Q&As.Telehealth_Services.doc

RFP-244-19-0001-REL – Tele-Health Services Pre-Proposal Conference

Billings Area Indian Health Service Judge Jamison Federal Building 1st Floor Training Room

Tuesday, June 18, 2019

8:00 AM – 11:30 AM

ATTENDEES:

Billings Area Indian Health Service (BA IHS):

· Andrew Delgado, Director of Field Operations

· Larron Dolence, Acting Area Pharmacy Officer

· Destiny Doney, Area Credentialing Specialist

· Rita Langager, Area Contract Specialist

· Janice Roth, Area Infection Control Nurse

· Carol Strasheim, Area Nurse Educator/Diabetes Nurse Consultant

Vendor Attendees (copy of sign-in sheet is attached).

INTRODUCTION:

Ms. Langager introduced herself. The rest of the Billings Area Indian Health Service (IHS) representatives did the same.

Ms. Langager gave an overview of Request for Proposal (RFP)-244-19-0001-REL for the provision of Tele-Health Services at the IHS facilities in the Billings Area (Montana and Wyoming). The IHS service area includes 3 hospitals, 3 associated satellite clinics: Blackfeet Service Unit, Browning, MT; Crow Service Unit, Crow Agency, MT, and 3 health centers in Montana and Wyoming. Additional information regarding the IHS facilities can be found at ihs.gov.

Are all facilities on tribal land? Yes.

Each facility is a Federal facility.

Current incumbent?

There is no current incumbent for the Tele-Health Services. The IHS currently has a Tele-Radiology contract in place with Diagnostic Imaging Services that expires on July 23, 2019. A bridge contract will be awarded to the incumbent contractor through September 30, 2019. Therefore, the Tele-Radiology portion of the Tele-Health Services must commence on October 1, 2019.

The IHS also has a contract in place for Tele-ER Services at Browning, Crow Agency, Fort Belknap and Lame Deer, Montana. The contract is in the 3rd year of a 5-year contract.

Will the services be combined in the future? Possibly.

Physician Specialty Clinics: Cover all, see list referenced in RFP.

The IHS currently has onsite specialty clinics at some individual IHS locations that will be renewed for a short term; e.g., six months, then IHS will let them expire.

Contractor proposed potential use of an app for patient access from home.

This is not possible since IHS patients in rural, remote areas have limited availability to technology.

No show rates questioned. Foresee increase in numbers at the Browning, Montana. Anticipate patients utilizing Tele-Health Services.

Browning, Montana is patient centered for provider scheduling.

IHS has high provider vacancy rates. Lack of housing for providers contributes to the vacancies.

Improved Patient Care (IPC) – access at all IHS locations.

Scheduling – Patients contacted by phone and e-mail.

Doctor on Demand – Example of new technological advances.

Scheduling should improve call-backs – number of changes

IPC – Established to improve patient education

Government Performance and Results Act (GPRA) aggregate data available after 09/30/19. Will know by 12/31/19.

Contracting Officer’s Representative (COR) assigned? Yes, a COR from the Billings Area Office will be designated at time of award.

Went over applicable Blocks/Items in Section A – SF-1449, Solicitation/Contract/Order for Commercial Items.

Reviewed and discussed Section B – Supplies or Services and Price/Costs:

B.1

PRICE SCHEDULE – TELE-HEALTH SERVICES

· Tele-Health Services at the IHS facilities in the Billings Area (Montana and Wyoming).

· The procurement is conducted pursuant to Federal Acquisition Regulation (FAR) Part 15; FAR 37.6, Performance-Based Acquisition; and FAR 37.4, Non‑Personal Health Care Services Contract

· Fixed-price commercial item contract for 12 months with four 12-month options.

· Prospective offerors may submit alternate proposals to satisfy the requirements of the solicitation as provided in Subsection E.1, paragraph (e).

· Went over each line item description. Conveyed that the Site Assessment and Implementation Plan; and Site Implementation and Education are only applicable to the first year.

