B09_Clinic_Services_YELL_-_QA_0001.pdf

1. Is this a pure “fee for service” contract or a “cost recovery” program in which the medical provider recovers the costs for the National Park Service? This is a firm fixed price type contract in which the NPS will pay the monthly cost for services provided IAW the PWS.

2. Are there services that are charged to the National Park Services? If yes, what services?

The services charged to the NPS are the items identified in the price schedule per the requirements of the PWS. Direct medical care is billed directly to the patient.

3. Percent of patients using medical insurance verses private pay? This information is not readily available.

4. Percent breakdown of insurance levels of patients seen and treated (Level 2: 99202, Level 3:

99203, Level 4: 99204, Level 5: 99205) for 2021? This information is not readily available.

5. Most common type of medical patients seen? Top 5 diagnosis? - Infection, Prevention, Medical, Cardiovascular, Respiratory

6. Number of firefighter examinations performed a year? Type and testing components of exam? –

See attachment #7 DO 58 1-5-2022 for NFPA reference.

7. Number or percent of pediatric patients seen and treated? This information is not readily available.

8. Number or percent of mental health patient visits seen and treated? approximately 2-3%.

9. How often is it expected to have the mental health clinician come to the clinic? -Reference the

SOW

10. How many telehealth mental health visits were perform each year? Unknown as the service is new

11. Does the mental health clinician advertise about mental health services only to the Yellowstone

Park?

-Yes

12. What types of POC ultrasound does the incumbent clinic perform? The PWS mentions eFAST only. Any other ultrasound studies? Unkown as the service is new

13. Is it expected to have an ultrasound technician onsite fulltime that performs and read the images? Reference PWS page 10, section g, subsection i.

14. Number of times thrombolytics used in the last year? This information is not readily available.

15. When and what were the last mass casualty incident that the clinic support? Jan 2022, snowcoach rolled on its side with 12 passengers and driver.

16. What are the types of onsite laboratory testing performed compared to offsite testing? All testing referenced in the PWS page 9, section f, subsection ii is onsite testing. There are no offsite testing requirements.

17. Size and biosafety level of area available at each clinic for onsite laboratory testing? Depends on individual configuration choices. See attachment 3 for floor plan details.

18. Size and security of area available for consumable and medication inventory storage? Depends on individual configuration choices. See attachment 3 for floor plan details.

19. Is there a required Electronic Medical Record (EMR) system or can we implement our own system? See PWS page 7, para F, section 2: “The Contractor must maintain all new and existing patients' medical records in an electronic format. The Contractor is responsible for supplying all staff and equipment necessary to store and maintain electronic medical records.”

There is no specified system required.

20. Is the provider responsible for the maintenance and calibration of the National Park Services medical equipment? Is this a chargeable service? See PWS, page 7, “The Contractor is responsible for all facility operations of the assigned clinics. Facility operations include but are not limited to the following…Cleaning or servicing of equipment.”

21. Are Past Performance Questionnaires counted against the 20 page count limitation? No.

22. Are requested attachments (Quality Assurance, Operating plans, etc.) counted against the page limitation? No.

24. Can additional attachments be provided for supplemental information? Yes, but attachments will be counted against the page limitation.

25. What specific license or certification (if any) and in what state or other jurisdictions (if any) are required for the onsite mental health professionals(s). This question is for the onsite mental health service, not for the licensed medical providers working on site who may also provide mental health services. Qualifications are to be proposed by the contractor and approved by the Service

26. Please confirm the proposed contract includes all of the following revenue sources and clarify any restrictions on these or other sources. The contract does not provides for these types of direct payment.

a. Direct pay by patients (varies with volume and type of services delivered)

The contractor is expected to collect and retain these payments as part of their operations

b. Insurance claims for patients (varies with volume and type of services delivered)

The contractor is expected to collect and retain these payments as part of their operations

c. Equivalent to current Seasonal Employee Health Plan Contributions (varies with employee count and participation)

The contractor is expected to collect and retain these payments as part of their operations

d. Current NPS authorized / directed paid "gap" funds paid by hotel, restaurant, gas station concessioners

The contractor is expected to collect and retain these payments as part of their operations

e. Annual fees as required to bid in this RFQ (are these fees fixed per year or do they change with any variables)

Fees paid to the government are firm fixed price

f. Providing of buildings and some equipment as listed.

