S02 - Pierre CBOC 36C26324R0005_0003_ 05292025.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. DUNS: DUNS+4:

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. 2/2012)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 152

36C26324R0005 - 0003 11/30/2023

Shanna Comparato, Contract Specialist

402-995-3692 06/30/2025

17:00 CDT

1 36C263

Department of Veterans Affairs Network 23 Contracting Office

316 Robert Street N. STE. 506 St. Paul, MN 55101

X

621498

$25.5 Million

X

N/A

X

36C618

Department of Veterans Affairs VA Black Hills Health Care System 113 Comanche Road h Fort Meade SD 57741

Network 23 Contracting Office

316 Robert Street N. STE. 506 St. Paul, MN 55101

Financial Services Center PO Box 149971 Austin, TX 78714-9971

See CONTINUATION Page

Community Based Outpatient Clinic (CBOC) services to be located Within the city limits of Pierre, South Dakota to provide Primary Care Health Services.

See B.2 for Schedule of Services, on Page 6

See B.3 for Performance Work Statement, Pages 10 - 78

See CONTINUATION Page

Paid separately via individual issued Task Orders

X X

X -One-

John Becker Contracting Officer

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION OF SF 1449 BLOCK 18A

B.1 Contract Administration Data

B.2 Schedule of Services

B.3 Performance Work Statement (PWS)

B.4 Records Management Obligations (NARA Language)

B.5 VA Information and Information System Security / Privacy Language

SECTION C – CONTRACT CLAUSES

C.1 FAR 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services (November 2023) C.2 FAR 52.204-9 Personal Identity Verification of Contractor Personnel (January 2011) C.3 FAR 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (November 2021) C.4 FAR 52.216-18 Ordering (August 2020) C.5 FAR 52.216-19 Order Limitations (October 1995) C.6 FAR 52.216-22 Indefinite Quantity (October 1995) C.7 FAR 52.217-8 Option to Extend Services (November 1999) C.8 Addenda to 52.217-8 Evaluation of Option to Extend under FAR 52.217-8 C.9 FAR 52.217-9 Option to Extend the Term of the Contract (March 2000) C.10 FAR 52.222-30 Construction Wage Rate Requirements-Price Adjustment (None or Separately Specified Method) (August 2018) C.11 FAR 52.228-5 Insurance Work on a Government Installation (January 1997) C.12 Supplemental Insurance Requirements C.13 VAAR 852.201-70 Contracting Officer’s Representative (December 2022) C.14 VAAR 852.203-70 Commercial Advertising (May 2018) C.15 VAAR 852.204-71 Information and Information Systems Security (February 2023) C.16 VAAR 852.211-76 Liquidated Damages – Reimbursement for Data Breach Costs (February 2023) C.17 VAAR 852.215-71 Evaluation Factor Commitments (October 2019) C.18 VAAR 852.219-70 VA Small Business Subcontracting Plan Minimum Requirements (January 2023) C.19 VAAR 852.232-72 Electronic Submission of Payment Requests (November 2018) C.20 VAAR 852.237-70 Indemnification and Medical Liability Insurance (October 2019) C.21 VAAR 852.237-72 Crime Control Act – Reporting of Child Abuse (October 2019) C.22 VAAR 852.237-74 Nondiscrimination in Service Delivery (October 2019) C.23 VAAR 852.237-75 Key Personnel (October 2019) C.24 VAAR 852.239-70 Security Requirements for Information Technology Resources (February 2023) C.25 VAAR 852.239-73 Information System Hosting, Operation, Maintenance, or Use (February 2023)

C.26 VAAR 852.239-74 Security Controls Compliance Testing (February 2023) C.27 VAAR 852.239-76 Information and Communication Technology Accessibility (February 2023) C.28 VAAR 852.242-71 Administrative Contracting Officer (October 2020) C.29 FAR 52.252-2 Clauses Incorporated by Reference (February 1998) C.30 FAR 52.212-5 Contract Terms and Conditions Required to Implement Statues or Executive Orders – Commercial Products and Commercial Services (January 2025)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 FAR 52.212-1 Instructions to Offerors – Commercial Products and Commercial Services (September 2023) E.2 Proposal Preparation Instructions (Addendum to FAR 52.212-1) E.3 52.212-2 Evaluation – Commercial Products and Commercial Services (November 2021) ....................................................................................................... Error! Bookmark not defined.

