S02 RFP 36C24821R0092.pdf

PAGE 1 OF 200 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

36C24821R0092 04-11-2022

Mechelle Reaser, Contract Specialist 407-646-4061 05-10-2022

15:00 EDT

36C248

Department of Veterans Affairs

Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy, Suite 525

Tampa FL 33637

X

621498

$22 Million

N/A

Department of Veterans Affairs

West Palm Beach Veterans Affairs Medical

Executive Office

7305 N Military Trail

West Palm Beach FL 33410

36C248

Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy

Tampa FL 33637

Financial Services Center

P.O. Box 149971

Austin TX 78714-9971

See CONTINUATION Page

The contractor shall provide five (5) Community Based

Outpatient Clinics (CBOC) in support of the West Palm Beach

Veterans Affairs Medical Center (WPBVAMC).

The CBOCs shall be located at the following locations: Boca

Raton, FL; Ft. Pierce, FL; Stuart, FL; Vero Beach, FL; and

Okeechobee, FL.

Reference pages six (6) through 18 for the Schedule of Service

Reference pages 19 through 144 for the Performance Work

Statement.

The current wage determination listed on DOL’s website will be the applicable wage determination included in the awarded

Contract and updated if the option year is exercised.

X 1

Yamil O. Gomez, Contracting Officer

36C24821R0092

Table of Contents

SECTION A

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

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES

B.3 PERFORMANCE WORK STATEMENT (PWS)

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (NOV

2020)

C.2 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL

(JAN 2011)

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

C.8 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.9 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

C.10 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA

ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

C.11 VAAR 852.204-70 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR

PERSONNEL (MAY 2020)

C.12 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.13 VAAR 852.219-76 SUBCONTRACTING PLANS MONITORINGAND COMPLIANCE

(JUL 2018)

C.14 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.15 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.16 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2021) (JUL 2020)

(DEVIATION)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 ORGANIZATIONAL CONFLICT OF INTEREST

D.2 CONTRACTOR RULES OF BEHAVIOR

D.3 PAST PERFORMANCE QUESTIONNAIRE

D.4 CONTRACTOR IMMIGRATION CERTIFICATION

D.5 WAGE DETERMINATION – SERVICE CONTRACT ACT WAGE DETERMINATION

D.6 WAGE DETERMINATION – DAVIS BACON ACT WAGE DETERMINATION

D.7 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

D.8 PATIENTS’ RIGHTS AND RESPONSIBILITIES

D.9 VHA DIRECTIVE 1033 – ANTICOAGULATION THERAPY MANAGEMENT

D.10 SPECIMEN COLLECTION

D.11 VHA NOTICE 2020-02 - STORAGE OF VACCINES AND MEDICATIONS

D.12 DESIGN FRAMEWORK FOR WHOLE HEALTH IMPLEMENTATION

D.13 VHA DIRECTIVE 1137 -PROVISION OF COMPLEMENTARY AND INTEGRATED

HEALTH (CIH)

D.14 MEDICAL CENTER MEMORANDUM NUMBER 548-110-305 WOMEN VETERANS

HEALTH CARE

D.15 MEDICAL CARE MEMORANDUM NUMBER 548-99-246 – MEDICATION

RECONCILLATION

D.16 PATH AND LAB MEDICINE SERVICE REFERENCE MANUAL

D.17 MEDICAL CARE MEMORANDUM NUMBER 548-116-173 – IDENTIFICATION

AND MANAGEMENT OF VETERANS

D.18 MEDICAL CARE MEMORANDUM NUMBER 548-113-074 – POINT OF CARE –

ANCILLARY TESTING POLICY

D.19 UPDATED PRE-TREATMENT AND TRANSPORATION OF SOILED CRITICAL

AND SEMI-CRITICAL RME

D.20 PRE-TREATMENT AND TRANSPORATION OF SOILED CRITICAL AND SEMI-

CRITICAL RME

D.21 VHA DIRECTIVE 1608 COMPREHENSIVE AND COMPLIANCE ROUNDING

PROCESS GUIDE

D.22 VHA PROGRAM GUIDE

D.23 CBOC LABORATORY SUPPLIES AND PANELS

D.24 PATH AND LAB MEDICINE SERVICE REFERENCE MANUAL

D.25 SERVICE SPECIFIC ENVIRONMENT OF CARE ROUNDS

D.26 ENVIRONMENT OF CARE ROUNDS ASSESSMENT AND COMPLIANCE

ROUNDING PROCESS GUIDE

D.27 VHA DIRECTIVE 1660.06 TRICARE NETWORK AGREEMENTS

D.28 MEDICAL CARE MEMORANDUM NUMBER 548-136-376 – PATIENT CARE

DATA CAPTURE

D.29 VA DIRCTIVE 2011-012

D.30 VHA HB 1101.01 (4) COORDINATED CARE FOR TRAVELING VETERANS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (NOV 2021)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018) .. 176