Listed government assigned facilities and personal property will be made available for use without cost

g. Please list any other sources None

27. Is this a fixed fee contract? No, it is firm fixed price.

28. Can the awarded vendor brand the clinic? Branding and marketing plans are reviewed by the Service and may be approved at the discretion of the Service

29. Can the awarded vendor remodel the clinic space? Potentially but would have to be approved by the Service.

30. Can the government provide the wage determined rate or the category for a mid-level provider (specifically NPs and PAs)? No, this is a professional service and rates are based on competitive market rates rather than a wage determination.

31. Will accessible and inhabitable housing be made available independent of the assigned medical housing listed in attachment 5 at the interior clinic locations to facilitate the early spring operating dates? No additional housing outside the attachment is guaranteed

32. Will contract fees continue to be paid by the Park Service in the event of a Park Closure? -

Dependent on whether services are still being provided.

33. Is the term of this contract 1/1/23 to 12/31/27? Yes, with the possibility of an addition 6-month IAW 52.217-8 if necessary. Also, each clinic has differing operating seasons as indicated in the PWS and price schedule.

34. For those clinics that are seasonal in nature, is it the responsibility of the Contractor to maintain upkeep and maintenance year-round? Yes, to include winterization / spring opening within the facility

35. Will you describe the financial model of this arrangement outside direct patient billing?

Specifically, does this include NPS employees? Does the revenue from the SEHCP go to the

Contractor? Are there other contracted services between NPS and Contractor? Direct patient billing applies to all persons who utilize the clinic. Yes, revenue from SEHCP does go directly to the contractor. There are no other contracted services between NPS and the Contractor outside of the services described in the PWS.

36. Is the intent for Attachment 14 to be the price paid to the Contractor from the NPS per unit

(month/day) of operations for a "subsidy?" Attachment 14 is the price paid per unit, but there is no subsidy.

37. Is there an existing Electronic Health Record (EHR)? Is it property of NPS or the current

Contractor? EHR is not shared nor combined with NPS EMS Recording. EHR is property of

Contractor.

38. Will you more clearly define ‘pharmacy services’ as referenced in the RFQ? Are there baseline expectations? Basic pharmacy necessary to provide the services described in the PWS.

39. Will you share the historical staffing matrices for the 3 clinics? Not available.

40. Will you extend the deadline for proposal submission given public notice was available on

4/15/22?

Yes, see amendment.

41. Please provide the annual report from the current medical vendor for the last three years?

The current services are provided under a concessions contract and annual reports are proprietary.

42. Please provide the following data by clinic for the last three years:

a. Annual revenue and usage by month and location (charges and volumes, by CPT code if available) Not available.

b. Unique visits, total visits, reason for visit, by clinic. If not available, could you share the top 10 diagnosis codes by clinic? All clinics combined: prevention; infection; medical;

cardiovascular; respiratory; neuro; trauma; GI; UTI; dermatology

c. Pharmaceuticals dispensed by location. Basic pharmaceuticals necessary to provide the services described in the PWS.

d. Lab test utilization by location. Not available.

e. Imaging and Ultrasound utilization by location. Not available.

f. Total number of transports out of the park by clinic, and total ground EMS transports out of the park. Ranges between 3-5% of total clinic visits (85% ground; 15% air).

g. Total medical flights out of the park, and the number of flights originating from the clinics, by location. Ranges between 3-5% of total clinic visits (85% ground; 15% air).

h. Seasonal Employee Health Care Program (SEHCP) visits and CPT codes utilized. Not available.

i. What percentage of employees have other health insurance? Not available.

j. Frequency for after-hours call outs, by inclusion criteria and by location. See Attachment 1

Performance Work Statement for inclusion criteria. Call outs vary by year, can be as high as

0.5% of total clinic visits.

k. FTE by site and job category. Unavailable.

43. Please provide a breakdown of the amount collected from the SEHCP and the GAP program for the last year. Please provide the current SEHCP and GAP program brochures and material given to employees. Unavailable.

44. Are Indirect Costs allowed? No, this is not a cost reimbursable contract.

45. Is this contract subject to a franchise fee? If so, what is the current franchise fee? No.

46. Can you please provide samples of promotional materials related to medical care and mental health services utilized throughout the park? This is a new service.

47. Ultrasound: Can you provide a breakdown of the historical utilization by CPT codes for ultrasound services? What are the equipment specifications being utilized by each clinic?

This is a new service.

48. Are images and impressions stored by Medcor? Can you provide a list of the clinical services expected in the clinics related to ultrasound? Unavailable.

49. Is there an additional equipment list from MedCor we would purchase from them? If so, what is the book value of assets (such as equipment, furnishings, etc)?

