VA256-16-R-0542-A00002000.docx

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) A00002 08-01-2017

NA

Department of Veterans Affairs Chief, A&MM (90C/NLR) Central Arkansas Veterans HCS 2200 Fort Roots Drive, Bldg 41, Room 213 North Little Rock

AR

72114 1706 Department of Veterans Affairs Chief, A&MM (90C/NLR) Central Arkansas Veterans HCS 2200 Fort Roots Drive, Bldg 41, Room 213 North Little Rock

AR

72114 1706 To all Offerors/Bidders

VA256-16-R-0542

08-22-2017

X X X X The Purpose of the Amendment is to Answer all of the Questions that were Submitted from potential Offerors.

All of these Questions were considered timely (received by 7/8/17). All of the Questions and Answers start on page 2:

**All other Terms and Conditions remain unchanged**

Billy R. Morris Contracting Officer

CONTINUATION PAGE

Questions and Answers for VA256-16-R-0542 (McComb CBOC)

1. On page 17 section B.5 Schedule of Services, the estimated quantity mental health patients enrolled in the clinic in the base year is 350. On page 53 paragraph 4.4.14 it states, “it is estimated that 25% of enrolled veterans will require a level of services equivalent in intensity to that delivered through a PCMH clinic. It is estimated that 5% of enrolled veterans will require a level of services equivalent in intensity to that delivered through a PCHM clinic.” Which one of these percentages (5% or 25%) are correct because in our experience operating six of the Mississippi CBOCs, we have only seen a 5-8% mental health enrollment and we are currently seeing approximately 115 patients in the McComb CBOC?

· 5% is correct.

2. On page 21 in Section 1.1 Services Required it states, “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.” Currently the VA provides home based primary care. Will the VA or the contractor be required to provide home based primary care in this new contract?

· The VA currently provides home based primary care (HBPC) services. The contractor will not be required to provide this service.

3. On page 30 under Registered Nurse (RN) Care Manager it states, “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 unrestricted registration as a graduate professional nurse in the state of the Outpatient Site of Care (i.e. CBOC); Authorization for prescriptive authority is required.” Is the “authorization for prescriptive authority” required an error, as the Board of Nursing does not allow prescriptive authority for RNs?

· This is an error. RNs are not required to have prescriptive authority.

4. On page 32 under Specialty Services – Tele-Retinal Healthcare Technician, it states, “2.0 FTE (teleretinal and tele-psychiatry technician services) per estimated 1200 Panel size 1 primary and 1 back up.” Is the VA requesting one full time TCT and one full time teleretinal/tele-psychiatry position per 1200 panel size? Or is the full time TCT the primary teleretinal/tele-psychiatry imager and a backup teleretinal/tele-psychiatry imager required as it is currently being provided in all Mississippi CBOCs?

· The requirement is for 1- full time primary teleretinal imager and 1 FTEE tele-psychiatry imager. They will back each other up.

5. On page 35 paragraph 2.1.6.0 it states, “the Outpatient Site of Care must be a DEA registered clinic under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.” Is this DEA registry being utilized for telehealth services provided by the VA at the McComb CBOC? If so, when obtaining the DEA for the McComb CBOC, will the VA be listed as the online pharmacy and provide the required information for the registry?

· DEA registration is only necessary for locations that order, store, and dispense controlled substances. No CBOC location managed or dispensed controlled substances, therefore; the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 does not apply to CBOCs. Therefore, it does not affect a provider’s ability to prescribe controlled substances to Veterans through telehealth modalities.

6. On page 36 paragraph 2.4 it states, “Contractor staff shall complete VA mandatory training as requested and complete ACLS/BLS training and keep ACLS/BLS certifications current throughout the life of the contract.” Does the VA require ACLS and BLS certification?

· Providers are required to have BLS certification as required per by licensure. Contract providers are not required to have BLS certifications.

7. On page 41 under Registration and Enrollment it states, “All veterans applying for care at the Contractor’s Outpatient Site of Care shall have an application processed in VISTA by the Contractor to determine priority enrollment category for benefits.” In addition, on page 41 under Financial Assessment it states, “The demographic and financial assessment information will be input into VISTA and maintained by the Contractor.” The VA does not currently allow the Contractor to handle these functions. Is this going to be a new requirement under the new contract?

· This will not be a requirement of the Contractor.