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.6 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.7 52.212-2 EVALUATION—COMMERCIAL ITEMS (NOV 2021)

E.8 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (NOV 2021)

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:

Title:

Address:

Telephone:

E-mail:

Federal Taxpayer ID Number:

Dun and Bradstreet Number:

b. GOVERNMENT: Contracting Officer (36C248)

Contracting Officer

Yamil O. Gomez

Department of Veterans Affairs

Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy Suite 525

Tampa FL 33637

Phone: 813-631-2831

Email: yamil.gomez@va.gov

Contract Specialist (36C248)

Mechelle Reaser

Department of Veterans Affairs

Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy Suite 525

Tampa FL 33637

Phone: 813-972-2000 Ext. 7541

Email: mechelle.reaser@va.gov

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

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

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly

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

mailto:mechelle.reaser@va.gov

Financial Services Center

P.O. Box 149971

Austin TX 78714-9971

5. CONFORMITY TO REGULATIONS: The contractor and his/her operations shall conform to all regulations, Federal, State, and local governing the performance of contracted services.

6. MANDATORY WRITTEN DISCLOSURES: Mandatory written disclosure required by FAR clause

52.201-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at http://www.va.gov/oig/contacts/hotline .asp and clicking on

“FAR clause 52.203-13 Reporting. “If you experience difficulty accessing the website, call the Hotline at

1-800-488-8244 for further instructions.

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

AMENDMENT NO DATE

8. CAUTION: Late submissions, modification, and withdrawals: See Provisions 52.212-1.

9. POST AWARD ORIENTATION: The contracting officer will schedule a post award orientation conference for contract orientation purposes as required by https://www.va.gov/oal/library/vaam/vaamM842.asp#M84250270 .

END OF CONTRACT ADMINISTRATION DATA

http://www.va.gov/oig/contacts/hotline%20.asp https://www.va.gov/oal/library/vaam/vaamM842.asp#M84250270

B.2 SCHEDULE OF SERVICES

1. CONTRACT TYPE: The government intends to award a Fixed Price, Indefinite Delivery Indefinite

Quantity (IDIQ) contract.

2. PERIOD OF PERFORMANCE: Three (3) year base period and seven (7), one (1) year option periods.

3. TASK ORDER PROCEDURES: One (1) task order will be issued for each period of performance based on estimated amounts and terms and conditions on this contract. Each task order will be obligated with a Not to Exceed (NTE) amount and the contractor shall not exceed the estimated dollar threshold without the expressed or written consent of the contracting officer. Adjustments made without approval will be considered an unauthorized commitment; violation under Federal Acquisition Regulation, FAR

1.602-3. Should the government choose to exercise any option periods, an individual task order will be issued for each option period at the time of exercising the option. The task order will contain date of order, contract number, order number, line-item number, description, quantity, unit price or estimated cost, performance schedule, place of performance, accounting and appropriation data, and method payment.

4. MINIMUM AND MAXIMUM GUARANTEED: This contract includes a guaranteed minimum of

$100,000.00 of services for the base period of the contract. The maximum amount to be ordered for this contract for the base period, and option periods, if exercised by the government, is $300,000,000.00. If the maximum aggregate amount of $300,000,000.00 is reached prior to the end date of the final period of performance, no further task order will be issued on the contract.

5. ESTIMATED QUANTITIES: The quantities or dollar threshold listed in the Price Schedule, effective for the periods stated are estimated only, and are not purchase by the resultant contract. Except as this contract may otherwise provide, if the VA’s requirement does not result in orders in the quantities or dollar amount described that fact shall not constitute the basis for an equitable price adjustment.

