SPECIAL NOTICE
Q -- Havre CBOC
- Notice Date
- 6/24/2008
- Notice Type
- Special Notice
- NAICS
- 622110
— General Medical and Surgical Hospitals
- Contracting Office
- Department of Veterans Affairs, Ft. Harrison VAMROC (See VA Rocky Mountain Consolidated Contracting Center), Department of Veterans Affairs Medical & Regional Office Center, Department of Veterans Affairs;VA Montana;3687 Veterans Drive;POB 187;Fort Harrison, MT 59636
- ZIP Code
- 59636
- Archive Date
- 6/24/2008
- Point of Contact
- Jeanne PlummerVA Montana Healthcare System
- Small Business Set-Aside
- N/A
- Description
- Questions and AnswersSolicitation Number VA-259-08-RP-0146 Havre CBOC Question 1: Page 7 under the NOTE, section sates: For each contract option year the enrolled patient must receive a minimum of one office visit before receiving payment for the option year. Page 8, paragraph 2, states: The contractor(s) will be paid for the full contract year at the time of the initial visit. For disenrolled patients, the contractor will be paid a pro-rata portion up to the full month in which the date of disenrollment occurred. Disenrolled is defined as not seen by the contractor provided for a period of two years (24 months). a.For clarification purposes, must the enrolled patient be seen yearly in order to receive the payments for the option year even though the patient is not disenrolled until they have not been seen for two years? Answer 1: I am not sure of the question that you are asking. For example, in the schedule the contractor will provided a price of per patient per month and a price per patient per year. Per the solicitation, for each contract option year, the enrolled patient must receive a minimum of one office visit before receiving payment for the option year. The Contractor will get paid for that veteran through 2 years even if he is only seen one time. As long as the veteran is enrolled, payment will be made. Question 2: Page 23, Section F, Paragraph 2, states: The VA will provide clerical staff for the veterans and primary care providers. This VA clerk will work full-time with primary responsibilities to the VA. Coverage for extended pre-planned annual leave and sick leave will be negotiated with and provided by VA staff from other Community Based Outpatient Clinics (CBOCs). Sick or annual leave coverage of a less extensive nature will be provided by the contract clerical assistant and the individual primary care support staff with follow-up by the assigned VA clerk upon his/her return. a.Will the contracted provider have any input in the selection of the VA Clerk? Answer 2a: No. The clerical position is considered a full time employee who works for the VA VA employee. The position is advertised and hired by the VA Human Resources department. No authority, but value input. b.This is the only reference to the contract clerical assistant. Does the VA expect the contracted provider to employ this individual? Or may the contracted provided supply sick and annual leave coverage of a less extensive nature by utilizing personnel? Answer 2b: The clerical position is a VA employee who is located at the Havre CBOC and an employee of the VA. This is a full time position that is hired and paid by the VA just like any other VA employee and the clerical position is entitled to benefits provided by the VA (sick and annual leave). If the VA clerk is gone for emergent leave, the contract staff may need to take messages until the clerk returns. The contractor may use personnel to take messages. Question 3: Page 25, Paragraph 2 states: The VA shall be responsible for maintenance and on-going technical support for all VA provided IT hardware, software and peripherals. a.What is the type and nature of the software training and support the VA will provide? Answer 3a: Any VA owned IT hardware and software; the VA will provide to the contractor and VA staff the necessary training to utilize those products. This includes for example the VA software package called CPRS and VISTA. Question 4: Page 27, Paragraph 2(b) states: Records created by Contractor in course of performing this agreement are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable federal law, regulations, and policy. Access to the date will be limited to the minimum necessary for performance of the contract. Contractor will take steps to ensure that access is limited to those employees who need access to the data to perform the contract. Contractor will not copy information contained in the system, either by printing to paper or by copying to another digital format, without the express permission of one of the officials listed in paragraph (b), above, except as is necessary to make single copies in the ordinary course of providing patient care. Contractor will not commingle the data from the system with information form other sources. a.Due to the remote location and distance from other providers and in order to provide seamless continuity of care to the veterans, may the Contractors allow access to the VA Computerized Record System to the Northern Montana Hospital Emergency Room Physicians for further patient care in the event of a Veteran presenting to the ER for emergency services? Answer 4a: No. The VA has a process in place to release records to ERs if needed. Question 5: Page 28, Section J, Paragraph I states: The