The contractor will be required to provide all equipment necessary to provide the required services that is not assigned government personal property. The government will not specify how this equipment is to be acquired.

a. What equipment is fully depreciated and will be transferred at no cost to us?

Only government assigned personal property listed will be available at no cost to the contractor

b. Is there a timeline for upgrading any of the radiology equipment?

There is no established timeline for upgrading or replacing government assigned personal property.

50. Are telehealth services currently provided at the clinics? If so, please provide information on what telehealth services are currently available, and what services are expected/required?

Telehealth is a new service, and therefore there is no historical information available.

51. Is there an expectation of direct-to-patient telehealth (i.e., via iPad or mobile app)? Yes.

52. Housing for employees (Cost & Availability)

a. How is housing prioritized for clinic staff? At the discretion of the contractor

b. Is the vendor responsible for maintaining staff housing? Yes

53. Who is responsible for housekeeping for the clinic facilities? The Contractor.

54. How are we able to utilize signage in and around the clinics? Signage plans may be submitted for review and approval at the discretion of the Service and must meet park standards

55. Is there an expected list of future maintenance items we will be expected to complete at clinic facilities and/or staff housing? The contractor is required to provide general maintenance and upkeep.

56. Provide pictures of the clinic facilities if available. Exterior photos are publicly available, however interior images are for internal use only and not currently available.

57. Please provide a five-year capital plan for building maintenance/infrastructure if available.

Not available.

58. Who is the ISP provider for facilities and speeds? Unavailable.

a. Does a coverage map of broadband exist that can be provided? Broadband is available at each clinic but can be slow, especially at peak visitation. The park is considering the installation of fiber optic cable to all developed areas in the time frame of this contract, which will vastly improve broadband access. No specific timeline for this, if any, has been established.

59. Please clarify the requirements for the “small laboratory for minimal diagnostic tests” that is listed under the Lake Facility. Sufficient available testing to meet the requirements of the

PWS.

60. Performance Standards for Performance Requirement 2: How has the current contractor ensured their rates didn’t exceed those of similar communities resulting in zero complaints?

Information is not available. These performance metrics are different than the current contract as this is a FAR firm fixed price contract and the existing contract is a concessionaire contract.

61. Does the park or contractor set fee schedule and conduct analysis? The contractor sets fee schedules.

62. Can you provide the current fee schedule? Does YNP establish the fee schedule for services offered, or does the medical vendor set the pricing? NPS does not set the fee schedule.

64. How are EMS flights from the clinic currently dispatched? Flights are only able to be dispatched through the park Emergency Operations Center.

65. Does YNP have a preference on the flight vendor(s) that transport from the park? The park has a list of available resources. The closest resource is called first and then rotated.

66. Does the medical vendor need to provide vehicles for inter-clinic transportation? NPS EMS is responsible for inter-facility transfers from the clinic to out of park hospital destination. NPS does not transfer from one clinic to another.

67. Regarding pharmacy services regulatory ii: Billings Clinic is DNV certified instead of Joint

Commission. Is Joint commission a requirement if DNV is a comparable certification?

Pharmacy certification must meet the requirements of the state of WY.

68. How is the conservation requirement currently being met? Information not available.

69. How is the medical vendor handling linen services? The contractor will be responsible for arranging for linen services.

70. Can you provide clarification on the pharmacy service expectations specific to pharmacy dispensing for urgent and preventive care? Are medications being dispensed directly by the clinics? Is there an expectation for after-hours pharmaceutical access? Pharmacy services necessary to provide the services described in the PWS. The clinics dispense pharmaceuticals directly. There is no after hours pharmaceutical access expectation.

71. FAR 52.217-5 (RFP p. 25) states that proposals will be evaluated based on price. However, if YNP specifies the patient charge rate, all offerors should have the same price. What other factors are considered in award? NPS does not specify the patient charge rate. The pricing submitted is for the cost of staffing and providing services as outlined in the PWS net of expected revenues.

72. Are there specific quality program indicators that have been established and expected of future the awarded medical vendor? Quality standards have not been established.

73. If available, please provide a summary of utilization of mental health services. How many visits are occurring for mental health services and crisis intervention? How many patients are accessing remote vs in person care? Is utilization primarily therapy or med management psychiatric support? Information not available.

74. What mental health promotion and support has been successful to date? This is a new service.

75. Is there any appropriation for mental health services that isn’t covered by the patient visit fee? There is not appropriation for any services not described in the PWS.