· Discussed feasibility of the services, including, but not limited to:

· IHS infrastructure

· implementation schedule

· performance and data requirements

· clearance and access procedures

· IHS support staff

· patient schedules

· proposed contract type

· reimbursement methodology

· suitability of the proposal instructions and evaluation criteria

· any other industry concerns or questions Contract Award: 12 months with four 12-month options

Number of Award: One (1)/Single award.

Possibility parties may renegotiate terms. Price schedule currently requests a flat monthly rate.

Specialty Services – Variation in amounts. Variation in Quantity clause will allow variation in Currently have some contracts for onsite specialty services.

Refer to the RFP for the Specialties required by each IHS facility for the base year and each four year option:

SECTION C - CONTRACT CLAUSES

C.1

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these addresses:

Clauses highlighted https://www.acquisition.gov/ No. FAR Clause

Title

Date

2. 52.204-7 System for Award Management

OCT 2018

Must be registered prior to award for DUNS #

3. 52.204-9 Personal Identity Verification of Contractor Personnel

JAN 2011

Clearance to enter facility. Contractors Level II. No badge but background.

4. 52.204-13 System for Award Management Maintenance

OCT 2018

Must remain in compliance.

9.

52.211-16 Variation in Quantity

APR 1984

Indicate whether this will incur change in price 10.

52.212-4 Contract Terms and Conditions – Commercial Items

OCT 2018

(a)Inspection/Acceptance

(b)Assignment

(c)Changes

Primary – inspect/accept/assign/allow changes

11.

52.215-5 Facsimile Proposals

OCT 1997

Accepted

12.

52.217-8 Option to Extend Services

NOV 1999

30 days prior to end of 12-month term exercise next OY 19.

52.226-1 Utilization of Indian Organizations and Indian-Owned

JUN 2000

Economic Enterprises Is there IP? Yes if sub-contracting, it is encouraged. Sub-contractors will be reviewed.

25.

52.232-18 Availability of Funds

APR 1984

Use 3rd party funds rather than annual appropriation

Invoices net 30 days when received; interest & taxes.

What is budget? Not allowed to share.

26.

52.232-40 Providing Accelerated Payments to Small Business

DEC 2013

Subcontractors

To be paid within 15 days 27.

52.237-2 Protection of Government Buildings, Equipment, and

APR 1984

Vegetation

Leave in same condition

28.

52.237-3 Continuity of Services

JAN 1991

No interruption.

Highlighted specific provisions in the Performance Work Statement

Statistics and Workload

Ambulatory Patient Count / Workload

These are completed visits.

No shows. One reason: Lack of patient transportation.

Contractor will not charge fee.

Lack of negotiation with patient. Lack of pre-appointment.

Need efficient / timely reminders.

Patient engagement: return to clinic with patient.

EHR reminder – follow vendor process.

Mental Health issue – only 2 partners with Tribes.

Are there dedicated staff or BH? No

Role model for each location.

Telepsych allowable? Yes, vendor to be champion.

Potential: make provider available.

Primary care is the buy-in. IHS help facilitate with goal of helping IPC.

Telehealth: not seen if in ER, within 24 hours by same provider, defer to whoever is on call BH: contract provider facilitate same level of facilitation, coordination, follow through.

Appropriate to transfer. Not involved in daily but possibly consult.

Discharge – video-counseling/evaluation onsite visits.

Inpatient at night? Checking order not visually verifying.

Services to general medical and surgical inpatients via two-way mobile video access.

Will vendor provide or use existing?

Use current mobile to all of our sites.

Electronic Health Record

Outlying clinics: Northern Cheyenne refers to Crow/Northern Cheyenne hospital coordinator

Northern Cheyenne Hospital Coordinator outside referral.

Telehealth Security Meet Federal regulations. Defined by NIST.

FedRAMP internal government program risk/security assessments, authorization and granting of ATO.

Credentialing and Privileging (C&P) C&P required at all sites.

