VA250-17-R-0203-00007000.docx

VA250-17-R-0203 Terre Haute CBOC Indianapolis, Indiana

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE

OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO.

IN ITEM 10A.

15C. DATE

SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

BY

Contractor

16C. DATE

SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 00007 01-11-2018 None 00583 Department of Veterans Affairs Network Contracting Office 10 8888 Keystone Crossing Suite 1100 Indianapolis IN 46240 00583 Department of Veterans Affairs Network Contracting Office 10 8888 Keystone Crossing Suite 1100 Indianapolis IN 46240 To all Offerors/Bidders

VA250-17-R-0203

12-19-2017

X X X HOUR & DATE for Receipt of Offers is EXTENDED to:

2pm EST , Tuesday, 01/23/2018 X

ONE (1)

The Government has reassessed and clarified certain aspects of its requirements. This amendment requires offerors to submit revised price proposals . The Government will then re-evaluate the technical proposals and revised price proposals and make a source selection decision in accordance with the re-evaluation.

All revised price proposals shall be submitted by 2pm local time, Tuesday, January 23, 2018.

No contractor questions shall be submitted. Any questions submitted will not be answered.

Revised price proposals shall be submitted electronically to Jaime.Reed2@va.gov or mailed to the following address:

Network 10 Contracting Office, ATTN: Jaime N. Reed, Contracting Officer, 8888 Keystone Crossing, Suite 1100, Indianapolis, IN 46240.

Jaime N. Reed Contracting Officer

The following has been amended in the subject solicitation.

1. Updated FAR Clause 52.212-5 to the NOV 2017 version.

2. Updated FAR Provision 52.212-3 to the NOV 2017 version.

3. Updated the Schedule of Services and Price to change the contract maximum from a dollar value to a per member per month quantity.

4. Line item number two for mental health services is removed from the base year and all option years, leaving only one line item for primary care services. Any cost for the provision of mental health services shall be included in the price for primary care services.

5. Removed Specialty Care requirements.

6. Section B3.4.35, VHA Directive 1406, Patient Centered Management Module (PCMM) for Primary Care was replaced with an updated hyperlink.

7. Section B3.6.1.1. Clinical Pharmacy Services was moved to the original paragraph (B3.6.1) and all paragraphs were re-numbered.

8. Section B3.23.8.3 – Add a section with information for Communicating Test Results to Providers and Patients (B3.23.8.4).

9. Section B3.23.10, Pharmacy Services (Prescription Fulfillment) – This section initially indicated the VA will provide medications, supplies, and vaccines and then stated the Contractor will provide all medications and vaccines. Per Pharmacy Benefits Management at VA Central Office (VACO), the VA can no longer supplies medications, to include vaccines, to Contractors. Contractors shall supply their own medications/vaccines. Therefore, these two sentences are now removed and a sentence was added to reflect the responsibility of the contractor to provide their own medications/vaccines.

10. Section B3.25, Space Requirements – Identified that the VA is providing social work and pharmacist.

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

VA250-17-R-0203

06-06-2017 Jaime Reed, Contracting Officer 317-988-1510 07-17-2017 2PM Local Time 00583 Department of Veterans Affairs Network Contracting Office 11 8888 Keystone Crossing Suite 1100 Indianapolis IN 46240 X Y 621498 $20.5 Million N/A X N/A X 00583 Department of Veterans Affairs Richard L. Roudebush VA Medical Center Ambulatory Care 1481 W. 10th Street Indianapolis IN 46202 00583 Department of Veterans Affairs Network Contracting Office 11 8888 Keystone Crossing Suite 1100 Indianapolis IN 46240

Department of Veterans Affair FMS PO Box 149971 Austin TX 78714-9971 1-866-372-1145 512-460-5429 See Schedule of Supplies/Services and Prices on pages 7 to 8 Contractor shall provide primary care and mental health services via a community-based outpatient clinic (CBOC) in Terre Haute, Indiana for the "parent facility," Richard L.

