S02 - 36C26125Q0543 Mohs Services.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

36C26125Q0543 08-06-2025

Cynthia Diezel 916-923-4567 08-20-2025

10:00AM PDT

612MCP

Department of Veterans Affairs

Network Contracting Office (NCO) 21

X

621511

$41.5 Million

N/A

Reference the Performance Work Statement

612MCP

FMS VA-9(101) Financial Services Center

PO Box 149971 Austin TX 78714-9971

See CONTINUATION Page

The contractor shall provide Mohs Surgical Technicians and equipment required to perform services on-site in accordance with the Performance Work Statement.

IDIQ Period of performance: 10/01/2025-09/30/2030

Ordering Period 1: 10/01/2025-09/30/2026 Ordering Period 2: 10/01/2026-09/30/2027 Ordering Period 3: 10/01/2027-09/30/2028 Ordering Period 4: 10/01/2028-09/30/2029 Ordering Period 5: 10/01/2029-09/30/2030

See CONTINUATION Page

Cynthia Diezel Contracting Officer

36C26125Q0543

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 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 Performance Work Statement for Dermatology Mohs Surgery Services

B.4 IT CONTRACT SECURITY

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 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.7 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) 41

C.8 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.9 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.10 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.11 VAAR 852.211-76 LIQUIDATED DAMAGES - REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023)

C.12 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (OCT 2019)

C.13 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (OCT 2019)

C.14 852.222-71, Compliance with Executive Order 13899 (Deviation) (April 2025)

C.15 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.16 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.17 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

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

1998)

E.2 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT ORDERS—

REPRESENTATION AND DISCLOSURES (DEC 2023)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

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

SERVICES (NOV 2021)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.7 VAAR 852.215-72 NOTICE OF INTENT TO RE-SOLICIT (OCT 2019)

E.8 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.9 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (NOV 2021)

E.10 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (MAY 2024) (DEVIATION FEB 2025)

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:

b. GOVERNMENT: Contracting Officer 36C261

c. ADMINISTRATION: Contract Specialist 36C261

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

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

Management, or

[ ] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly [ ]

b. Semi-Annually [ ]

c. Other [X] Monthly in arrears

4. GOVERNMENT INVOICE ADDRESS: Invoices will be electronically submitted to the Tungsten website at http://www.tungstennetwork.com/uk/en/ Tungsten direct vendor support number is 877- 489-6135 for VA contracts. The VA-FSC pays all associated transaction fees for VA orders. During Implementation (technical set-up) Tungsten will confirm your Tax Payer ID Number with the VA- FSC. This process can take up to 5 business days to complete to ensure your invoice is automatically routed to your Certifying Official for approval and payment. In order to successfully submit an invoice to VA-FSC please review “How to Create an Invoice” within the how to guides. All invoices submitted through Tungsten to the VA-FSC should mirror your current submission of Invoice, with the following items required. Clarification of additional requirements should be confirmed with your Certifying Official (your CO or buyer). The VA-FSC requires specific information in compliance with the Prompt Pay Act and Business Requirements. For additional information, please contact:

Tungsten Support Phone: 1-877-489-6135

Website: http://www.tungsten-network.com/uk/en/ Department of Veterans Affairs Financial Service Center

Phone: 1-877-353-9791 Email: vafscched@va.gov

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

AMENDMENT NO DATE

mailto:vafscched@va.gov

B.2 PRICE/COST SCHEDULE

The Contractor shall furnish all personnel to perform Mohs Surgical Technician services for Veterans Affairs Medical Center, VA San Francisco (VASFMC). The services will be performed over a one year base plus four (4) year period of performance. All services performed will be in accordance with the performance work statement.

The guaranteed minimum, for the contract is $1,000.00. The maximum of the contract, inclusive of ordering periods, shall not exceed $750,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum award amount.

Place of Performance: Services shall be provided on site, VA Medical Center San Francisco 4150 Clement Street, San Francisco, CA. 94121.

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

636.00 EA __________________ __________________

Mohs Micrographic Surgery Technician In Accordance With Performance Work Statement.