6. EVALUATION OF OPTIONS: Except when it is determined in accordance with FAR 17.206 (b) not to be in the government’s best interest, the government will evaluate offers for award purposes by adding the total price for each option period to the total price for the basic requirement. Evaluation of options will not obligate the government to exercise the option (s). Prior to exercising any option years, the Government will determine if there is a need for services at each CBOC location. The government reserves the right to exercise all or select line-item numbers (LINs). In accordance with Federal

Acquisition Regulation (FAR) Clause 52.217-9, Option to Extend the Term of the Contract, written notification will be provided to the contractor 30 calendar days prior to contract expiration notifying the contractor of the Government’s intent to exercise the option. The notification will identify the LINs that are intended to be exercised for the option year. Government may extend the term of the contract by written notice to the contractor within 15 calendar days prior to contract expiration.

7. PRICING: Price schedule for Line-Item Number (LIN) for the base period and each option year includes the following: estimated quantity, unit, proposed unit price, proposed total annual price for each

LIN, and the estimated grand total. Estimated quantity for the base period should be multiplied by three

(3) due to the base period being for three (3) years.

PERIOD OF PERFORMANCE: BASE PERIOD 09/01/2022 – 08/31/2025

LIN

No.

Services

Unit Estimated

Quantity

Price Per

Unit

Total Estimated

Cost

0001 Primary Care Services at capitation rates per member per month

(PMPM)

Okeechobee, FL

PMPM 1524

0002 Mental Health

Services at capitation rates per member per month (PMPM)

PMPM 426

0003 Primary Care Services member per month

(PMPM)

Vero Beach, FL

PMPM 3176

0004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

0005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

0006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

0007 Primary Care Services at capitation rates per member per month

PMPM 2807

(PMPM)

Boca Raton, FL

0008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

0009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

0010 Mental Health

Services at capitation rates per member per month (PMPM)

Ft Pierce, FL

PMPM 1091

Total for Base Period One $________________________

PERIOD OF PERFORMACE: OPTION YEAR ONE (1) 09/01/2025 – 08/31/2026

LIN

1001 Primary Care Services member per month

(PMPM)

1002 Mental Health rates per member per month (PMPM)

1003 Primary Care Services

PMPM 3176

Vero Beach, FL

1004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

1005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

1006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

1007 Primary Care Services at capitation rates per member per month

(PMPM)

Boca Raton, FL

PMPM 2807

1008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

1009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

1010 Mental Health

Services at capitation rates per member per month (PMPM)

Fort Pierce, FL

Total for Option Year One (1) $________________________

PERIOD OF PERFORMACE: OPTION YEAR TWO (2) 09/01/2026 – 08/31/2027

LIN

2001 Primary Care Services member per month

(PMPM)

2002 Mental Health rates per member per month (PMPM)

2003 Primary Care Services member per month

(PMPM)

Vero Beach, FL

PMPM 3176

2004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

2005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

2006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

2007 Primary Care Services at capitation rates per

Boca Raton, FL

2008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

2009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

2010 Mental Health

Services at capitation rates per member per month (PMPM)

Total for Option Year Two (2) $________________________

PERIOD OF PERFORMACE: OPTION YEAR THREE (3) 09/01/2027 – 08/31/2028

LIN

3001 Primary Care Services member per month

(PMPM)

3002 Mental Health rates per member per month (PMPM)

3003 Primary Care Services

Vero Beach, FL

3004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

3005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

3006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

3007 Primary Care Services at capitation rates per member per month

(PMPM)

Boca Raton, FL

PMPM 2807

3008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

3009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

3010 Mental Health

Services at capitation rates per member per month (PMPM)

Total for Option Year Three (3) $________________________

PERIOD OF PERFORMACE: OPTION YEAR FOUR (4) 09/01/2028 – 08/31/2029

LIN

4001 Primary Care Services member per month

(PMPM)

4002 Mental Health rates per member per month (PMPM)

4003 Primary Care Services member per month

(PMPM)

Vero Beach, FL

PMPM 3176

4004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

4005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

4006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

4007 Primary Care Services at capitation rates per

Boca Raton, FL

4008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

4009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

4010 Mental Health

Services at capitation rates per member per month (PMPM)

Total for Option Year Four (4) $________________________

PERIOD OF PERFORMACE: OPTION YEAR FIVE (5) 09/01/2029 – 08/31/2030

LIN

5001 Primary Care Services member per month

(PMPM)

