Q--PROVIDE EXTERNAL CLINICAL CONSULTANTS TO CONDUCT QUALITY OFCARE REVIEWS

SCHEDULE OF SUPPLIES/SERVICE Provide the following service in accordance with the requirements of the contract: Health Care resources in accordance with Public Law 104-262 and 38 USC 8153 to be furnished by the contractor at the Department of Veteran Affairs, Readjustment Counseling Service, Knoxville Vet Center, 2817 East Magnolia Ave., Knoxville, TN, 37914, and the Department of Veterans Affairs, Readjustment Counseling Service, Chattanooga Vet Center, 5700 Building, Suite 300 951 Eastgate Loop Road,Chattanooga, Tennessee. DESCRIPTION/SPECS/WORK STATEMENT Services: This is a contract for Non-Personal Services. Furnish clinical consultation to Knoxville and Chattanooga Vet Center, clinical staff in accordance to Readjustment Counseling Service (RCS) Policy Memorandum 7-3 entitled "External Clinical Consultants" and Reference: VHA M-12, Part I BID ITEMS Line Item ESTIMATED No. Description Quantity UNIT Unit Cost Total Cost Base Period March 15, 2007 - March 14, 2008 1a. Quality Management 48 Visits $ $ Knoxville Consult services 1b. Quality Management 48 Visits $ $ Chattanooga Consult services RENEWAL OPTION ONE March 15, 2008 - March 14, 2009 2a. Quality Management 48 Visits $ $ Knoxville Consult services 2b. Quality Management 48 Visits $ $ Chattanooga Consult services RENEWAL OPTION TWO March 15, 2009 - March 14, 2010 3a. Quality Management 48 Visits $ $ Knoxville Consult services 3b. Quality Management 48 Visits $ $ Chattanooga Consult services RENEWAL OPTION THREE March 15, 2010 - March 14, 2011 4a. Quality Management 48 Visits $ $ Knoxville Consult services 4b. Quality Management 48 Visits $ $ Chattanooga Consult services RENEWAL OPTION FOUR March 15, 2011 - March 14, 2012 5a. Quality Management 48 Visits $ $ Knoxville Consult services 5b. Quality Management 48 Visits $ $ Chattanooga Consult services DESCRIPTION/SPECS/WORK STATEMENT SCOPE OF WORK The Contractor will provide quality management review/quality of care reviews continuity of that care for all veterans upon eligibility verification and enrollment in the Readjustment Counseling Centers. Successful bidders will be required to submit a written evaluation of the treatment and care plans provided by the Veteran Center Staff. Each written report will address at a minimum the efficacy and value of the treatment rendered, recommendations of changes and improvements that will improve the treatment and quality of life / quality of care of the Veterans center beneficiaries. Written reports shall be due at the close of each site visit or consultation. PRIMARY MENTAL HEALTH SERVICES The contractor shall provide quality management review/quality of care review services to include but not limited to the following CPT codes: a. PROCEDURES: CPT CODE DESCRIPTION 1. DIAGNOSTIC INTERVIEW 90801 Diagnostic Interview 90885 Evaluation of Records 2. TEAM CONFERENCE 99361 30 MIN. (Pt. not present) 99362 60 MIN. (Pt. not present) b. DIAGNOSES 1. DELIRIUM 293.0 Delirium Sec. to General Medical Condition 780.09 Delirium NOS 2. DEMENTIA 290.10 Early Onset Dementia, Uncomplicated 290.11 With Delirium 290.12 With Delusion 290.13 With Depressed Mood 290.0 Late Onset Dementia, Uncomplicated 290.3 With Delirium 290.20 With Delusion 290.21 With Depressed Mood 290.40 Vascular Dementia/uncomplicated 290.41 With Delirium 290.42 With Delusion 290.43 With Depressed Mood 294.1T1-12042 Dementia due to HIV 294.1T2 Dementia NOS 3. MENTAL DISORDERS DUE TO MEDICAL CONDITION 295.20T1 Catatonic 310.1 Personality Change 293.9 Mental D/O NOS 4. ALCOHOL RELATED D/O 303.90 Alcohol Dependence 305.0 Alcohol Abuse 303.0 Alcohol Intoxication 291.8T1 Alcohol Withdrawal 291.0T1 Alcohol Intoxicant Delirium 291.0T2 Alcohol Withdrawal Delirium 291.2 Alcohol Induced Persistent Dementia 291.1 Alcohol Amnestic D/O 291.5 Alcohol Induced Delusions 291.3 Alcohol Induced 291.8T2 Alcohol Induced Mood D/O 291.8T3 Alcohol Induced Anxiety 291.8T Alcohol Induced Sleep D/O 291.9 Alcohol Related D/O NOS 5. AMPHETAMINE RELATED D/O 304.40 Amphetamine Dependence 305.70 Amphetamine Abuse 292.89T1 Amphetamine Intoxication 