Yes, through CVO/BAO to facilities. Privileges at each location.

Staff meetings: by facility by-laws.

Proxy C&P if contractor is JCAHO accredited.

Request for multiple sites? Yes

How many providers at one time? All – up to 15 - who have a completed/full packet.

Focus on top from / by each specialty.

How to meet timeline: CVO staff at each site will process.

C&P timeline: 45 days or sooner.

Complete application one time.

Completed packet up to 70 days.

Credentialing average: 80 days.

Depends on provider.

CVO will work with contractor.

Pharmacy Services Would like list of Chief Pharmacists.

Volumes: M-F supplemental Inpatient overnight? 20 Rx overnight

UC – double that #.

Chief Pharmacists can drill down the numbers.

EHR & RPMS – how do they engage? GUI

Similar to VA. Pharmacists works in RPMS.

Providers use EHR view Facilities do not share information with one another.

Schedule II – not capable. C3-5 need wet signature DEA – system not ready.

MT MCD – counseling EHR standard template – varies

Clinical Applications Coordinator (CAC) for Area – make changes to the template.

IPC using PCMH to increase revenue

MT/MCD/PI

Wet signatures required.

Billings office notified at same time.

Providers cleared at another IHS area? Need fingerprints.

Is there an issue using a provider at multiple sites? No

Reimbursement: IHS will bill Medicare/Medicaid where provider is located.

Billing approaches – use appropriate code.

IT questions:

Does each site have same?

Teleradiology – do reads go back into EHR ISSA – current

ISSO – ITAC requests at each location? May process through AO/DFO. DFO serve as Federal supervisor.

VTC – currently in Client? Sysco DT Client.

Video Gateway – CISCO.

SK stand-alone

PAK System

EHR integrated VISTA Currently at all sites.

No patient to patient.

Cloud based work / cloud-based connect?

There are barriers.

On premises preferred.

PATO (?) for cloud-based? Not at IHS yet.

What layer? Capability inherit.

Protocols for power outages? IT battery back-up.

Generator – determined by individual facility.

ER has back-up.

PIV for log-in is the goal No 2-factor

No EHR yet

Mobile? Not yet

Name/passwords - yes

Scanning? Medical devices as necessary.

There are servers at each site.

Ports protocol. Disallow P2P.

Go through own / secure transfer.

Firewalls.

ATOS cannot accept.

ATO transfer – IHS/VA DOD

VISTA closer.

Deliverables

Number of patients: from contractor’s system or IHS? Both.

CME – by provider? No. Vendor to provide education, CME/CNE. Clarify – telehealth? Or provider?

Hospitalist Services Bedside for Browning and Crow Agency.

Assist mid-levels and nursing staff.

Subcontractor Template

On-site? No.

Providers as subcontractors.

Internal reviews

Quarterly reports.

Map of BA IHS Sites.

List of Area Clinical Directors.

NAICS is 622110; Size Standard above $38.5 million = large business

Radiology reads into EHR?

Yes

Access at all sites?

Yes

SECTION E - SOLICITATION PROVISIONS

E.1

52.212-1 INSTRUCTIONS TO OFFERORS--COMMERCIAL ITEMS (OCT 2018)

(e) Multiple offers.

Submit multiple and/or alternate offers separately.

E.3

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS --

COMMERCIAL ITEMS (OCT 2018)

System for Award Management (SAM) accessed through https://www.sam.gov. Offeror complete the annual representations and certifications electronically.

E.4

PROPOSAL SUBMISSION INSTRUCTIONS

Submission requirements - minimum acceptable.

1.

Standard Form SF-1449, Solicitation/Contract/Order for Commercial Items

2.

Subsection B.1 – Price Schedule

3. Subsection E.2 – 52.212-2 Evaluation – Commercial Items (OCT 2014) Offerors shall provide evidence of, or submit a written response to, the technical evaluation factors in FAR 52.212-2.

4.

Subsection E.3 - 52.212-3 Offeror Representations and Certifications -- Commercial Items (OCT 2018)

Offerors shall submit a completed copy of FAR 52.212-3 with the offer unless the Representations and Certifications have been completed electronically through the System for Award Management (SAM).

E.7

TO BE COMPLETED BY THE OFFEROR

An individual authorized to bind the prospective offeror must execute the Representations and Certification.

E.8

CONSENT FOR FINANCIAL CHECK

Both of these must be submitted.

E-MAILED QUESTIONS AND ANSWERS:

06/05/2019 E-mail:

1. Is the Government mainly looking for Tele-health services or are they also looking to acquire a solution in addition to providing personnel/clinician services?[Delgado, Andrew A.] The Government is mainly looking to identify a vendor that can provide specialty service by providers through tele-health services equipment. The vendor is expected to provide a recommended information technology system for tele-health connection that is compatible with Government system.

2. PWS Page 13, Section “Indian Health Service Electronic Health Record”: Will the government please clarify if existing technology will be used or a new solution is needed in reference to the below statement from the PWS?[Delgado, Andrew A.] Contractor will access Government system through an approved connection to document in the Government’s Electronic Health Record.

“The contractor shall use the IHS Electronic Health Record (EHR) system to maintain accurate and up-to-date information on clinical care provided to patients. EHR systems are located at each IHS facility and remote access to each EHR system will be enabled through the IHS VPN system. The telehealth specialty services is to be provided via the agency's existing video and network infrastructure.”

3. PWS Page 8, Section “Tele-health specialty Clinics”: Is the government expecting onsite medical staff/clinicians or wanting them mainly for remote consultation?[Delgado, Andrew A.] Government is expecting the vendor to provide medical staff/clinicians via agency’s existing network and expect the vendor to identify the best feasible video equipment at each site.

4. PWS Page 10, Section “Hospitalist Services”: Will the Government clarify which system is now used to provide two-way mobile video access? Is the Government planning to replace this current system?

“Contractor will provide Hospitalists telehealth services to general medical (age 18 and over) and surgical inpatients via two-way mobile video access.”[Delgado, Andrew A.] The Government expects the vendor to provide a two-way mobile video access solution as well as Hospitalist services.

06/05/2019 E-mail:

Provided is the response the Contracting Office received.

There are only two national telehealth accreditation bodies - URAC (originally known as the Utilization Review Accreditation Commission, but name shortened completely to URAC) and CHQI (ClearHealth Quality Institute).

However, to date, I have not seen any IHS Telehealth contracts requiring the contractor to have telehealth accreditation—I believe we are usually more focused on ensuring the providers are credentialed and privileged at our accredited (or certified) hospitals and clinics.

For example, one telehealth network has accreditation with Joint Commission for Ambulatory Health Care (not telemedicine accreditation, which is not even offered by TJC.)

06/12/2019 E-mail:

QUESTION: By any chance is there a way for me to obtain copies of each facility location's bylaws to review?

ANSWER: This information will be released to the successful contractor after the contract is awarded.

06/14/2019 E-mail:

We have a few questions concerning highlighted item on page 13 of the PWS.

Indian Health Service Electronic Health Record

The contractor shall use the IHS Electronic Health Record (EHR) system to maintain accurate and up-to-date information on clinical care provided to patients. EHR systems are located at each IHS facility and remote access to each EHR system will be enabled through the IHS VPN system. The telehealth specialty services is to be provided via the agency's existing video and network infrastructure.

Question: Can you provide more detail on the agency's existing video and network infrastructure?

1. Is your agency's existing Tele-Health infrastructure the only system to be used in the performance of this contract? [Delgado, Andrew A.] No. The vendor can provide an equipment and video recommendation to augment existing IHS equipment in an effort to satisfy the contract statement of work.

2. Is the agencies existing system a standard established by the Federal Government for use? ?

3. Will the use of other Tel-Health systems with increased capability be considered for use? [Delgado, Andrew A.] Yes

4. Will the contractor be allowed to "plug-in" their Tele-Health system into your agency's? [Delgado, Andrew A.] No 06/17/2019 E-mail:

1. Level-set site assessment reporting

2. Equipment: eCARE has wired vs wireless options

3. Site internal wireless capabilities

* Wireless is an option for the televideo equipment. Wireless at each facility would need to be assessed to verify adequate coverage in the area it will be needed . The Billings Area IT preference is to have the equipment wired for performance reasons but wireless is not off the table as an option.

4. Network Connectivity at Sites: bandwidth, utilization, capacity discussion

* Avera’s site assessment has placed the Ft. Washakie location as a high risks deployment because of their limited bandwidth. IHS has been attempting to upgrade the circuit at that location but has so far been unsuccessful. We may need to look into Satellite or additional T1 circuits to use for video traffic. They currently operate on 6Mbps.

5. EMR

* The IHS EHR for the Billings Area is located at each of the facilities. The vendor would need to utilize a VPN tunnel to the agency as a means for connecting the contract staff to the 6 instances of the EHR.

06/24/2019 E-mail:

QUESTION: I noticed in Section C, you have checked the SCA-Service Contract Act clauses. However, I did not see the required Wage Determination included in this solicitation packet, so wanted to ask you for that if possible?

ANSWER: Sections C and D include the Service Contract Labor Standards Act; however, the Indian Health Service is unable to incorporate the wage rates until the “distant site” is determined. There is also a caveat to SCLS Act applicability. FAR clause 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services-Requirements, provides in part that service employees who perform less than 20 percent of available hours during the contract period are exempt from the SCLS Act. Therefore, the Indian Health Service is uncertain at this time whether the SCLS Act will apply or not.

06/27/2019 E-mail:

QUESTION: We’re working on our technical response for the telehealth RFQ and wondered if we should include Eagle Child Health Station in our proposal? They are included in the opening paragraph of Part 1 but not included in other places within the RFQ.

ANSWER: Yes, please include the Fort Belknap Hospital and Eagle Child Health Station when developing your proposal.

06/27/2019 E-mail:

QUESTION: On page 14 of the PWS it is referenced:

“ Accurate Common Procedural Terminology (CPT) coding shall be documented for all patient encounters. Contractor will preform quarterly CPT audits for coding compliance.”

Our question is; how is this information obtained? Will IHS provide data or will IHS provide access for the vendor to provide the data?

ANSWER: We [IHS] can provide the data directly to the vendor each quarter for them to perform the audits.

06/27/2019 E-mail:

Below is the response for Blackfeet:

It was a pleasure to finally meet you in person at the meeting in Montana. We are very excited about developing a telehealth program for IHS. As we are working through the proposal I wanted to see if you could provide clarification on a few items.

? You had mentioned that the volume of scripts could be 20 IP and 40 urgent care scripts per night. Is that per facility?

· IP 10

· ER ~100

0 Inpatient and ER prescriptions---CSU has overnight pharmacy services in place. Additionally, 0 for LG and Pryor. These facilities are staffed with full time pharmacy services.

? Do you have an idea of how many pharmacists you are needing for the night time coverage and what facilities they will be allocated to?

· 1

0 Pharmacists for CSU ? Would you be able to provide a monthly summary or average number of discharges that the pharmacist is required to participate in?

· 100%

0 for CSU

? Was any further clarification given regarding the processing of Schedule 2 scripts from telehealth providers?

· Original signed hard copy is required for all CII prescriptions dispensed from the ER. Telepharmacy will not process these prescriptions.

CSU does not dispense any C2 rxs from the ER, but would be same answer as supplied above if we did. (same for all IHS facilities)

06/28/2019 E-mail:

QUESTION: I wondered if you could pass me the name and phone number of the credentialing specialist that we met at the telehealth meeting. She sat on the panel with you and the others. I was trying to look her up in the IHS directory but cant seem to find her name or contact info.

ANSWER:

Destinie Doney, CPCS

Area Credentialing Supervisor

Billings Area I.H.S/Centralized CVO

Office of Quality Management

P.O. Box 36600

Billings, MT 59101

Email: Bil_AOCVO@ihs.gov P: 406.247.7123

F: 406.247.7224 07/01/2019 E-mail:

QUESTION: Please ask Rita or the program manager to clarify what their expectations they have of the Telemedicine doctor’s physically coming to the facilities at any time? There is verbiage for having a presence at medical staff meetings.

ANSWER: The Government expects the vendor to identify the need and frequency of on-site visits necessary as part of the site assessment and evaluation during the implementation phase. Vendor is encouraged to participate in Medical Staff Meetings to promote the Telehealth Specialty Services.

07/02/2019 E-mail:

Can we get a description of how the pharmacy service will work?

They want Pharmacy service nights, weekends and holidays. [Delgado, Andrew A.] Inpatient only for verifying orders when necessary.

Is this for patients in the hospital only? (In the ER or inpatient)?

Since a Pharmacists usually dispenses medication, how will this be achieved?[Delgado, Andrew A.] Pharmacist(s) is not expected to dispense medication but is expected to verify orders only.

Do they want us to engage outside pharmacies to deliver to patients home or only use their in house pharmacy? [Delgado, Andrew A.] Not applicable.

07/09/2019 E-mail:

Question for you on Fort Belknap and radiology. You are requesting pricing for this location on page B4. Can you provide the volumes for Fort Belknap as you did for the other service units on page 12 of the Performance Work Statement?

The tele-medicine volumes for the Fort Belknap Service Unit will be included in the forthcoming amendment. The tele-radiology volumes are not necessary since the Fort Belknap Service Unit is awarding a separate contract for the services. Lastly, the amendment should be publicized on Federal Business Opportunities (FedBizOpps) in the next day or two.

07/09/2019 E-mail:

Can you give us the total number of people from last year for each referral categories? For example: of the 6,452 referrals in 2018 at Blackfeet, what % of those are were Cardiology, GI, Psychiatry, etc…[Delgado, Andrew A.] We are not able to provide that level of specificity.

Six of the units are required to have 6 exam rooms for the telehealth clinic. For the non-hospital facilities/outlying clinics, how many locations where telehealth specialty clinics will be provided should be identified within each facility? We need to know this so we know a total number of rooms we will need to equip for telehealth consults.[Delgado, Andrew A.] Six at each site at a minimum 07/09/2019 E-mail:

Please can you confirm the submission requirements for this solicitation? Section E.1 (b) of the RFP only states that we should “Submit signed and dated offers to the office specified in this solicitation at or before the exact time specified in this solicitation” but does not specify the method of submission. Can the proposal be submitted via email?

Yes, the solicitation authorizes faxed and e-mailed proposals.

07/10/2019 E-mail:

We have a question on the CLIN structure, please ma’am. What does the Annual Site Utilization Services for? We just want to make sure we are on the same page with your office expectations.

Provided is the response.

Annual Site Utilization Services[Delgado, Andrew A.] Vendor should include any other support services on an annual basis that would include Physician support, site visits, continued education, etc.

07/10/2019 E-mail:

Just to confirm, the purchased referred care totals per service unit was specifically for the “specialty” care. This does not include the Behavioral Health, correct?

That is correct; the PRC totals are for physician specialty services.

07/10/2019:

I appreciate you talking with me earlier about the data on patient counts & BH utilization rates for purposes of submitting for the RFP.

Pursuant to that conversation, it would be much appreciated if you could send additional data that provides a further breakdown of the Ambulatory Patient Counts associated with the various IHS Service Units.

This is the information available at this time:

Our FY2018 Official Billings Area User Population: 71,180

The Billings Area Behavior Health Workload for FY2018: 20,356 visits

Behavior Health utilization rates would require approval from our Headquarters.