5002 Mental Health rates per member per month (PMPM)

5003 Primary Care Services

Vero Beach, FL

5004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

5005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

5006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

5007 Primary Care Services at capitation rates per member per month

(PMPM)

Boca Raton, FL

PMPM 2807

5008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

5009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

5010 Mental Health

Services at capitation rates per member per month (PMPM)

Total for Option Year Five (5) $________________________

PERIOD OF PERFORMACE: OPTION YEAR SIX (6) 09/01/2030 – 08/31/2031

LIN

6001 Primary Care Services member per month

(PMPM)

6002 Mental Health rates per member per month (PMPM)

6003 Primary Care Services member per month

(PMPM)

Vero Beach, FL

PMPM 3176

6004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

6005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

6006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

6007 Primary Care Services at capitation rates per

Boca Raton, FL

6008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

6009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

6010 Mental Health

Services at capitation rates per member per month (PMPM)

Total for Option Year Six (6) $________________________

PERIOD OF PERFORMACE: OPTION YEAR SEVEN (7) 09/01/2031 – 08/31/2032

LIN

7001 Primary Care Services member per month

(PMPM)

7002 Mental Health rates per member per month (PMPM)

7003 Primary Care Services

Vero Beach, FL

7004 Mental Health

Services at capitation rates per member per month (PMPM)

Vero Beach, FL

PMPM 889

7005 Primary Care Services at capitation rates per member per month

(PMPM)

Stuart, FL

PMPM 5491

7006 Mental Health

Services at capitation rates per member per month (PMPM)

Stuart, FL

PMPM 1537

7007 Primary Care Services at capitation rates per member per month

(PMPM)

Boca Raton, FL

PMPM 2807

7008 Mental Health

Services at capitation rates per member per month (PMPM)

Boca Raton, FL

PMPM 786

7009 Primary Care Services at capitation rates per member per month

(PMPM)

Fort Pierce, FL

PMPM 3898

7010 Mental Health

Services at capitation rates per member per month (PMPM)

Total for Option Year Seven (7) $________________________

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. GENERAL:

1.1. SERVICES REQUIRED: The West Palm Beach VA Medical Center (WPVAMC); requires the following services to be provided in a hospital, office or clinic environment to Veterans, primarily residing in Okeechobee, FL (2V08) (548GF), Vero Beach, FL (2V08)(548GE), Stuart, FL

(2V08)(548GC), Boca Raton, FL (2V08)(548GD), and Fort Pierce, FL (2V08)(548GA).

1.1.1. [X] Primary Care CBOC: offers both primary 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 and mental health services. Mental Health service will be provided by on site by Contractor.

1.2. PLACE OF PERFORMANCE: CBOCs shall be located within city limits of the following locations:

1.2.1. Community Based Outpatient Clinic

Fort Pierce, FL 34947

1.2.2. Community Based Outpatient Clinic

Boca Raton, FL 33433

1.2.3. Community Based Outpatient Clinic

Vero Beach, FL 32960

1.2.4. Community Based Outpatient Clinic

Okeechobee, FL 34972

1.2.5. Community Based Outpatient Clinic

Stuart, FL 34997

1.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153, Federal Acquisition

Regulation (FAR) parts 12 and 15 to be furnished by the contractor on behalf of West Palm Beach

VA Medical Center, 7305 North Military Trail, West Palm Beach, FL 33410.

1.4. POLICY AND REGULATIONS: The Contractor shall meet VHA performance and quality criteria and standards including, but not limited to, access, customer satisfaction, prevention index, chronic disease index 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 Veterans Affairs (VA) and Veterans

Health Administration (VHA) publications can be located at http://www.va.gov/vhapublications/ or at http://www.va.gov/vapubs/. 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/Resources.asp.

1.5. DEFINITIONS/ACRONYMS:

1.5.1. ABMS: American Board of Medical Specialties

1.5.2. ACLS: Advanced Cardiac Life Support

1.5.3. ACPE: American Council on Pharmaceutical Education

1.5.4. ADE: adverse drug events

http://www.va.gov/vhapublications/ http://www.va.gov/vapubs/ https://www.patientcare.va.gov/primarycare/Resources.asp

1.5.5. AED: Automatic External Defibrillator

1.5.6. AIS: Automated Information Security

1.5.7. ANA: American Nurses Association

1.5.8. Assigned: A Veteran is “assigned” to an outpatient clinic via Primary Care Management

Module (PCMM) (i.e. Community Based Outpatient Clinic (CBOC)) where the patient receives their primary care after the patient’s eligibility is determined through registration and enrollment.

