Loren Data's SAM Daily™

FBO DAILY ISSUE OF MAY 07, 2009 FBO #2719
SOLICITATION NOTICE

Q -- Community-Based Outpatient Clinic (CBOC) in Martinsville, Indiana

Notice Date

5/5/2009
 

Notice Type

Modification/Amendment
 

NAICS

621498 — All Other Outpatient Care Centers
 

Contracting Office

Department of Veterans Affairs, Indianapolis VAMC, Richard L. Roudebush Department of Veterans Affairs Medical Center, Department of Veteran Affairs;VA Medical Center (90 CSC);1481 West Tenth Street;Indianapolis IN 46202
 

ZIP Code

46202
 

Solicitation Number

VA-251-09-RP-0105
 

Response Due

5/20/2009 11:59:00 PM
 

Archive Date

8/27/2009
 

Point of Contact

Jaime N KrystyniakContract Specialist<br />
 

Small Business Set-Aside

Total Small Business
 

Description

The purpose of this amendment is to answer questions regarding Solicitation No. VA251-09-RP-0105. Q: On page 7, it indicates this CBOC contract has a Base Year and Four (4) Option Years. This has only Three (3) Option Years. Is there consideration for the 4th option year? A: The solicitation is for a base year and three (3) option years. Q: On page 13, it states that Retinal Screening will be performed on patients. Who provides the retinal screening? A: Under the Retinal Screening, it states (Government-furnished equipment and supplies) the camera will be supplied by the VA. Q: On page 13, it indicated that established patients should be seen within 30 days of request. Does this meet VA guidelines for established patients? A: Established patients should be seen within 30 days of request. Q: On page 14, it states that Contractor shall purchase the following: Zostavax, Gardesil, Psychiatric Medications and Toradol. These are normally part of the medications provided by VA pharmacy. Is this a change in policy? A: The Contractor will be responsible for the listed medications. Q: What is the timing for awarding the RFP after proposals are accepted? A: After receipt of proposals, contract award is anticipated to be made on or before July 20, 2009. Q: "The Contractor shall comply with the following contract requirements within 60 calendar days of the Date of Award." While a 60-day start-up period may be appropriate for the transition from an existing CBOC to successor, it is really too short of a start-up period for a new contract like this. We strongly urge VA to consider extending it another 30 days. A: No, there will not be an extension for a start-up period. The start-up period will remain to be 60 calendar days from the date of award. Q: Where are veterans in this area currently being seen? Are they being seen at primary care clinics in Indianapolis? Elsewhere? A: A portion of the veterans are currently being seen at the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana and the Bloomington, IN CBOC; the VA cannot predict how many patients will want to transfer to the Martinsville, IN CBOC. Q: If the "expected" population in the primary service area ranges from approximately 16,700 in 2009 to 15,600 in FY 2014, why does VA envision a maximum of 3,000 enrollees in the CBOC? What is the definition of "expected" population, and why is the maximum number of enrollees projected for the CBOC not closer to the expected population? A: The VA has historical information on market penetration. The population of veterans would include many who are Priority 8 and ineligible for care. Q: We understand that the income level for Priority 8 veterans will be increased by 10 percent effective July 01, 2009, thereby increasing the number of veterans eligible for enrollment. Is that correct? Does the "expected population" data include any increases associated with this change? If not, what impact is it expected to have on the CBOC enrollee population? A: The expected population is all veterans in the area. The data would include the raising of the income level. For the entire Indiana market (includes Indianapolis, Marion and Fort Wayne VA) the increase in Priority 8 utilization is only expected to be 1,700 unique veterans and for Indianapolis, the increase in primary care is only 1,996 total stops. Expected impact is minimal. Q: Approximately, how many females are eligible in the catchment area? How many are currently enrolled? A: Historically, of the uniques treated at the Indianapolis VAMC, five (5) percent are female and the CBOC can be expected to be the same. Q: Are any of the counties listed within the catchment area of any other CBOC? A: Yes, there are other CBOCs within the counties listed. Q: Prescriptions are to be filled at a local pharmacy. Is the local pharmacy contractor known at this time? If so, please indicate who and where it is. A: No, the local pharmacy contractor is not known at this time. Q: "If a patient needs a medication(s) immediately and cannot wait to receive the medication through the CMOP, the