292.OT1 Amphetamine Withdrawal 292.81T1 Amphetamine Intox Delirium 292.11T1 Amphetamine with Delusions 292.12T1 Amphetamine/Hallucinations 292.84T1 Amphetamine, Mood, disorder 292.89T1 Amphetamine, Anxiety D/O 292.89T3 Amphetamine, Sexual Dysfunction 292.89T4 Amphetamine, Sleep D/O 292.9T1 Amphetamine, D/O NOS 6. CANNABIS RELATED D/O 304.30 Cannabis Dependence 305.20 Cannabis Abuse 292.89T5 Cannabis Intoxication 292.81T2 Cannabis Intoxicant Delirium 292.11T2 Cannabis w/Delusions 292.12T2 Cannabis w/Hallucinations 292.89T6 Cannabis induced Anxiety 292.9T2 Cannabis Disorder NOS 7. COCAINE RELATED DISORDERS 304.20 Cocaine Dependence 305.60 Cocaine Abuse 292.89T7 Cocaine Intoxication 292.OT2 Cocaine Withdrawal 292.81T3 Delirium Cocaine, w/Delusions 292.11T3 Cocaine, w/Delusions 292.12T3 Cocaine, w/Hallucinations 292.84T2 Cocaine Induced Mood Disorder 292.89T8 Cocaine Induced Anxiety D/O 292.89T9 Cocaine Induced Sexual Dysfunc 292.89T10 Cocaine Induced Sleep 292.9T3 Cocain Related Disorder NOS 8. HALLUCINOGEN RELATED D/O 304.50 Hallucinogen Dependence 305.30 Hallucinogen Abuse 292.89T11 Hallucinogen Intoxication 292.89T12 Hallucinogen Persistence Perception Disorder 292.81T4 Hallucinogen Intox Delirium 292.11T4 Hallucinogen, w/Delusions 292.12T4 Hallucinogen/Hallucination 292.84T3 Hallucinogen Induced Mood D/O 292.89T13 Hallucinogen Induced Anxiety D/O 292.9T4 Hallucinogen D/O NOS 9. NICOTINE RELATED D/O 305.1 Nicotine Dependence 292.OT3 Nicotine Withdrawal 292.9T5 Nicotine Related D/O NOS 10. OPIOID RELATED DISORDERS 304.00 Opioid Dependence 305.50 Opioid Abuse 292.89T14 Opioid Intoxication 292.OT4 Opioid Withdrawal 292.81T5 Opioid Intoxication Delirium 292.11T5 Opioid w/Delusions 292.12T5 Opioid w/Hallucinations 292.84T4 Opioid Induced Mood D/O 292.89T15 Opioid Induced Sexual Dynfuc 292.89T16 Opioid Induced Sleep D/O 292.9T6 Opioid Related D/O NOS 11. POLYSUBSTANCE RELATED D/O 304.80 Polysubstance Dependence 12. SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS 295.3 Schizophrenia, Paranoid Type 295.1 Schizophrenia Disorganized 295.2T2 Schizophrenia Catatonic Type 295.9 Schizophrenia Undiff Type 295.6 Schizophrenia Residual Type 295.4 Schizophreniform 295.7 Schizoaffective 297.1 Delusional Disorder 298.8 Brief Psychotic Disorder 297.3 Shared Psychotic Disorder 297.3 293.81 Med Cond w/ Delusions 293.82 Med Cond w/ Hallucinations 298.9 Psychotic Disorder NOS 13. DEPRESSIVE DISORDER 296.20 Major Depressive D/O Single 296.30 Major Depress D/O Recurren 300.4 Dysthymic Disorder 311 Depressive Disorder NEC 14. BIPOLAR DISORDERS 296.00 Bipolar, Single, Manic 296.40 Bipolar, Recent, Manic 296.50 Bipolar, Recent, Depressed 296.60 Bipolar, Recent, Mixed 296.7T1 Bipolar, Recent, Unspecified 296.80 Bipolar, k Man/Depress, NOS 301.13 Cyclothymic Disorder 296.7T2 Bipolar Disorder NOS 293.83 Mood Disorder Due to Medical Condition 296.90 Mood Disorder NOS 15. ANXIETY DISORDERS 300.21 Panic w/Agoraphobia 300.01 Panic w/o Agoraphobia 300.22 Agoraphobia w/o Hx of Panic 300.23 Social Phobia 300.29 Specific Phobia 300.3 Obsess/Compulsive Disorder 309.81 Post Traumatic Stress Disorder 300.02 Generalized Anxiety Disorder 293.89 Anxiety D/o Due to Medical 300.00 Anxiety Disorder NOS 16. SOMATOFORM D/O 300.81T1 Somatization disorder 300.81T2 Undiffer somatoform d/o 300.11 Pain d/o w/psych factors 307.89 Pain d/o w/phych & medical factors 17. EATING DISORDER 307.1 Anorexia Nervosa 307.51 Bulimia 307.50 Eating Disorder NOS 18. SLEEP DISORDERS 307.42 Primary Insomnia 307.44 Primary Hypersomnia 347 Narcolepsy 780.59 Breathing Related Sleep D/O 307.47T1 Dyssomnia NOS 307.47T2 Nightmare Disorder 307.46T1 Sleep Terror Disorder 307.46T2 Sleepwalking Disorder 307.47T3 Parasomnia 19. IMPULSE CONTROL, D/O 312.34 Intermittent Explosive D/O 312.32 Kleptomania 312.33 Pyromania 312.31 Pathological Gambline 312.39 Trichotillomania 312.30 Impulse Control D/o NOS 20. ADJUSTMENT D/O 309.0 Adjustment D/O Depressed 309.24 Adjustment D/O Anxious 309.28 Adjustment D/O Mixed Emotion 309.3 Adjustment D/O Disturbance of Conduct 309.4 Adjustment D/O Mixed Emotion and Conduct 309.9 Adjustment D/O Unspecified 21. PERSONALITY D/O 301.0 Paranoid 301.20 Schizoid 301.22 Schizotypal 301.7 Antisocial 301.83 Borderline 301.50 Histrionic 301.8l Narcissistic 301.82 Avoidant 301.6 Dependent 301.4 Obsessive/Compulsive 301.9 Personality Disorder NOS 22. RELATION PROBLEMS V61.9 Related to Mental D/O or Medical V6l.20 Parent-Child Problem NOS V61.1 Marital Problems V61.8 Sibling Relational Problem V61.81 Relation Problem NOS 23. MISCELLANEOUS V15.81 Noncompliance w/Treatment 294.9 Cognitive Disorder NOS V65.2 Malingering V71.01 Adult Antisocial Behavior V62.89T1 Borderline Intell Functioning 780.9 Age-Related Cognitive Decline V62.82 Bereavement, uncomplicated V62.2 Occupational Problem 313.82 Identity Disorder V62.89T2 Religious/Spiritual Problem V62.4 Acculturation Problem 995.2 Adverse Effects of Meds NOS 300.9 Unspec Mental Disorder Access: Vet Center clinical staff will provide the external clinical consultant with the clinical chart and all pertinent information and documentation associated with the clinical case being presented. Once a clinical course of action is decided upon between the clinical staff and the external consultant, the assessment and treatment plan will be documented in the clinical chart and signed by external consultant and all clinical staff present at time of consultation. d. Vested: Each active clinical case must receive at least one clinical review annually and/or any appropriate follow-up reviews that maybe necessary to provide the quality and continuum of care decided on by the clinical staff and external clinical consultant. Comprehensive documentation will be filed in each clinical chart and the "External Clinical Consultant Case Summary" for any additional clinical reviews above and beyond the mandatory annual clinical review. The clinical review assessment, diagnosis and treatment will be described by one of the Current Procedural Technology Codes as designated by the VA to reflect a thorough assessment or psychotherapy. Caseload: Ability to analyze and provide feedback on complex clinical cases of four (4) to eight (8) per session. Consult Schedule: Every other Wednesday of each month (unless otherwise specified) from 10:00 a.m. to 12:00 noon. External Clinical Consultant will meet with Clinical Staff to provide consultation and feedback to Vet Center Staff. Case Management/Continuity of Care The contractor shall be responsible for providing quality management/quality of care reviews for the management of mental health care and continuity of care for all active veteran clinical cases. These functions may be performed by the contractor or Contractor's Mental Health Care Provider as specified: The contractor will provide analysis and feedback to clinical staff and a written assessment in clinical chart using the established RCS recording criteria. The contractor and all clinical staff present will sign the documented assessment note. Contractor will make recommendations of referrals as is appropriate for specialty care and/or services. Contractor will follow and meet the guidelines for all applicable VA and Readjustment Counseling Service policies regarding clinical treatment of veteran clients. Contractor will complete any mandatory training. Global Assessment of Functioning (GAF): All active clinical cases will have a Global Assessment of Functioning (GAF) on an initial assessment and every 12 month period thereafter. (GAF is located in the Mental Health Computer package in CPRS). Contractor will not have any access to VA/Vet Center Computer files or any other electronic information that may be contained in VA Computers. The contractor will strictly comply with all HIPAA requirements. 1.) The contractor will hire, train, and ensure licensure-ship of necessary personnel. 2.) The contractor will have completed sub-contracting will health care providers capable of providing primary mental health care services through the area where the plan is offered. PERSONNEL REQUIREMENTS a. The contractor shall provide personnel, either through direct hire or through sub-contracting, in numbers and qualifications capable of fulfilling the requirements of this contract. The contractor shall provide a sufficient number of mental health providers which ensures compliance with the approved QM/QI program. Mental Health Care Providers shall include licensed physicians who may also employ extenders such as Physicians Assistants or Nurse Practitioners, etc.  b. Mental Health Care Providers may include licensed physicians board certified in Psychiatry or within 4 years of having completed psychiatric residency as well as nurse practitioners, physician assistants, social workers, psychologist, and clinical nurse specialist, practicing in accordance with State law and knowledgeable in the use of the DSM-IV. LICENSURE OF STAFF The contractor is responsible for assuring that all persons, whether they be employees, agents, subcontractors, providers or anyone acting for or on behalf of the contractor, are properly licensed at all times under applicable state law and/or regulations. PERSONNEL QUALIFICATIONS: The contractor or contractor providers must meet the standards set forth by the Health Care Finance Administration (HCFA) Quality Assurance standards for Health Maintenance Organization's (HMO's) and Competitive Medical Plan (CMP) contraction with Medicare Programs. (a) Physicians providing services under this contract shall be board certified in Psychiatry or within four years of having completed psychiatric residency. Physicians (including subcontractors) Physicians Assistants and Nurse Practitioners must be properly credentialed and privileged according to JCAHO requirements and VA procedures. (b) Physician Assistants providing services under this contract must be a graduate of an accredited Physician Assistant program and be certified by the National Commission on Certification of Physician Assistants. Physician Assistants must hold an active, current, full and unrestricted Tennessee license and operate only within the scope of that license and acceptable community standards of practice. (c) Nurse Practitioners providing services under this contract must be a graduate of an accredited Nurse Practitioner program and be certified by the American Nursing Association in either Adult Health or Family Practice. Nurse Practitioners must hold an active, current, full and unrestricted Tennessee license and operate only within the scope of that license and acceptable community standards of practice. (d) Psychologists providing services under this contract must hold a current unrestricted license granted by a state/provincial licensing regulatory board and have completed Doctoral Training and a Pre-doctoral Internship approved by the American Psychological Association. Licensed Clinical Social Worker must hold a current unrestricted license granted by a state/provincial licensing regulatory board and have completed a Masters Degree in Social Work from an accredited institution. LCSW must have expertise in diagnosing and treating mental disorders in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Must be effective in planning and utilization of time and demonstrating sound decision-making skills. Any sub-contractor utilized by the contractor for the provision of services required under this contract must meet the same qualifications specified herein for the contractor. The contractor must notify and obtain approval from the Contracting Officer for any sub-contractor to be utilized for the provision of mental health services required. Security Background Investigation: The contractor will be required to under go any security and/or background investigation specified by VA policies and procedures and any other pertinent federal regulations. Position Risk Determination: The contractor will be subject to suitability considerations relating to the efficiency and integrity of the Federal Service. This will include, but may not be limited to a National Agency check with written Inquiries (NACI). HRM at VA field facilities and VA Central Office will coordinate the initiation of the NACI investigations within 14 calendar days of an individual's appointment, and make final suitability determinations for individuals in these positions. This position has been determined to be a Low Risk/Non-sensitive position.