76. How does the EMS communication system currently function within YNP? NPS-owned radio equipment is currently issued to the existing clinic operator for use in communicating with the government. The new contract will require the contractor to purchase and maintain compatible radio equipment.

77. What communication equipment is required to be compatible with the NPS EMS equipment? The NPS will work with the contractor to approve compatible communication equipment.

78. Is there a standard for air transportation, response time, positioning, etc.? This is managed by the NPS and the clinics will not be responsible for tracking.

79. Is there RW search and rescue/backcountry response need? Or does NPS provide? NPS provides backcountry response.

80. How does patient coordination work from National Park Service EMS services, ambulances within the park and at each entrance? Rendezvous based on acuity, location or weather? Patient

Coordination is handled by park dispatch or Emergency Operations Center.

81. What type of patients and modes of transport to outside of the park have occurred in prior data? Destination locations? The park transports via ambulance to area hospitals outside the park.

Dispatch/EOC coordinates rendezvous and air responses.

82. Can the government provide clarification related to the type of support offerors are expected to provide NPS Emergency Services? For example: Dispatch services, chain of communication, in-service trainings, vendor liaison requirements, vendor expectations post operating hours, telehealth requests for emergency personnel.

The Service is not requiring these kinds of support services for NPS EMS. Post operating hours support may include callouts as specified.

83. Are meetings for the Clinic Manager to be on-site in Mammoth?

Meeting sites can be arranged as needed. Mammoth would be the default.

84. Beyond the weekly on-site meetings with NPS, will there be any additional meetings be on-site in Mammoth and scheduled on a monthly or quarterly basis?

As needed.

85. Will meetings with the Clinic Manager be limited to operating hours?

Yes, unless in extraordinary circumstances.

86. How will the “additional services” be accounted for in proposal evaluation?

The unit prices proposed should be fully burdened and inclusive of all services called for in the PWS net of revenues collected.

87. Will the government please provide the list of contractors currently serving NPS that provide janitorial, waste management or additional services that facilitate the clinics operations?

The current clinic operator provides janitorial services. Solid waste management is provided by the Service except for medical waste, which the Contractor will need to provide as described.

88. Please list the location of sites where travel trailers or fifth wheel trailers can be utilized. Will contractor be required to secure the space for travel trailers year-round?

Travel trailer sites may be available at Old Faithful and Lake. The sites are not reserved or maintained by the contractor year-round and the contractor or its employees are responsible for securing the space only when occupied.

89. If contractors utilize trailers for staff housing, will the sites need to be reserved year-round?

Will contractors be required to pay rent for the land?

Trailer sites, when available, are reserved only when in use and rent is paid only when occupied.

90. How will replacement or modernization of equipment be addressed at the clinics for those items provided by NPS?

The NPS will work collaboratively with the contractor to replace or modernize assigned personal property as needed on an ongoing basis. No set schedule exists.

91. How are you managing pharmacy needs currently? Current concessioner is managing self needs.

92. Who (what labor category) is currently performing x-ray and ultrasound services in the clinic? Information not available.

93. What locked rooms or dedicated areas will there be to facilitate pharmacy operations at all clinics? Dependent upon contractor configuration of assigned facilities.

94. Will the government provide the utilization data for ultrasound and x-rays services from the past five years? New service, no utilization records.

95. Will the government provide the current project staffing model?

Minimum staffing requirements are provided in the PWS.

96. How many housing units are being used under the current contract per site during the on-season vs during the off season?

The list of available housing is representative of current usage.

Are personnel who are required to perform quarterly or monthly on the contract considered in the housing plan currently provided? For example, Mental Health professorial. If not, is there additional housing set aside for surge events? The list of available housing is representative of current usage.

Will the government guarantee housing to house the required personnel? The list of available housing is representative of current usage. The government does not guarantee housing beyond this list.

97. Does SEHCP include commercial contracted employees? If not, would the contractor have the option to promote this program to commercial contracted employees? The contractor may be permitted to market the SEHCP to contractor employees with review and approval from the Service.

98. Does the government own the current clinic website, or will the offeror be responsible for creating and maintaining the clinic website? The government does not own the clinic website. The contractor will be expected to establish and maintain its own.

99. Is the Medical Director referenced in the Quality Assurance Program the same as the Fire

Department Physician referenced in the PWS? If not will the Medical Director also be required to be on-site, or what hours are expected, services to NPS? Currently, the medical director and the department physician are not the same person. The medical director is not currently required to be onsite.