Martinsville CBOC provider shall issue a prescription for a 10-day supply (or less) to the patient from a pre-approved list of emergency medications, to be filled by a local pharmacy at no expense to the VAMC or the veteran." Who pays for the 10-day or less supply of the prescription, if it is to be at "no expense to the VA or veteran"? We assume this means that the offeror is to build the cost of the 10-day or less emergency fill prescriptions into the capitation rate and that there is to be no "additional cost" to the VAMC or veteranbeyond that already built into the capitation rate. Please confirm. A: Contractor pays for 10-day fills of medication. Q: Has VA initiated any changes with respect to flu vaccines that would affect this contract in light of the swine flu developments? A: No, the VA has not initiated any changes with respect to flu vaccines that would affect this contract in light of the swine flu developments. Q: Are all patients to be seen for mental health services a subset of patients enrolled at the Martinsville CBOC for primary care, or could they be veterans not enrolled in the CBOC? A: There may be some veterans seen in Mental Health that are NOT enrolled at the CBOC, but are enrolled at the Indianapolis VA. Q: "These assignments shall be documented by use of the Primacy Care Management Module (PCMM) or the latest electronic panel assignment module to allow VA to review panel size and workload per PC team. (Reference Primary Care Directive VHA Directive 2003-063, Active Patients in PCMM, October 23, 2003 and VHA Directive 2004-027 Primary Care Direct Patient Care Time)." Does the Indianapolis VAMC consider panel sizes referred to in these directives as requirements or guidelines? A: Panel sizes are guidelines. Q: "Contractor may (emphasis added) be required to provide a care manager who will be trained by the VAMC Indianapolis, to manage the data from multiple chronically ill patients, assess their status and refer to their clinician as needed according to mutually agreed protocols." How is this position to be priced in the proposal, since it is not clear whether it will be required, and if so, at what point? We suggest that VA add a separate CLIN to the pricing schedule for this position with the understanding that the Government may elect to exercise it at some point in the life of the contract. A: This could be duties assigned to the triage RN or full time administrator. Q: How many enrollees are classified as co-managed with community practitioners under the VHA Dual Care Policy? A: Unable to provide a number, as we currently do not have a CBOC in Martinsville. Q: "For patients admitted to a nursing home while enrolled at a CBOC, Contractor shall provide history and physicals required for nursing home admissionVA Community Nursing Home contracts stipulate that nursing homes are responsible for physician coverage during patient's stay in a patient's nursing home. However, Contractor is responsible for providing information promptly to the nursing home regarding the patient's medical history. Contractor shall resume patient care after discharge from nursing home as appropriate." If a CBOC enrollee is admitted to a nursing home, is the patient to be disenrolled as an active primary care patient? With respect to billing, does VA have guidance in regarding treatment of CBOC enrollees who are admitted to a nursing home? A: Patients must have an annual physician to be considered active and Contractor to bill for the patient. If a patient is admitted to a nursing home, they must still have an annual visit to remain on the Active patient roles. Patients are followed by the nursing home physician, but must be seen by the provider at the CBOC annually to receive reimbursement. Q: The minimum staff requirements are as follows: "A full-time administrator (clinic director) specifically identified to administer the day to day business activities of this contract." We believe a full-time administrator for a CBOC with a maximum of 3,000 enrollees is not necessary for a population of that size and request that VA reconsider this requirement. We are capable of providing it, however, we think it will add unnecessarily to the cost, without a commensurate increase in overall benefit for the relatively small population involved. A: VA requires an Administrator be available to administer day-to-day activities. This person is required to provide reports, such as clinical reminders, hire/terminate, resolve patient issues, handle billing (i.e. screening mammogram, 10-day emergent medication fills, handle requests from the COTR, etc.). Q: "The Contractor shall provide physicians who are Board Certified in either Internal Medicine or Family Practice Medicine with at least three (3) years of post graduate training in their board." This statement is then followed by: "The Contractor shall provide physicians who are Board Certified in either Internal Medicine or Family Practice Medicine with at least three (3) years of post graduate training in their board specialty or two (2) years of Emergency Department experience or hospitalist experience within the last five (5) years." Please clarify. A: Emergency Department and Hospitalist will be considered, if meeting the requirements of the VA Credentialing and Privileging office. Q: "There is no evidence supporting an annual physical for well veterans. However, given the acuity of the population, an annual visit during the term of the contract may be required with the care provided at the levels listed below: Established patient expanded problem focused, detailed, or comprehensive office visit (99213, 99214, 99215) Periodic preventive visit with comprehensive history and exam (99393, 99396, 99397)". The use of the term "may" is confusing. Is an annual vesting visit of any type required, or not? Please clarify. A: Yes, annual visits are required. Q: If the Indianapolis VAMC has determined that the patient must be seen annually, the qualifying visit must be coded at CPT 99203-99205 for new patients or 99213-99215 for established patients. Medical record documentations must support these CPT codes. If a patient does not have a visit at the level of the qualifying codes he/she will be inactivated at the Martinsville CBOC. No compensation shall be provided for inactivated patients...If the Indianapolis VAMC has determined that an assigned patient should be seen annually and assigned patient had not been seen within the previous 13 months, the patient shall be inactivated at the Martinsville CBOC. No compensation shall be provided for inactivated patients. This paragraph adds to the confusion as to whether the contractor is expected to see every patient at least annually. Under what circumstances would the Indianapolis VA determine that a CBOC enrollee would not have to be seen at least once every12 months? Is the contractor paid a capitation rate for such patients? A: Patients must be seen at least annually for reimbursement. Q: "The Contractor shall ensure that assigned patients are assigned a primary care provider in the Primary Care Management Module (PCMM) per VHA Directive 2003-063 Active Patients in PCMM." By "ensure" does that mean that the contractor must ensure that panel size guidelines are not exceeded? A: Panel size is a guideline not a requirement. Panel size can be adjusted as long as capacity does not exceed 3,000 patients and patients are receiving the same standard of care as the VA is providing. Q: C.3 52.216-19 ORDER LIMITATIONS (OCT 1995) (a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than 3,000 patients, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract. (b) Maximum order. The Contractor is not obligated to honor-- (1) Any order for a single item in excess of 3,000 patients; (2) Any order for a combination of items in excess of 3,000 patients; or (3) A series of orders from the same ordering office within 365 days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section. (End of Clause) NOTE: The minimum and maximum annual contract amounts for each line item for each year of the contract are as follows: "Contract Line Item Number 1: The minimum amount for each year (base and option years 1, 2, and 3) is 50 patients. The maximum amount for the base year is 1,500 patients, and the maximum amount for option years 1, 2, and 3 is 3,000 patients. Contract Line Item Number 2: The minimum amount for the base year and option years 1, 2 and 3 is two (2) patients, and the maximum amount for each year of the contract is 50 patients We are confused by the language related to minimum and maximum order quantities. Please clarify these inconsistencies. A: The minimum number of patients is less than 50 each year of the contract. The maximum number of patients is not to exceed 1,500 during the base year of the contract. The maximum number of patients is not to exceed 3,000 during Option Years 1, 2 and 3 of the contract. The minimum number of non-enrolled patients is less than two (2) during the base year and option years 1, 2 and 3, and the maximum number of non-enrolled patients is not to exceed 50 patients during each year of the contract.
 

Web Link

FedBizOpps Complete View
(https://www.fbo.gov/?s=opportunity&mode=form&id=ee3e791693d2bebc66ab95f89ec7cd8a&tab=core&_cview=1)
 

Place of Performance

Address: Department of Veterans Affairs;Richard L. Roudebush VA Medical Center;1481 W. Tenth Street;Indianapolis, IN<br />

Zip Code: 46202<br />
 

Record

SN01809506-W 20090507/090505221634-ee3e791693d2bebc66ab95f89ec7cd8a (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
(may not be valid after Archive Date)

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