8. On page 45 paragraph #4.4.7.1, it states, “The Contractor will be responsible for emailing the VA Pathology and Laboratory Medicine Service’s contact a list of needed supplies on a quarterly basis. When supplies are approaching the expiration date on the packages, VA Pathology and Laboratory Medicine Service’s contact will need to be notified.” Does the VA or the contractor provide laboratory supplies?

· The VA will provide laboratory supplies.

9. On page 47 paragraph 4.4.7.18 it states, “It is required that urine pregnancy tests be available at all sites (including CBOCs and mobile clinics).” Currently the VA does not allow any point of care testing in the CBOCs. Is the VA now requiring urine pregnancy point of care testing?

· No, the urine test will not be point of care testing. The urine collection will be sent to the VA laboratory.

10. On page 48 paragraph 4.4.8.1 it states, “x-rays shall be performed by the Contractor on site at the CBOC.” Given the enrollment of approximately 2000 patients in the McComb CBOC, will the VA require x-rays be performed onsite?

· General x-rays can be performed at the CBOC to avoid having to send patients all the way to the Jackson Medical Center for a general x-ray. The Contract can choose to subcontract x-rays in the area.

11. On page 68 paragraph 4.4.17 it states, “the Contractor must make provisions for toll free telephone care, twenty-four (24) hours a day, seven (7) days a week, including evenings, weekends and holidays, for all enrolled patients.” Currently the McComb CBOC does not require toll free telephone care. Is toll free telephone care a new requirement under the new contract?

· This is only a requirement for sites delivering care for greater than 5,000 patients. The Contractor should however make arrangements with the parent VA facility’s after hours WHEN call center to provide after-hours telephone access. It is recommended that the Contractor’s telephone rolls over to the VA after-hours number if technology allows. If not, the after-hours telephone message should clearly provide instructions regarding access to WHEN telephone triage.

12. On page 82 paragraph 4.4.29.5 it states, “The Contractor shall provide a private office, no smaller than 120 square feet, and appropriate office furniture for each VA mental health provider who will work out of the CBOC.” How many VA mental health provider offices are required?

· A private office that meets the requirements should be provided for each VA mental health provider who will work out of the CBOC.

13. On page 131 paragraph E.2 Addendum to instructions to offerors, it divides the proposal into four parts: Part I - Price Proposal, Part II - Technical Proposal, Part III - Veteran Participation, Part IV - Pricing. Is the pricing in Part I or Part IV? Would the VA like the bidder to present each Part in a separate file?

· Price Proposal should be in Part I. Part IV should be reserved for Past Performance. That was an error in the Addendum. Since we are requesting that the proposal be submitted via email (with a 9MB max limit per email), each Part does not have to be in Separate emails but please keep them in separate files and clearly labeled to differentiate each Part.

14. In the Evaluation Factors and Criteria section on page 142 under (3) Factor 3 – Past Performance it says, “Limited to no more than 2 pages per contract listed. Only references for same or similar type contract desired. Submit original and two (2) copies. (a) Quality and Satisfaction Rating for Contracts Completed in the Past Three Years: Provide any information currently available (letters, metrics, customer surveys, independent surveys, etc.) . . .”

If the Past Performance references are being submitted electronically, what is meant by submitting original and two (2) copies? With the no more than 2 page limitation per contract listed, can the requested letters, metrics, customer surveys, independent surveys, etc. be provided as an attachment and not be counted as part of the 2 page limitation?

· The Original and 2 Copies is an error. With the proposal being submitted electronically (email), 1 Copy will suffice. Also, providing all of the referenced documents as an attachment is perfectly fine to stay within the 2 page limitation.

15. Part I Price Proposal outlines the requirements of the volume but Part IV Pricing does not.

Can you please outline what is requited in Part IV Pricing?

· See Answer for Question 13

16. Is the current clinic comingled or veteran only? If comingled, are there dedicated VA staff?

· Please refer to the information in the current solicitation package.

17. Is the current facility designed to meet the VA’s standards to accommodate the PACT Model?

· Please refer to the information in the current solicitation package.

18. Is the current incumbent operating under a PACT model? If so, how many teamlets are there?

· The PACT Model Care is currently being executed in accordance with the current contract’s terms and conditions.

PACT requires a 3:1 staff-provider ratio per 1200 patients panel model.

19. Page 32 - Diagnostic or Therapeutic Radiologic Tech. Is the VA responsible for x-rays, if so will there be a local site to perform radiology?