100. States “The Contractor is responsible for working directly with the provider for all other utility services, including, but not limited to electricity, phones, and internet.” Please confirm the Contractor is not responsible for the costs associated with these utilities. If the awarded Contractor is responsible for these charges, please provide a complete list of all utility services the Contractor will be responsible for and the average historical/annual cost of these services. The contractor is responsible for all utility services not provided by the NPS, including electricity, phones, and internet. Historical costs are not available.

101. Please confirm the Contractor is not responsible for lawn and landscaping maintenance for the Lake Clinic and/or Old Faithful Clinic.

The contractor is not responsible for lawn or landscaping maintenance at the Lake and Old

Faithful clinic.

102. States “The Contractor must provide all other equipment necessary to provide the required services under this contract.” Please confirm that the Contractor is responsible for all computer(s) and medical-related electronic hardware.

The contractor is responsible for providing all equipment necessary to successfully provide the required services that is not specifically listed in the assigned personal property.

103. Please provide historical data/utilization/costs as it relates to pharmacy services, laboratory services/testing, ultrasound services, and X-ray services. Information not available.

104. Please confirm that CLIN 0020 Telehealth Mental Health Services is for a mental health care provider to provide telehealth mental health services onsite in Yellowstone for one day, quarterly. Confirmed

105. States “the Contractor will bill for all costs associated with the above services as part of the Basic Level of Services.” Please confirm this is an error and the costs associated with

Telehealth Mental Health Services and Crisis Intervention need to be billed under the CLIN

0020 line item. Telehealth services will be billed under CLIN 0020. The PWS will be corrected to reflect this.

106. The clinic-specific requirements for Lake Medical Services Facility and Old Faithful

Medical Facility require Telehealth Mental Health Services and Crisis Intervention; however, there is no line item for CLIN 0020 on attachment

“Attachment_14_Price_Schedule_Final.xlsx” for these facilities. Please advise where these costs need to be captured and if it is the same requirement as it is for Mammoth Hot Springs

Clinic. As indicated in the header of Attachment 14, CLIN 0020 is for Mammoth, Old

Faithful, and Lake.

107. Please provide the operating hours for each facility during each performance period.

Current clinic hours can be found on the current operator’s website:

https://www.medcor.com/yellowstone/

108. Please confirm that all training and orientation can be completed during normal business hours. Some training may be accomplished during temporary clinic closures, as needed.

109. The CLIN structure on the pricing worksheet for each service, facility, and year is the same. Will the Government please change the CLIN structure on the pricing sheet to differentiate between the different services, facilities, and contract years? The CLIN structure is set up in that manner because of the services being provided at each clinic shall be the same, the difference is the location of performance throughout the year. Furthermore the services required per CLIN are explained in detail in attachment 1 PWS. The CLIN structure will remain as is.

110. There are discrepancies between the pricing worksheet and the base period scheduling for the Old Faithful Clinic in the PWS (page 13 of 23). The PWS shows that the period of performance for the two-day clinics for the Old Faithful Clinic is from December 15 through March 15; however, the pricing worksheet shows the POP for the base period to be

01/01/23—03/15/23. Further, the POP for the base year is only 2.5 months in the pricing worksheet and three months for Option Years One – Four. Please confirm that this is an oversight, and the pricing worksheet should show three months for the base period. If this is not an oversight and there will only be two 2-day clinics in the base period, we kindly request that the unit of measure for each year be changed from “Month” to “One 2-Day

Clinic” and the “Quantity” changed to 2 for the base period. The description in the header indicates the dates which there will be 2 day clinic services. The Government respectfully declines the request to alter the unit of issue and quantity.

111. Will the Government please provide the 5-year budget for this requirement? The

Government does not release our Government estimates for requirements.

112. Will the government please provide previous utilization of services at the various clinic sites, number of patients seen, top 10 diagnosis and top 10 procedure codes? See other questions / answers for available information.

113. Will the government provide the current billable services being performed and the associated fee schedule? Current billable services information is not available. The fee schedule is set by the contractor.

114. Will the government provide utilization data for emergency services that required services such as response or personnel from the medical clinic vendor? Variable. See other questions / answers.

115. Will licensed healthcare workers who are licensed in areas/states covered in the park but not in the state of Wyoming be able to practice at the clinics under federal protections while licensing for the state of Wyoming is being obtained? Providers must be licensed in WY to perform their work for billable services.

116. Please provide the current staffing model and pay rates for each facility. This information is not available.

117. Please provide the current contract, contract price, and exhibits. There is no current contract in place.

118. What are the primary payers that the clinics accepts for billing? Direct patient billing.