RFP - 36C26224R0118 - CBOC - Alamogordo NM - NMVAHCS.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

36C26224R0118 1/7/2025

Ramonalisa Aviles, Contract Specialist 562-766-2255 02/06/2025

10:00AM PDT

36C262

Department of Veterans Affairs

Network Contracting Office 22

4811 Airport Plaza Drive

Suite 600

Long Beach CA 90815

X 100

X

621498

$25.5 Million

N/A

X

36C501

Department of Veterans Affairs

New Mexico VA Healthcare System

1501 San Pedro Drive, SE

Albuquerque, NM 87108

36C262

Department of Veterans Affairs

Network Contracting Office 22

4811 Airport Plaza Drive

Suite 600

Long Beach CA 90815

Department of Veterans Affairs

Financial Services Center

Submit invoices electronically to:

https://www.tungstenautomation.com/

See CONTINUATION Page

The Department of Veterans Affairs New Mexico VA Health Care

System has a need for the provision of Primary Care and Mental

Services for Veterans in the city of Alamogordo, New Mexico off-site in a Community-Based Outpatient Clinic.

Please see Section B.2 for Schedule of Services and Price.

Paid via separately issued Task Order.

X 1

James Moran

Contracting Officer https://www.tungstenautomation.com/

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 SERVICE AND PRICE

B.3 PERFORMANCE WORK STATEMENT (PWS)

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (NOV 2023)

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

C.3 52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS (NOV 2021)

C.4 52.216-18 ORDERING (AUG 2020)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.8 52.222-32 CONSTRUCTION WAGE RATE REQUIREMENTS—PRICE ADJUSTMENT

(ACTUAL METHOD) (AUG 2018)

C.9 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.10 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.11 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.12 VAAR 852.201-70 CONTRACTING OFFICER‘S REPRESENTATIVE (DEC 2022) ... 122

C.13 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.14 VAAR 852.204-71 INFORMATION AND INFORMATION SYSTEMS SECURITY (FEB

2023)

C.15 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

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

C.16 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED SERVICE-

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

C.17 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.18 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.19 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.20 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019) 139

C.21 VAAR 852.239-70 SECURITY REQUIREMENTS FOR INFORMATION

TECHNOLOGY RESOURCES (FEB 2023)

C.22 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.23 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2024)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 - NMVAHCS – MCP 116-8 – Suicide Risk Assessment (attached)

D.2 - VA Rules of Behavior for Non-Organizational Users (attached)

D.3 - Conflict of Interest for Sharing of Health Care Resources (attached)

D.4 - Contractor Certification Immigration and Nationality Act of 1952 -As Amended (attached)

D.5 - NMVAHCS – MCP 11-53 – Medication Reconciliation (attached)

D.6 - NMVAHCS – MCP 119-60 – Multidisciplinary Anticoagulation Services (attached)

D.7 - PBM Guidance: Pharmacy Clinic Set-up and Stop Code (attached)

D.8 - POC 50 CBOC Specimen Processing (attached)

D.9 - Blood Specimen Collection – Venipuncture Vacuum – Extraction Method (attached)

D.10 - NMVAHCS – MCP 113-14 - Ancillary Testing (attached)

D.11 - NMVAHCS – Waived Testing Test Systems/Instruments and Reagents Information

(attached)

D.12 - REACH VET Predictive Model (attached)

D.13 - REACH VET Steps Provider (attached)

D.14 - Risk ID Staff Specific Guidance (attached)

D.15 - VA Suicide Prevention Safety Plan and Suicide Behavior and Overdose (SBOR)

Templates Staff Specific Guidance (attached)

D.16 - Conditions of Participation Standards, Criteria and Evidence (Narrative) (attached)

D.17 - VHA’s Office of Connected Care Telehealth Manual (attached)

D.18 - Asynchronous Store and Forward Telehealth Manual (attached)

