S02 - RFP - 36C26220R0128 - ESCONDIDO CBOC.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 171

36C26220R0128 06-29-2020

Alice McGruder 562-766-2238 07-30-2020

4:00pm PST

36C262

Department of Veterans Affairs

Network Contracting Office 22

4811 Airport Plaza Drive

Suite 600

Long Beach CA 90815 x 100% x

621498

$22 Million

N/A

X

36C664

Department of Veterans Affairs

VA San Diego Healthcare System (VASDHS)

3350 L Jolla Village Drive

San Diego CA 92116

36C664

Department of Veterans Affairs

VA San Diego Healthcare System (VASDHS)

3350 L Jolla Village Drive

San Diego CA 92116

Department of Veterans Affairs

Financial Services Center

P.O. Box 149971

Austin TX 78714-9971

See CONTINUATION Page

THE VA SAN DIEGO HEALTHCARE SYSTEM REQUIRES ONE (1)

COMMUNITY BASED OUTPATIENT CLINIC IN THE CITY LIMITS OF

ESCONDIDO, CA.

PLEASE PROVIDE PRICING PER SECTION B.2 PRICE SCHEDULE AND

ATTACHMENT D2 – PRICE WORK SHEET.

THIS REQUIREMENT IS 100% SDVOSB SET ASIDE.

$0.00

See CONTINUATION Page

X X

X 1

Alice McGruder

36C26220R0128

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 PRICE SCHEDULE

B.3 PERFORMANCE WORK STATEMENT

SECTION C - CONTRACT CLAUSES

C.1 FAR 52.204-7 SYSTEM FOR AWARD MANAGMEENT (OCT 2018)

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

PERSONNEL (JAN 2011)

C.3 FAR 52.204-13 – SYSTEM FOR AWARD MANAGEMENT MAINTENANCE (OCT

2018)

C.4 FAR 52.204-21 – BASIC SAFEGUARDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (JUN 2016)

C.5 FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT

2018)

C.6 FAR 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (OCT 2018)

C.7 FAR 52.216-18 ORDERING (OCT 1995)

C.7 FAR 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.8 FAR 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.9 FAR 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.10 FAR 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) 110

C.11 FAR 52.224-1 PRIVACY ACT NOTIFICATION (APR 1984)

C.12 FAR 52.224-2 PRIVACY ACT (APR 1984)

C.13 FAR 52.227-17 RIGHTS IN DATA—SPECIAL WORKS (DEC 2007)

C.14 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.15 FAR 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR

1984)

C.16 FAR 52.237-3 CONTINUITY OF SERVICES (JAN 1991)

C.17 FAR 52.245-1 GOVERNMENT PROPERTY (JAN 2017) ALTERNATE I (APR 2012) 114

C.18 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.19 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.20 VAAR 852.211-72 – TECHNICAL INDUSTRY STANDARDS (NOV 2018)

C.21 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM

REQUIREMENTS (DEC 2009)

C.22 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND

COMPLIANCE (JUL 2018)

C.23 VAAR 852.219-76 SUBCONTRACTING PLANS MONITORING AND COMPLIANCE

(JUL 2018)

C.24 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

36C26220R0128

C.25 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(JAN 2008)

C.26 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 FAR 52.204- 16 COMMERICAL AND GOVERNMENT ENTITIY CODE REPORTING

(JUL 2016)

E.2 FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)

E.3 FAR 52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE

CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS OR STATEMENTS—

REPRESENTATION (JAN 2017)

E.4 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.5 FAR 52.209-11 REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT

TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

E.6 FAR 52.211-6 BRAND NAME OR EQUAL (AUG 1999)

E.7 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

E.8 FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.9 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008)

E.10 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) 146

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

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016) (DEVIATION)

E.13 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(SEP 2018)

E.14 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (SEP 2018)

E.15 FAR 52.212-2 EVALUATION- COMMERCIAL ITEMS

E.16 FAR 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS (OCT 2018)

SECTION F VA SPACE REQUIREMENT -REAL PROPERTY LEASE

1.02 EXPRESS APPURTENANT RIGHTS

1.03 RENTAL CONSIDERATION FOR SIMPLIFIED LEASES

1.04 TERMINATION RIGHTS

1.05 RENEWAL RIGHTS

1.06 LABOR STANDARDS

1.07 SUMMARY PRICING SCHEDULE:

36C26219R0038

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR:

b. GOVERNMENT:

Alice McGruder

Contracting Officer 36C262

Email: Alice.McGruder@va.gov

Phone: 562-766-2238

Department of Veterans Affairs

Network Contracting Office 22

4811 Airport Plaza Drive

Suite 600

Long Beach CA 90815

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the Contractor shall 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 [MONTHLY]

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

Invoicing shall be in accordance with the requirements of The Department of Veteran Affairs (VA)

Financial Service Center (VAFSC). The latest 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 http://www.fsc.va.gov/einvoice.asp

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the

Solicitation numbered and dated as follows:

AMENDMENT NO DATE

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

B.2 PRICE SCHEDULE

This is an indefinite delivery, indefinite quantity, (IDIQ) fixed-price contract. Prices in this schedule represent an all-inclusive rate including labor, facility, incidental costs, and overhead. Costs not incorporated into the contractor’s price will not be reimbursed by the Government.

The guaranteed minimum amount for this contract is $2,000.00. The maximum aggregate value of the orders that can be placed under this contract is $40,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum amount.

The previous option year pricing will apply to any extension pursuant to FAR 52.217-8

BASE YEAR: October 15, 2020 – October 14, 2021

CLIN

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

0001 Primary Care Services at capitation rates per member per month

(PMPM)

PMPM 4,447

OPTION YEAR ONE: October 152021 – October 14, 2022

CLIN

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

1001 Primary Care Services at capitation rates per member per month

PMPM 4,491

OPTION YEAR TWO: October 15, 2022 – October 14, 2023

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

2001 Primary Care Services at capitation rates per member per month

PMPM 4535

OPTION YEAR THREE: October 15, 2023 – October 14, 2024

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

3001 Primary Care Services at capitation rates per member per month

PMPM 4,580

OPTION YEAR FOUR: October 15, 2024 – October 14, 2025

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

4001 Primary Care Services at capitation rates per member per month

PMPM 4,625

OPTION YEAR FIVE: October 15, 2025 – October 14, 2026

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

5001 Primary Care Services at capitation rates per member per month

PMPM 4,671

OPTION YEAR SIX: October 15, 2026 – October 14, 2027

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

6001 Primary Care Services at capitation rates per member per month

PMPM 4,717

OPTION YEAR SEVEN: October 15, 2027 – October 14, 2028

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

7001 Primary Care Services at capitation rates per member per month

PMPM 4,764

OPTION YEAR EIGHT: October 15, 2028 – October 14, 2029

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

8001 Primary Care Services at capitation rates per member per month

PMPM 4,811

OPTION YEAR NINE: October 15, 2029 – October 14, 2030

NUMBER

DESCRIPTION OF

SERVICES UNIT

ESTIMATED

QUANTITY UNIT PRICE

9001 Primary Care Services at capitation rates per member per month

PMPM 4,859

*CBOC ORDERING PROCEDURES: VA has the sole authority to assign Veterans treated by the

Contractor into the Primary Care Management Module (PCMM) software program used to track primary care clinic Veteran rosters. Specific billable processes for issuing task orders under the resultant contract includes: determining Veteran eligibility, enrollment eligibility, and qualifying encounter.

B.3 PERFORMANCE WORK STATEMENT

Outpatient Site of Care

PERFORMANCE WORK STATEMENT (PWS)

Outpatient Site of Care per VHA Handbook 1006.02 “VHA Site Classifications and Definitions”

1. GENERAL:

1.1. SERVICES REQUIRED: The VA San Diego Healthcare System; requires the following services to be provided in a private hospital, office or clinic environment to veterans, primarily residing in the city of Escondido, California:

1.1.1. [ X] Primary Care CBOC: offer both medical (physically on site) and mental health care

(either physically on site or 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. Sites that do not provide both primary care and mental health services are classified as Other Outpatient Services. Access to specialty care is not provided on site but may be available through referral or telehealth. A Primary care CBOC often provides home-based primary care (HBPC) and home telehealth to the population it serves to meet the primary care and mental health needs of Veterans who have difficulty accessing clinic-based care. Primary care in VA includes both medical and mental health care services, as they are inseparable in providing personalized, proactive, patient-centered health care. Primary Care Requirements. A point of service is said to provide primary care services if the site registers more than 500 primary care encounters within the primary care stop class within a given fiscal year. Mental Health

Requirements. A point of service is said to provide mental health services if the site registers more than 500 mental health encounters within a single mental health clinic stop class within a given fiscal year.