Roudebush VA Medical Center (RLR VAMC) in Indianapolis, IN.

This acquisition is being negotiated under FAR Parts 12 and 15 under the statutory authority of Title 38 USC 8153.

X X Jaime Reed Contracting Officer Table of Contents

VA250-17-R-0203 Terre Haute CBOC Indianapolis, Indiana

Page 1 of Page 1 of

Page 1 of Page 1 of

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:

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: 52.232-33, Payment by Electronic Funds Transfer – Systems for Award Management

3. INVOICES: Invoices shall be submitted in arrears: Monthly

4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address:

VA Financial Service Center PO Box 149971 Austin, TX 78714-8971 Phone: 1-877-353-9791

See Section B3.38.3 of the Performance Work Statement for Electronic Invoicing information.

All invoices shall include the following:

1. Invoice Number

1. Invoice Date

1. Purchase Order Number (will always begin with 583)

5. CHANGES/MODIFICATIONS TO THE CONTRACT: The Contracting Officer will be the only person authorized to approve changes or modify any of the requirements under this resultant contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer will be authorized to make commitments or issue changes that affect price, quantity, delivery or quality of performance of this resultant contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered unauthorized by the local VAMC and no adjustment will be made in the contract price to cover any increase in cost incurred as a result thereof.

The Contracting Officer’s Representative (COR) will be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority.

6. SUBMISSION OF OFFER: Documents that are to be provided to the Contracting Officer shall be submitted to the Network 10 Contracting Office, using the appropriate address identified in 52.212-1, Instructions to Offerors. Submit all offers to the address referenced in 1b, Contract Administration.

7. SOLICITATION/DOCUMENT: This solicitation and resulting contract adheres to the format defined in FAR 12.303 for the acquisition of commercial items. This procurement will be conducted using the procedures of FAR Parts 12 and 15.

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

9. SECURE FAX: In accordance with VA Handbook 6500, the following statement is required on all fax cover sheets; if it is determined the ordering process will include a fax: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

10. POST-AWARD ORIENTATION (Contract Awards Exceeding $1M): The Contracting Officer will schedule a post-award orientation conference for contract orientation purposes as required by Information Letter (IL) 003A3-12-04 (http://www.va.gov/oal/docs/library/ils/il12-04.pdf).

11. LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes FAR 52.219-4 Notice of Price Evaluation Preference for HubZone Small Business Concerns. Accordingly, any contract resulting from this solicitation will include this clause provided that (1) the awarded contractor is a HUBZone small business concern and (2) the concern did not waive the evaluation preference identified in the aforementioned clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

12. SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71 (Deviation), Evaluation Factor Commitments. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.

13. SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes FAR 52.219-9, Small Business Subcontracting Plan, and VAAR 852.219-9, VA Small Business Subcontracting Plan Minimum Requirement. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing the contractor's compliance with the plan, including reviewing the contractor's accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting plan.

SCHEDULE OF SUPPLIES/SERVICES AND PRICES

B.2 Contractor shall provide community-based outpatient clinic (CBOC) services in Terre Haute, Indiana for eligible veterans at the Department of Veterans Affairs (VA), Richard L. Roudebush VA Medical Center (RLR VAMC), 1481 W. 10th Street, Indianapolis, Indiana 46202. Healthcare resources will be solicited on a competitive basis in accordance with the performance work statement (PWS) under the statutory authority of Title 38 USC 8153. The RLR VAMC intends to enter into a single-award, indefinite-delivery, indefinite-quantity (IDIQ) contract. The services are for a 12-month base year with four 12-month option year renewals, which may be exercised at the discretion of the Government.