D.19 - Synchronous Telehealth Manual (attached)

D.20 - Remote Patient Monitoring - Home Telehealth Manual (attached)

D.21 - Telehealth Business Operational Guidance (attached)

D.22 - NMVAHCS MCP 11-81 Ordering and Reporting Test Results (attached)

D.23 - NMVAHCS MCP 11-64(1) Critical Test Results (attached)

D.24 - NMVAHCS MCP 003-34 Patient Rights and Responsibilities (attached)

D.25 - FSL III – Security Requirements (attached)

D.26 - VA Approved List of Printer and Scanner Models (attached)

D.27 - Quality Assurance Surveillance Plan (QASP) (attached)

D.28 - PG 18-10 Signage Design Manual (attached)

D.29 - Wage Determination - Service Contract Acts (SCA) #: 2015-5455 (attached)

D.30 – Wage Determination – Davis Bacon Act (DBA) #: NM20240025 (attached)

D.31 – Reference Contract Worksheet (attached)

SECTION 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

PRODUCTS AND COMMERCIAL SERVICES

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 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) . 162

E.7 52.216-1 TYPE OF CONTRACT (APR 1984)

E.8 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 VAAR 852.209-70 ORGANIZATION CONFLICT OF INTEREST (OCT 2020)

E.10 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(SEP 2018)

E.11 VAAR 852.233-71 ALTERNATIVE PROTEST PROCEDURE (SEP 2018)

E.12 VAAR 852.239-75 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY NOTICE (FEB 2023)

E.13 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.14 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (NOV 2023)

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: Company Name: _____________________

POC Name & Title: ___________________

Email: ______________________________

Address: ____________________________

Phone: ______________________________

UEI #: ______________________________

b. GOVERNMENT: James Moran, Contracting Officer

Department of Veterans Affairs

VHA Regional Procurement Office - West

Network Contracting Office-22

650 East Indian School Road, Phoenix, AZ 85012

E-Mail: James.Moran3@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

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

Invoicing shall be in accordance with the requirements of The Department of Veterans Affairs (VA)

Financial Services Center (VAFSC). The latest information shall be used for invoicing and payments and may change during the Period of Performance on this acquisition. Current invoicing information is located at http://www.fsc.va.gov/einvoice.asp

• Tungsten e-Invoice Setup Information: 1-877-489-6135

• Tungsten e-Invoice email: VA.Registration@Tungsten-Network.com

• FSC e-Invoice Contact Information: 1-877-353-9791

• FSC e-Invoice email: vafsccshd@va.gov

5. POST AWARD ORIENTATION – The Contracting Officer shall schedule a post award orientation for contract orientation purposes as applicable per FAR 42.501(c).

mailto:James.Moran3@va.gov http://www.fsc.va.gov/einvoice.asp mailto:vafsccshd@va.gov

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

AMENDMENT NO DATE

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 instruction.

http://www.va.gov/oig/contacts/hotline.asp

B.2 SCHEDULE OF SERVICE AND PRICE

Alamogordo Community Based Outpatient Clinic Services

Contract Guaranteed Minimum and Contract Minimum

The fixed-price indefinite-delivery indefinite-quantity (IDIQ) contract will have a one (1) year base period with eight (8) 12-month option periods. 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 $1,000.00, 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 $49,000,000.00.

Ordering Procedures

Any services to be furnished under this contract shall be ordered by issuance of task orders by the

Contracting Officer. Orders may be issued by electronic commerce methods. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount of $1,000.00. See FAR clause 52.216-19, Order Limitations, for minimum and maximum values of each TO. Task Orders will be issued to the Contractor via email by the Contracting Officer. Task

Orders are contingent upon availability of funds per FAR clause 52.232-18. See Monthly Billable Roster and Invoice Reconciliation section in the PWS below 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.