1.2. PLACE OF PERFORMANCE: VA San Diego Healthcare System (VASDHS) has a need for the provision of primary care services for Veterans in the City of Escondido of California off-site in a Community Based Outpatient Clinic. The city of Escondido is located approximately 23 miles from the VASDHS.

1.3. AUTHORITY: In accordance with FAR Part 12, 15 and Title 38 United States Code (USC)

8153 to be furnished by the contractor on behalf of VA San Diego Healthcare System.

1.4. POLICY AND REGULATIONS: The Contractor is required to 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 course of 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 VHA and VA publications can be located at http://www.va.gov/vhapublications/ / http://www.va.gov/vapubs/ respectively. 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, patient safety and performance, including, but not limited to, the following:

http://www.va.gov/vhapublications/ http://www.va.gov/vapubs/

1.4.1. Title 21 C.F.R 900.12(c), “Mammography Quality Standards” http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf

1.4.2. Title 21 CFR, “Food and Drugs” Section 1300-end”.

https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html

1.4.3. 38 USC. Section 7332, regarding a timely special consent for any medical treatment for drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus (HIV), or sickle cell anemia, to a Veteran with health insurance. A special consent from the Veteran is needed to allow VA to release bills and medical records associated with the treatment. http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-

2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html

1.4.4. 42 CFR Part 482, “Conditions of Participation” http://www.gpo.gov/fdsys/pkg/CFR-

2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf

1.4.5. 42 CFR 493.15(b), “Laboratories Performing Waived Tests” http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf

1.4.6. Clinical Laboratory Improvement Amendments (CLIA):

http://cms.hhs.gov/Regulations-and-

Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp

1.4.7. VA Directive 1663, “Health Care Resources Contracting – Buying” https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.4.8. VA Directive 6371, “Destruction of Temporary Paper Records” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2

1.4.9. VHA Record Control Schedule 10-1 http://www1.va.gov/vhapublications/rcs10/rcs10-

1.pdf

1.4.10. "Patient Medical Records-VA" 24VA10P2 https://www.oprm.va.gov/privacy/privacy_SOR.aspx

1.4.11. VHA Handbook 1101.11(2), “Coordinated Care for Traveling Veterans” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

1.4.12. VHA Directive 2007-033, "Telephone Service for Clinical Care," http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605

1.4.13. VHA Directive 1088, “Communicating Test Results to Providers and Patients” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

1.4.14. VHA Directive 2009-038 “VHA National Dual Care Policy” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058 http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf http://www.gpo.gov/fdsys/pkg/CFR-2012-title21-vol8/pdf/CFR-2012-title21-vol8-sec900-12.pdf https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html http://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf http://www.gpo.gov/fdsys/pkg/CFR-2003-title42-vol3/pdf/CFR-2003-title42-vol3-sec493-17.pdf http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2 http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058

1.4.15. VHA Directive 1033, “Anticoagulation Therapy

Management”http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129

1.4.16. VHA Directive 1108.08, “VHA Formulary Management Process” http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291

1.4.17. VHA Directive 1230 “Outpatient Scheduling Processes and Procedures” http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

1.4.18. VHA Directive 1115, “Military Sexual Trauma (MST) Program” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6402

1.4.19. VHA Directive 2010-053, “Patient Record Flags”.

www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341

1.4.20. VHA Directive 2011-012, “Medication Reconciliation”

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3133

1.4.21. VHA Directive 2011-020, “Automated Safety Incident Surveillance and Tracking

System (ASISTS)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407

1.4.22. VHA Directive 2012-022, “Reporting Cases of Abuse and Neglect, September 4, 2012” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2782

1.4.23. VHA Directive 2012-026, “Sexual Assaults and Other Defined Public Safety

Incidents in VHA” The directive specifically includes contracted sites of care and defines procedures specific to patient disruptive behavior.

http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797

1.4.24. VA Handbook 0730, “Security and Law Enforcement”

http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=755&FType=2

1.4.25. VHA Directive 1003.04, "VHA Patient Advocacy,"

https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970 .