contracted provider must document all care provided in the VA Computerized Record System (CPRS) following VA policy, Department of Veterans Affairs, Center Circular No: 11-08-06 found in Part III Contract Documents, Exhibits and Attachments Attachment C. a.May the Contracted provider utilize the services for a scribe, for input into the VA Computerized Record System (CPRS)? Answer 5a: No, and a scribe cannot be used. Question 6: Please provide clarification regarding the Detailed Medical Exam, Enrollment Exam, and Initial Visit. Answer 6: Please refer to page 20 of the solicitation. Each new patient will receive a comprehensive history and physical at the first visit. This visit will meet the criteria for specific CPT codes (99203, 99204, 99205, 99213, 99214, and 99215) and will include an EKG, chest x-ray, and baseline lab work (CBC, UA, and Chem profile). A problem list will be developed from information obtained during the H&P. The problem list will contain active problems and annotation of any past major procedures and must be updated to maintain currency. Established patients will receive a problem focused history and physical annually. Question 7: How are patients initially assigned to the Havre CBOC? Answer 7: After the enrollment and are seen once by the clinic, they are assigned into a VA Database by VA Clerk. Question 8: If a patient is enrolled at another VA Facility and seeks services at the Havre CBOC how is this transfer facilitated? Answer 8: Veteran makes an appointment and transfer is completed in VA Database by the VA Clerk to Havre CBOC and care provider is assigned. Question 9: What is the estimated contract start date? Answer 9: On page 23, G. Contract Start-up Requirements: The contractor shall comply with the following contract requirements within 30 days of the Date of the Notice to Proceed. Solicitation is due on 7/3/08. Evaluation will take approximately one week. Anticipate award being made on approximately 7/14/08. VA will need to plan for installation of VA IT equipment and CPRS training also. Please see question 30 due date has been changed. Question 10: Will contract be a 12 month base period as stated on page 19 of the solicitation or less than one year as stated on page 6? Answer 10: The base year of the contract is date of contract award to September 30, 2008. There are four option years to be exercised at the discretion of the Government. For example, option year 1 begins October 1, 2008 and end September 30, 2009 and so on. Question 11: Where are the current enrollees treated? Answer 11: The current enrollees may be treated at other VAs that may include the contract clinics, VA clinics, private sector or IHS. Currently enrollees are any veteran enrolled in the VA. Question 12: Are all current services provided by the Government? Are there any contract providers treating these enrollees? Answer 12: Treatment may be offered in private sector authorized by the VA, may use the VA or use the private sector and not utilize the VA at all. Question 13: What the current number of enrollees? Answer 13: As stated in the solicitation on page 9, there is an estimated population of 4,325 veterans in the area which includes seven different counties identified in the solicitation, but not limited to those counties. The schedule has estimates of patients per year. These are estimates only and it is difficult to determine the number of enrollees for the area. Question 14: What were the average number of enrollees between 1/1/07 and 6/4/08? Answer 14: Since this is a new clinic, I do not know the average number of enrollees between those dates. Please be more specific if you are asking outside of Havre. Question 15: Will these current enrollees carry over as currently enrolled or will they first require an initial/annual visit as stated on page 7 Note? Answer 15: Please refer to the solicitation on page 8 defining disenrolled. Once a patient is enrolled and continues, they are not re-enrolled, but will be paid for the first initial exam. Question 16: Please clarify NOTE on page 7 of solicitation. Will the Government pay contractor a price per enrollee per month for all enrollees who have been treated in the past 12 months or yearly payment for each new annual visit/enrollment? The wording of the NOTE leads one to believe that each option year starts with zero enrollees. Is this correct? Answer 16: The schedule shows per patient per month price and per patient per year price, with an estimated quantity and capitated rate. Question 17: Please define what is meant by routine radiology services on page 21 of the solicitation. Will all radiology films be read by the contractors radiologist? Will anything other than flat films be required such as fluoroscopy and barium enemas? Answer 17: Yes, only exclusions that are not included in the contract are listed in paragraph 10. The remaining radiology services will be provided by the contractor. Question 18: Will chest x-rays be required for any currently enrolled patients? Answer 18: If indicated. Question 19: Are there currently any females enrolled? Are there any females anticipated during the course of the contract? Will mammography for males and females be required as part of the contract? Answer 19: Yes. Yes and included in contract. Question 20: On page 6 and 7 of the solicitation, it refers