The guaranteed minimum only applies to the Federal government Fiscal Year in which the contract is awarded. The total minimum amount, or guaranteed minimum, for the initial fiscal year in which this contract is awarded is 500 per member per month (PMPM). The maximum PMPM of the contract, inclusive of the base year and all options exercised, shall not exceed 6,400 PMPM. Individual task orders will be funded annually. The Contracting Officer is the only authorized individual that can place annual task orders against this contract for the estimated amount of services for the specific timeframe, and the task orders will be issued to the contractor.

BASE YEAR: One year from the date of contract award

Total for Base Year: $

OPTION YEAR 1: One year commencing on the day following the last day of the base year

Total for Option Year 1: $

OPTION YEAR 2: One year commencing on the day following the last day of Option Year 1

Total for Option Year 2: $

OPTION YEAR 3: One year commencing on the day following the last day of Option Year 2

Total for Option Year 3: $

OPTION YEAR 4: One year commencing on the day following the last day of Option Year 3

Total for Option Year 4: $

TOTAL FOR BASE AND OPTION YEARS: $

PERFORMANCE WORK STATEMENT (PWS)

B3. GENERAL:

B3.1. SERVICES REQUIRED: The Richard L. Roudebush VA Medical Center (RLR VAMC) requires the following services to be provided in a private hospital, office, or clinic environment to veterans, primarily residing in Terre Haute, Indiana:

B3.1.1. Multi-Specialty Community-Based Outpatient Clinic (CBOC): Offers both primary and mental health care and two or more specialty services physically on-site. Access to additional specialty services may be offered by referral or telehealth. These clinics may offer support services, such as pharmacy, laboratory, and x-ray. The clinic may be operational from 1 to 7 days per week. These clinics are permitted to provide invasive procedures with local anesthesia or minimal sedation, but not with moderate sedation or general anesthesia (see VHA Directive 2006-023 Moderate Sedation by Non-Anesthesia Providers VHA Directive 1073 www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3073).

B3.1.2. Requirements: Multi-Specialty CBOCs are subject to the same requirements as Primary Care CBOCs, and are also required to provide multiple (two or more) specialty services.

B3.2. PLACE OF PERFORMANCE: Within city limits of Terre Haute, Indiana.

B3.3. AUTHORITY: In accordance with Title 38 United States Code (USC) 8153 to be furnished by the contractor on behalf of the RLR VAMC in Indianapolis, Indiana.

B3.4. POLICY AND REGULATIONS: The contractor shall be required to meet the Veterans Health Administration’s (VHA) performance and quality criteria and standards including, but not limited to, customer satisfaction, access, 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 shall be provided to the contractor before implementation date. 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:

B3.4.1. 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

B3.4.2. Title 21 CFR, “Food and Drugs” Section 1300-end” https://www.deadiversion.usdoj.gov/21cfr/cfr/index.html

B3.4.3. 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

B3.4.4. 42 CFR Part 482, “Conditions of Participation” http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol5/pdf/CFR-2010-title42-vol5-part482.pdf

B3.4.5. 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

B3.4.6. Clinical Laboratory Improvement Amendments (CLIA): http://cms.hhs.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/clia/appendc.asp

B3.4.7. VHA Directive 2006-041, “Veterans Health Care Service Standards” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

B3.4.8. VA Directive 1663, “Health Care Resources Contracting – Buying” http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=347

B3.4.9. VA Directive 6371, “Destruction of Temporary Paper Records” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=742&FType=2

B3.4.10. VHA Record Control Schedule 10-1 http://www1.va.gov/vhapublications/rcs10/rcs10-1.pdf

B3.4.11. "Patient Medical Records-VA" (24VA19) 24VA19 http://vaww.vhaco.va.gov/privacy/SystemofRecords.htm.