E.4 FAR 52.204-24 Representation Regarding Certain Telecommunication and Video Surveillance Equipment (November 2021) E.5 FAR 52.209-7 Information Regarding Responsibility Matters (October 2018) E.6 FAR 52.216-1 Type of Contract (Apr 1984) E.7 FAR 52.222-5 Construction Wage Rate Requirements – Secondary Site of the Work (May 2014) E.8 FAR 52.233-2 Service of Protest (September 2006) E.9 VAAR 852.209-70 Organizational Conflicts of Interest (October 2020) E.10 VAAR 852.233-70 Protest Content/ Alternative Dispute Resolution (September 2018) ... 146 E.11 VAAR 852.233-71 Alternate Protest Procedure (September 2018) E.12 VAAR 852.239-71 Information System Security Plan and Accreditation (February 2023)147 E.13 VAAR 852.239-75 Information and Communication Technology Accessibility Notice (February 2023) E.14 VAAR 852.252-70 Solicitation Provisions or Clauses Incorporated by Reference (January 2008) E.15 VAAR 852.273-70 Late Offers (November 2021) E.16 852.273-74 Award Without Exchanges (November 2021) E.17 FAR 52.252-1 Solicitation Provisions Incorporated by Reference (February 1998) E.18 FAR 52.212-3 Offeror Representations and Certifications – Commercial Products and Commercial Services (May 2024)

Pierre, South Dakota CBOC 36C26324R0005

SECTION B - CONTINUATION OF SF 1449 BLOCK 18A.

B.1 Contract Administration Data System for Award Management (SAM):

SAM Registration: Offeror must be registered in the System for Award Management (SAM). No contract will be entered into with an unregistered contractor. Internet access allows registration by completing an electronic on-line registration application at https://sam.gov/content/home.

Under the authority of Title 38 USC § 8153, “Health Care Resources (HCR) Sharing Authority”, the Contractor agrees to provide Health Care Resources in accordance with the terms and conditions stated herein, furnished to/and at the VA Black Hills Health Care System, the services and prices specified in the Sections B.2 (Schedule of Services) and B.3 (Performance Work Statement).

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

a. CONTRACTOR: (Offerors are required to designate a person and their point of contact information for prompt administration).

Name of Company:

Name of Government POC:

Title/Position of Government POC:

Email of Government POC:

Phone Number of Government POC:

Contractor Address:

City/State/Zip:

b. GOVERNMENT: John Becker, Contracting Officer (90C)

Network Contracting Office (NCO) 23 2501 W. 22nd Street Sioux Falls, SD 57105 605-585-3908 John.Becker3@va.gov

c. Contractor and Government points of contact can be changed by written notification to the other party.

Notification will be placed in the Contract file and shall not require a modification to the Contract.

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor should be mailed to the following address (Contractor fill in address information below): N/A

3. ELECTRONIC INVOICE SUBMISSION: All Invoices 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 (VA FSC). The ;attest information shall be used for invoicing and payments and may change during the Period of Performance of this acquisition. Current invoicing information is located at: https://www.fsc.va.gov/einvoice.asp.

A) Tungsten direct vendor support number is 877-489-6135 for VA contracts;

B) The VA-FSC pays all associated transaction fees for VA orders;

C) During Implementation (technical set-up) Tungsten will confirm your Taxpayer ID Number with the VA-FSC;

D) 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;

https://sam.gov/content/home https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section8153&num=0&edition=prelim mailto:John.Becker3@va.gov https://www.fsc.va.gov/einvoice.asp

E) To successfully submit an invoice to VA-FSC please review “How to Create an Invoice” within the “how-to” guides;

F) All invoices submitted through Tungsten to the VA-FSC should mirror the current submission of Invoice, with the following items required.;

G) Clarification of additional requirements should be confirmed with your Certifying Official the Contracting Officer or Contract Specialist.

H) Payments will only be made for actual services rendered;

I) Payments shall be made monthly, in arrears upon receipt of a properly prepared invoice IAW FAR 52.212-4(g), FAR 52.232-33, and VAAR 852.232-72;

J) The Contractor shall be reimbursed at the capitation rate specified in Section B.2 Schedule of Services;

K) The VA-FSC requires specific information in compliance with the Prompt Pay Act and Business Requirements;

L) The Contractor shall be reimbursed upon receipt of a proper invoice. Invoices must contain the following information:

a) Total number of listed Veterans from the previous month's invoice;

b) New Veterans added to the billable roster since the previous month's invoice;

c) Veterans removed from the billable roster since the previous month's invoice;

d) Number of Veterans (if any) whose disenrollments generate a credit, the amount of the credit, and the calculation(s) used to arrive at the credit;

e) Firm’s Taxpayer ID Number (TIN);

f) Firm’s “Remit Address” information;

g) The VA Purchase Order (PO) number;

h) Firm’s contact information: (Personal Name, Email, and Phone);

i) VA point of contact information: (Personal Name, Email, and Phone);

j) The Period of Performance dates (Beginning and Ending); and

k) All discount information if applicable (Percent and Date Terms)

M) For additional information, please contact:

1) Tungsten Support:

a) Phone: 1-877-489-6135

b) Website: https://www.fsc.va.gov/einvoice.asp

2) Department of Veterans Affairs Financial Service Center

a) Phone: 1-877-353-9791

b) Email: vafscched@va.gov

4. Type of Contract:

Primary Care Services at Capitation Rates; Per Member/Per Month (PMPM). 10-Year, Fixed Price, Indefinite Delivery Indefinite Quantity Contract.

https://www.fsc.va.gov/einvoice.asp mailto:vafscched@va.gov

B.2 Schedule of Services In accordance with Title 38 USC § 8153, “Health Care Resources (HCR) Sharing Authority” and FAR Part 15; the Contractor shall provide continuous delivery of Contractor Operation Primary Care Services, including Primary Care Services inclusive of space for tele-health services in accordance with the terms, conditions, and provisions stated herein. The Contractor shall furnish services to eligible Veteran beneficiaries enrolled within the VA Black Hills Health Care System, and the prices specified within the Schedule of Services below. A contract resulting from this solicitation will be awarded for a one year base period, with the Government having the option to extend the contract for nine (9) additional one-year periods.

This solicitation covers the provision of Primary Care Services. The clinic is to be located within the city limits of Pierre, South Dakota. The Contractor shall establish one location to provide the required services specified under the resultant contract. Primary care must be provided at the same site as the primary clinic. Veterans to be services under the resultant contract reside primarily in Pierre, South Dakota, inclusive of Veterans residing in Fall River, Hughes, Hyde, Jones, Lyman, Meade, Potter, Stanley and Sully Counties.

Primary Care Services will be provided to patients enrolled to the clinic by the VA Black Hills Health Care System (VA BHHCS). Payment for services will be based upon orders issued against the resultant contract.

CBOC ORDERING PROCEDURES: VA has the sole authority to assign Veterans treated by the Contractor into the Primary Care Management Model (PCMM) software program used to track primary care clinic Veteran rosters.

Specific billable processes for issuing task orders under the resultant contract include: determining Veteran eligibility, enrollment eligibility, and at least one qualifying encounter by the Contractor’s primary care provider (PCP) within the previous 12 months.

The Contractor will be provided a list of all enrolled patients at the beginning of the contract and will be able to bill for these patients immediately. In order to remain enrolled in the clinic, patients must have a qualifying visit within 12 months of their last visit. Qualifying encounters are further defined in PWS Section 6.2.2. Please review in detail to ensure compliance for issuance of subsequent task orders and payment processing.

Any services to be furnished under this contract shall be ordered by issuance of Delivery Orders or Task Orders by the Contracting Officer or Administrative Contracting Officer. Orders may be issued by electric commerce methods.

This is a Fixed Price (FP) Indefinite Delivery, Indefinite Quantity (IDIQ) Contract under C.6 FAR 52.216-22. The Task Orders shall specify the estimated quantities of services for each Period of Performance and to be furnished under this contract and shall comply with C.4 FAR 52.216-18 and C.5 FAR 52.216.19.

Billing/Payment Procedures

The Contractor will be provided a list of all patients on the billable roster at the time when the Contractor begins performing clinical services and will be able to bill for those patients on the billable roster in the following month’s invoice. In order to remain on the monthly billable roster, patients shall have at least one qualifying encounter during the previous 12 months. See the Billing and Invoicing Procedures section 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 - PMPM includes cost of unassigned/unenrolled patient visits.

Contractor shall not bill separately or propose an additional LIN for these costs.

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

Contract Minimum: $500,000.00, Contract Maximum: $17,000,000.00.

https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section8153&num=0&edition=prelim https://www.acquisition.gov/far/part-15

The Schedule Table Formula shall be calculated as follows: Estimated Quantity * (Price per Unit) = Total Estimated Cost per month * (12 months) = Total Estimated Cost per year.

Base Year, Period of Performance – 1/1/2026 – 12/31/2026

Line Item

Services Unit

Estimated Quantity

Price per

Total Estimated Cost per month

Total Estimated Cost per year

0001 Primary Care Services at capitation rates per member per month (PMPM)

PMPM

Estimated Total for Base Year $________________________

Option Year One, Period of Performance – 1/1/2027 – 12/31/2027

Total Estimated Cost per month

Total Estimated Cost per year

1001 Primary Care Services at

Estimated Total for Option Year One $________________________

Option Year Two, Period of Performance – 1/1/2028 – 12/31/2028

Total Estimated Cost per month

Total Estimated Cost per year

2001 Primary Care Services at

Estimated Total for Option Year Two $________________________

Option Year Three, Period of Performance – 1/1/2029 – 12/31/2029

Total Estimated Cost per month

Total Estimated Cost per year

3001 Primary Care Services at

Estimated Total for Option Year 3 $________________________ Option Year Four, Period of Performance – 1/1/2030 – 12/31/2030

Item

Total Estimated Cost per month

Total Estimated Cost per year

4001 Primary Care Services at

Estimated Total for Option Year Four $________________________

Option Year Five, Period of Performance – 1/1/2031 – 12/31/2031

Total Estimated Cost per month

Total Estimated Cost per year

5001 Primary Care Services at

Estimated Total for Option Year Five $________________________

Option Year Six, Period of Performance – 1/1/2032 – 12/31/2032

Total Estimated Cost per month

Total Estimated Cost per year

6001 Primary Care Services at

1,005

Estimated Total for Option Year Six $________________________

Option Year Seven, Period of Performance – 1/1/2033 – 12/31/2033

Total Estimated Cost per month

Total Estimated Cost per year

7001 Primary Care Services at

1,025

Estimated Total for Option Year Seven $________________________

Option Year Eight, Period of Performance – 1/1/2034 – 12/31/2034

Total Estimated Cost per month

Total Estimated Cost per year

8001 Primary Care Services at

1,045

Estimated Total for Option Year Eight $________________________

Option Year Nine, Period of Performance – 1/1/2035 – 12/31/2035

Total Estimated Cost per month

Total Estimated Cost per year

9001 Primary Care Services at

1,066

Estimated Total for Option Year Nine $________________________

ESTIMATED TOTAL FOR BASE AND ALL NINE OPTION YEARS $________________________

B.3 Performance Work Statement (PWS)

1. GENERAL:

1.1 Services Required: The VA Black Hills Health Care System requires the following services to be provided in a private hospital, office, or clinic environment to Veterans, primarily residing in Pierre, SD. Primary Care CBOC: offers both medical and mental health care (physically on site and by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Primary Care CBOCs are required to provide both primary care and mental health services. Mental Health services will be provided by VA staff via telehealth.

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

1.3 Place of Performance: Services shall be performed by Contractor within the city limits of Pierre, SD on behalf of VA Black Hills Health Care System.

1.4 Authority: In accordance with Title 38 USC § 8153, “Health Care Resources (HCR) Sharing Authority”, in combination with FAR 15.

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

1.6 Acronyms/Definitions:

ABMS: American Board of Medical Specialties ACGME: Accreditation Council for Graduate Medical Education ACIP: Advisory Committee on Immunization Practices ACLS: Advanced Cardiac Life Support ACO: Administrative Contracting Officer ACPE: American Council on Pharmaceutical Education ADE: Adverse Drug Events AED: Automatic External Defibrillator AIS: Automated Information Security ANA: American Nurses Association AOA: American Osteopathic Association APRN: Advanced Practice Registered Nurse ARRT: American Registry of Radiologic Technology ASC: Ambulatory Surgery Center Assigned: A Veteran is “assigned” to an outpatient clinic via PCMM (i.e., CBOC) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

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 https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section8153&num=0&edition=prelim 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

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 CPRS: Computerized Patient Record System CPT: Current Procedural Terminology CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org.

CVT: Clinical Video Telehealth DICOM: Digital Image and Communication in Medicine DIGMA: Drop-in Group Medical Appointment DRG: Diagnostic Related Group DSS: Decision Support System ECC: Extended Care Center Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to an outpatient clinic like a CBOC, however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

EPRP: External Peer Review Program FDA: Food and Drug Administration FSMB: Federation of State Medical Boards FTE: Full Time Equivalent HCC: Health Care Center - A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least 5 days per week that provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

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

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, “Uniform Mental Health Services in VHA Medical Points of Service” 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: 883 (as of 2/6/2025).

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. 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. Contractor is required to provide at least 1 FTE 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 (or board eligible) 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. Ensures the patient’s care plan contains medical recommendations for clinically indicated care. Offers clinically indicated health care services to patients assigned to the PACT.

Provides or arranges for care to which patients consent. Provides leadership to the team including shared delegation of appropriate care and care processes to appropriate team members. Reviews available clinical and performance data with the team, and focuses on continuous improvement of critical team processes. Ensures the patient has same-day access for face-to-face and virtual care visits during regular clinic hours. Collaborates 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 https://www.abms.org/ https://certification.osteopathic.org/bureau-of-osteopathic-specialists/ 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. Provides health care commensurate to the PCP’s licensure and clinical privileges or scope of practice. Ensures 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.

Provides 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. Ensures the patient has same-day access for face-to-face and virtual care visits during regular clinic hours, and collaborating with PACT staff to develop personal health plans that incorporate care management and care coordination appropriate to the patient’s needs.

Option 3: Physician Assistant (PA): Qualifications: PA’s (including Subcontractors) shall be a graduate of a training program which is accredited by the Accreditation Review Commission on Education of PA (ARC-PA) or one of its predecessor organizations. Additionally, PAs shall have a master’s degree in any discipline or a bachelor’s degree in any discipline with one year of experience as a PA. PAs shall have successfully passed the PA National Certifying Exam (PANCE). Authorization for prescriptive authority is required. PA shall have current, full, active, and unrestricted license and registration in the state in which the outpatient site of care (i.e., CBOC) is located; otherwise, qualifications as per VA qualification standards for Physician Assistant located in the VA Qualification Standards. See the Policy and Regulations section of this PWS for VA Qualification Standards access information. Position Responsibilities: Responsible for the provision of covered services to assigned and unassigned patients presenting for care. Provides health care commensurate to the PCP’s licensure and clinical privileges or scope of practice. Ensures 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. Provides 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. Ensures the patient has same-day access for face-to-face and virtual care visits during regular clinic hours. Collaborates 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. Provides 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. Enhances 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. Participates 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. Identifies 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. Enters consultation requests to discipline-specific PACT members, if required for formal communications. Assumes 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. Enters orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders. Ensures 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. Provides care to patients and determines 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, and designs. 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 and 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.

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,…