to 10 enrollment exams for each year of the contract. How do these differ from the all new enrollments since the government project significantly higher enrollment growth? Answer 20: The numbers provided for the enrollment exams are estimated only and those numbers could very well fluctuate. At this time, that is strictly an estimate. We are projecting an estimated growth of 167 new enrollees from first to second year and from the second to third year and not sure of outlying years. Question 21: Can contractor order immunizations and other injectables through the VA at government expense or will contractor bare all cost? Answer 21: The VA provides influenza and pneumonia vaccine (VA pays). Question 22: Page 30 states: The provider shall refer the patient to the RN Liaison to release records; the contract shall provide the patient with a blank VA Form 5345. a.Where will the RN Liaison be physically located, and is the Liaison a government employee or a contractor employee? Answer 22a: The location is the service at Fort Harrison and is referred to as Release of Information a government employee. Question 23: Will the VA interpret the x-ray images or is that part of the services expected to be provided by the CBOC? If the VA Radiologist interprets the exam do you use PACS? Answer 23: The CBOC does the reading and yes we use PACs at VA Montana. If we want to capture those images into our system, we can do it several ways. Question 24: Reference pages 6 and 7 of the solicitation. The solicitation schedule includes a line item, number 0002, for enrollment exam. Does the enrollment exam apply to all patients enrolled to the Havre CBOC or only to patients that are new to the VA system? Please clarify this line item. Answer 24: On page 7, the solicitation states for new enrollees, payment is for enrollment exam plus the capitated rate. The enrollment exam is for new patients. Question 25: Reference pages 6 and 7. The solicitation includes a separate line item, number 0003, for Mental Health. How will patients be enrolled and disenrolled for mental health? Answer 25: As stated in the solicitation, page 5, contractor shall provide primary, preventive and mental health care. The same methods as seeking primary care. Question 26: Are mental health services to be provided to veterans other than those enrolled in Havre CBOB? Question 26: Those patients seen at the Havre CBOB are veterans and veterans from the VA system may have health services provided at contract clinics, VA clinics or private sector. Question 27: Part 1, 2nd paragraph last sentence, page. 6. The offerors are requested to quote on a unit cost based on per patient per month (PPPM). Pg. 8, 2nd paragraph, 3rd sentence, states the contractor will be paid for the full year at the time of the initial visit (PPPY). Please clarify. Question 27: The schedule of items is set up to receive prices for both PPPM and PPPY. The Contractor will be paid for the full contract year at the time of the initial visit. For newly enrollees, payment is for enrollment exam plus capitated rate. Question 28: Would the VA consider changing the payment methodology to Per Member Per Month (PMPM)? Question 28: In essence, that is how the solicitation is set up. You are being paid per patient who is still enrolled, assigned to Havre and seen at least once per year. Question 29: Reference page 34 of the solicitation. Does the payment and invoicing direction in Special Contract Requirements 11.b apply to mental health as well as primary care? That is a full PPPY payment on enrollment with a prorated refund if the patient is disenrolled before the end of the contract option? Please clarify. Question 29: The Contractor will be paid per patient per month for the entire year, assuming the patient is enrolled and assigned to Havre. In this case, for the base year, it is defined as the date of contract award to September 30, 2008. Question 30: Reference SF 1449, Block 8. Would the VA consider a short extension to the offer due date from 7-3-08 to 7-15-08? Question 30: Yes to allow more time but not until 7/15/08. An amendment will be posted on FBO that will change the due date from 7/3/08 to 7/11/08. Question 31a: The solicitation indicates that 24/7 coverage is required for mental health, but there is no further details regarding this. Additionally, there are no specific details about what type of mental health providers are required or allowed for this clinic. Can the VA please clarify the Mental Health requirement? Specifically, what designations are acceptable in delivering mental health? APRNs and PAs are mentioned above are Psychiatrists, Psychologists and/or Licensed Clinical Social Worker preferred, if available? Answer 31a: Yes Question 31b: Question Also, please elaborate on the 24/7 coverage requirement. Is this to by phone, if the need arises after hours? Please clarify. Answer 31b: The Contractor must be able to treat any patient in crisis, and the Contractor needs to indicate in their response how they are planning to accomplish this. Question 32: It states that the va will provide clerical staff (pg 23, section f 2). Can the VA please clarify the specifics of this VA clerk, and any other clerical staff the VA will provide? What are the duties and functions of this /these position(s)? In what way will they serve the veterans