On-Site Extracorporeal Shock Wave Lithotripsy (ESWL) & Laser
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THIS IS A SOURCES SOUGHT NOTICE
(a) The Government does not intend to award a contract on the basis of this Sources Sought or to otherwise pay for the information solicited.
(b) Although proposal, offeror, contractor, and offeror may be used in this sources sought notice, any response will be treated as information only. It shall not be used as a proposal.
(c) Any information received from a contractor in response to this Sources Sought may be used in creating a solicitation. Any information received which is marked with a statement, such as proprietary or confidential, intended to restrict distribution will not be distributed outside of the Government, except as required by law.
(d) This Sources Sought is issued for the purpose of collecting information about the availability of Services from different sources for the desired equipment and services listed within the Draft-Performance of Work Statement (PWS).
(e) Contractors that feel they have an equal product are encouraged to email full information to Latasha Winston at latasha.winston@va.gov.
Contractors shall identify the FSC and NAICS code for the product being offered as well as their size status.
Contractors shall complete the Price-Cost Schedule for the purpose of market research.
PERFORMANCE WORK STATEMENT
ON-SITE EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) AND LASER SERVICES
GENERAL:
Services Provided. The Contractor shall provide Technologist(s) and Equipment to provide Extracorporeal Shock Wave Lithotripsy (ESWL) and Laser Services on-site at VA in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the VA Palo Alto Health Care System (VAPAHCS), located at: 3801 Miranda Avenue, Palo Alto, California 94304.
The Contractor s Technologist(s) shall be licensed, certified, and trained in ESWL Lithotripsy, Greenlight Laser, and Holmium Laser Services and operation of the equipment unit(s). The Technologist(s) shall administer procedure(s) under the direction and supervision of VAPAHCS Physician(s).
The contractor shall provide portable, state-of-the-art, digital units that can be moved into the operating room. The equipment shall meet or exceed the following:
Treat all stones anywhere in the urinary tract.
Greenlight laser that can perform prostate ablation.
Holmium laser that can perform lithotripsy to treat all stones anywhere in the urinary tract.
Has a greater than 80% success rate based on FDA clinical study data.
Is modular and can treat patients in the operating room.
Can do endourological procedures before and after the procedure without moving the patient.
VAPAHCS anticipates an estimated 15 ESWL cases, 10 Greenlight laser, and 20 emergency Holmium laser cases annually. This is only an estimate and is dependent upon patient volume and actual need.
Contractor personnel shall be required to attend a VAPAHCS orientation and prior to commencing work under this contract. Contractor personnel will also be required to check-in and check-out when on-site.
The orientation shall include a tour of the surgical facility.
Review of applicable VA policies and procedures governing the medical care provided at VAPAHCS.
The contractor will be contacted to schedule work to perform including what procedure will be performed. The technologist will arrive with equipment and check in at the reception desk where the technologist will be logged in. Afterwards, the technologist will be escorted to the operating room and then escorted back to the reception desk to check out after the procedure is performed.
Authority. Title 38 USC 8153, Health Care Resources (HCR) Sharing Authority.
QUALIFICATIONS:
License.
The Contractor s employee(s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the United States or the District of Columbia.
All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor s employee(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be eligible to participate in this contract.
Board Certification. All contractor s employee(s) shall be certified by an accrediting agency and be currently certified in Basic Life Support (BLS). All continuing education courses required for maintaining certification must be kept up to date. Documentation verifying current certification shall be provided by the Contractor to the VA COR for each year of contract performance.
Credentialing and Privileging.
Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced at section 1(c)(5) utilizing VHA Handbook 1100.19, Credentialing and privileging. The Contractor is responsible to ensure that proposed employee(s) possess the requisite credentials enabling the granting of privileges. No services shall be provided by any contractor s employee(s) prior to obtaining approval by the VAPAHCS Professional Standards Board, Medical Executive Board and Medical Center Director.
If a contractor s employee(s) is/are 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. The Contractor s employee(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 s employee(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 employee(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 contract employee(s).
Training (ACLS, BLS, CPRS and VA MANDATORY): Contractor shall meet all of the VA educational requirements and mandatory course requirements listed below; all training must be completed by the contractor s employee(s) as required by the VA.
Training
Frequency
Annual Hours
Advanced Cardiac Life Support (ACLS)
Biannually
Certificate program
Basic Life Support (BLS)
Biannually
Certificate program
Annual Government Ethics Training
Annually
1.0
Prevention of Workplace Harassment/NO FEAR
Annually
1.5
Privacy and HIPPA Training
Annually
1.0
VA Privacy and Information Security Awareness
Annually
1.0
Standard Personnel Testing (PPD, ETC). Contractor shall provide proof of the following tests for contract employee(s) 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 Tuberculosis Skin Test (TST) or interferon-gamma release assays (IGRA) for all Contractor s employee(s) (This is applicable to all health care workers). A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results. The TST or IGRA testing shall be repeated annually.
MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor employee. This is applicable to all health care workers.
VARICELLA: Contractors shall provide proof of immunity for all Contractor employee(s). This is applicable to all health care workers.
ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor employee(s). This is applicable to all health care workers.
INFLUENZA: Contractors shall provide proof that all Contractor employee(s) have received the annual Influenza vaccine unless it is contraindicated. If the Contractor employee(s) has a medical contraindication to the vaccine they shall be required to wear a mask during the Influenza season. This is applicable to all health care workers.
OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor s employee(s). This is applicable to all health care workers}; provide their own hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; 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.
Conflict of Interest. The Contractor and all contractor s employee(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 employee(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 triple damages. 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 VAPAHCS Chief of Staff (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 employee(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 employee(s) are prohibited from referring VA patients to contractor s or their own practice(s).
Inherent Government Functions: Contractor and Contractor s employee(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 employee(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 employee(s). When a Contractor or contractor s employee(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 employee(s)) action or non-action shall be the responsibility of the Contractor and/or insurance carrier.
Key Personnel.
Procedures shall be scheduled in advance. The contractor shall be responsible to ensure contract employee(s) are available and in place to provide services.
VAPAHCS anticipates between 15 to 25 procedures per year.
The Contractor shall be responsible for providing coverage to the VA during periods of vacancies of the Contractor s employee(s) due to sick leave, personal leave, vacations and additional coverage as required.
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 30 calendar days 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 30 calendar 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 10 calendar days after receipt of all required information of the decision on the proposed substitutes.
For temporary substitutions where the key person shall not be reporting to work, the Contractor shall provide a qualified replacement for the key person. The substitute shall have comparable qualifications to the key person.
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 employee(s), she/he may request, without cause, immediate replacement of said Contractor s employee(s). The CO and COR shall deal with issues raised concerning Contractor s employee(s) conduct. The final arbiter on questions of acceptability is the CO.
Contingency Plan: Because continuity of care is an essential part of the VAPAHCS medical services, The Contractor shall have a contingency plan in place to be utilized if the Contractor s employee(s) leaves Contractor s employment or is unable to continue performance in accordance with the terms and conditions of the resulting contract.
HOURS OF OPERATION.
Procedures shall be scheduled in advance between VAPAHCS and the contractor.
VAPAHCS will attempt to provide a minimum of five (5) calendar days notice prior to the scheduled procedure date. In the event the contractor is unable to confirm the scheduled procedure date, VAPAHCS and contractor shall determine an acceptable date.
Short Notice/Urgent Requests. The contractor will attempt to fulfill short notice or urgent service requests when contacted by VAPAHCS. If unable to provide short notice or urgent services, the contractor and VAPAHCS will negotiate the procedure date or abide by the five (5) calendar day notice.
Cancellations. The contractor and/or the Government shall provide a minimum of 24-hour notice when cancelling a procedure.
Unless a state of emergency has been declared or clinics are otherwise cancelled by VAPAHCS, the Contractor shall be responsible for providing services.
Federal Holidays. The following holidays are observed by the Department of Veterans Affairs:
New Year s Day
President s Day
Martin Luther King s Birthday
Memorial Day
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.
CANCELLATIONS AND RETREATMENTS.
Advance Cancellation will adhere to a 24-hour notice period.
The contractor shall not invoice for procedures if VAPAHCS provides a 24-hour cancellation notice.
The contractor may invoice for 50% of the contract procedure cost if the VAPAHCS cancels the procedure with less than a 24-hour notice.
The contractor shall provide 50% credit/discount of the contract procedure cost if the contractor cancels the procedure with less than 24-hour notice. The credit/discount will be applied to the rescheduled date. If not rescheduled, the credit/discount shall be applied to the next available procedure.
Same Day Cancellation Procedures for Single and Multiple Procedures.
In the event, multiple procedures are scheduled consecutively on the same day, and the contractor is only making one trip to VAPAHCS, and a procedure is cancelled, the contractor shall be paid 25% of the contract procedure price for the cancelled procedure.
In the event, multiple procedures are scheduled at various intervals (breaks greater than 1.5 hours) on the same day, and the contractor is making trips to VAPAHCS between the scheduled procedures, and a procedure is cancelled, the contractor shall be paid 50% of the contract procedure price for the cancelled procedure.
In the event, one procedure is scheduled at VAPAHCS, and the procedure is cancelled, the contractor shall be paid 50% of the contract procedure price for the cancelled procedure.
Additional Treatment. If a patient must undergo an additional treatment within ninety (90) days from his/her initial procedure date due to continued problems with the stone(s) (i.e., stone(s) was not broken down small enough to pass or fragments of the stones(s) remain, the contractor will provide the treatment at 50% of the contract procedure cost).
CONTRACTOR RESPONSIBILITIES
Personnel Required. The Contractor shall provide contract employee(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.
Contractor s employee(s) shall be responsible for signing in and out when in attendance. Time sheets will be used by the COR to confirm services provided against the contractor s invoices.
Standards of Care. The contractor s employee(s) care shall cover the range of Lithotripsy, Greenlight, and/or Holmium Laser services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding and the following national standards as established by:
American Urological Association Guidelines: https://www.auanet.org/education/aua-guidelines.cfm
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.
Contractor Equipment.
Contractor shall provide a state-of-the art portable/modular, digital unit that can be easily moved into the procedure room at the VAPAHCS. Contractor is responsible for obtaining all necessary licenses and approvals and shall comply with all Federal, state, and local laws and regulations applicable to the equipment and delivery of ESWL and/or Laser Services.
Contractor is responsible for preventive and emergency maintenance of the contractor s equipment.
Maintenance of contractor equipment shall be in accordance with manufacturer s recommendations.
Contractor s equipment shall be inspected annually. Proof of maintenance and inspection must be provided to the VA upon request.
The Government may, at its option and expense, request an unrelated third party to inspect the equipment provided by the contractor. The contractor shall repair, at the contractor s cost, any defects discovered by the inspection of the third party within fifteen (15) days when notified by the COR.
All equipment maintenance documentation is to be provided quarterly to Biomedical Services at VAPAHCS. All equipment is required to be safety checked by the local VA Biomed staff each time it arrives on site before any procedures begin. The VA Service Line shall arrange for the VA Biomedical staff to inspect the equipment with the contractor technologist.
Contract employee(s) shall provide support in ESWL and/or laser procedure(s) and must be present at all time while the equipment is used at VAPAHCS. The VA will not be held liable for any loss or damage to the Contractor s property.
Contractor will supply additional materials and supplies including consumables as are necessary to conduct ESWL and/or laser services, i.e., stirrups.
Contractor s equipment must meet or exceed the following criteria:
Has ability to treat all stones anywhere in the urinary tract.
Greenlight laser that can perform prostate ablation.
Holmium laser that can perform lithotripsy to treat all stones anywhere in the urinary tract.
Has been approved by the Federal Drug Administration (FDA).
Has a greater than 80% success rate based on FDA clinical study data.
Has ability to do endourological procedures before and after the operation without moving the patient.
Contractor Technologist Responsibilities.
Operate the ESWL and/or laser equipment under direction of the attending VA physician.
Troubleshoot and resolve equipment issues.
Educate VAPAHCS employee(s) as it relates to the operation and parameters of the lithotripsy and/or laser machines.
Deliver all digital reports and files of all procedures performed with the equipment to the Surgery Nurse Manager.
Clean and sterilize the ESWL and/or laser machines.
GOVERNMENT RESPONSIBILITIES.
The VA shall provide the following:
Suitable electric service to operate the unit(s). Contractor to notify VAPAHCS in advance of power requirements for machines.
Scheduling of patients for the procedure and coordinating the scheduling of any in-service, relating to the units for facility staff.
Pre-operative preparation of patients for ESWL and/or laser procedures.
VAPAHCS shall obtain written patient consent forms and provide patients with the necessary services related to post procedure recovery. Facility shall be responsible for providing emergency service personnel, physicians, facilities and supplies necessary to provide patients with emergency medical care as may be required, as well as physicians, facilities and supplies necessary to provide patients with inpatient or outpatient post procedure care.
Collect and dispose of infectious waste and sharps related to the ESWL and/or laser procedures.
Provide other necessary personnel for the operation of the services contracted for at the VA. These other necessary personnel shall be mutually agreed upon between the VA and the contractor who are compatible with the safety of the patient and are personnel with quality medical care programming.
Procedures will only be conducted when the attending VA physician is present. The VA physician shall provide direction and oversight.
MEDICAL RECORDS.
Authority: Contractor s employee(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. B' 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 employee(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: VAPAHCS attending physician shall document care 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
The contractor s employee(s) will NOT have direct access to patient records or information. VAPAHCS shall maintain control of releasing any patient medical information and will follow policies and standards as defined, but not limited to Privacy Act requirements.
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:
Aaron Cork, Privacy Officer
Aaron.cork@va.gov
605-336-3230 x9-6784
PATIENT SAFETY COMPLIANCE AND REPORTING. Contractor s employee(s) shall follow all established patient safety and infection control standards of care. Contractor s employee(s) shall make every effort to prevent any injury(s) caused by acts of commission or omission in the delivery of care. All events related to patient injury, errors, and other breaches 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).
Contract employee(s) shall be subject to Quality Management measures. Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.
Complaints: The CO will resolve complaints concerning Contractor relations with the Government. The CO is the final authority on validating complaints. In the event the Contractor s employee(s) is involved and named in a validated complaint, the Government reserves the right to refuse acceptance of the services of such employee(s). 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 Contract employee 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.
SPECIAL CONTRACT REQUIREMENTS
The services specified herein may be changed by written modification to this contract. The modification will be prepared by the VA Contracting Officer.
Other necessary personnel for the operation of the services contracted for at VA will be provided by VA that is compatible with the safety of the patient and personnel and with quality medical care programming.
The service to be performed by the Contractor will be performed within the ethical, professional, and technical standards of the healthcare industry and that are consistent with VA policies and procedures and the regulations of the medical staff bylaws of this VA facility.
The contractor is required to maintain medical liability insurance for the duration of this contract. Contractor must indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance.
PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA), AND QUALITY IMPROVEMENT (QI).
Contract personnel shall be subject to Quality Management measures, such as patient satisfaction surveys, timely completion of services, and Peer Reviews. Methods of Surveillance: Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.
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: Employee Quality Performance
Performance Requirement: Follows procedures and operates equipment without difficulty or issues.
Standard: 100%
Acceptable Quality Level: 100% No deviations accepted
Surveillance Method: Direct Observation
Frequency: Quarterly
Measure: Qualifications of Key Personnel
Performance Requirement: All contractor employee(s) shall be certified and trained to operate equipment.
Standard: 100%
Acceptable Quality Level: 100% No deviations accepted
Surveillance Method: Direct Observation
Frequency: Annually
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: All (100%) of patient safety incidents are reported using Patient Safety Report within 24 hours of incident. No acceptable deviation.
Surveillance Method: Direct Observation
Frequency: Quarterly
Measure: Mandatory Training
Performance Requirement: Contractor shall complete all required training on time per VA policy.
Standard: All (100%) of required training is complete on time by contract employee(s)
Acceptable Quality Level: 100% completions, no deviations
Surveillance Method: Periodic Sampling
Frequency: Annually
Measure: Privacy, Confidentiality and HIPAA
Performance Requirement: All (100%) contractor employee(s) comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA.
Standard: All (100%) contractor employee(s) comply with all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPAA
Acceptable Quality Level: 100% compliance, no deviations
Surveillance Method: Periodic Sampling
Frequency: Annually
Measure: Equipment Maintenance and Documentation
Performance Requirement: All equipment maintenance documentation shall be provided quarterly to the VAPAHCS Biomedical Service Line
Standard: All equipment maintenance documentation shall be provided quarterly to the VAPAHCS Biomedical Service Line
Acceptable Quality Level: 100% compliance, no deviations
Surveillance Method: Direct Observation
Frequency: Quarterly
GOVERNMENT RESPONSIBILITIES.
Contract Administration/Performance Monitoring: After award of contract, all inquiries and correspondence relative to the administration of the contract shall be addressed to the Contracting Officer or Contracting Officer s Representative.
Identification of CO and Responsibilities.
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 or the Contracting Officer s designated Contract Specialist 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.
Identification of COR and Responsibilities:
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 entering 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 or services performed 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.
INVOICING
Invoice requirements and supporting documentation. Supporting documentation and invoice must be submitted no later than the 30 business days after services are provided. 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
Unit Cost
Total price
Vendor Electronic Invoice Submission Methods
Invoice(s) will be electronically submitted to the Tungsten website at http://www.tungstennetwork.com/uk/en/
Tungsten direct vendor support number is 877-489-6135 for VA contracts.
The VA-FSC pays all associated transaction fees for VA orders. During Implementation (technical set-up) Tungsten will confirm your Tax Payer ID Number with the VA-FSC. This process can take up to five (5) business days to complete to ensure your invoice is automatically routed to your Certifying Official for approval and payment.
In order to successfully submit an invoice to VA-FSC please review How to Create an Invoice within the how to guides.
All invoices submitted through Tungsten to the VA-FSC should mirror your current submission of Invoice, with the following items required. Clarification of additional requirements should be confirmed with your Certifying Official (your CO or buyer).
The VA-FSC requires specific information in compliance with the Prompt Pay Act and Business Requirements.
For additional information, please contact:
Tungsten Support
Phone: 1-877-489-6135
Website: http://www.tungsten-network.com/uk/en/
Department of Veterans Affairs Financial Service Center
Phone: 1-877-353-9791
Email: vafscched@va.gov
Payment Adjustments.
The contractor shall be paid only for actual work performed onsite. Contract employee(s) shall be responsible for reporting services performed accurately. The Contract shall be paid for actual services performed.
The contract shall be adjusted in the event a procedure is not previously billed 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.
Background Investigations and Special Agreement Checks. All contractor employees are subject to the same level of investigation as VA employees who have access to VA Sensitive Information. The level of background investigation commensurate with the level of access needed to perform the statement of work is: TIER 1, LOW RISK. This requirement is applicable to all subcontractor personnel requiring the same access
Personal Identity Verification (PIV) of Contractors.
All contractor employee(s) are required to wear an identification badge during the entire time that they are on VA property. Contract employee(s) shall be issued a VA Non-PIV Card.
Access Requirements: Unsupervised, logical and/or physical access for less than 6 months OR less than 180 aggregate days in a one year period.
ID Requirements: Two IDs compliant with PIV Guidelines
Background Investigation Requirements: Favorable SAC adjudication and scheduled investigation commensurate with risk designation. National Agency Check with Inquiries (Low levels of investigation are significant enough for access to patients, patient records, restricted areas, etc. (NACI/Tier 1, Low Risk).
Upon contract award, the Contracting Officer shall provide the contractor with a VSC Notice of Award letter. The VSC Notice of Award letter will be accompanied by the following:
Contract Security Services Request Form (Form #1A/B), partially completed by the CO/COR
Fingerprinting Request Form (Form #2),
PIV Sponsorship Form (Form #3),
Declaration for Federal Employment (OF 306),
Authorization for Release of Information (VA Form 0710), and
Self-Certification of Continuous Service Form.
Within five business days of receiving the VSC Notice of Award letter and the list of forms in Section above, the contractor shall submit all completed forms to the sender (CO/COR).
Within five business days of receiving the VSC Notice of Award letter, each contract employee identified to provide services under the contract must be fingerprinted. The VSC Notice of Award letter instructs the contractor to contact the COR or local VA facility with assistance in scheduling an appointment to be fingerprinted.
Once a contract employee has submitted the required paperwork and has been fingerprinted, the VSC conducts the background screening. Upon completion of a background screening, the VSC will forward a Fingerprint Check - National Criminal History Check Completion Notice (NCHC) to the Contracting Officer, which will indicate a favorable or unfavorable screening decision for each contract employee listed on the form.
Upon receipt of the NCHC notice from the VSC, and verification of a fully executed local or National Business Associate Agreement if required, the Contracting Officer shall send the contractor a VSC Notice to Proceed letter together with a copy of the NCHC notice, which will instruct those contract employees who have favorable screening decisions to begin working and fulfill remaining security requirements.
Background Investigations: If the contractor is required to have a background investigation, the VSC enters the request in the VA Security and Investigation Center (SIC) database. Once the VA SIC processes the request, the contractor POC, contract employee, CO, COR and VSC receives an e-mail with instructions for completing the Electronic Questionnaire for Investigations Processing (e-QIP).
The contract employee must complete the e-QIP within five (5) business days of receiving the e-mail from the VA SIC.
If the e-QIP is not completed within the required timeframe, the CO shall notify the contractor that the individual is prohibited from working on the contract (or delivery/task order) until the e-QIP is completed.
PIV Badging: Once the investigation is either transmitted to OPM and scheduled or reciprocated, VSC will manage and sponsor badges for all personnel that were favorably adjudicated on the NCHC form and have at minimum a scheduled NACI investigation.
Special Note. Non-PIV badges are managed and sponsored at the completion of the NCHC form for all contractors with a favorable adjudication. * PIV Courtesy Issue forms are sent to the CO, COR, contractor POC and contract employee at the completion of the sponsorship of the PIV or Non-PIV badge. The contract employee should take the PIV Courtesy Issue form with them to their badging appointment in order to ensure they have their investigative data to present to the Registrar. The contract employee should also bring two forms of ID in accordance with the I-9 requirements; the same ID s as presented during the fingerprint appointment will be sufficient.
Certificates of Investigation/Eligibility, COI/COE: These certificates are the final adjudication of the investigation. For those contracts that require COI or COE documents, the VSC will author a document to fulfill this requirement as OPM/NBIB has requested that they are not transferred outside of the adjudicative office.
PIV or Non-PIV Badge Reissuance: For contracts that are awarded in excess of three (3) years, PIV or Non-PIV badges will need to be reissued as the longest period of badge issuance is three (3) years. Each contract is assigned a personnel security POC at the VSC; the COR or CO should contact the security POC at the VSC for reissuance forms. The COR or CO should complete these forms and send them back to the assigned security POC.
VA Information and Information System Security/Privacy Language. See Attachment.
QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)
PURPOSE
This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:
What will be monitored?
How monitoring will take place.
Who will conduct the monitoring?
How monitoring efforts and results will be documented.
This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government s responsibility to be objective, fair, and consistent in evaluating performance.
This QASP is a living document and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor through contract modification. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.
GOVERNMENT ROLES AND RESPONSIBILITIES
The following personnel shall oversee and coordinate surveillance activities.
Contracting Officer (CO) The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor s performance.
Assigned CO: TBD
Organization or Agency: NCO 21
Contracting Officer s Representative (COR) The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government s behalf.
Assigned COR: TBD
Organization or Agency: VA Palo Alto Health Care System
CONTRACTOR REPRESENTATIVES. The following employee(s) of the contractor serve as the contractor s program manager(s) for this contract.
Primary:
Alternate:
PERFORMANCE STANDARDS
The contractor is responsible for performance of ALL terms and conditions of the contract. CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined. Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards.
The Performance Requirements are listed below in Section 6. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.
METHODS OF QA SURVEILLANCE
Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.
DIRECT OBSERVATION. 100% surveillance: (if this method is used, define how surveillance will be accomplished.)
PERIODIC INSPECTION. Inspections scheduled and reported quarterly per COR delegation or as needed. (Define what and how often it will be inspected. For example, ten (10) randomly selected patient files will be reviewed per inspection period. All inspections and reports will be conducted in compliance with VA Privacy and Information security standards.)
VALIDATED USER/CUSTOMER COMPLAINTS. If this method is used, explain how data will be collected and reported.
RANDOM SAMPLING. If this method is used, define what and how often it will be sampled. (For example, ten (10) randomly selected patient files will be reviewed per quarter. All reviews and reports will be conducted in compliance with VA Privacy and Information security standards.)
VERIFICATION AND/OR DOCUMENTATION PROVIDED BY CONTRACTOR. Review PWS and if this method of surveillance is selected, define how documentation will be verified and how assessment will be conducted. (For example, off-site contracts may require the contractor to provide information on services provided to patients).
PRICE/COST SCHEDULE
The Contractor shall furnish all personnel to provide services necessary to perform onsite Lithotripsy ESWL and/or Laser Services to eligible beneficiaries of the Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS). The contractor s employee(s) care shall cover the range of Lithotripsy ESWL and/or Laser Services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by the American Society of Radiologic Technologists (https://www.asrt.org/).
Place of Performance: Services shall be provided on site, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304.
Pricing Instructions:
The offeror is instructed to provide a Unit and Total Cost for the Contract Line Item Number (CLIN) and identify offeror s employee(s), Title, Education, and Level of Experience.
The offeror is instructed to include all other than price and cost information supporting the proposed price as directed in Instructions to Offerors addendum to 52.212-1 and/or Section D- Contract Documents, Exhibits, or attachments.
The Contractor shall propose a minimum of one (1) key person to be credentialed and be available to provide contract coverage.
CLIN
Description
Estimated Quantity
Unit
Unit Cost
Total Cost
0001
Base Year
From 3/1/2019 to 2/29/2020
Cost per Lithotripsy ESWL Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
0002
Base Year
From 3/1/2019 to 2/29/2020
Cost per Greenlight Laser Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
0003
Base Year
From 3/1/2019 to 2/29/2020
Cost per Holmium Laser Procedure
Estimated 20 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
20
EA
$__________
$__________
1001
Option Year 1
From 3/1/2020 to 2/28/2021
Cost per Lithotripsy ESWL Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
1002
Option Year 1
From 3/1/2020 to 2/28/2021
Cost per Greenlight Laser Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
1003
Option Year 1
From 3/1/2020 to 2/28/2021
Cost per Holmium Laser Procedure
Estimated 20 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
20
EA
$__________
$__________
2001
Option Year 2
From 3/1/2021 to 2/28/2022
Cost per Lithotripsy ESWL Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
2002
Option Year 2
From 3/1/2021 to 2/28/2022
Cost per Greenlight Laser Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
2003
Option Year 2
From 3/1/2021 to 2/28/2022
Cost per Holmium Laser Procedure
Estimated 20 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
20
EA
$__________
$__________
3001
Option Year 3
From 3/1/2022 to 2/28/2023
Cost per Lithotripsy ESWL Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
3002
Option Year 3
From 3/1/2022 to 2/28/2023
Cost per Greenlight Laser Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
3003
Option Year 3
From 3/1/2022 to 2/28/2023
Cost per Holmium Laser Procedure
Estimated 20 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
20
EA
$__________
$__________
4001
Option Year 4
From 3/1/2023 to 2/29/2024
Cost per Lithotripsy ESWL Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
4002
Option Year 4
From 3/1/2023 to 2/29/2024
Cost per Greenlight Laser Procedure
Estimated 10 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
10
EA
$__________
$__________
4003
Option Year 4
From 3/1/2023 to 2/29/2024
Cost per Holmium Laser Procedure
Estimated 20 cases per year
Name of Contract Employee:
Title:
Education:
Level of Experience:
20
EA
$__________
$__________
Total Cost (Base plus all options)
$__________
Latasha Winston
latasha.winston@va.gov
Contract Specialist
