This is a REQUEST FOR INFORMATION NOTICE for market research purposes only to determine the availability of potential businesses with capabilities to provide the services described below.  Potential offerors are invited to provide feedback via e-mail to Fallyn Defae at Fallyn.Defae@va.gov . Responses will be used to determine the appropriate acquisition strategy for a potential future acquisition. The Contractor shall furnish all personnel to provide services necessary to perform onsite Dental Assistant and Dental Hygienist Services to eligible beneficiaries of the Department of Veterans Affairs Medical Center, VA Portland Health Care System, Seattle, Washington. The contractor s dental assistants shall have successfully completed a 1-year dental assistant program accredited by the American Dental Association s commission on Dental Accreditation (CODA) www.ada.org/en/coda. The contractor s dental hygienists shall have an Associate Degree or higher in an accredited dental hygiene program. This program must be accredited by the American Dental Association s Commission on Dental Accreditation (CODA) www.ada.org/en/coda. The contractor s dental hygienist must be currently licensed to practice as a dental hygienist with a full, current, and unrestricted license in a State, Territory, or Commonwealth of the United States, or the District of Columbia. Potential contractors shall provide, at a minimum, the following information to Fallyn Defae at Fallyn.Defae@va.gov : 1) Company name, address, point of contact name, phone number, e-mail address, and company s Dun and Bradstreet number (DUNS). All companies wishing to do business with the federal government must be registered at https://www.sam.gov/ ; there is no charge. 2) Is your firm eligible for participation in one of the following small business programs? If so, please indicate the program. Anticipated North American Industry Classification System (NAICS) code is 561320, Temporary Help Services; the largest a firm can be and still qualify as a small business for Federal Government programs is no larger than $30.0 Million under NAICS code 561320. _____ Small Business (SB) _____ Service Disabled Veteran Owned Small Business (SDVOSB) registered and verified in the VetBiz.gov VIP database (https://www.vip.vetbiz.va.gov/). _____ Veteran Owned Small Business (VOSB) registered and verified in the VetBiz.gov VIP database (https://www.vip.vetbiz.va.gov/). _____ HUBZone _____ Small Business 8(a) _____ Small Disadvantaged Business (SDB) _____ Women-Owned (WO) Small Business _____ Other (please specify) 3) Please comment on how you charge for onsite Dental Assistant and onsite Dental Hygienist services (e.g., you charge per patient, per procedure, per CPT code [please tell us which CPT codes], other.) 4) If you were awarded a contract, how many days after contract award until your company could begin onsite Dental Assistant and Dental Hygienist services? A Background Investigation and Credentialing process must be completed prior to any physician start date. 5) The DRAFT Performance Work Statement (PWS) follows. What information do you need to know from the VA that is not included in the PWS? 6) Provide a brief Capability Statement (less than 5 pages) with enough information to determine if your company can meet the requirement. The Capabilities Statement for this Request for Information is not expected to be a Request for Quotations, Request for Proposals or Invitation for Bids, nor does it restrict the Government to an ultimate acquisition approach, but rather the Government is requesting a short statement regarding your company s ability to provide the services listed above. Any commercial brochures or currently existing marketing material may also be submitted with the Capabilities Statement. Submission of Capabilities Statement will assist our office in tailoring the requirement to be consistent with industry standards. The capabilities will be evaluated solely for the purpose of determining to Set-Aside for the Small Business (SB) Community or to conduct as an Unrestricted Procurement. Other than small businesses may respond to this notice in the event the market does not indicate SB interest. This Sources Sought Notice is for information and planning purposes only and is not to be construed as a commitment by the Government. The Government will not pay for information solicited. Respondents will not be notified of the results of the evaluation. All interested contractors should notify this office via email by October 18, 2021, 10AM PST. Submit response and information to: Fallyn Defae, Department of Veterans Affairs, Fallyn.Defae@va.gov . Thank you for your participation. Performance Work Statement for Onsite Dental Assistant and Dental Hygienist Services GENERAL: Services Provided: The Contractor shall provide Dental Assistant and Dental Hygienist Services on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Seattle VA Medical Center (SVAMC). Place of Performance SVAMC 1660 S. Columbian Way Seattle, WA 98108 American Lake VA 9600 Veterans Drive Tacoma, WA 98493 Mount Vernon CBOC 307 S. 13th Street, Suite 200 Mount Vernon, WA 98274 Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority. Policy/Handbooks: VHA Handbook 1100.17: National Practitioner Data Bank Reports: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 VHA Handbook 1100.18 Reporting and Responding To State Licensing Boards: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 VHA Handbook 1100.19 Credentialing and Privileging: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 VHA Directive 1192.01: Seasonal Influenza Prevention Program: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472 VHA Directive 1220: Facility Procedure Complexity Designation Requirements to Perform Invasive Procedures In Any Clinical Setting: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8365 VA Directive 1663: Health Care Resources Contracting Buying: https://www.