and providers, versus serving the VA? Please clarify the work responsibilities of these positions. Answer 32: The clerical position is a VA employee who is located at the Havre CBOC and an employee of the VA. This is a full time position that is hired and paid by the VA just like any other VA employee, and the clerical position is entitled to benefits provided by the VA. Per the solicitation on pg 23, a VA clerk is identified. In the past, the VA clerk has completed scheduling for the veterans, answered questions for the veterans and provides VA enrollment. Question 33: Can the testing be subcontracted, or does it have to be on-site? (PG 21 OF RFP): Contractor must have onsite lab testing and laboratory collection services in a lab approved by the College of American Pathologists (CAP) or equivalent. Also, regarding labs that will be sent to ft. Harrison va; who is responsible for the fed ex charges? Answer 33: Contractor must have this onsite, and the Contractor pays for FED EX charges. Answer 34: On site radiology - can radiology be sub contracted, and who is responsible for interpreting the films? (PG. 21 OF RFP) The Havre CBOC must have on-site radiology services and all routine radiology services will be included in the provision of services for care of primary care patients, with the exception of the following: Thallium Stress Tests, Persantine Stress (pharmacological stress) Tests, Colonoscopy, Sleep Studies, and procedures with IV conscious sedation. These studies must be scheduled at the approved VA facility. The contractor shall meet all standards, accreditation and certification required by the American Board of Radiology or American Osteopathic Board of Radiology for radiologists; American Registry of Radiologic Technologist for radiologic technologists as well as responsibility for equipment maintenance. Answer 34: Onsite and local facility interprets the films. Question 35: primary care - is the contractor responsible for performing treadmills and pft's? (PG. 19 OF RFP): The contract will also include treadmills and pulmonary function tests interpreted by a Board Certified or qualified Internist or Cardiologist. Answer 35: yes Question 36: Primary care what type of ekg will be utilized downloadable or regular? PG. 19 OF RFP): Planned care includes primary care with diagnostics associated with that level of care (lab, EKG, non-complex X-ray, basic wound care/suturing, removal of benign lesions, joint injections, and/or other office procedures provided in the primary care setting). Answer 36: Either, there is no designation in contract. Question 37: primary care will a downloadable glucometer be supplied by the va or the contractor? Answer 37: Yes Question 38: What were the number of enrollees on or around January 1, 2007? Answer 38: Out of the 4,325 (from solicitation) that are veterans in the catchment area, approximately 1300 was the number of enrollees on or around January 1, 2007. Question 39: Is the capitated rate based on an estimated patient base per month or on the actual number of patients seen by month? Could you give examples for the base year and year one? Answer 39: For example, on the schedule of items for the base year 0001 primary care, the estimated quantity is 948 patients. This is an estimate and not sure the number fluctuation. The actual payment is unknown at this time. Per the solicitation, the contractor will be paid in arrears for each enrolled patient who has had an initial appointment (see page 7 of 119). Since this is a new clinic, I do not have numbers for what the base and option years would be and may only be able to estimate. Question 40: How and when will the clerk be hired? Does the Department of Veterans Affairs pay the clerks salary and benefits? Answer 40: In the past, HR has advertised for the position and has been able to fill in a timely manner. If HR is not able to fill for the position timely, in the past the position has been filled within the VA. Yes, this is considered a full time employee position. Question 41: Which patients are considered new patients? Answer 41: Veterans in that catchment area that have not been seen before or have not been seen within the last 2 years. Question 42: Do all patients who are new to the CBOC located in Havre have to have a comprehensive history and physical at the first visit which includes EKG, chest x-ray and baseline lab work? Answer 42: Veterans in that catchment area that have not been seen before or have not been seen within the last 2 years. Please see page 20 of the solicitation. (8)Each new patient will receive a comprehensive history and physical at the first visit. This visit will meet the criteria for specific CPT codes (99203, 99204, 99205, 99213, 99214, and 99215) and will include an EKG, chest x-ray, and baseline lab work (CBC, UA, and Chem profile). A problem list will be developed from information obtained during the H&P. The problem list will contain active problems and annotation of any past major procedures and must be updated to maintain currency. Established patients will receive a problem focused history and physical annually. Question 43: Are patients who were seen within the last year at another CBOC in the state considered established patients? Question 43: Yes, they are in the VA system.
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