· X-rays (general film) are provided at the contractor’s expense.

20. Page 33 – Tele-Retinal Technician – Can the backup tele-health technician be an LPN or MA that is assigned as one of the PACT members?

· The tele-retinal backup can be a LPN assigned as one of the PACT members.

21. Page 46 – Does the VA supply ALL laboratory collection devices and supplies? At VA cost or contractor cost?

· The VA will supply laboratory collection devices and supplies at no cost to the contractor for laboratory tests. The Contractor will be responsible for emailing the VA Pathology and Laboratory Medicine Service’s contact a list of needed supplies on a quarterly basis. Supplies will be limited to what is on the supply list.

22. Page 47 – 4.4.7.10 States Contractor is responsible for cost of collection, does that mean the VA does not pay for laboratory collection devices, including tubes, needles, cups etc.

· The VA provides a limited amount of collection supplies, but does not pay for the “fee” and staff to collect the specimens. The fee and staff to collect specimens are the responsibility of the contractor.

23. Page 49 – 4.4.9 Interpretation of results – Is the VA responsible for x-ray only if x-ray is taken at VAMC location?

· Yes, the VA is responsible for the interpretation of x-rays performed at the VAMC.

24. Page 50 Please identify which vaccines VA will supply to Contractor for patient use? .

· All routine vaccines will be provided to CBOCs by the VA. Influenza, pneumococcal, tetanus/diphtheria toxoid, with and without pertussis (TD/TDaP), Herpes zoster, human papilloma virus, and PPD will be stocked at the Contractor’s Outpatient Site of Care.

In case a vaccine is not routinely stocked, for example if the vaccine is non- formulary, the process is in place for the provider to request the vaccine. Upon review and approval, the vaccine will be purchased and shipped to the CBOC location for administration. The CBOC provider can request a review by the Chief of Staff for any disapproved vaccines.

25. Is the Contractor responsible for the cost of any other vaccines? If so, please provide a list of those vaccines

· The Contractor is not responsible for the cost of other vaccines. Processes are in place for request any vaccine whether it is formulary or non-formulary.

26. Page 65 – Is Contractor required to supply an LCSW Homeless Outreach Specialist? If so, what is the FTEE requirement?

· No, this service will be provided by the VA (see page 32). The LCSW at the CBOC will be the point of contact for these services.

27. Page 82 unable to open the following hyperlink: http://www.cfm.va.gov/til/dGuide/dgPACT.pdf

· The link provided works properly.

28. Will VA supply VA telephones to the CBOC?

· The VA has not provided telephones to the CBOC.

29. On pg 34 of the RFP it mentions a FTE ratio of 0.5 FTE per patient panel of 1200 for LCSW… does this mean 0.5 LCSW per 1200 primary care patients registered in the clinic or 0.5 FTE LCSW per 1200 mental health patients registered?

· This means 0.5 FTEE per patient panel of 1200 primary care patient registered in the clinic for the LCSW.

30. On pg 51 it states that the provider may write a bridge supply of drugs to be filled at the local contracted pharmacy. Who is responsible to pay for the local fill, VA or contractor?

· VA is responsible for the payment of the bridge supply.

31. On pg 53, it states that there is an estimated 25% and also 5% of enrolled veterans needing PCMH clinic. Which percentage is correct?

· 5% is correct.

32. Will the VAMC provide CPS staffing? If so, how many hours a week? What support staff will be required for the CPS. Will the CPS manage Coumadin?

· The VA will have CPS staffing available as needed to support the outpatient site of care as appropriate based on patient population. There is no requirement for support staff at this time. The CPS will work with the CBOC to manage Coumadin and other specific disease states as appropriate.

33. Will the existing vesting visit dates of enrollees be rolled over to the new contractor for the new contract?

· Yes, existing vesting dates of enrollees will be rolled over for the new contract.

34. What is the current capitation rate for primary care services?

· Current Capitation Rates are:

· $61.24 for 1-1500 enrollees and

· $31.24 for 1501-3000 enrollees

35. How many billable enrollees does the existing clinic have?

· There are currently 1998 billable enrollees.

36. Please list any staff (positions) the VA will place at the CBOC and number of days per month they will be on site.

· Currently, this is not a requirement or need of the VA.

37. Is the present location acceptable for the next contractor?

· The current location meets the terms and conditions of the contract.

There are no more Questions after Question 37.