Billing/Payment Procedures

VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management

Model (PCMM) software program used to track primary care clinic Veteran rosters. Specific billable processes for issuing task orders under the resultant contract include: determining Veteran eligibility, enrollment eligibility, and at least one qualifying encounter by the Contractor’s primary care provider

(PCP) within the previous 12 months.

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 shall have at least one qualifying encounter during the previous 12 months. See the Billing and Invoicing Procedures section 19 for further information on the billable roster, qualifying encounters, and invoicing procedures.

The estimated number of billable patients is 1,856 for the base period of performance.

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.

The current option period pricing will apply to any extension pursuant to the exercise of FAR 52.217-8.

Base Year: 4/1/2025 – 03/31/2026

Line

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

0001 Primary Care Services PM/PM 1,856 $ $ $

Primary Care Mental Health

Integration Services

PM/PM 278 $ $ $

Total for Base Year: $_____________________

Option Year One (1): 4/1/2026 – 03/31/2027

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

1001 Primary Care Services PM/PM 1,871 $ $ $

Primary Care Mental Health

PM/PM 281 $ $ $

Total for Option Year One (1): $_____________________

Option Year Two (2): 4/1/2027 – 03/31/2028

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

2001 Primary Care Services PM/PM 1,887 $ $ $

Primary Care Mental Health

PM/PM 283 $ $ $

Total for Option Year Two (2): $_____________________

Option Year Three (3): 4/1/2028 – 03/31/2029

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

3001 Primary Care Services PM/PM 1,903 $ $ $

Primary Care Mental Health

PM/PM 285 $ $ $

Total for Option Year Three (3): $_____________________

Option Year Four (4): 4/1/2029 – 03/31/2030

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

4001 Primary Care Services PM/PM 1,918 $ $ $

Primary Care Mental Health

PM/PM 288 $ $ $

Total for Option Year (4): $_____________________

Option Year Five (5): 4/1/2030 – 03/31/2031

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

5001 Primary Care Services PM/PM 1,934 $ $ $

Primary Care Mental Health

PM/PM 290 $ $ $

Total for Option Year Five (5): $_____________________

Option Year Six (6): 4/1/2031 – 03/31/2032

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

6001 Primary Care Services PM/PM 1,950 $ $ $

Primary Care Mental Health

PM/PM 293 $ $ $

Total for Option Year Six (6): $_____________________

Option Year Seven (7): 4/1/2032 – 03/31/2033

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

7001 Primary Care Services PM/PM 1,967 $ $ $

Primary Care Mental Health

PM/PM 295 $ $ $

Total for Option Year Seven (7): $_____________________

Option Year Eight (8): 4/1/2033 – 03/31/2034

Item Services Unit

Estimated

Quantity

Price per

Unit

Total

Estimated Cost per month

Total Estimated

Cost per year

8001 Primary Care Services PM/PM 1,983 $ $ $

Primary Care Mental Health

PM/PM 297 $ $ $

Total for Option Year Eight (8): $_____________________

ESTIMATED TOTAL FOR BASE AND OPTION YEARS $______________________

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. Services Required: The New Mexico VA Healthcare System (NMVAHCS); requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in Alamogordo, NM: Alamogordo CBOC.

1.2. Site Classification: [X] Primary Care CBOC: offers both medical and mental health care

(physically on site and by telehealth) 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 and via tele-health by contractor.

1.3. Place of Performance: Within the city limits of Alamogordo, NM which is approximately 207 miles from the NMVAHCS parent facility.

1.4. Authority: In accordance with Title 38 United States Code (USC) 8153, FAR Parts 12 and 15 and to be furnished by the contractor on behalf of the New Mexico VA Healthcare System at 1501 San

Pedro Dr, SE Albuquerque, New Mexico 87108.