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 VHA Directive 1907.01: VHA Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9235 VHA Directive 2012-030 Credential of Health Care Professionals: https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2815 Privacy Act of 1974 (5 U.S.C. 552a) as amended: http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern. ADA: American Dental Association www.ada.org AOD: Admitting Officer of the Day BLS: Basic Life Support CDC: Centers for Disease Control and Prevention CDR: Contract Discrepancy Report CEU: Certified Education Unit CME: Continuing Medical Education CMS: Centers for Medicare and Medicaid Services CODA: Commission on Dental Accreditation www.ada.org/en/coda Contracting Officer (CO) The person executing this contract on behalf of the Government with the authority to enter into and administer contracts and make related determinations and findings. Contracting Officer s Representative (COR) A person appointed by the CO to take necessary action to ensure the Contractor performs in accordance with and adheres to the specifications contained in the contract and to protect the interest of the Government. The COR shall report to the CO promptly any indication of non-compliance in order that appropriate action can be taken. COS: Chief of Staff CPARS: Contractor Performance Assessment Reporting System CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA. Credentialing: Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status. DEA: Drug Enforcement Agency ED: Emergency Department FSMB: Federation of State Medical Boards Full Time Equivalent (FTE): VA s definition for full time- working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included. HHS: Department of Health and Human Services HIPAA: Health Insurance Portability and Accountability Act HR: Human Resources ISO: Information Security Officer Medical Emergency - a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part. MOD: Medical Officer of the Day National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). NLNAC: National League for Nursing Accrediting Commission. www.nlnac.org Non-Contractor s provider(s) - any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its subcontractors NP: Nurse Practitioner NPPES: National Plan and Provider Enumeration System PA: Provider Assistant PALS: Pediatric Advanced Life Support POP: Period of Performance PPD: Purified Protein Derivative PWS: Performance Work Statement Privileging (Clinical Privileging): Privileging is the process by which a practitioner, licensed for independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual s license, based upon the individual s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific. QA/QI: Quality Assurance/Quality Improvement QM/PI: Quality Management/Performance Improvement QASP: Quality Assurance Surveillance Plan Veterans Health Administration (VHA): The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C. Veterans Integrated Services Network (VISN): The regional oversight for the VA medical centers in Michigan and Indiana. VISTA (Veterans Integrated Systems Technology Architecture): A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient s medical record and with the hospital information system. VetPro: a federal web-based credentialing program for healthcare providers. Veterans Affairs Medical Center (VAMC): Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean the Seattle VA Medical Center. Washington State Dental Association: www.wsda.org QUALIFICATIONS: Staff/Facility Credentialing and Privileging Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed provider(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any Contractor s provider(s) prior to obtaining approval by the SVAMC Professional Standards Board, Medical Executive Board and Medical Center Director. If a Contractor s provider(s) is not credentialed and privileged or has credentials/privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government. Technical Proficiency - Contractor s provider(s) shall be technically proficient in the skills necessary to fulfill the government s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all Contractor s provider(s) and Contractor s provider(s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the VAMC. Contractor s provider(s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credentials office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for Contractor s provider(s) . Training (ACLS, BLS, EHR and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor s physician(s) as required by the VA. Other training may become required. VA will communicate any changes to the training requirement to the contractor. Training Frequency Annual Hours Active Threat Training Government Ethics Prevention of Workplace Harassment/No Fear Act VA Core Values Training (ICARE Recommitment) VA Privacy and Information Security Awareness and Rules of Behavior VHA Privacy and HIPAA Focused Training ACLS/BLS Patient Safety Patient Abuse Patient Rights Prevention/Management of Disruptive Behavior/Violence Prevention Level I Suicide Prevention: Suicide Risk Management Training for Clinicians EHR VISTA Imaging Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for providers within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative reaction to PPD testing for all Contractor s provider(s) . A negative chest radiographic report for active tuberculosis shall be provided in cases of positive PPD results. The PPD test shall be repeated annually. RUBELLA TESTING: Contractor shall provide proof of immunization for all Contractor s provider(s) for measles, mumps, rubella or a rubella titer of 1.8 or greater. If the titer is less than 1.8, a rubella immunization shall be administered with follow-up documentation to the COR. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS: Contractor shall provide generic self-study training for all Contractor s provider(s) ; provide their own Hepatitis B vaccination series at no cost to the VA if they elect to receive it; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. The VAMC shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The Contractor shall have or obtain appropriate NPI and if pertinent the Taxonomy Code confirmation notice issued by the Centers for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES) be provided to the Contracting Officer with the proposal. Conflict of Interest: The Contractor and all Contractor s provider(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document. Citizenship related Requirements: The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals; While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all E-Verify requirements consistent with Executive Order 12989 and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach. This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001. The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document. Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs. Therefore, Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed Contractor s provider(s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries. By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed. Clinical/Professional Performance: The qualifications of Contractor personnel are subject to review by VA Medical Center COS or his/her clinical designee and approval by the Medical Center Director as provided in VHA Handbook 1100.19. Clinical/Professional performance monitoring and review of all clinical personnel covered by this contract for quality purposes will be provided by the VAMC COS and/or the Chief of the Service or his designee. A clinical COR may be appointed, however, only the CO is authorized to consider any contract modification request and/or make changes to the contract during the administration of the resultant contract. Non Personal Healthcare Services: The parties agree that the Contractor and all Contractor s provider(s) shall not be considered VA employees for any purpose. Indemnification: The Contractor shall be liable for, and shall indemnify and hold harmless the Government against, all actions or claims for loss of or damage to property or the injury or death of persons, arising out of or resulting from the fault, negligence, or act or omission of the Contractor, its agents, or employees.  Prohibition Against Self-Referral: Contractor s provider(s) are prohibited from referring VA patients to contractor s or their own practice(s). Inherent Government Functions: Contractor and Contractor s provider(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy. No Employee status: The Contractor shall be responsible for protecting Contractor s provider(s) furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract: Workers compensation Professional liability insurance Health examinations Income tax withholding, and Social security payments. Tort Liability: The Federal Tort Claims Act does not cover Contractor or Contractor s provider(s) . When a Contractor or Contractor s provider(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor s (or Contractor s provider(s) ) action or non-action shall be the responsibility of the Contractor and/or insurance carrier. Key Personnel: The number of Dental Assistant and the number of Dental Hygienist providers required to be available on a daily basis is three (3) each defined in paragraph Hours of Operation in this section. Dental Assistants shall: Education - Have successfully completed a 1-year dental assistant program accredited by the American Dental Association s commission on Dental Accreditation (CODA). Dental Hygienists shall: Education - Have an Associate Degree or higher in an accredited dental hygiene program. This program must be accredited by the American Dental Association s Commission on Dental Accreditation (CODA). Licensure - Must be currently licensed to practice as a dental hygienist with a full, current, and unrestricted license in a State, Territory, or Commonwealth of the United States, or the District of Columbia. The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor s personnel due to sick leave, personal leave, vacations and additional coverage as required. In the event a scheduled contract employee is unable to complete an assigned shift, the contractor shall provide replacement coverage within 2 hours and notify the Contracting Office Representative (COR) at the SVAMC immediately of the schedule change. No Leave Pay is compensated by the government for any contractor s provider(s). Contractor s provider(s) are solely employed by contractor and shall