1.5.9. 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, securing messaging and training.

1.5.10. BAA: Business Associate Agreement

1.5.11. BI-RADS: Breast Imaging-Reporting and Data System; a quality assurance tool designed to standardize mammography reporting

1.5.12. BLS: Basic Life Support

1.5.13. BOS: Bureau of Osteopathic Specialists

1.5.14. CAHEA: Committee on Allied Health Education and Accreditation

1.5.15. CAP: College of American Pathologists

1.5.16. CARF: Commission on Accreditation of Rehabilitation Facilities

1.5.17. CDC: Centers for Disease Control and Prevention

1.5.18. CEU: Certified Education Unit

1.5.19. CLIA: Clinical Laboratory Improvement Amendments

1.5.20. CME: Continuing Medical Education

1.5.21. CMS: Center for Medicare and Medicaid Services

1.5.22. CO: Contracting Officer

1.5.23. COPD: chronic obstructive pulmonary disease

1.5.24. COR: Contracting Officer’s Representative

1.5.25. COS: Chief of Staff

1.5.26. CPA: Collaborative Practice Agreement

1.5.27. CPS: Clinical Pharmacy Specialist

1.5.28. CPT: Current Procedural Terminology

1.5.29. CRNP: Certified Registered Nurse Practitioners

1.5.30. CSWE: The Council on Social Work Education the CSWE website is http://www.cswe.org/ .

1.5.31. CPARS: Contractor Performance Assessment Reporting System

1.5.32. CVT: Clinical Video Telehealth

1.5.33. DIGMA: Drop in Group Medical Appointment

1.5.34. DSS: Decision Support System

1.5.35. 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.

1.5.36. EPRP: External Peer Review Program

1.5.37. FDA: Food and Drug Administration

1.5.38. FSMB: Federation of State Medical Boards

1.5.39. HCC: Health Care Center A HCC is a VA-owned, VA-leased, contract, or shared clinic operated at least five (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.

1.5.40. HHS: Department of Health and Human Services

1.5.41. HICPAC: Healthcare Infection Control Practices Advisory Committee- a federal advisory committee made up of fourteen (14) external infection control experts who provide advice http://www.cswe.org/ 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.

1.5.42. HT: Home Telehealth

1.5.43. ICD 10: International Classification of Diseases 10th edition

1.5.44. iMED: software used by VA for informed consent

1.5.45. INR: International Normalized Ratio

1.5.46. ISO: Information Security Officer

1.5.47. LIP: licensed independent practitioner

1.5.48. LPN: Licensed Practical Nurse

1.5.49. MCCR: Medical Care Cost Recovery

1.5.50. Mental Health Services: per VHA Handbook 1160.01, is meant to include services for the evaluation, diagnosis, treatment, and rehabilitation of 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;

(b) Treatment services using evidence-based pharmacotherapy, or primary evidence-based psychotherapy for patients with mental health conditions and substance use disorders;

(c) Patient education;

(d) Family education 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).

Specialty mental health services include:

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

(b) Evidence-based psychotherapy;

(c) Mental Health Intensive Case Management (MHICM);

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

(e) PTSD teams or specialists;

(f) MST special clinics;

(g) Homeless programs; and

(h) Specialty substance abuse treatment services.

1.5.51. MQSA: Mammography Quality Standards Act

1.5.52. MSN: Master of Science in Nursing

1.5.53. NCCPA: National Commission on Certification of Physician Assistants

1.5.54. NLN: National League for Nursing

1.5.55. OTC: Over the Counter

1.5.56. PA: Physician Assistant

1.5.57. PACS: Picture Archiving and Communications System

1.5.58. 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 environments 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.

1.5.59. Parent Facility: VAMC responsible for performance monitoring and payment for contracted Outpatient Site of Care services.

1.5.60. PCMH: Patient-Centered Medical Home

1.5.61. PCMM: Primary Care Management Module- a software program used to track Primary

Care Clinic Veteran rosters.

1.5.62. PCP: Primary Care Provider

1.5.63. Phar.D.: Doctor of Pharmacy

1.5.64. POC: Point of Care Testing

1.5.65. PRIMARY CARE VISIT: an episode of care furnished in a clinic 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.

1.5.66. PCMHI: Primary Care-Mental Health Integration

1.5.67. PWS: Performance Work Statement

1.5.68. QAPI: Quality Assessment and Performance Improvement

1.5.69. QASP: Quality Assurance Surveillance Plan

1.5.70. RN: Registered Nurse

1.5.71. SOP (Clinical): Scope of Practice

1.5.72. SELF-REFERRAL: Referring patients to Contractor’s facility for follow-up care.

Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.5.73. SFT: Store and Forward Telehealth

1.5.74. SMA: Shared Medical Appointments

1.5.75. SPD: Sterile Processing Division

1.5.76. SPE: Senior Procurement Executive

1.5.77. SPECIALTY CARE VISIT: A specialty care outpatient visit is an episode of care furnished in a clinic that does not provide primary care, and is only provided through a referral. These services are generally divided into two (2) sub-categories: medicine specialties and surgery specialties. 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.

1.5.78. SUPPORT STAFF: staff present in the clinic area assisting providers in the actual delivery of care to patients. It consists of RNs, LPNs, Medical Assistants, Health Technicians, and

Medical Clerks in the clinic.

1.5.79. 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.

1.5.80. TJC: The Joint Commission

1.5.81. TCT: Telehealth Clinical Technicians

1.5.82. VA: Veterans Affairs

1.5.83. VA EHR: VA electronic health record

1.5.84. VAMC: Veterans Affairs Medical Center

1.5.85. VetPro: a federal web-based credentialing program for healthcare providers.

1.5.86. VHA: Veterans Health Administration

1.5.87. VVC: VA Video Connect

1.5.88. WHEN: Weekend- Holiday- Every Night

1.5.89. WPBVAMC: West Palm Beach Veterans Affairs Medical Center

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), and discipline specific team members (Clinical Pharmacy Specialists (CPSs), Licensed

Clinical Social Workers (LCSWs), Registered Dietician/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 in ratios to

Primary Care Providers of at least three (3) full time equivalent (FTE) support staff (one (1) FTE

RNCM, one (1) FTE Clinical Associate, one (1) FTE Administrative Associate) for each FTE

Primary Care Provider. The Clinical Pharmacy Specialist (CPS) shall be provided the same support staffing given to other providers on the team when they are working in the capacity of a mid-level provider. The Contractor shall provide personnel in numbers and qualifications capable of fulfilling the standards outlined in the resultant contract. The Contractor must 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. Total Primary Care Estimated Patients enrolled/assigned to site: 1524 Okeechobee, FL (2V08)(548GF), 3176 Vero Beach, FL

(2V08)(548GE), 5491 Stuart, FL (2V08)(548GE), 2807 Boca Raton, FL (2V08)(548GD), and 3898

Fort Pierce, FL (2V08)(548GA). Total Mental Health Estimated Patients enrolled/assigned to site:

426 Okeechobee, FL (2V08) (548GF), 889 Vero Beach, FL (2V08) (548GE), 1537 Stuart, FL

(2V08)(548GE), 786 Boca Raton, FL (2V08)(548GD), and 1091 Fort Pierce, FL (2V08)(548GA).

2.2. 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. Contactor’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. May also be credentialed and privileged 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 Handbook 5005, Appendix G2 located at: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. Position

Responsibilities: Serves as medical director to oversee and be responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site.

2.3. PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by Contractor.

2.3.1. 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 midlevel 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.

One (1) PCP is required to be a physician at each site.

2.3.1.1. OPTION 1: Physician (MD): Qualifications: Physicians shall demonstrate evidence of education, training, and experience in Internal Medicine or Family Practice.