B3.1.12. VHA Handbook 1101.11(2), “Coordinated Care for Traveling Veterans” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3099

B3.4.13. VHA Directive 2007-033, "Telephone Service for Clinical Care," http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1605

B3.4.14. VHA Directive 2008-015, “Public Access to Automated External Defibrillators (AEDs): Deployment, Training, and Policies for use in VHA Facilities” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1665

B3.4.15. VHA Directive 1088, “Communicating Test Results to Providers and Patients” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

B3.4.16. VHA Directive 2009-038 “VHA National Dual Care Policy” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2058

B3.4.17. VHA Directive 1033, “Anticoagulation Therapy Management” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3129

B3.4.18. VHA Directive 1108.08, “VHA Formulary Management Process” http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

B3.4.19. VHA Directive 1230 “Outpatient Scheduling Processes and Procedures” http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3218

B3.4.20. VHA Directive 2010-014, “Assessment and Management of Veterans Who Have Been Victims of Alleged Acute Sexual Assault” https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2177

B3.4.21. VHA Directive 2010-033, “Military Sexual Trauma (MST) Programming,” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2272

B3.4.22. VHA Directive 2010-053, “Patient Record Flag” www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2341

B3.4.23. VHA Directive 2011-012, “Medication Reconciliation” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2390

B3.4.24. VHA Directive 2011-020, “Automated Safety Incident Surveillance and Tracking System (ASISTS)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2407

B3.4.25. VHA Directive 2012-022, “Reporting Cases of Abuse and Neglect, September 4, 2012” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2782

B3.4.26. 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

B3.4.27. VA Handbook 0730, “Security and Law Enforcement” http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=755&FType=2

B3.4.28. VHA Handbook 1003.4, "VHA Patient Advocacy Program" http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1303

B3.4.29. VHA Handbook 1004.07, “Financial Relationships between Health Care Professionals and Industry” http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3059

B3.4.30. VHA Handbook 1006.02,“VHA Site Classifications and Definitions” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2970

B3.4.31. VHA Handbook 1050.01, “VHA National Patient Safety Improvement Handbook” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2389

B3.4.32. VHA Handbook 1100.17, “National Practitioner Data Bank Reports” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

B3.4.33. VHA Handbook 1100.18, “Reporting and Responding to State Licensing Boards” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

B3.4.34. VHA Handbook 1100.19, “Credentialing and Privileging” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

B3.4.35. VHA Handbook 1101.02, “Primary Care Management Module” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5430

B3.4.36. VHA Directive 1306, “Querying State Prescription Drug Monitoring Programs (PDMP)” www.va.gov/vhapublications/viewpublication.asp?pub_id=3283

B3.4.37. VHA Handbook 1101.10, “Patient Aligned Care Team (PACT)” http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2977

B3.4.38. VHA Handbook 1105.03, “Mammography Program Procedures and Standards” http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2411

B3.4.39. VHA Handbook 1106.01, “Pathology and Laboratory Medicine Service (P&LMS) Procedures” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3169

B3.4.40. VHA Handbook 1108.05, “Outpatient Pharmacy Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=3209

B3.4.41. Handbook 1120.2, "Health Promotion and Disease Prevention Core Program Requirements" http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=1501

B3.4.42. VHA Handbook 1122.01, “VHA Handbook 1122.01, “Podiatric Medical and Surgical Services for Veterans Health Administration Medical Facilities” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2122

B3.4.43. VHA Handbook, “1330.01 Health Care Services for Women Veterans” https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5332

B3.4.44. VHA Handbook 1160.01, “Uniform Mental Health Services” http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762

B3.4.45. VHA Handbook 5005, Part 2, Appendix G15, “Licensed Pharmacist Qualification Standards” http://www.va.gov/vapubs/viewPublication.asp?Pub_ID=512&FType=2

B3.4.46. Privacy Act of 1974 (5 U.S.C. 552a) as amended http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

B3.4.47. Title 38 CFR §17.107, “VA Response to Disruptive Behavior of Patients” (2010) www.gpo.gov/.../pdf/CFR-2012-title38-vol1-sec17-107.pdf

B3.4.48. Title 38 CFR § 1.203, “Information to be reported to VA Police” (2003) https://www.gpo.gov/fdsys/granule/CFR-2011-title38-vol1/CFR-2011-title38-vol1-sec1-203