1.5. Policy and Regulations: The contractor is required to meet VHA performance and quality criteria, policy and standards including, but not limited to, access, quality of care, Veteran satisfaction, coordination of care, and clinical guidelines. Performance and quality standards may change during the contract. New or revised quality/performance criteria or standards will be provided to the contractor before implementation date and throughout the life of the contract through unilateral or bi-lateral modifications, as applicable. Copies of current VA and VHA publications can be located at http://www.va.gov/vapubs/ or at http://www.va.gov/vhapublications/. Some VA policy documents include Standard Operating

Procedures (SOPs) located on internal VA websites that are not available to the public. SOPs relevant to this requirement are provided as attachments under Section D. Compliance with mandated performance is required as a condition of this contract. Contractor shall comply with all relevant VA policies and procedures, including those related to quality, access, patient safety and performance, including, but not limited to the policies listed on the Contracted Clinic Policy

Document located at https://www.patientcare.va.gov/primarycare/docs/List-of-contracted-clinic-policy-documents.xlsx#. A link to the VA Qualifications Standards is also included in this document.

1.6. Acronyms/Definitions:

ABMS: American Board of Medical Specialties

ACGME: Accreditation Council for Graduate Medical Education

ACIP: Advisory Committee on Immunization Practices

ACLS: Advanced Cardiac Life Support

ACO: Administrative Contracting Officer

ACPE: American Council on Pharmaceutical Education

ADE: Adverse Drug Events

AED: Automatic External Defibrillator

AIS: Automated Information Security

ANA: American Nurses Association

AOA: American Osteopathic Association

APRN: Advanced Practice Registered Nurse

ARRT: American Registry of Radiologic Technology

ASC: Ambulatory Surgery Center

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

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

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, http://www.cswe.org/ strategies for surveillance and prevention and control of health care associated infections in United

States health care facilities.

HPE: Health Professions Education

HPT: Health Professions Trainee

HT: Home Telehealth

ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

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

INR: International Normalized Ratio

LIP: Licensed Independent Practitioner

MCCR: Medical Care Cost Recovery

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

General mental health services include:

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

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

(c) Patient education

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

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

(f) Consultation about special emphasis problems including Post Traumatic Stress Disorder

(PTSD) and Military Sexual Trauma (MST)

(g) Suicide Prevention

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

Specialty mental health services include:

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

(b) Evidence-based psychotherapy

(c) Intensive Community Mental Health Integration (ICMHR)

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

(e) PTSD teams or specialists

(f) MST special clinics

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

MQSA: Mammography Quality Standards Act

MSN: Master of Science in Nursing

NLN: National League for Nursing

NLNAC: National League for Nursing Accreditation Commission

NP: Nurse Practitioner

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

Cardiac Surgical Program

OTC: Over the Counter

PA: Physician Assistant

PACS: Picture Archiving and Communications System

PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s

Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team-based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

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

SYNCHRONOUS CARE: Bookable, real-time care provided in person or virtually (VA Video

Connect, CVT, telephone) with a Veteran and involves clinical decision-making in a two-way conversation. Parent Facility: VAMC responsible for performance monitoring and payment for contracted outpatient site of care services.

PBM: Pharmacy Benefits Management

PCMH: Patient-Centered Medical Home

PCMHI: Primary Care-Mental Health Integration

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

(1) set up and define health care teams, (2) assign staff and their associated full-time equivalent

(FTE) staff to positions within each team, (3) assign patients to the team, and (4) assign patients to specific team members.

PCP: Primary Care Provider

Pharm.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 shall be determined by the VA in accordance with VHA Directive 1406 Patient Centered Management

Module (PCMM) for Primary Care. The staffing standard for support staff shall be at least three full time equivalent (FTE) support staff (1 FTE RNCM, 1 FTE Clinical Associate, 1 FTE

Administrative Associate) for each FTE Primary Care Provider. The Clinical Pharmacist

Practitioner (CPP) shall be provided the same support staffing when they are working in the capacity of an advanced practice provider. The contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The contractor shall establish and implement contingency plans for ensuring patients receive continuity of and access to appropriate primary care during periods of inadequate resources, extended staff absences, staff turnover, understaffing, and nature-related events (e.g., extreme weather conditions, natural disasters). If the number of patients reaches 90% of maximum panel size assigned by the facility the contractor shall communicate to the VA, the contractor’s future staffing plan to ensure staffing ratio standards remain in accordance with PCMM staffing standards. The total estimated patients assigned to site: 1,856.