1.4.26. VHA Handbook 1004.07, “Financial Relationships between Health Care

Professionals and Industry” http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

1.4.27. VHA Handbook 1006.02, “VHA Site Classifications and Definitions” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970

1.4.28. VHA Handbook 1050.01, “VHA National Patient Safety Improvement Handbook” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389

1.4.29. VHA Handbook 1100.17, “National Practitioner Data Bank Reports”-http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.4.30. VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3291 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6402 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3133 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2782 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2797 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=755&FType=2 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5970 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.4.31. VHA Handbook 1100.19, “Credentialing and Privileging” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.4.32. VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary Care https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

1.4.33. VHA Directive 1406, “Patient Centered Management Module (PCMM) For

Primary Care” http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

1.4.34. VHA Directive 1306, “Querying State Prescription Drug Monitoring Programs

(PDMP)”

http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283

1.4.35. VHA Handbook 1101.10(1), “Patient Aligned Care Team (PACT)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977

1.4.36. VHA Directive 1105.03, “Mammography Program Procedures and Standards” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6423

1.4.37. VHA Directive 1106, “Pathology and Laboratory Medicine Service (P&LMS)

Procedures” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7477

1.4.38. VHA Handbook 1108.05, “Outpatient Pharmacy Services”

http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209

1.4.39. VHA Directive 1120.02 Health Promotion and Disease Prevention Core Program

Requirements https://www1.va.gov/vhapublications/ViewPublications.asp?pub

ID=5965

1.4.40. VHA Directive 1122, “Podiatric Medical and Surgical Services” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5959

1.4.41. VHA Directive “1330.01(2) Health Care Services for Women Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332

1.4.42. VHA Handbook 1160.01, “Uniform Mental Health Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762

1.4.43. VHA Handbook 5005/36, Part 2, Appendix G15, “Licensed Pharmacist

Qualification Standards” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2

1.4.44. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.4.45. Title 38 CFR §17.107, “VA Response to Disruptive Behavior of Patients” (2010) www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdf

1.4.46. Title 38 CFR § 1.203, “Information to be reported to VA Police” (2003) http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430 http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3283 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6423 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7477 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209 https://www1.va.gov/vhapublications/ViewPublications.asp?pub https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5959 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332 http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762 http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm http://www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdf https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-

1.4.47. “Guidelines for Preventing Workplace Violence for Health Care and Social Service

Workers,” Occupational Safety and Health Administration (OSHA) OSHA 3148-

01R 2004) https://www.osha.gov/Publications/osha3148.pdf

1.4.48. “Violence: Occupational Hazards in Hospitals, National Institute for Occupational

Safety and Health” (NIOSH) NIOSH 2002-101, April 2002.

http://www.cdc.gov/niosh/docs/2002-101/default.html

1.4.49. VA Assistant Secretary OSP Memo, Clarification of Policy for Sexual Assault

Reporting, June 2011. http://www.diversity.va.gov/products/files/DAW/v10i05.docx

1.4.50. VHA Directive 1231 Outpatient Clinic Practice Management http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296

1.4.51. Amendment to VHA Handbook 1100.18, “”Reporting and Responding to State

Licensing Boards” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962

1.4.52. VHA Directive 1315 Access to VHA Clinical Programs for Veterans Participating in State-

Approved Marijuana Programs https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711

1.4.53. VHA Directive 1134 Provision of Medical Statements and Completion of Forms by

VA Health Care Providers https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300

1.4.54. VHA Directive 1192 Seasonal Influenza Prevention Program for VHA Health Care

Personnel https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472

1.4.55. VHA Handbook 1660.03 Conflict Of Interest For The Aspects Of Contracting For

Sharing Of Health-Care Resources (HCR) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3152

1.4.56. VA Directive 6008 Acquisition and Management of VA Information Technology

Resources https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=891&FType=2

1.4.57. VA Handbook 6500.6 Contract Security

https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=471&FType=2

1.4.58. VHA Directive 1300.01 National Viral Hepatitis Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6421

1.4.59. VHA Directive 1210 Chiropractic Care

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6425

1.4.60. VHA Directive 1341 Providing Health Care for Transgender and Intersex Veterans https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6431 https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203 https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203 https://www.osha.gov/Publications/osha3148.pdf http://www.cdc.gov/niosh/docs/2002-101/default.html http://www.diversity.va.gov/products/files/DAW/v10i05.docx http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=5962 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5711 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=4300 https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472 https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472 https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3152 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=891&FType=2 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=471&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6421 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6425 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=6431

