amount invoiced and the direct labor hours expended on the services performed under this contract. The information is collected through the System for Award Management (SAM) and included in the agency’s mailto:VETS4212-customersupport@dol.gov mailto:VETS4212-customersupport@dol.gov http://www.sam.gov/ service contract inventory. Contractors are encouraged to review this information and to make note of reporting dates and deliverables to ensure their compliance with the law and regulation. Refer to FAR

4.1703 for thresholds. Indefinite-delivery contracts reporting requirements, which will be based on the expected dollar amount and type of the orders issued under the contracts. FAR 4.1703. See FAR 4.17 - Service Contracts Inventory. Guidance for contractors is in the “Service Contract Reporting” clause of their contract (52-204-14 or 52.204-15), and in SAM’s Quick Start Guide for Service Contract Reporting, and SAM’s Full User Guides, available at www.SAM.gov under the “Help” tab.

10. MANDATORY WRITTEN DISCLOSURES:

Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at http://www.va.gov/oig/contacts/hotline.asp and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions.

11. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

(End of Contract Administration Data) http://www.sam.gov/ http://www.va.gov/oig/contacts/hotline.asp

B.2 SCHEDULE OF SERVICES

Contractor is required to provide Community Based Outpatient Clinic (CBOC) services within the city of McComb but not limited to, the counties of Amite, Lincoln, Pike, and Walthall County, MS in accordance with the terms and conditions stated herein and at the pricing stated below for the period of performance included below:

Contract Guaranteed Minimum and Contract Maximum

The fixed-price indefinite-delivery indefinite-quantity (IDIQ) contract will have a Five (5) year period of performance with NO option years (FAR 52.217-8 is included). All PMPM quantities are estimated. The total guaranteed minimum quantity of services that the Government will acquire under this indefinite delivery, indefinite quantity (IDIQ) contract is $20,000.00, which also represents a bona fide need of the current fiscal year. The guaranteed minimum award amount is for the entire contract duration. The ceiling amount for the entire contract effort is $14,000,000.00.

Ordering Procedures

The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount of $20,000.00. Fixed price Task Order (TOs) will be issued by the COR (as authorized by Contracting Officer) via email to the contractor, prior to the start of each month, the fixed quantity of members for the upcoming month but billed in arrears based on billable roster. See FAR clause 52.216-19, Order Limitations, for minimum and maximum values of each TO. TOs are contingent upon availability of funds per FAR 52.232-18. See Monthly Billable Roster and Invoice Reconciliation section in the PWS paragraph 20 regarding the invoicing instructions for reconciliation of task orders once the monthly billable roster is finalized. The aggregate value of orders placed under this contract shall not exceed the IDIQ contract maximum. This is a single award. The Government will only pay for services performed and certified by the Contracting Officer Representative (COR).

The contractor shall initiate work when, so directed by a Task Order. No work under any Task Order shall be performed unless specifically authorized by the Contracting Officer or Administration Contracting Officer. Approval of a Task Order shall not constitute approval to exceed any item listed in the contract or general provisions of the contract. The contractor shall not exceed the task order amount or change the task order without prior written approval of the Contracting Officer.

Task orders within scope of the IDIQ contract will be issued unilaterally in accordance with the IDIQ Contract terms and conditions and bilaterally when change in terms and conditions is negotiated in accordance with contract clauses FAR 52.212-4 (c), FAR 52.216-18, FAR 52.216-19 and FAR 52.216- 22.

Contractor is required to deliver services in accordance with the task order terms and conditions during the task order specified period of performance.

The NCO 16 Contracting Officer is the only authorized official to issue task orders under this IDIQ Contract.

Task order prices shall be Fixed-Price (FP) as agreed to in the contractor’s schedule and individually funded.

Billing/Payment Procedures

The contractor will be provided a list of all patients on the billable roster at the time when the contractor begins performing clinical services and will be able to bill for those patients on the billable roster in the following month’s invoice. In order to remain on the monthly billable roster, patients must have at least one qualifying encounter during the previous 12 months. See the Billable Roster section in the PWS below for further information on qualifying encounters and invoicing procedures.