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 the 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 with equivalent support staff. The numbers are based on the providers FTE when entered into the PCMM module. The actual panel size will vary based on provider FTE. If a panel is less than maximum, then the contractor shall propose quantity of FTE to meet appropriate panel size. Contractor can utilize 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. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification

Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the

PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Option 2: Advanced Practice Registered Nurse (APRN): Qualifications: APRN’s (including subcontractors) shall possess a master’s degree from a program accredited by the National League for Nursing Accreditation Commission (NLNAC) or the Commission on Collegiate Nursing

Education (CCNE) and maintain full and current certification as a Certified Nurse Practitioner

(CNP) from the American Nurses Association or another nationally recognized certifying body in either Adult Health or Family Practice. Authorization for prescriptive authority is required. CNPs shall prescribe controlled substances in accordance with limitations imposed by the Controlled

Substances Act and the CNP’s State licensure on the authority to prescribe or administer controlled substances. Three years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CNP shall have current, full, active, and unrestricted license and registration as a graduate professional nurse in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Advanced Practice Nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information.

Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care, providing health care commensurate to the PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with

PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Option 3: Physician Assistant (PA): Qualifications: 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. 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. Promotes systems to improve access and continuity of care, uses advanced clinical knowledge and critical thinking skills to mentor staff in planning, implementing and evaluating interventions that improve patient outcomes, designs and provides age and population specific health promotion and risk reduction strategies, translates evidence-based research into practice to ensure that patients benefit from the latest innovations in nursing science, manages patients in transition between levels of care, serves as an expert resource to implement and teach skills, including motivational interviewing to promote patient self-management toward patient-driven holistic care plan for life.

Teamlet Member 3: Clinical Associate FTE Ratio Performance Standard: Current standard is

1.0 FTE clinical associate per 1.0 FTE PCP. Contractor to propose the mix of Clinical Associates from the options below.

Option 1: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN):

Qualifications: Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for

Licensed Practical or Vocation Nurse located in the VA Qualification Standards. See the Policy and

Regulations section of this PWS for VA Qualification Standards access information. Position

Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Staff will be assigned telehealth trainings in TMS by the Office of Connected Care Service Section. Staff will receive face-to-face training once all trainings are completed in TMS. One backup is required per OCC; Staff will provide TCT back up.

Option 2: Unlicensed Assistive Personnel (Health Technician, Nursing Assistant) This staffing is part of the PACT Teamlet and is not the primary telehealth clinical technician

(TCT): Qualifications: Nursing Assistant qualifications per VA qualification standards for

Nursing Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Health Technician qualifications per Health Aid and Technician Series 0640 located at: Health Aid and Technician

Series 0640 (opm.gov). Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/0600/health-aid-and-technician-series-0640/ https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/0600/health-aid-and-technician-series-0640/ patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies, and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. Staff will be assigned telehealth trainings in TMS by the

Office of Connected Care Service Section. Staff will receive face-to-face training once all trainings are completed in TMS. One backup is required per OCC; Staff will provide TCT back up.

Teamlet Member 4: Administrative Associate: FTE Ratio Performance Standard: Current standard is 1.0 FTE administrative associate per 1.0 FTE PCP. Qualifications: Required education and experience demonstrating skills and abilities to provide clerical support and administrative functions to support site operations. Completion of scheduling training per VA policies and guidance. See VA qualification standards for Medical Support Assistant located in the VA

Qualification Standards for additional qualifications. See the Policy and Regulations section of this

PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned…