RFP 36C26225R0004 - CBOC Services - El Centro - VASDHS.pdf

PAGE 1 OF- 189 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

36C26225R0004 11-22-2024

Jesus Vargas, Contract Specialist 562-587-5964 01-07-2025 11:00am PST

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

36C664

Department of Veterans Affairs VA San Diego Healthcare System 3350 La Jolla Village Drive

San Diego CA 92161

Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815

Financial Services Center P.O. Box 149971 Austin, TX 78714-9971 http://www.tungsten-network.com/

The Department of Veterans Affairs San Diego Healthcare System has a need for the provision of Primary Care Services for Veterans in the City of El Centro, California off-site in a Community Based Outpatient Clinic.

Please see Schedule of Services and Price.

Paid via separately issued Task Order.

X 1

Alice McGruder Contracting Officer

36C26225R0004

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES AND PRICE

B.3 PERFORMANCE WORK STATEMENT

B.4 IT CONTRACT SECURITY

B.5 MANDATORY WRITTEN DISCLOSURES

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 52.204-9 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 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.10 52.222-32 CONSTRUCTION WAGE RATE REQUIREMENTS—PRICE ADJUSTMENT

(ACTUAL METHOD) (AUG 2018)

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) .. 125

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 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED SERVICE-

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

C.18 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.19 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.20 VAAR 852.237-70 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(OCT 2019)

C.21 VAAR 852.237-74 NON-DISCRIMINATION IN SERVICE DELIVERY (OCT 2019) 141

C.22 VAAR 852.239-70 SECURITY REQUIREMENTS FOR INFORMATION

TECHNOLOGY RESOURCES (FEB 2023)

C.23 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.24 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.25 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 REFERENCE CONTRACT WORKSHEET (ATTACHED)

D.2 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) (ATTACHED)

D.3 WAGE DETERMINATION (ATTACHED):

a) WAGE DETERMINATION No.: 2015-5607 (Attached)

b) DAVIS-BACON ACT WAGE DETERMINATION # CA20240002 (attached)

D.4 IMMIGRATION AND NATIONALITY ACT (ATTACHED)

D.5 ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020) (ATTACHED)

D.6 RULES OF BEHAVIOR (ATTACHED)

D.7 VHA HANDBOOK 1106.1 (ATTACHED)

D.8 MCM 11-99 - VASDHS POLICY AND PROCEDURES AND TJC STANDARDS FOR

ANY CRITICAL RESULTS OR URGENT RESULTS (ATTACHED)

D.9 MCM 113-03 INFORMATION CONCERNING THE LABORATORY TESTS

(ATTACHED)

D.10 MCM 113-02 - WAIVED TESTING TEST SYSTEMS/INSTRUMENTS, QUALITY

CONTROL, AND REAGENT INFORMATION (ATTACHED)

D.11 MCM 11-27 - MEDICATION RECONCILIATION PER VASDHS (ATTACHED)

D.12 MCM 119-20 - ANTICOAGULATION THERAPY MANAGEMENT (ATTACHED) .. 153

D.13 VASDHS REPRODUCTIVE WORKFLOW (ATTACHED)

D.14 RESOURCES FOR ENHANCING ALL CAREGIVES HEALTH (REACH)

VA PROGRAM (ATTACHED)

D.15 VA SUICIDE PREVENTION SAFETY PLAN AND SUICIDE BEHAVIOR AND

OVERDOSE REPORT (SBOR) TEMPLATES STAFF SPECIFIC GUIDANCE (ATTACHED):

D.16 VHA’s OFFICE OF CONNECTED CARE TELEHEALTH MANUAL AND

ASSOCIATED ASYNCHRONOUS STORE AND FORWARD TELEHEALTH MANUAL,

SYNCHRONOUS TELEHEALTH MANUAL, REMOTE PATIENT MONITORING - HOME

TELEHEALTH MANUAL AND TELEHEALTH BUSINESS STANDARD OPERATING

PROCEDURES:

D.17 VHA HIM HEALTH RECORD DOCUMENTATION PROGRAM GUIDE VERSION 1.1

(ATTACHED)

D.18 VA OFFICE OF INFORMATION AND TECHNOLOY STANDARDS AND CRITERIA

(ATTACHED)

D.19 PRICE WORKSHEET (SEE BELOW)

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 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.4 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

E.5 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.6 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.7 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) .. 169

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) ... 171

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 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: Company Name: _____________________

POC Name & Title: ___________________

Email: ______________________________

Address: ____________________________

Phone: ______________________________

b. GOVERNMENT: Alice McGruder, Contracting Officer

Network Contracting Office 22 4811 Airport Plaza Drive, Suite 600, Long Beach CA 90815

Email: Alice.McGruder@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 mailto:Alice.McGruder@va.gov http://www.fsc.va.gov/einvoice.asp mailto: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).

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

AMENDMENT NO DATE

B.2 SCHEDULE OF SERVICES AND PRICE

El Centro Community Based Outpatient Clinic (CBOC) Services

Contract Guaranteed Minimum and Contract Maximum

The fixed-price indefinite-delivery indefinite-quantity (IDIQ) contract will have a Base Year and Nine (9) One-Year Option Periods. All PMPM quantities are estimated. The total guaranteed minimum quantity of services that the Government will acquire under this IDIQ contract is $5,000.00. The ceiling amount for the entire contract effort is $40,000,000.00.

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 $5,000.00. 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

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. Contractor shall not invoice for services until the CBOC is open and the contractor is providing Primary Care Services. 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 on page 97 for further information on the billable roster, 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 - The Price per Unit shown in the Tables below include the Contractor’s cost of unassigned/unenrolled patient visits. Contractor shall not bill separately or propose an additional LIN for unassigned/unenrolled patient visits.

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

Base Year – 05/01/2025 – 04/30/2026

Line Item Services Unit Price per Unit

Primary Care Services at capitation rates per member per month

(PMPM)

PMPM

Mental Health Services at capitation rates per member per month

(PMPM)

Option Period One (1) – 05/01/2026 – 04/30/2027

Primary Care Services at capitation rates per member per month (PMPM)

Mental Health Services at capitation rates per member per

Option Period Two (2) – 05/01/2027 – 04/30/2028

Primary Care Services at

Mental Health Services at capitation rates per member per

Option Period Three (3) – 05/01/2028 – 04/30/2029

Primary Care Services at

Mental Health Services at capitation rates per member per

Option Period Four (4) – 05/01/2029 – 04/30/2030

Primary Care Services at

Mental Health Services at capitation rates per member per

Option Period Five (5) – 05/01/2030 – 04/30/2031

Primary Care Services at capitation rates per member per month (PMPM)

Mental Health Services at capitation rates per member

Option Period Six (6) – 05/01/2031 – 04/30/2032

Primary Care Services at

Mental Health Services at capitation rates per member

Option Period Seven (7) – 05/01/2032 – 04/30/2033

Primary Care Services at

Mental Health Services at capitation rates per member

Option Period Eight (8) – 05/01/2033 – 04/30/2034

Primary Care Services at

Mental Health Services at capitation rates per member

Option Period Nine (9) – 05/01/2034 – 04/30/2035

9001 Primary Care Services at

9002 Mental Health Services at

Intentionally Left Blank

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL:

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

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

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

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

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

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

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties ACGME: Accreditation Council for Graduate Medical Education ACIP: Advisory Committee on Immunization Practices ACLS: Advanced Cardiac Life Support ACO: Administrative Contracting Officer ACPE: American Council on Pharmaceutical Education ADE: Adverse Drug Events AED: Automatic External Defibrillator AIS: Automated Information Security ANA: American Nurses Association AOA: American Osteopathic Association APRN: Advanced Practice Registered Nurse ARRT: American Registry of Radiologic Technology ASC: Ambulatory Surgery Center 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

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 http://www.cswe.org/

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

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

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

General mental health services include:

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

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

(c) Patient education

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

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

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

(g) Suicide Prevention

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

Specialty mental health services include:

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

(b) Evidence-based psychotherapy

(c) Intensive Community Mental Health Integration (ICMHR)

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

(e) PTSD teams or specialists

(f) MST special clinics

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

MQSA: Mammography Quality Standards Act MSN: Master of Science in Nursing NLN: National League for Nursing NLNAC: National League for Nursing Accreditation Commission NP: Nurse Practitioner NSQIP/CICSP: National Surgical Quality Improvement Program/Continuous Improvement in Cardiac Surgical Program OTC: Over the Counter PA: Physician Assistant PACS: Picture Archiving and Communications System

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

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

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

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

PBM: Pharmacy Benefits Management PCMH: Patient-Centered Medical Home PCMHI: Primary Care-Mental Health Integration PCMM: Patient Centered Management Module - is an enterprise application that enables users to

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

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

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

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

RME: Reusable Medical Equipment SFT: Store and Forward Telehealth SMA: Shared Medical Appointments SOP (Clinical): Scope of Practice SPD: Sterile Processing Division SPE: Senior Procurement Executive

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

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

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

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

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

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

2. STAFFING AND QUALIFICATIONS

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

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

Physician Director (Mandatory for all sites): FTE Ratio Performance Standard: 0.05 FTE per PACT. Responsible Party: Shall be provided by contractor. Qualifications: Contractor’s Physicians (including subcontractors) providing physician director services under the resultant contract shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice.

Contractor’s Physicians performing under this contract shall be board certified by the ABMS in Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or Family Practice. If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. The physician director may also be credentialed and privileged to function as a PCP. (If so, authorization for prescriptive authority is required).

Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located;

otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site.

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

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

Contractor to propose mix of PCP from the options below. At least one of the primary care providers must be a physician.

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

If proposed staff do not meet VA credentialing requirements, the contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities:

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

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

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

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

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

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

Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Licensed Practical or Vocation nurse located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities:

Responsible for the provision of covered services to assigned and unassigned patients presenting for care at the site, providing evaluation and care consistent with licensure, certification, and functional statement with elements of practice, to patients assigned PACTs, collaborating with PACT staff to develop comprehensive health care plans and care management plans for patients assigned to patient panels, managing clinic workflow, ensuring patients are placed in examination rooms in a timely manner, and providing direction to patients as they move through the clinic environment. Duties include but are not limited to the ability to perform a variety of specialized clinical support skills, ability to perform basic patient care service, have knowledge of medical terminology, demonstrate skills in interpersonal communication, demonstrate knowledge of aseptic technique and infection control and knowledge of patient confidentiality, policies and procedures. Shall assist all health care providers in performing patient care services and duties pertaining to the effective and efficient delivery of patient centered care in all clinical areas. The LPN is to serve in the PACT teamlet clinical associate role, not as primary TCT. May be trained as a TCT back-up, but not as the primary TCT.

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

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

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

See VA qualification standards for Medical Support Assistant located in the VA Qualification Standards for additional qualifications. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. Provide clerical support and administrative functions to PACT staff and collaborate with PACT staff to incorporate the logistical elements of care coordination into comprehensive care management plans. Provide guidance and direction to patients and personal support persons for navigating the VA health care system and administrative functions in VA. Provide scheduling services in accordance with VA policies and guidance.

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

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

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

Discipline Specific 3: Licensed Social Worker (this position provides general/medical social work services): Contractor shall provide a Licensed Social Worker. FTE Ratio Performance Standard: 1 FTE per 2 PACTs. Qualifications: Social Workers providing general social work services under this contract shall have a master’s degree in social work (MSW) from a school accredited by the Council on Social Work Education (CSWE). Current, full, active, and unrestricted license in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Social Worker located in the VA Qualification

Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned Veterans presenting for care. Covered services include, but are not limited to, conducting bio-psychosocial assessments to determine needs of Veterans, Veteran’s family members and caregivers. Provide a full range of clinical social work services within established standards of social work practice which includes treatment planning, individual, family and group counseling, VA and community-based resource referrals, case management and other services as appropriate.

Providing tailored interventions for a wide range of psychosocial issues to include housing/homelessness, food, finances, family/caregiver support, home care/placements, legal, education, employment, disability, mental health/addiction, medical and reporting of abuse/neglect.

Participate in treatment planning with interprofessional teams, members, and other programs. Assist with long term care placement, discharge planning, hand off communication and transitions between levels of care and arranging for in home services to ensure care is timely and appropriate.

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

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

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

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

• Collaborative Care Management: 0.17 FTE Collaborative Care Managers per 1200 primary care patients. (Typically options 2-5 below) per PACT. Collaborative Care Managers will also require a consulting PwPP (options 4 - 6 depending on the provider’s scope of practice).

Collaborative Care Managers (CoCMs) have specialized training in behavioral health and are typically RNs but could also be other Licensed Practitioners (LP) of varying disciplines.

(See the VHA Directive 1160.01, Uniform Mental Health Services for more information…