Physicians performing under this contract shall be board certified by the ABMS in

Internal Medicine and/or Family Practice or the BOS in Internal Medicine and/or

Family Practice. Authorization for prescriptive authority is required. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. Physicians shall be licensed in the state in which the Outpatient Site of Care (i.e. CBOC) is located; otherwise qualifications as per VA Handbook 5005, Appendix G2 located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. Position

Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the

PCP’s licensure and clinical privileges or scope of practice, ensuring the patient’s care plan contains medical recommendations for clinically indicated care, offering clinically indicated health care services to patients assigned to the PACT, and providing or arranging for care to which patients consent, providing leadership to the team including shared delegation of appropriate care and care processes to appropriate team members, reviewing available clinical and performance data with the team, and focusing on continuous improvement of critical team processes, ensuring the patient has same-day access for face-to-face, telehealth, and telephone 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.

2.3.1.2. OPTION 2: Certified Registered Nurse Practitioner (CRNP): Qualifications:

CRNP’s (including subcontractors) must have a MSN from a NLN accredited nursing program and have ANA Certification as a Nurse Practitioner in either Adult Health or

Family Practice. Authorization for prescriptive authority is required. Three (3) years of clinical nursing experience is required. A minimum of one (1) year clinical experience as a CRNP is required (three (3) years preferred). Experience in outpatient care in a Family Medicine or Internal Medicine environment is preferred. CRNP 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 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 located; otherwise qualifications as per VA Handbook 5005, Appendix G6 located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. . Position

Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the

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

2.3.1.3. OPTION 3: Physician Assistant (PA): Qualifications: PA’s (including subcontractors) must meet one (1) of the three (3) following educational criteria: a) A bachelor’s degree from a PA training program which is certified by the CAHEA; or b)

Graduation from a PA training program of at least twelve (12) months duration, which is certified by the CAHEA and a bachelor’s degree in a health care occupation or health related science; or c) graduation from a PA training program of at least twelve (12) months duration which is certified by the CAHEA and a period of progressively responsible health care experience such as independent duty medical corpsman, licensed practical nurse, registered nurse, medical technologist, or medical technician.

The duration of approved academic training and health care experience must total at least five (5) years. 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

HANDBOOK 5005 APPENDIX G8 PHYSICIAN ASSISTANT QUALIFICATION

STANDARD located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 . Position

Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care, providing health care commensurate to the

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

2.3.2. 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 approved by the appropriate

State-accrediting agency and accredited by one (1) 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 Handbook 5005, Appendix G6 located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2. Position

Responsibilities: Responsible for the provision of covered services to enrolled and unassigned patients presenting for care at the site, providing all aspects of professional nursing services consistent with licensure, certification, nursing professional standards of practice, and the clinician’s Functional Statement with elements of practice, enhancing patient safety and quality of care by collaborating with PACT staff to develop, oversee, and manage care management plans and care coordination for patients assigned to PACTs, participating in modes of communication and care delivery including, but not limited to, secure messaging, telephone care, view alerts management, shared medical appointments, clinical video telehealth visits, face to face visits, etc., as part of care management, identifying patient needs for involvement of discipline-specific team members and discussing nursing recommendations with the PCP, engaging relevant PACT staff to support nursing care, according to locally established informal and formal communication processes, including entering consultation requests to discipline-specific PACT members, if required for formal communications, assuming full accountability for the appropriateness of assignments made by the RNCM to clinical associates or administrative associates related to care management, care coordination, nursing services, and outcomes of care, entering orders in the VA EHR for tests per approved standardized RN care management protocols or PCP orders, ensuring the RNCM has same-day access for face-to-face and telephone care visits, using nursing expertise, evidence-based guidelines, standardized nursing protocols, and professionally accepted practice standards to promote patient engagement, self-care and wellness, and provide care to patients and determine care management requirements for individual patients or cohorts of patients. The RN collaborates for the improvement of patient care outcomes in the Patient Aligned Care

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

2.3.3. 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.

2.3.3.1. OPTION 1: Licensed Practical Nurse (LPN): 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 HANDBOOK 5005 APPENDIX G13

LICENSED PRACTICAL OR VOCATIONAL NURSE QUALIFICATION

STANDARD located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 . CBOC)

Position Responsibilities: Responsible for the provision of covered services to enrolled 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 aability 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. Licensed Practical

Nurse will receive back-up training for telehealth services.

2.3.3.2. OPTION 2: 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 HANDBOOK 5005

APPENDIX G13 LICENSED PRACTICAL OR VOCATIONAL NURSE

QUALIFICATION STANDARD located at:

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=1006&FType=2 . Position

Responsibilities: Responsible for the provision of covered services to enrolled 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.