For Veterans newly assigned in PCMM The contractor may bill for patients newly assigned in PCMM the month following a qualifying encounter.

For unassigned/unenrolled patient visits/encounters - PMPM includes cost of unassigned/unenrolled patient visits. Contractor shall not bill separately or propose an additional LIN for these costs.

See section E instructions to offerors for further information regarding pricing proposals related to clinic buildout.

Ordering Period One (1) – November 1, 2025 through October 31, 2026

Line Item

Services Unit

Estimated Quantity

Price per

Total Estimated Cost per month

Total Estimated Cost per year

1001 Primary Care Services at capitation rates per member per month

(PMPM)

PMPM

1,850

Estimated Total for Ordering Period 1 $____________________

Ordering Period Two (2) – November 1, 2026 through October 31, 2027

Price per Unit

Total Estimated Cost per month

Total Estimated Cost per year

2001 Primary Care Services at capitation rates per

Estimated Total for Ordering Period 2 $_______________________

Ordering Period Three (3) – November 1, 2027 through October 31, 2028

Total Estimated Cost per month

Total Estimated Cost per year

3001 Primary Care Services at capitation rates per

Estimated Total for Ordering Period 3 $______________________

Ordering Period Four (4) – November 1, 2028 through October 31, 2029

Total Estimated Cost per month

Total Estimated Cost per year

4001 Primary Care Services at capitation rates per

Estimated Total for Ordering Period 4 $_____________________

Ordering Period Five (5) – November 1, 2029 through October 31, 2030

Total Estimated Cost per month

Total Estimated Cost per year

5001 Primary Care Services at capitation rates per

Estimated Total for Ordering Period 5 $_________________________

NOTE: Ordering Period 5 pricing will apply to any extensions pursuant to FAR 52.217-8.

Estimated Total for Ordering Period 1 $_______________________(12 months) Estimated Total for Ordering Period 2 $_______________________(12 months) Estimated Total for Ordering Period 3 $_______________________(12 months) Estimated Total for Ordering Period 4 $_______________________(12 months) Estimated Total for Ordering Period 5 $_______________________(12 months)

Total ordering periods not to exceed five (5) years.

ESTIMATED TOTAL FOR ALL ORDERING PERIOD $_____________________________

The evaluation will consider the possibility that the option can be exercised at any time and can be exercised in increments of one to six months, but not for more than a total of six months during the life of the contract. The evaluation will assume that the prices for any option exercised under FAR 52.217-8 will be at the same rates as those in effect under the contract at the time the option is exercised. The evaluation will therefore assume that the addition of the price or prices of any possible extension or extensions under

FAR 52.217-8 to the total price of all proposals relative to each other and will not affect the ranking of proposals based on price, unless, after reviewing the proposals, the Government determines that there is a basis for finding otherwise. This evaluation will not obligate the Government to exercise any option under

FAR 52.217-8.

(End of B.2 Price/Cost Scheduled of Services)

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

1.1 Services Required: The G.V. Sonny Montgomery VA Medical Center requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in but not limited to, the counties of Amite, Lincoln, Pike, and Walthall County, MS.

1.2 Site Classification: This site is classified as a Primary Care CBOC offers both medical and mental health care and may offer support services such as pharmacy, laboratory, and x-ray.

Primary Care CBOCs are required to provide both primary care and mental health services.

Mental Health services will be provided on site by VA staff, and by VA staff via TeleHealth.

1.3 Place of Performance: Services shall be performed by contractor within the city limits of McComb, Pike County, MS on behalf of G.V. Sonny Montgomery VA Medical Center at 1500 East Woodrow Wilson Ave, MS 39216.

1.4 Authority: Title 38 United States Code (USC) 8153 and Federal Acquisition Regulation Federal (FAR) Parts 12 and 15 to be furnished by the contractor on behalf of the G.V. (Sonny) Montgomery VA Medical Center.

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

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties

ACGME: Accreditation Council for Graduate Medical Education

ACIP: Advisory Committee on Immunization Practices

ACLS: Advanced Cardiac Life Support

ACO: Administrative Contracting Officer

ACPE: American Council on Pharmaceutical Education http://www.va.gov/vapubs/ http://www.va.gov/vhapublications/ https://www.patientcare.va.gov/primarycare/docs/List-of-contracted-clinic-policy-documents.xlsx https://www.patientcare.va.gov/primarycare/docs/List-of-contracted-clinic-policy-documents.xlsx

ADE: Adverse Drug Events

AED: Automatic External Defibrillator

AIS: Automated Information Security

ANA: American Nurses Association

AOA: American Osteopathic Association

APRN: Advanced Practice Registered Nurse

ARRT: American Registry of Radiologic Technology

ASC: Ambulatory Surgery Center

Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e., CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

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

BAA: Business Associate Agreement

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

BLS: Basic Life Support

BOS: Bureau of Osteopathic Specialists

CAHEA: Committee on Allied Health Education and Accreditation

CAP: College of American Pathologists

CARF: Commission on Accreditation of Rehabilitation Facilities

CBO: VA Central Billing Office.

CCNE: Commission on Collegiate Nursing Education

CDC: Centers for Disease Control and Prevention

CEU: Certified Education Unit

CLIA: Clinical Laboratory Improvement Amendments

CME: Continuing Medical Education

CMS: Center for Medicare and Medicaid Services

CNP: Certified Nurse Practitioner

CNS: Clinical Nurse Specialist

CO: Contracting Officer

COPD: Chronic Obstructive Pulmonary Disease

COR: Contracting Officer’s Representative

COS: Chief of Staff

CPA: Collaborative Practice Agreement

CPARS: Contractor Performance Assessment Reporting System

CPP: Clinical Pharmacist Practitioner

CPT: Current Procedural Terminology

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

CVT: Clinical Video Telehealth

DICOM: Digital Image and Communication in Medicine

DIGMA: Drop-in Group Medical Appointment

DRG: Diagnostic Related Group

DSS: Decision Support System

ECC: Extended Care Center

Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

EPRP: External Peer Review Program

FDA: Food and Drug Administration

FSMB: Federation of State Medical Boards

FTE: Full Time Equivalent

HCC: Health Care Center - A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

HCFA: Health Care Financing Administration

HHS: Department of Health and Human Services

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

http://www.cswe.org/

HPE: Health Professions Education

HPT: Health Professions Trainee

HT: Home Telehealth

ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

ICD: International Classification of Diseases iMED: software used by VA for informed consent.

INR: International Normalized Ratio

LIP: Licensed Independent Practitioner

MCCR: Medical Care Cost Recovery

Mental Health Services: per VHA Directive 1160.01 is meant to include services for the evaluation, diagnosis, treatment, rehabilitation, suicide prevention and crisis intervention, and coordination of care for both substance use disorders and other mental disorders.

General mental health services include:

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

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

(c) Patient education

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

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

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

(g) Suicide Prevention

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

Specialty mental health services include:

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

(b) Evidence-based psychotherapy

(c) Intensive Community Mental Health Integration (ICMHR)

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

(e) PTSD teams or specialists

(f) MST special clinics

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

MQSA: Mammography Quality Standards Act

MSN: Master of Science in Nursing

NLN: National League for Nursing

NLNAC: National League for Nursing Accreditation Commission

NP: Nurse Practitioner

NSQIP/CICSP: National Surgical Quality Improvement Program/Continuous Improvement in Cardiac Surgical Program

OTC: Over the Counter

PA: Physician Assistant

PACS: Picture Archiving and Communications System

PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team-based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

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

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

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

PBM: Pharmacy Benefits Management

PCMH: Patient-Centered Medical Home

PCMHI: Primary Care-Mental Health Integration

PCMM: Patient Centered Management Module - is an enterprise application that enables users to

(1) set up and define health care teams, (2) assign staff and their associated full-time equivalent (FTE) staff to positions within each team, (3) assign patients to the team, and (4) assign patients to specific team members.

PCP: Primary Care Provider

Phar.D.: Doctor of Pharmacy

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

POC: Point of Care Testing

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

PWS: Performance Work Statement

QAPI: Quality Assessment and Performance Improvement

QASP: Quality Assurance Surveillance Plan

REACH VET: Recovery Engagement and Coordination for Health Veterans Enhanced Treatment- REACH VET summarizes information from the Veterans Health Record and uses predictive modeling to identify Veterans at statistical risk for suicide and other negative outcomes. This tool supplements clinical strategies used to identify at-risk Veterans and may help providers intervene prior to these negative outcomes occurring.

RME: Reusable Medical Equipment

SFT: Store and Forward Telehealth SMA: Shared Medical Appointments SOP (Clinical): Scope of Practice

SPD: Sterile Processing Division SPE: Senior Procurement Executive

Specialty Care Visit: The VHA site classification defines specialty care as those encounters that occur within the geriatric medicine; allergy; cardiology; dermatology; emergency; employee health; endocrinology; gastroenterology; general medicine; hematology or oncology; infectious disease; nephrology; neurology; outreach; pulmonary or respiratory disease; rheumatology;

amputation follow-up; amputation; anesthesia; cardio-thoracic; ear, nose, and throat (ENT); eye;

general surgery; gynecology (GYN); neurosurgery; orthopedics; plastic surgery; urology; or vascular clinic stops.

STORM: Stratification Tool for Opioid Risk Monitoring

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

TCT: Telehealth Clinical Technician TIU: Text Integration Utility

TJC: The Joint Commission

TMS: Talent Management System VA: Veterans Affairs

VA ECHO: VA Extension for Community Health Outcomes

VA EHR: VA electronic health record

VAMC: Veterans Affairs Medical Center

VAST: VHA Site Tracking database

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

VHA: Veterans Health Administration

VSSC: VHA Support Service Center

VVC: VA Video Connect

WHEN: Weekend- Holiday- Every- Night

2. STAFFING AND QUALIFICATIONS:

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

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

1,850.

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

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

Teamlet Member 1: Primary Care Provider (PCP): FTE Ratio Performance Standard: Current standards are 1200 active patients per full time physician and 900 active patients per full time mid-level provider. Contractor shall propose quantity of FTE to meet standard FTE ratio to panel size.

Contractor to propose mix of PCP from the options below.

Option 1: Physician (MD/DO): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice. Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. Authorization for prescriptive authority is required.

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

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

Option 3: Physician Assistant (PA): Qualifications: Must have an MD/DO on site for direct collaboration before considering a PA for position within CBOC. PA’s (including subcontractors) shall be a graduate of a training program which is accredited by the Accreditation Review Commission on Education of PA (ARC-PA) or one of its predecessor organizations. Additionally, PAs shall have a master’s degree in any discipline or a bachelor’s degree in any discipline with one year of experience as a PA. PAs shall have successfully passed the PA National Certifying Exam (PANCE). Authorization for prescriptive authority is required. United States Drug Enforcement Administration (DEA) prescriptive authority is required for controlled substances. PA shall have current, full, active, and unrestricted license and registration in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Teamlet Member 2: Registered Nurse (RN) Care Manager: FTE Ratio Performance Standard:

Current standard is 1.0 FTE RNCM per 1.0 FTE PCP Qualifications: Graduate of a school of professional nursing accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The accreditation Commission for Education in Nursing (ACEN) or the commission on Collegiate Nursing Education (CCNE). Current, full, active, and unrestricted registration as a graduate professional nurse in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, virtual care, view alerts management, shared medical appointments, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and virtual care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care Team.