B3.4.49. “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

B3.4.50. “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

B3.4.51. VA Assistant Secretary OSP Memo, Clarification of Policy for Sexual Assault Reporting, June 2011 http://www.diversity.va.gov/products/files/DAW/v10i05.docx

B3.4.52. VHA Directive 1231 Outpatient Clinic Practice Management http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3296

B3.5. DEFINITIONS/ACRONYMS:

· ABMS: American Board of Medical Specialties

· ACLS: Advanced Cardiac Life Support

· ACGME: Accreditation Council for Graduate Medical Education

· ACPE: American Council on Pharmaceutical Education

· ACO: Administrative Contracting Officer

· ADE: adverse drug events

· AED: Automatic External Defibrillator

· AIS: Automated Information Security

· ANA: American Nurses Association

· AOA: American Osteopathic Association

· ARRT: American Registry of Radiologic Technology

· ASC: Ambulatory Surgery Clinic

· 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.

· BAA: Business Associate Agreement

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

· BLS: Basic Life Support

· BOS: Bureau of Osteopathic Specialists

· CAHEA: Committee on Allied Health Education and Accreditation

· CAP: College of American Pathologists

· CARF: Commission on Accreditation of Rehabilitation Facilities

· CBO: VA Central Billing Office.

· CDC: Centers for Disease Control and Prevention

· CEU: Certified Education Unit

· CLIA: Clinical Laboratory Improvement Amendments

· CME: Continuing Medical Education

· CMS: Center for Medicare and Medicaid Services

· CO: Contracting Officer

· COPD: chronic obstructive pulmonary disease

· COR: Contracting Officer’s Representative

· COS: Chief of Staff

· CPA: Collaborative Practice Agreement

· CPS: Clinical Pharmacy Specialist

· CPT: Current Procedural Terminology

· CRNP: Certified Registered Nurse Practitioners

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

· CPARS: Contractor Performance Assessment Reporting System

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

· CVT: Clinical Video Telehealth

· DICOM: Digital Image and Communication in Medicine

· DIGMA: Drop In Group Medical Appointment

· DRG: Diagnostic Related Group

· DSS: Decision Support System

· ECC: Extended Care Center

· Enrollment: The process of establishing eligibility for VA’s “Medical Benefits Package.” Most Veterans are required to “enroll” into the VA Health Care System to be eligible for VA health care and to be assigned to a outpatient clinic like a CBOC; however some can still receive care without enrolling. Applicants are only required to “enroll” once for VA health care unless they are determined ineligible for care at time of application or they have disenrolled.

· EPRP: External Peer Review Program

· FDA: Food and Drug Administration

· FSMB: Federation of State Medical Boards

· 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.

· HHS: Department of Health and Human Services

· HCFA: HealthCare Financing Administration

· 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.

· HT: Home Telehealth

· ICAVL: Intersocietal Commission for the Accreditation of Vascular Laboratories

· INR: International Normalized Ratio

· ISO: Information Security Officer

· LIP: licensed independent practitioner

· MCCR: Medical Care Cost Recovery

· 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.

· MQSA: Mammography Quality Standards Act

· MSN: Master of Science in Nursing

· NCCPA: National Commission on Certification of Physician Assistants

· NLN: National League for Nursing

· NSQIP/CICSP: National Surgical Quality Improvement Program/Continuing Improvement in Cardiac Surgical Program

· OTC: Over the Counter

· PA: Physician Assistant

· PACS: Picture Archiving and Communications System

· PACT: Patient Aligned Care Team Background & Introduction: VA has implemented a PCMH model at all VA Primary Care sites which is referred to as PACT. This initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, in team based environment including the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions.

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

· PCMH: Patient-Centered Medical Home

· PCMM: Primary Care Management Module- a software program used to track Primary Care Clinic Veteran rosters.

· PCP: Primary Care Provider

· Phar.D.: Doctor of Pharmacy

· POC: Point of Care Testing

· 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.

· PWS: Performance Work Statement

· QAPI: Quality Assessment and Performance Improvement

· QASP: Quality Assurance Surveillance Plan

· RME: reusable medical equipment

· SOP (Clinical): Scope of Practice

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

· SMA: Shared Medical Appointments

· SPD: Sterile Processing Division

· SPE: Senior Procurement Executive

· 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.

· 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.

· TJC: The Joint Commission

· TIU: Text Integration Utility

· TCT: Telehealth Clinical Technicians

· VA: Veterans Affairs

· VAMC: Veterans Affairs Medical Center

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

· VHA: Veterans Health Administration

· VISTA: Veterans Health Information Systems and Technology Architecture

B3.6. STAFFING AND QUALIFICATIONS:

B3.6.1. MINIMUM PACT STAFFING REQUIREMENTS: Sufficient support staff to conduct daily business, including such functions as patient registration, financial assessments, and medical record documentation in VISTA. The Contractor shall provide personnel 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 1,200 active patients per full time physician and 900 active patients per full time midlevel provider. Actual panel sizes can be determined by the facility 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 support staff for each full time equivalent Primary Care Provider. Clinical Pharmacy Services (CPS): The CPS shall be provided the same support staffing given to other providers on the team when working in the capacity of a mid-level provider. The support staffing mix standard includes a registered nurse care manager for every 1,200 patients served by the Outpatient Site of Care. Anticoagulation clinic management and Telephone Care for the primary care patients are also considered support staff, even if located in a separate area. Staff time dedicated to Business Office functions (means testing, registrations or billing), phlebotomy, and file room activities, or supporting non-primary care clinics (e.g., podiatry, social work, and dietary) are not considered support staff for the purposes of this definition. These numbers may be adjusted, upon approval by the Government, based on the availability of exam rooms and support staff (refer to VHA Handbook 1101.02). If the number of patients reaches 90% of the maximum panel size assigned by the facility, the Contractor shall communicate to the VA the Contractor’s future staffing plan to ensure VA contract staffing ratio standards remain in accordance with Primary Care Management Module (PCMM) staffing standards. Total Estimated Patients enrolled/assigned to the site is: 4,400.

B3.6.1.1. PHYSICIAN DIRECTOR (MANDATORY FOR ALL SITES)

FTE Ratio Performance Standard: 0.05 FTE per 1,200 patients Responsible Party: shall be provided by the 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 (IM) or Family Practice (FP). Contactor’s physicians performing under this contract shall be board-certified (or board-eligible) by the American Board of Medical Specialties (ABMS) in IM and/or FP or the Bureau of Osteopathic Specialists (BOS) in IM and/or FP. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located in Indiana. If proposed staff does 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 Primary Care Provider (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.

B3.6.1.2. PRIMARY CARE TEAMLET STAFFING (MANDATORY FOR ALL SITES): All primary care teamlet staffing shall be provided by the contractor. The selection of teamlet and specialty team staffing mix is the responsibility of contractor.

B3.6.1.2.1. TEAMLET MEMBER 1: PCP

FTE Ratio Performance Standard: Current standards are 1,200 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 shall propose mix of PCP from the options below.

B3.6.1.3.2.1. OPTION 1: Physician (MD) Qualifications: Physicians shall demonstrate evidence of education, training, and experience in IM or FP. Physicians performing under this contract shall be board-certified (or board-eligible) by the ABMS in IM and/or FP or the BOS in IM and/or FP. Authorization for prescriptive authority shall be required. Physicians shall be licensed in the state where the Outpatient Site of Care (i.e. CBOC) is located. If the proposed staff does 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.

B3.6.1.3.2.2. OPTION 2: Certified Registered Nurse Practitioner (CRNP) Qualifications: CRNP’s (including subcontractors) shall have a Master of Science in Nursing (MSN) from a National League for Nursing (NLN) accredited…