adhere to contractor s Annual and Sick Leave provisos, as well as contractor s holiday pay and policies. Key Personnel shall receive a favorable adjudication through the federal background investigations and fingerprinting conducted through the Department of Veteran Affairs VHA Service Center Personnel Security Office (VSC Security). Individuals receiving less than favorable adjudication shall not be granted access or PIV badging and therefore will not be allowed inclusion as key personnel. Key Personnel shall receive a PIV badge as a contract provider prior to assumption of duties. Key Personnel are required to hold valid, unexpired badges at all times during active service. Key Personnel shall wear scrubs provided by the VA during clinic care. Scrubs are not to be worn outside of clinic. Scrubs are to be changed daily. Used scrubs shall be left with the VA at end of shift prior to leaving the facility in approved dirty linen receptacles available on-site. Personnel Substitutions: During the first ninety (90) calendar days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death or termination of employment. The Contractor shall notify the CO, in writing, within 5 calendar day (s) after the occurrence of any of these events and provide the information required below. After 90 days, the Contractor shall submit the information required below to the CO at least 2 business days prior to making any permanent substitutions. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the CO. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The CO will notify the Contractor within 2 business days after receipt of all required information of the decision on the proposed substitutes. The contract will be modified to reflect any approved changes of key personnel. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. Should the VA COS or designee show documented clinical problems or continual unprofessional behavior/actions with any Contractor s provider(s) , s/he may request, without cause, immediate replacement of said Contractor s provider(s) .The CO and COR shall deal with issues raised concerning Contractor s provider(s) conduct. The final arbiter on questions of acceptability is the CO. Contingency Plan: Because continuity of care is an essential part of VAMC s medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor s provider(s) leaves Contractor s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract. VA HOURS OF OPERATION/SCHEDULING: VA Business Hours: Dental Clinic Schedule: Seattle: Monday through Friday 8:00 a.m. through 4:30 p.m. Due to the nature of the work, the Dental Assistant or Dental Hygienist may occasionally be required to stay later than 4:30 p.m., but if that would cause the Dental Assistant or Dental Hygienist to exceed 8 hours that day, contracted providers will not be requested nor required by VA staff to work additional time; there is no provision for pay beyond 40 hours per week. American Lake: Monday through Friday 7:00 a.m. through 3:30 p.m. Due to the nature of the work, the Dental Assistant or Dental Hygienist may occasionally be required to stay later than 3:30 p.m. , but if that would cause the Dental Assistant or Dental Hygienist to exceed 8 hours that day, contracted providers will not be requested nor required by VA staff to work additional time; there is no provision for pay beyond 40 hours per week. Mount Vernon CBOC: Monday through Friday 8:00 a.m. through 4:30 p.m. Due to the nature of the work, the Dental Assistant or Dental Hygienist may occasionally be required to stay later than 4:30 p.m. , but if that would cause the Dental Assistant or Dental Hygienist to exceed 8 hours that day, contracted providers will not be requested nor required by VA staff to work additional time; there is no provision for pay beyond 40 hours per week. The above times reflect a 30-minute break for lunch/personal time. The above times reflect a standard eight (8) hour workday. No provision is made for overtime pay or premium pay. Contracted providers are not to work more than 40 hours per week. Contracted providers will not be requested nor required by VA staff to work additional time. This contract calls for on-call temporary help. Contractor s provider(s) shall be available and present in clinic during normal clinic hours, per requested services and may be revised, as deemed appropriate for patient care by the Chief of Dental Services. Currently, normal clinic hours for each location are listed above. Patients must be seen by a Contractor s provider(s) on-site at each of the listed facility locations in a timely manner in accordance with VA Rules and Regulations on clinic wait times and consult completion. Contractor shall notify the COR at least monthly about any obstacles to meeting this performance measure. Federal Holidays: The following holidays are observed by the Department of Veterans Affairs: No holiday pay is compensated for any work provided by any contractor s provider(s) on these days. Contractor s provider(s) are solely employed by contractor and shall adhere to contractor s holiday provisos. New Year s Day President s Day Martin Luther King s Birthday Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Christmas Any day specifically declared by the President of the United States to be a national holiday. 3.1.4. Cancellations: Unless a state of emergency has been declared, the Contractor shall be responsible for providing services. CONTRACTOR RESPONSIBILITIES Clinical Personnel Required: The Contractor shall provide Contractor s provider(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties. Contractor s provider(s) shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm hours/day and services provided against the contractor s invoices. Standards of Care: The Contractor s provider(s) care shall cover the range of Dental Care services as would be provided in a state-of-the-art civilian dental treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized TJC, VA and national standards as established by: VA Standards: VHA Directive 2006-041 Veterans Health Care Service Standards (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 The professional standards of the Joint Commission (TJC) http://www.jointcommission.org/standards_information/standards.aspx The standards of the American Hospital Association (AHA) http://www.hpoe.org/resources?show=100&type=8 and; The requirements contained in this PWS On-Call Requirements: On-call requirements will be provided by Puget Sound VA to the Contractor for each location separately. Both immediate and long-term requirements are anticipated for this contracted coverage at each location. On-call services shall only to be provided during normal clinic hours as stated above. A Puget Sound VA Dental Services point-of-contact will be established for each location served by this contract. An appointed point-of-contact and one substitute will be responsible for requests for coverage per location. The Chief of Dental Services or designee will be default point-of-contact for all locations included in this contract. Requests for coverage will be made by the Puget Sound VA point-of-contact to the Contractor at the earliest understanding of the VA needs to allow Contractor the longest lead-time to fulfill contract requirements. Contractor shall supply appropriate key personnel within 2 hours of contact for immediate coverage needs. Billing shall commence upon arrival of contracted personnel at the location requesting service. In the event that 2 hours will not be sufficient to provide appropriate contract personnel Contractor will contact the requesting official immediately to discuss options or unavailability. It is the VA s prerogative to cancel the order and note the request as unfilled. No charges will be incurred for unavailability. Orders cancelled for inability to provide coverage shall not exceed 4% of all orders requested annually. MEDICAL RECORDS Authorities: Contractor s provider(s) providing healthcare services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of certain medical records), Title 5 U.S.C. § 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (HIPAA). HIPAA: This contract and its requirements meet exception in 45 CFR 164.502(e), and do not require a BAA in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a BAA is not required for this contract. Treatment and administrative patient records generated by this contract or provided to the Contractors by the VA are covered by the VA system of records entitled Patient Medical Records-VA (24VA19). Contractor generated VA Patient records are the property of the VA and shall not be accessed, released, transferred, or destroyed except in accordance with applicable laws and regulations. Contractor shall ensure that all records pertaining to medical care and services are available for immediate transmission when requested by the VA. Records identified for review, audit, or evaluation by VA representatives and authorized federal and state officials, shall be accessed on-site during normal business hours or mailed by the Contractor at his expense. Contractor shall deliver all final patient records, correspondence, and notes to the VA within twenty-one (21) calendar days after the contract expiration date. Disclosure: Contractor s provider(s) may have access to patient medical records: however, Contractor shall obtain permission from the VA before disclosing any patient information. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives, and designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA s records, at VA s place of business on request during normal business hours, to inspect and review and make copies of such records. The VA will provide the Contractor with a copy of VHA Handbook 1907.1, Health Information management and Health Records and VHA Handbook 1605.1, Privacy and Release of Information. The penalties and liabilities for the unauthorized disclosure of VA patient information mandated by the statutes and regulations mentioned above, apply to the Contractor. Professional Standards for Documenting Care: Care shall be appropriately documented in medical records in accordance with standard commercial practice and guidelines established by VHA Handbook 1907.01 Health Information Management and Health Records: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 and all guidelines provided by the VAMC. Release of Information: The VA shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements. In the case of the VA authorizing the Contractor to release patient information, the Contractor in compliance with VA regulations, and at his/her own expense, shall use VA Form 3288, Request for and Consent to Release of Information from Individual s Records, to process Release of Information Requests. In addition, the Contractor shall be responsible for locating and forwarding records not kept at their facility. The VA s Release of Information Section shall provide the Contractor with assistance in completing forms. Additionally, the Contractor shall use VA Form 10-5345, Request for and Authorization to Release Medical Records or Health Information, when releasing records protected by 38 U.S.C. 7332. Treatment and release records shall include the patient s consent form. Completed Release of Information requests will be forwarded to the VA Privacy Officer at the following address: Privacy/FOIA Officer Seattle: James D. Weivoda, 1660 S Columbian Way, Seattle, WA 98108, (206)277-5156, james.weivoda@va.gov. Direct Patient Care: 100% of the time involved in direct patient care. Per the qualification section of this PWS, the Contractor shall provide the following staff: Dental Assistant(s) 3 (on-call availability) Dental Hygienist(s) 3 (on-call availability) Scope of Care: Contractor s provider(s) (as appropriate and within scope of practice/privileging) shall be responsible for providing Dental care, including, but not limited to: Clinic and Surgical Care: Contractor provider(s) shall provide clinical dental assistant services and clinical dental hygienist services. Contractor provider(s) shall be present on time for any scheduled clinics as documented by physical presence in the clinic at the scheduled start time. Dental Hygienists shall provide direct patient care under the general supervision of a dentist and perform other clinical and clerical functions independently of direct supervision. Duties include but are not limited to, Providing routine oral prophylactic care to include application of fluoride solutions; Provides gross debridement, deep scaling, and curettage and FboNotice planning procedures; Administers topical and local anesthetic agents (in accordance with Washington licensure/training requirements RCW 18.29.050 and 18.29.053); Provides patient education; Charts findings and treatment provided in electronic patient records; Complies with Employee Education requirements. Contracted dental hygienist(s) will typically see between 6 and 10 patients per full clinic day. Dental Assistant services shall include, but are not limited to, performing chair side assistance in all phases of restorative, prosthodontic, surgical, endodontic and periodontal treatment according to standard, usual and acceptable or customary methods and techniques. The contractor provider will report to the Chief of Dental Service or his/her designee. The contractor provider shall be expected to cooperate with and participate in duties or functions related to quality of care review and improvement, including orientation to SVAMC safety and infection control procedures. Scope of practice shall be in compliance with Washington State Code RCW 18.260.040 Scope of practice. Contracted dental assistant(s) will typically see between 6 and 10 patients per full clinic day, depending on which dentists they work with. Medications: Contractor provider(s) shall follow all established medication policies and procedures. No sample medications shall be provided to patients. Discharge education: Contractor provider(s) shall provide discharge education and follow up instructions that are coordinated with the next care setting for all Dental clinical patients. Patient Safety Compliance and Reporting: Contractor s provider(s) shall follow all established patient safety and infection control standards of care. Contractor s provider(s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to the COR VA Safety Policy. As soon as practicable (but within 24 hours) Contractors shall notify COR of incident and submit to the COR the Patient Safety Report, following up with COR as required or requested. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT(QI) Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that the Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse. The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor s conduct. The final arbiter on questions of acceptability is the CO. Performance Standards: Measure: Qualifications of Key Personnel Performance Requirement: All Contractor s provider(s) shall be in accordance with American Dental Association Standards and Washington State Dental Legislation. Standard: All (100%) Contractor s Hygienist(s) shall hold valid Dental Hygienist License from any state in the United States as required per current RCWs 18.29.011 and 18.29.021. Contractor s Registered Dental Assistants shall be graduates of an ADA Accredited dental assistant school. Acceptable Quality Level: 99% Surveillance Method: Random Inspection of qualification documents Frequency: Annual Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation. Contract employee may be removed from services until appropriate licenses or degrees are provided. Measure: Scope of Practice/Privileging Performance Requirement: Contractor s provider(s) perform within their individual scopes of practice/privileging. Standard: All (100%) Contractor s provider(s) perform within their scope of practice/privileges 100% of the time. Acceptable Quality Level: 99% Contractor s provider(s) perform within their scope of practice/privileges 99%of the time. No deviations accepted. Surveillance Method: Direct observation and Random Inspection of records. Frequency: As necessary. Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation. Contract provider may be removed from approved providers. Measure: Patient Access Performance Requirement: The Contractor shall provide Contractor s provider(s) in accordance with the operating hours and VA clinical schedule outlined in this PWS. Standard: All (100%) Contractor s provider(s) are on time and available to perform services. Acceptable Quality Level: Contractor s provider(s) is on-time and available to perform services 95%of the time Surveillance Method: Periodic Sampling of Time and Attendance Sheets Frequency: Monthly Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation. Measure: Patient Safety Performance Requirement: Patient safety incidents shall be reported using Patient Safety Report. All incidents reported immediately (within 24 hours.) Standard: All (100%) of patient safety incidents are reported using Patient Safety Report within 24 hours of incident. Acceptable Quality Level: 99% of patient safety incidents are reported using Patient Safety Report within 24 hours of incident. Surveillance Method: Direct observation Frequency: As necessary Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation, Contract employee may be removed from approved providers. Measure: Maintains licensing, registration, and certification Performance Requirement: Updated Licensing, registration or certifications shall be provided as they are renewed. Licensing and registration information kept current. Standard: All (100%) licensing, registration(s) and certification(s) for Contractor s provider(s) shall be provided as they are renewed. Licensing information kept current. Acceptable Quality Level: 97% licensing for Contractor s provider(s) shall be provided as they are renewed. Licensing information kept current. Surveillance Method: Periodic Sampling as necessary Frequency: Annual as necessary Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation. Contract employee may be removed from services until appropriate licenses or registrations are provided. Measure: Mandatory Training Performance Requirement: Contractor shall complete all required training on time per VAMC policy Standard: All (100%) of required training is complete on time by Contractor s provider(s) Acceptable Quality Level: 85% completions, no deviations. Surveillance Method: Periodic Sampling Frequency: Quarterly Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contractor performance evaluation, Contract employee may be removed from approved providers until such time as the training is complete and submitted. Measure: Privacy, Confidentiality and HIPAA Performance Requirement: Standard: All (100%) contractor provider(s) comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA Acceptable Quality Level: 99% compliance. Surveillance Method: Periodic Sampling; Contractor shall provide evidence of annual training required by VAMC, reports violations per VA Directive 6500.6. Frequency: review Quarterly Incentive: Favorable contactor performance evaluation. Disincentive: Unfavorable contactor performance evaluation. Contract employee may be removed from approved providers. Registration with Contractor Performance Assessment Reporting System As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates Contractor past performance on all contracts that exceed $150,000, and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for Contractor responsibility determination information. Each Contractor whose contract award is estimated to exceed $150,000 requires a CPARS evaluation.   A government Focal Point will register your contract within thirty days after contract award and, at that time, you will receive an email message with a User ID (to be used when reviewing evaluations).  Additional information regarding the evaluation process can be found at www.cpars.gov or if you have any questions, you may contact the Customer Support Desk @ DSN: 684-1690 or COMM: 207-438-1690. For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the Contractor s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the Contractor s designated representative for comment. The Contractor representative will have sixty (60) days to submit any comments and re-assign the report to the CO. Failure for the Contractor s representative to respond to the evaluation within those sixty (60) days, will result in the Government s evaluation being placed on file in the database with a statement that the Contractor failed to respond; the Contractor s representative will be locked out of the evaluation and may no longer send comments. GOVERNMENT RESPONSIBILITIES VA Support Personnel, Services or Equipment: All supplies, personnel and equipment are available in the Dental Clinics. Contract Administration/Performance Monitoring: After award of contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to: (enter contract administration if not already listed in another area- list the title (not name) and contact information for COR, Clinical point of contact, and any other relevant personnel involved). CO RESPONSIBILITIES: CO TBD Network Contracting Office 20 5115 NE 82nd Ave, Suite 200 Vancouver, WA 98662 The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality of performance of this contract. The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof. In the event that contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for Contractor personnel to be provided by the VA; replacement of the contract personnel and/or renegotiation of the contract terms or termination of the contract. COR Responsibilities: The COR for this contract is: Surgical Services COR Bldg 1/314 MS: S112-SRG 1660 S Columbian Way Seattle, WA 98108 Office: 206-277-1477 Fax: 206-764-2529 The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer. The COR will be responsible for monitoring the Contractor s performance to ensure all specifications and requirements are fulfilled. Quality Improvement data that will be collected for ongoing monitoring includes but is not limited to: enter data that may be collected. The COR will maintain a record-keeping system of services electronically. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record-keeping system and those on the invoices. Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer. The COR will review and certify monthly invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference. All contract administration functions will be retained by the VA. SPECIAL CONTRACT REQUIREMENTS Reports/Deliverables: The Contractor shall be responsible for complying with all reporting requirements established by the Contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required. The following are brief descriptions of required documents that must be submitted by Contractor: upon award; weekly; monthly; quarterly ; annually, etc. identified throughout the PWS and is provided here as a guide for Contractor convenience. If an item is within the PWS and not listed here, the Contractor remains responsible for the delivery of the item. What Submit as noted Submit To Quality Control Plan: Description and reporting reflecting the contractor s plan for meeting of contract requirements and performance standards Upon proposal and as frequently as indicated in the performance standards. Contracting Officer Copy of Subcontracting Plan (as required) Copy of Contractor Certification Statement if non-subcontracting possibilities exist. Upon proposal and as updated Contracting Officer Copies of any and all licenses, board certifications, NPI, to include primary source verification of all licensed and certified staff Upon proposal and upon renewal of licenses and upon renewal of option periods or change of key personnel. Contracting Officer with proposal; renewal submitted to VETPRO system. Certification that staff list have been compared to OIG list Upon proposal and upon new hires. Contracting Officer Proof of Indemnification and Medical Liability Insurance Upon proposal and upon renewals. Contracting Officer Certificates of Completion for Cyber Security and Patient Privacy Training Courses Before receiving an account on VA Network and annual training and new hires. Contracting Officer ACLS/BLS Certification Upon award and every two years after award. COR Contingency plan for replacing key personnel to maintain services as required under the terms of the contract Upon proposal and as updated COR Billing: Invoice requirements and supporting documentation: Supporting documentation and invoice must be submitted no later than the 20th workday of the month. Subsequent changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a proper invoice in accordance with FAR 52.212-4 (g), all invoices must include: Name and Address of Contractor Invoice Date and Invoice Number Contract Number and Purchase/Task Order Number Date of Service Contractor s provider(s) (Name of Contractor s employee) Hourly Rate Quantity of hours worked Total price Vendor Electronic Invoice Submission Methods: Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods below: VA s Electronic Invoice Presentment and Payment System The FSC uses a third-party contractor, OB10, to transition vendors from paper to electronic invoice submission. Please go to this website: http://ob10.com/us/en/veterans-affairs-us/ to begin submitting electronic invoices, free of charge. A system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) chartered by the American National Standards Institute (ANSI). The X12 EDI Web site (http://www.x12.org). The Contract may contact FSC at the phone number or email address listed below with any questions about the e-invoicing program or OB10: OB10 e-Invoice Setup Information: 1-877-489-6135 OB10 e-Invoice email: VA.Registration@ob10.com FSC e-Invoice Contact Information: 1-877-353-9791 FSC e-invoice email: vafsccshd@va.gov Payment Adjustments/ Payment Deductions: Invoices will be prorated for partial days/hours worked. The contractor shall be paid only for actual work performed onsite. Time worked will be prorated down to the closest quarter hour. Contractor s provider(s) s shall be responsible for reporting time worked accurately. The Contract shall be paid for actual hours performed. The contract shall be adjusted at the end of the period of performance (base or option year) in accordance with actual performance. Payments in full/no billing VA beneficiaries: The Contractor shall accept payment for services rendered under this contract as payment in full. VA beneficiaries shall not under any circumstances be charged nor their insurance companies charged for services rendered by the Contractor, even if VA does not pay for those services. This provision shall survive the termination or ending of the contract. To the extent that the Veteran desires services which are not a VA benefit or covered under the terms of this contract, the Contractor must notify the Veteran that there will be a charge for such service and that the VA will not be responsible for payment. The Contractor shall not bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against, any person or entity other than VA for services provided pursuant to this contract. It shall be considered fraudulent for the Contractor to bill other third party insurance sources (including Medicare) for services rendered to Veteran enrollees under this contract. Contractor Security Requirements (VA Handbook 6500.6)