Contract Period: Ordering Period 1 POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services PRODUCT/SERVICE CODE: Q504 - Medical - Dermatology

MANUFACTURER PART NUMBER (MPN): N/A

72.00 EA __________________ __________________

Immunohistochemistry Staining (IHC).

Estimated of 30 cases per year (includes labor rate + Immunochemistry kit).

Contract Period: Ordering Period 1 POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

648.00 EA __________________ __________________

Performance Work Statement.

Contract Period: Ordering Period 2 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

Estimated of 30 cases per year (includes labor rate + Immunochemistry kit).

Contract Period: Ordering Period 2 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

638.00 EA __________________ __________________

Performance Work Statement.

Contract Period: Ordering Period 3 POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

Estimated of 30 cases per year (includes labor rate + Immunochemistry kit).

Contract Period: Ordering Period 3 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

645.00 EA __________________ __________________

Performance Work Statement.

Contract Period: Ordering Period 4 POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

Estimated of 30 cases per year (includes labor rate + Immunochemistry kit).

Contract Period: Ordering Period 4 POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

643.00 EA __________________ __________________

Performance Work Statement.

Contract Period: Ordering Period 5 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

Estimated of 30 cases per year (includes labor rate + Immunochemistry kit).

Contract Period: Ordering Period 5 POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 541990 - All Other Professional, Scientific, and Technical Services

GRAND TOTAL __________________

36C26124Q0543

B.3 Performance Work Statement for Dermatology Mohs Surgery Services

GENERAL:

• The contractor shall provide a cryostat for Mohs technician use for processing specimens.

• The Mohs Tech should arrive no later than 8:00am.

• The Mohs Tech is responsible for maintaining the cryostat, setting up the work area, completing and maintaining the Mohs log, maintaining the appropriate paperwork for the tissue, marking and orienting the tissue correctly, embedding, cutting and staining the specimen so that usable sections can be analyzed by the Mohs surgeon, storing the tissue appropriately, observing and maintaining appropriate safety precautions, cleaning up the laboratory area after use, and Quality Assurance.

• Mohs Tech will have no computer access at the SF VAMC. Mohs Tech will have access to patient name and last 4 of SSN. Mohs Tech will review and sign Dermatology Service Business Continuity Plan (BCP) and Emergency Response Plan (ERP).

• Mohs Tech Minimum - Based on the number of lesions the VA is performing per day:

o Regardless of the caseload/# of lesions scheduled for the day, if one technician is sent, they must be able to handle 10-20 cases solo without compromising slide quality or wait time. Specifically, they must be able to produce slides within 30 minutes for simple cases and within 60-90 minutes for more complex cases, without the need for additional recuts of the tissue for processing errors. The ability to do so must be confirmed by two letters of recommendation from current companies that use the technician service.

o If unable to meet the above requirements, the technician company must always send two technicians, regardless of the caseload/#lesions scheduled for the day.

o If the VA is performing less than 5 lesions per day the contractor can invoice for a minimum of 5 lesions.

o The VA will pay the contractor based on the number of lesions and not the number of techs.

• If IHC staining is required, the Contractor shall provide Immunochemistry stain (e.g. Mart-1, CK5) per patient lesion site for IHC materials and staining.

o The same requirements regarding caseload/#lesions and technician ability apply for days with IHC cases scheduled. If one technician is sent, they must be able to handle 10-20 cases solo, including the IHC cases, without compromising slide quality or wait time.

• The need for additional technicians based on anticipated case size and patient safety is at the discretion of the VA Mohs Surgery Team and the contractor will be notified accordingly with 2 weeks’ notice.

PLACE OF PERFORMANCE:

Contractor shall furnish services at the VA Medical Center San Francisco 4150 Clement Street, San Francisco, CA. 94121.

AUTHORITY:

Title 38 USC 8153, Health Care Resources (HCR) sharing Authority

POLICY/HANDBOOKS:

VHA Directive 1101.12 MOHS MICROGRAPHIC SURGERY

a. Resources Needed for Mohs Operative Suite, MMS SharePoint

b. Required Resources for Mohs Laboratory, MMS SharePoint

c. Required MMS Operative Documentation, MMS SharePoint

d. Mohs Lab Slide Quality Control, MMS SharePoint,

e. Quarterly Proficiency Quality Control Form Cover Sheet, MMS SharePoint

f. Daily Tissue Staining Quality Control Form, MMS SharePoint

g. Staff Support Needed for Mohs Micrographic Surgery, MMS SharePoint, MOHS MICROGRAPHIC SURGERY SITE ACTIVATION

General Information. General Information about the Mohs Micrographic Surgery Site Activation Plan, MMS SharePoint

Checklist. Mohs Surgery Site Activation Checklist, MMS SharePoint

VHA MOHS SHAREPOINT:

https://dvagov.sharepoint.com/:f:/s/VACOVHAPS/10ppolrev/EjWufiO6mEJNk1jnEFXAcK YBUjubnTRyK_Ylcr_IHYIMTg?e=5U3SP3

VAMC SAN FRANCISCO DERMATOLOGY MOHS SURGERY POLICY AND PROCEDURE

TISSUE PROCESSING PROTOCOL FOR MOHS MICROGRAPHIC SURGERY

SCOPE:

Mohs surgery is performed using intraoperative frozen section slide evaluation to determine a clear margin for skin cancer, and these cases are routinely performed at the SFVA dermatology department. The frozen remnant of the final margin specimen is submitted to Pathology in 10% buffered formalin for permanent sections.

CRYOSTAT:

• The cryostat temperature is at an optimum cutting temperature between -18*C to - 35*C. Check and log the temperature using an external thermometer. If out of range, notify a supervisor and document corrective action in the temperature log.

• Make sure the handle is in locked position.

• De-ice microtome as needed using isopropanol.

• Oil all moving parts.

• Secure the blade holder tightly.

• Place the brushes, heat sink and lastly the disposable blade into the cryostat chamber.

PERSONAL PROTECTIVE EQUIPMENT:

• Place gloves and a face mask with a shield near the work area so these are readily available while working with fresh tissue and for

SET UP:

• Cover the work area with polyback drapes or any other non-porous covering to protect the counters.

• Set up your tools in a safe and ergonomic manner.

https://dvagov.sharepoint.com/:f:/s/VACOVHAPS/10ppolrev/EjWufiO6mEJNk1jnEFXAcKYBUjubnTRyK_Ylcr_IHYIMTg?e=5U3SP3 https://dvagov.sharepoint.com/:f:/s/VACOVHAPS/10ppolrev/EjWufiO6mEJNk1jnEFXAcKYBUjubnTRyK_Ylcr_IHYIMTg?e=5U3SP3

• Place your stains in the back of your work area. Make sure all reagent containers are marked with the appropriate reagent name.

• Place your inks on one side and the cover slipping gear on the other.

• Place the cutting board in the front closest to you and the scalpel just above the cutting board at 12 o’clock with the blade facing the cutting board.

• Place chucks, embedding medium, slides, and a slide marking pen close to the cryostat.

• Fill your cryac with liquid nitrogen following the LN2 Protocol using protective gear

(as stated in the LN2 protocol below) and place it close to the cryostat on an even surface.

• Make sure the room/lab temperature lies within the accepted range of 68-82 degrees of Fahrenheit. If out of range, notify a supervisor and document corrective action in the temperature log.

LN2 PROTOCOL:

• Liquid nitrogen is extremely cold and can result in burn injuries if exposed to bare skin.

• Make sure that you wear eye protection (face shield or safety glasses) and loose fitting insulated gloves whenever you are handling liquid nitrogen.

• With the cryac on a flat surface, slowly pour the LN2 into the container and be careful not to overfill the cryac. There is a line in the inside of the cryac that is approximately 1 inch from the top. This is the fill line according to cryac manufacturer.

• Screw the lid of the cryac on so that it is finger tight making sure that the red gasket is in place when doing so.

MOHS LOG:

• Fill in all the information as it becomes available.

• There are 5 sections each day that need to be completed: Patient Log, Cryostat

Maintenance Log, Cryostat Temperature Log, Mohs Lab Room Temperature Log, and Stain Quality/Section Quality Control Log.

• Review the Physician Profile and apply any special protocol noted on the profile to the workflow.

RECIVING THE SPECIMEN:

When picking up a specimen for frozen sectioning from the clinic, ask the surgeon for additional history that could be important in determining the diagnosis. It is useful to know the prior history of cancer, clinical differential diagnosis, or the question the frozen section seeks to answer (e.g., diagnostic tissue obtained, margins free of tumor etc). Ensure you have corresponding paperwork for any tissue. Make sure the orientation (12 o’clock) and the surgical marks correspond with the map whether it is drawn by the surgeons or the technician. Log all information needed in the Mohs log. Add accession number on the map if applicable.

MAPPING/RELAXING/INKING*:

Map out your work Use markings preferred by the surgeon Place the specimen on the prep board so that the 12’ orientation of the specimen matches the

12’ orientation of the prep board Divide the tissue into sections appropriate to fit on the slide There can only be one-site per slide Lay margins down using relaxing incisions Ink margins with permanent marking system and indicate appropriate colors on the map if not already performed by Mohs surgeon Number each piece of tissue

* The laboratory director will establish/document whether or not each Mohs technician is qualified to complete high complexity testing. If the Mohs technician is qualified, then testing will proceed as outlined in this protocol, if not, the Mohs surgeon will be responsible for grossing the tissue, i.e.

drawing the map for the Mohs surgery case, indicating which inks are used, and inking the tissue.

The surgeons would also be responsible for any other description of the tissue. Once this portion of the testing is complete, the Mohs technician can proceed to follow the protocol as outlined above.

EMBEDDING THE TISSUE:

• Specimen is positioned on a slide about ¼ of an inch from the bottom.

• Carefully place the slide on the bottom of the cryostat and leave it to freeze for 10-15 seconds.

• Label chuck on the back side to ensure you know which chuck belongs to which patient for any re-cuts.

• Place a chuck on the freeze bar and cover it with embedding medium.

• Carefully pick up the slide and cover the tissue with embedding medium.

• Invert the slide on top of the chuck and sandwich them together.

• Spray it with liquid nitrogen or freezing spray pulsing the spray to give the cold a chance to penetrate to the depth of the tissue.

• Let chuck freeze for a few minutes with the heatsink on it.

CUTTING:

• Be sure the cryostat handwheel is in the ‘lock’ position at all times, except when actually cutting the frozen section. Minimize the use of the pressurized cryofreeze to limit aerosolization.

• Place the chuck in the ball joint and tighten the thumbscrew securely.

• Bevel the chuck to remove excess medium.

• Angle the chuck parallel to the blade.

• Turn the advancement wheel until the tissue is in contact with the blade.

• If there are any questions, show the tissue to the attending before cutting the frozen section.

• Face off the specimen until the skin edge and the depth are visualized.

• Clean the blade of shavings and cut a section using constant and controlled speed.

• Guide the specimen on top of the blade holder and pick up the specimen with a clean slide. If a treated slide is used make sure that the specimen is picked up on the right side of the slide.

• Cut sections at 4-6 microns thick

• Label each slide with patient’s name, accession number, level and piece numbers.

• Make sure you have at least 6 cuts to present to the surgeon.

• Prepare an extra slide for Quality Control and present it to the surgeon with your first case to ensure stain quality and make sure the review of the slide is documented on the Quality Control Log.

• The blade is changed on each Mohs day (Mohs is performed 1-2 x weekly). This is done more often if requested by the surgeon depending on the number of sections cut weekly.

STAINING AND COVERSLIPPING:

The slide containing the freshly cut frozen section is placed into a slide cradle, and placed sequentially into the following solutions, with intermittent dipping to ensure even staining:

a. Hematoxylin and Eosin Staining Regimen:

Solution Time Time 99.9% Isopropyl Alcohol 1 min.

Tap-H²O 30 sec.

Gills Hematoxylin 1-2 min.

Tap H²O 10 sec.

Tap H²O 10 sec.

Tap H²O 10 sec.

Tap H²O 30 sec.

Eosin Y 1 sec.

99.9% Isopropyl Alcohol 10 sec.

99.9% Isopropyl Alcohol 10 sec.

99.9% Isopropyl Alcohol 10 sec.

99.9% Isopropyl Alcohol 10 sec.

Place the slides in the slide holder for staining.

Withdraw the slide from the last alcohol bath and drain from excess alcohol. Apply a line of Clearium on the slide. Place a coverslip over the slide. Wipe the back of the slide and any excess medium that might push out on the sides.

Place the slides on a flat and take them to the doctor with the corresponding map.

REPORTING OF FROZEN SECTION RESULTS:

The diagnosis is documented on the Mohs map with the initials of the Mohs surgeon. After reporting the diagnosis, and confirming that no further cuts are necessary, the frozen residual tissue should be placed into a labeled container filled with 10% buffered formalin and submitted to pathology department for accessioning and permanent sections. The residual frozen tissue must be submitted for paraffin-embedding and preparation of histologic sections using labeled cassettes with alphabetical sequence.

PERMANENT SLIDE LABELING:

• After slide has been read by the surgeon, label each slide with a paper label on the frosted end making sure it doesn’t cover any tissue.

• Each slide should have the following information: (Date, Last Name, First Name,

• Site/Location, Stage and Specimen Section #, Accession #)

• Make sure all of the slides are accounted for.

• Place the slides in cardboard slide holders and put in a place designated by the

• Mohs physician so that they can dry for 2 weeks (in Mohs lab Building 200, Module 3, room

GA-178A). At that time the office can safely store in permanent storage (Building 203, room 1C-13).

FROZEN SECTION STAIN MAINTENANCE:

All the reagents will be appropriately labeled. The solutions for staining of frozen sections will be changed at least once a week, or more often if necessary. This change will be recorded on the Cryostat Maintenance Log.

CLEAN UP:

• After the surgeon has cleared all patients you will start the cleanup process.

• Always first dispose of any sharps. All sharps including the disposable cryostat blade, scalpel blades, and used slides are disposed of in the sharps container.

• The cryostat is cleaned by first taking out the blade holder and rinsing it with water and then finally with 99% alcohol before storing it.

• Next the microtome and surrounding chamber is brushed clean of all shavings and the shavings are disposed in a biohazard container.

• Outside of the cryostat is wiped down with a disinfectant.

• When cryostat is defrosted the microtome and chamber are wiped down with the same disinfectant.

• Pour reagents and wastewater into chemical waste container. This waste container will be emptied by Environmental Health & Safety at least every 2 weeks or more frequently if needed.

• Throw away counter liners and wipe down counters.

RETENTION OF GLASS SLIDES:

The glass slides will be stored under appropriate conditions with minimum retention times as follows. All the Mohs surgery slides (located in building 203, room 1C-13), records (entered into patient electronic medical record and Mohs case log) and blocks (stored with pathology department) will be stored and retained for 10 years from the date of exam.

FROZEN SECTIONS COMPETENCY ASSESSMENT:

• Initial certification and annual competency assessment for all Mohs technicians will be performed by Contractor and provided to SFVAHCS Dermatology Service

• Records will be stored in Mohs Binder and on our SharePoint

HOURS OF OPERATION/SCHEDULING:

Patient Access/Timeliness of Scheduling:

The Contractor will ensure Mohs Tech(s) are present based on pre-determined schedule from 8:00am until all cases finished and dismissed by Mohs Attending. In rare circumstances cases can run quite long, we will stop and dismiss Mohs Tech(s) by 9pm at the latest. As this is an outpatient clinic, we do not operate on federal holidays.

Cancellations:

Unless a state of emergency has been declared, the Contractor shall be responsible for providing services.

CONTRACTOR RESPONSIBILITIES

The contractor is responsible for performance of ALL terms and conditions of the contract.

CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined.

Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards. The Performance Requirements are listed below in Section 6. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.

STANDARDS OF CARE:

The contractor personnel(s) care shall cover the range of Mohs Technician services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized TJC, VA and national standards as established by:

Mohs Micrographic Surgery (MMS) guidelines by the American Osteopathic Association (AOA) Board of Dermatology (AOBD) http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/Basic-Standards-MOHS.pdf http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/Basic-Standards-MOHS.pdf http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/Basic-Standards-MOHS.pdf http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/Basic-Standards-MOHS.pdf

The professional standards of the Joint Commission (TJC) https://www.jointcommission.org/en-us/standards/standards-manuals

The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and;

The requirements contained in this PWS

MEDICAL RECORDS:

Authorities: Contractor’s personnel(s)providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C.

7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA).

HIPAA: Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date.

Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual’s Records, to process “Release of Information Requests.” In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility.

The VA’s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient’s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: (No , only name, last 4, diagnosis as needed for labeling/handling of slides

REGISTRATION WITH CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM

As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates Contractor past performance on all contracts that exceed the Simplified Acquisition Threshold and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.jointcommission.org%2Fen-us%2Fstandards%2Fstandards-manuals&data=05%7C02%7C%7Cdbe62c53a1dc4468faf708ddd47dc0e2%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C638900358748206066%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=xlQboarPZG2m9r0JPtN8ESbQKC1dnRHRoLQCc69HrlA%3D&reserved=0 http://www.hpoe.org/resources?show=100&type=8 https://vaww.va.gov/vaforms/va/pdf/VA3288.pdf https://vaww.va.gov/vaforms/va/pdf/VA3288.pdf https://vaww.va.gov/vaforms/medical/pdf/10-5345.pdf https://vaww.va.gov/vaforms/medical/pdf/10-5345.pdf

PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for Contractor responsibility determination information.

Each Contractor whose contract award is estimated to exceed the Simplified Acquisition Threshold requires a CPARS evaluation. A government Focal Point will register your contract within thirty days after contract award and, at that time, you will receive an email message with a User ID (to be used when reviewing evaluations). Additional information regarding the evaluation process can be found at www.cpars.gov or if you have any questions, you may contact the Customer Support Desk @ DSN: 684-1690 or COMM: 207-438-1690.

For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the Contractor’s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the Contractor’s designated representative for comment. The Contractor representative will have sixty (60) days to submit any comments and re-assign the report to the CO.

Failure for the Contractor’s representative to respond to the evaluation within those sixty

(60) days, will result in the Government’s evaluation being placed on file in the database with a statement that the Contractor failed to respond; the Contractor’s representative will be “locked out” of the evaluation and may no longer send comments.

GOVERNMENT RESPONSIBILITIES

Contract Administration/Performance Monitoring: After award of contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to:

Name: Cynthia Diezel Phone: 916-923-4567 Email: Cynthia.diezel@va.gov

The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract.

The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof.

In the event that contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services;

consultation or training for Contractor personnel to be provided by the VA; replacement of the contract personnel and/or renegotiation of the contract terms or termination of the contract.

http://www.cpars.gov/

COR Responsibilities:

The COR for this contract is: Clarisse Mejia, Administrative Officer

4150 Clement Street SF.CA. 94121

Tel #: 415-849-5757

VA Email: Clarisse.mejia@va.gov

The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

The COR will be responsible for monitoring the Contractor’s performance to ensure all specifications and requirements are fulfilled. Quality Improvement data that will be collected for ongoing monitoring includes but is not limited to: enter data that may be collected.

The COR will maintain a record-keeping system of services by Clarisse Mejia. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record-keeping system and those on the invoices.

Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

The COR will review and certify monthly invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference.

All contract administration functions will be retained by the VA.

SPECIAL CONTRACT REQUIREMENTS

The Contractors’ facility shall meet all federal, state and local fire and life safety codes and must be accessible and convenient for wheelchair patients and other handicapped or disabled Veterans.

Reports/Deliverables: The Contractor shall be responsible for complying with all reporting requirements established by the Contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required.

The following are brief descriptions of required documents that must be submitted by Contractor:

upon award; weekly; monthly; quarterly’; annually, etc. identified throughout the PWS and is provided here as a guide for Contractor convenience. If an item is within the PWS and not listed here, the Contractor remains responsible for the delivery of the item.

What Submit as noted Submit To

Quality Control Plan: Description and reporting reflecting the contractor’s plan for meeting of contract requirements and performance standards

Upon proposal and as frequently as indicated in the performance standards.

Contracting Officer

BILLING:

Invoice requirements and supporting documentation: Payment to the Contractor shall be made monthly, in arrears, upon receipt of a properly prepared invoice. Payment for services will be at the rates specified in the Schedule of Supplies/Services. The Contractor shall submit invoices using CMS Uniform Billing (UB-04) forms covering the services performed mailto:Clarisse.mejia@va.gov under this contract. The invoices shall contain the following information: Invoice number, PO Number , Vendor Code, Invoice Date, Currency, Amount to Pay, Description, Quantity, Unit, Unit price. Delivery Note(Delivery Note and Payment Due)

Contract Number and Purchase Order Number (if applicable) Name of Beneficiary and last four digits of the Social Security Number Itemized statement of services rendered by CPT Code and Rates Total Price

VENDOR ELECTRONIC INVOICE SUBMISSION METHODS:

Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below:

Invoices will be electronically submitted to the Tungsten website at https://www.tungsten-network.com/us/support/ Tungsten direct vendor support number is 877-489-6135 for VA contracts. The VA-FSC pays all associated transaction fees for VA orders. During Implementation (technical set-up) Tungsten will confirm your Tax Payer ID Number with the VA-FSC. This process can take up to 5 business days to complete to ensure your invoice is automatically routed to your Certifying Official for approval and payment. In order to successfully submit an invoice to VA-FSC please review “How to Create an Invoice” within the how to guides. All invoices submitted through Tungsten to the VA-FSC should mirror your current submission of Invoice, with the following items required. Clarification of additional requirements should be confirmed with your Certifying Official (your CO or buyer). The VA-FSC requires specific information in compliance with the Prompt Pay Act and Business Requirements. For additional information, please contact:

Tungsten Support Phone: 1-877-489-6135 Website: https://www.tungsten-network.com/us/support/ Department of Veterans Affairs Financial Service Center Phone: 1-877-353-9791 Email: vafscched@va.gov

PAYMENTS IN FULL/NO BILLING VA BENEFICIARIES:

The Contractor shall accept payment for services rendered under this contract as payment in full. VA beneficiaries shall not under any circumstances be charged nor their insurance companies charged for services rendered by the Contractor, even if VA does not pay for those services. This provision shall survive the termination or ending of the contract.

To the extent that the Veteran desires services which are not a VA benefit or covered under the terms of this contract, the Contractor must notify the Veteran that there will be a charge for such service and that the VA will not be responsible for payment.

The Contractor shall not bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against, any person or entity other than VA for services provided pursuant to this contract. It shall be considered fraudulent for the Contractor to bill other third-party insurance sources (including Medicare) for services rendered.

VA INFORMATION AND INFORMATION SYSTEM SECURITY AND PRIVACY LANGUAGE

FOR INCLUSION IN CONTRACTS, AS APPROPRIATE

1. GENERAL. This entire section applies to all acquisitions requiring any Information Security and Privacy language. Contractors, contractor personnel, subcontractors and https://www.tungsten-network.com/us/support/ https://www.tungsten-network.com/us/support/ https://www.tungsten-network.com/us/support/ mailto:vafscched@va.gov subcontractor personnel will be subject to the same federal laws, regulations, standards, VA directives and handbooks, as VA personnel regarding information and information system security and privacy.

2. VA INFORMATION CUSTODIAL LANGUAGE. This entire section applies to all acquisitions requiring any Information Security and Privacy language.

a. The Government shall receive unlimited rights to data/intellectual property first produced and delivered in the performance of this contract or order (hereinafter “contract”) unless expressly stated otherwise in this contract. This includes all rights to source code and all documentation created in support thereof. The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General. The primary clause used to define computer software license (not data/intellectual property first produced under this contractor or order) is FAR 52.227-19, Commercial Computer Software License.

b. Information made available to the contractor by VA for the performance or administration of this contract will be used only for the purposes specified in the service agreement, SOW, PWS, PD, and/or contract. The contractor shall not use VA information in any other manner without prior written approval from a VA Contracting Officer (CO). The primary clause used to define Government and Contractor data rights is FAR 52.227-14 Rights in Data – General.

c. VA information will not be co-mingled with any other data on the contractor’s information systems or media storage systems. The contractor shall ensure compliance with Federal and VA requirements related to data protection, data encryption, physical data segregation, logical data segregation, classification requirements and media sanitization.

d. VA reserves the right to conduct scheduled or unscheduled audits, assessments, or investigations of contractor Information Technology (IT) resources to ensure information security is compliant with Federal and VA requirements. The contractor shall provide all necessary access to records (including electronic and documentary materials related to the contracts and subcontracts) and support (including access to contractor and subcontractor staff associated with the contract) to VA, VA's Office Inspector General (OIG) and/or Government Accountability Office (GAO) staff during periodic control assessments, audits, or investigations.

e. The contractor may only use VA information within the terms of the contract and applicable Federal law, regulations, and VA policies. If new Federal information security laws, regulations or VA policies become applicable after execution of the contract, the parties agree to negotiate contract modification and adjustment necessary to implement the new laws, regulations, and/or policies.

f. The contractor shall not make copies of VA information except as specifically authorized and necessary to perform the terms of the contract. If copies are made for restoration purposes, after the restoration is complete, the copies shall be destroyed in accordance with VA Directive 6500, VA Cybersecurity Program and VA Information Security Knowledge Service.

g. If a Veterans Health Administration (VHA) contract is terminated for default or cause with a business associate, the related local Business Associate Agreement (BAA) shall also be terminated and actions taken in accordance with VHA

Directive 1605.05, Business Associate Agreements. If there is an executed national BAA associated with the contract, VA will determine what actions are appropriate and notify the contactor.

h. The contractor shall store and transmit VA sensitive information in an encrypted form, using VA-approved encryption tools which are, at a minimum, Federal Information Processing Standards (FIPS) 140-2, Security Requirements for Cryptographic Modules (or its successor) validated and in conformance with VA Information Security Knowledge Service requirements. The contractor shall transmit VA sensitive information using VA approved Transport Layer Security (TLS) configured with FIPS based cipher suites in conformance with National Institute of Standards and Technology (NIST) 800-52, Guidelines for the Selection, Configuration and Use of Transport Layer Security (TLS) Implementations.

i. The contractor’s firewall and web services security controls, as applicable, shall meet or exceed VA’s minimum requirements.

j. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor may use and disclose VA information only in two situations: (i) in response to a qualifying order of a court of competent jurisdiction after notification to VA CO (ii) with written approval from the VA CO. The contractor shall refer all requests for, demands for production of or inquiries about, VA information and information systems to the VA CO for response.

k. Notwithstanding the provision above, the contractor shall not release VA records protected by Title 38 U.S.C. § 5705, Confidentiality of medical quality- assurance records and/or Title 38 U.S.C. § 7332, Confidentiality of certain medical records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse or infection with Human Immunodeficiency Virus (HIV). If the contractor is in receipt of a court order or other requests for the above- mentioned information, the contractor shall immediately refer such court order or other requests to the VA CO for response.

l. Information made available to the contractor by VA for the performance or administration of this contract or information developed by the contractor in performance or administration of the contract will be protected and secured in accordance with VA Directive 6500 and Identity and Access Management (IAM) Security processes specified in the VA Information Security Knowledge Service.

m. Any data destruction done on behalf of VA by a contractor shall be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management, VA Handbook 6300.1, Records Management Procedures, and applicable VA Records Control Schedules.

n. The contractor shall provide its plan for destruction of all VA data in its possession according to VA Directive 6500 and NIST 800-88, Guidelines for Media Sanitization prior to termination or completion of this contract. If directed by the COR/CO, the contractor shall return all Federal Records to VA for disposition.

o. Any media, such as paper, magnetic tape, magnetic disks, solid state devices or optical discs that is used to store, process, or access VA information that cannot be destroyed shall be returned to VA. The contractor shall hold the appropriate material until otherwise directed by the Contracting Officer’s Representative (COR) or CO.

Items shall be returned securely via VA-approved methods. VA sensitive information must be transmitted utilizing VA-approved encryption tools which are validated under FIPS 140-2 (or its successor) and NIST 800-52. If mailed, the contractor shall send via a trackable method (USPS, UPS, FedEx, etc.) and immediately provide the COR/CO with the tracking information. Self-certification by the contractor that the data destruction requirements above have been met shall be sent to the COR/CO within 30 business days of termination of the contract.

p. All electronic storage media (hard drives, optical disks, CDs, back-up tapes, etc.)

used to store, process or access VA information will not be returned to the contractor at the end of lease, loan, or trade-in.