1.4.61. VHA Directive 1177 Cardiopulmonary Resuscitation

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7487

1.4.62. VHA Directive 1108.10 Promotion of Drugs and Drug-related Supplies by

Pharmaceutical Company Representatives https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=6435

1.4.63. VHA Directive 1608 Comprehensive Environment of Care (CEOC) Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3171

1.4.64. VHA Directive 1003 VHA’s Veteran Customer Service Program https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=268

1.4.65. VHA Handbook 1003.1 Key Elements of VHA’s Veteran Customer Service

Program https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=422

1.4.66. VHA Handbook 1003.2 Service Recovery in the Veterans Health Administration https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=433

1.4.67. VHA Handbook 1330.03, Maternity Health Care and Coordination www.va.gov/ vhapublications/viewpublication.asp?pub_id=2803

1.4.68. VHA Directive 1330.02 Women Veterans Program Manager

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7484

1.4.69. VHA Directive 1004.08 Disclosure of Adverse Events to Patients https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8120

1.4.70. VA Handbook 6500 Risk Management Framework for VA Information Systems -

Tier 3: VA Information Security Program https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=793&FType=2

1.4.71. VHA Directive 1005(1) Informed Consent for Long-Term Opioid Therapy for Pain https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3005

1.4.72. VHA Handbook 1907.01 Health Information Management and Health Records https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.4.73. VHA Directive 1198 Intimate Partner Violence Assistance Program https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8192

1.4.74. VHA Directive 1031 Antimicrobial Stewardship Programs (ASP) https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8195

1.4.75. VHA Directive 1108.13 Provision and Use of Nursing Medication Management

Protocols In Outpatient Team-Based Practice Settings https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8199

1.4.76. VHA Handbook 5005, part 2, Appendix G20, “Dietitian Qualification Standard” www.va.gov/vapubs/viewPublication.asp?Pub_ID=764&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7487 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=6435 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=6435 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=6435 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3171 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=268 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=422 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=433 http://www.va.gov/vhapublications/viewpublication.asp?pub_id=2803 http://www.va.gov/vhapublications/viewpublication.asp?pub_id=2803 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7484 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8120 https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=793&FType=2 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3005 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8192 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8195 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8199 http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=764&FType=2

1.1. DEFINITIONS/ACRONYMS:

1.1.1. ABMS: American Board of Medical Specialties

1.1.2. ACLS: Advanced Cardiac Life Support

1.1.3. ACGME: Accreditation Council for Graduate Medical Education

1.1.4. ACPE: American Council on Pharmaceutical Education

1.1.5. ACO: Administrative Contracting Officer

1.1.6. ADE: adverse drug events

1.1.7. AED: Automatic External Defibrillator

1.1.8. AIS: Automated Information Security

1.1.9. ANA: American Nurses Association

1.1.10. AOA: American Osteopathic Association

1.1.11. ARRT: American Registry of Radiologic Technology

1.1.12. ASC: Ambulatory Surgery Clinic

1.1.13. 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.

1.1.14. BAA: Business Associate Agreement

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

1.1.16. BLS: Basic Life Support

1.1.17. BOS: Bureau of Osteopathic Specialists

1.1.18. CAHEA: Committee on Allied Health Education and Accreditation

1.1.19. CAP: College of American Pathologists

1.1.20. CARF: Commission on Accreditation of Rehabilitation Facilities

1.1.21. CBO: VA Central Billing Office.

1.1.22. CDC: Centers for Disease Control and Prevention

1.1.23. CEU: Certified Education Unit

1.1.24. CLIA: Clinical Laboratory Improvement Amendments

1.1.25. CME: Continuing Medical Education

1.1.26. CMS: Center for Medicare and Medicaid Services

1.1.27. CO: Contracting Officer

1.1.28. COPD: chronic obstructive pulmonary disease

1.1.29. COR: Contracting Officer’s Representative

1.1.30. COS: Chief of Staff

1.1.31. CPA: Collaborative Practice Agreement

1.1.32. CPS: Clinical Pharmacy Specialist

1.1.33. CPT: Current Procedural Terminology

1.1.34. CRNP: Certified Registered Nurse Practitioners

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

1.1.36. CPARS: Contractor Performance Assessment Reporting System

1.1.37. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.1.38. CVT: Clinical Video Telehealth

1.1.39. DICOM: Digital Image and Communication in Medicine

1.1.40. DIGMA: Drop in Group Medical Appointment

1.1.41. DRG: Diagnostic Related Group

1.1.42. DSS: Decision Support System

1.1.43. ECC Extended Care Center

1.1.44. 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.

1.1.45. EPRP: External Peer Review Program

1.1.46. FDA: Food and Drug Administration

1.1.47. FSMB: Federation of State Medical Boards

1.1.48. 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.

1.1.49. HHS: Department of Health and Human Services

1.1.50. HCFA: HealthCare Financing Administration

1.1.51. 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.

1.1.52. HT: Home Telehealth

1.1.53. ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

1.1.54. ICD 10: International Classification of Diseases 10th Edition

1.1.55. iMED: Software used by VA for informed consent

1.1.56. INR: International Normalized Ratio

1.1.57. ISO: Information Security Officer

1.1.58. LIP: licensed independent practitioner

1.1.59. MCCR: Medical Care Cost Recovery

1.1.60. 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.

1.1.61. MQSA: Mammography Quality Standards Act

1.1.62. MSN: Master of Science in Nursing

1.1.63. NCCPA: National Commission on Certification of Physician Assistants

1.1.64. NLN: National League for Nursing

1.1.65. NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing

Improvement in Cardiac Surgical Program

1.1.66. OTC: Over the Counter

1.1.67. PA: Physician Assistant

1.1.68. PACS: Picture Archiving and Communications System

1.1.69. 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.

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

1.1.71. PCMH: Patient-Centered Medical Home

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

Care Clinic Veteran rosters.

1.1.73. PCP: Primary Care Provider

1.1.74. Phar.D.: Doctor of Pharmacy

1.1.75. POC: Point of Care Testing

1.1.76. 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.

1.1.77. PCMHI: Primary Care-Mental Health Integration

1.1.78. PWS: Performance Work Statement

1.1.79. QAPI: Quality Assessment and Performance Improvement

1.1.80. QASP: Quality Assurance Surveillance Plan

1.1.81. RME: reusable medical equipment

1.1.82. SOP (Clinical): Scope of Practice

1.1.83. SELF- REFERRAL: Referring patients to Contractor’s facility for follow-up care. Self-referral for outpatient services at the Contractor’s facility is prohibited.

1.1.84. SFT: Store and Forward Telehealth

1.1.85. SMA: Shared Medical Appointments

1.1.86. SPD: Sterile Processing Division

1.1.87. SPE: Senior Procurement Executive

1.1.88. 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 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.

1.1.89. 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.

1.1.90. TJC: The Joint Commission

1.1.91. TIU: Text Integration Utility

1.1.92. TCT: Telehealth Clinical Technicians

1.1.93. VA: Veterans Affairs

1.1.94. VA EHR: VA Electronic Health Record

1.1.95. VAMC: Veterans Affairs Medical Center

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

1.1.97. VHA: Veterans Health Administration

1.1.98. VISTA: Veterans Health Information Systems and Technology Architecture

1.1.99. 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), 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 PCMM Handbook 1101.02.

The staffing standard for support staff shall be in ratios to Primary Care Providers of 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 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 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. Total Estimated Patients enrolled/assigned to site: 4,447.

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. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located; 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). 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.

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. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If proposed staff do not meet VA credentialing requirements, the Contractor shall propose substitute acceptable personnel within five (5) calendar days. 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 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.

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

CRNP’s (including subcontractors) shall 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 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 of the Outpatient Site of Care (i.e. CBOC); Reference VA Handbook 5005, Appendix G6 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 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.

2.3.2. TEAMLET MEMBER 2: Registered Nurse (RN) Care Manager: FTE Ratio

Performance Standard: Current standard is 1.0 FTE RNCM per 1.0 FTE PCP.

Reference VA Handbook 5005, Appendix G6 http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=464&FType=2

Qualifications: Graduate of a school of professional nursing approved by the appropriate

State-accrediting agency and 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…