15B20118R00000001_-_Solicitation.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

15B20118R00000001

2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

12/08/2017

7. FOR SOLICITATION INFORMATION

CALL:

a. NAME

Vikram Sighamony vsighamony@bop.gov

b. TELEPHONE NUMBER (No collect calls)

(972) 352-4516

8. OFFER DUE DATE / LOCAL

TIME

02/09/2018 2:00 PM CST

CODE 15BFA0

Federal Bureau of Prisons Field Acquisition Office U.S. Armed Forces Reserve Complex 346 Marine Forces Drive Grand Prairie, TX 75051

9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS: 622110

SIZE STANDARD: $38,500,000

10. THE ACQUISITION IS

SEE

SCHEDULE

X

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

NET 30

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER DPAS

(15 CFR 700)

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

15B201CODE15. DELIVER TO

Federal Bureau of Prisons FCC Allenwood

ROUTE 15

2 MILES NORTH OF ALLENWOOD

Allenwood, PA 17810

CODE 15B20116. ADMINISTERED BY

Federal Bureau of Prisons FCC Allenwood

ROUTE 15

2 MILES NORTH OF ALLENWOOD

Allenwood, PA 17810

FACILITY

CODE

CODE

TELEPHONE NO.

17a. CONTRACTOR/

OFFEROR

15B201CODE18a. PAYMENT WILL BE MADE BY

Federal Bureau of Prisons FCC Allenwood

ROUTE 15

2 MILES NORTH OF ALLENWOOD

Allenwood, PA 17810

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

Comprehensive Medical Services for the Federal Correctional Complex (FCC) Allenwood, Pennsylvania.

See Section 2, Schedule of Items; Section 2.1, Contract Pricing; and 2.2, Performance Work Statement

See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

15B20118R00000001 Page 1 of 55

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

15B20118R00000001 Page 2 of 55

Table of Contents

Section Description Page Number

1 Solicitation/Contract Form 2 Commodity or Services Schedule

2.1 Contract Pricing/Sub-Contract Certification

2.2 Performance Work Statement

3 Contract Clauses 52.21-603-70 Contracting Officer's Representative (COR) (June 2012) 52.24-403-70 Notice of Contractor Personnel Security Requirements (OCT 2005)

52.27-103-72 DOJ CONTRACTOR RESIDENCY REQUIREMENT BUREAU OF PRISONS (JUNE

2004)

52.218-000 CONTINUING CONTRACT PERFORMANCE DURING A PANDEMIC INFLUENZA

OR OTHER NATIONAL EMERGENCY (May 2008) 2852.223-70 Unsafe Conditions Due to the Presence of Hazardous Material (June 1996)

52.242-71 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS (APR

2011) DJAR-PGD-14-05 Federal Workplace Responses to Domestic Violence, Sexual Assault, and Stalking DJAR-PGD-15-03 Security of Department Information and Systems DJAR-PGD-15-02-2A Corporate Representation Regarding Felony Conviction Under Any Federal Law or Unpaid Delinquent Tax Liability - Award (DEVIATION 2015-02) (March 2015) DJAR-PGD-15-02-2B Contractor Internal Confidentiality Agreements or Statements Prohibiting or Restricting Reporting of Waste, Fraud, and Abuse - Award - (DEVIATION 2015-02) (March 2015) .26 DJAR-PGD-15-02-2C Contractor Certification of Compliance with Federal Tax Requirements - Award (DEVIATION 2015-02) (March 2015) 52.203-17 Contractor Employee Whistleblower Rights and Requirement To Inform Employees of Whistleblower Rights (Apr 2014) 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (June 2016) 52.216-18 Ordering (Oct 1995) 52.216-19 Order Limitations (Oct 1995) 52.216-21 Requirements (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.232-19 Availability Of Funds For The Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997) 52.252-6 Authorized Deviations in Clauses (Apr 1984) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders--Commercial Items (Nov 2017)

4 List of Attachments

4.1 Special Contract Conditions

5 Solicitation Provisions 52.209-7 Information Regarding Responsibility Matters (Jul 2013) 52.209-12 Certification Regarding Tax Matters (Feb 2016)

5.1 Tailoring

5.2 Submission and Evaluation of Proposals

DJAR-PGD-15-02-1A Corporate Representation Regarding Felony Conviction Under Any Federal Law or Unpaid Delinquent Tax Liability - (DEVIATION 2015-02) (March 2015) DJAR-PGD-15-02-1B Contractor Internal Confidentiality Agreements or Statements Prohibiting or Restricting Reporting of Waste, Fraud, and Abuse - Solicitation - (DEVIATION 2015-02) (March 2015) DJAR-PGD-15-02-1C Contractor Certification of Compliance with Federal Tax Requirements - Solicitation - (DEVIATION 2015-02) (March 2015) 52.233-2 Service of Protest (Sept 2006) 2852.233-70 Protests Filed Directly with the Department of Justice (Jan 1998)

52.27-103-71 FAITH-BASED AND COMMUNITY-BASED ORGANIZATIONS (AUG 2005)

52.252-5 Authorized Deviations in Provisions (Apr 1984) 52.212-2 Evaluation - Commercial Items (Oct 2014) 52.212-3 Offeror Representations and Certifications--Commercial Items (Nov 2017)

15B20118R00000001 Page 3 of 55

Section 2 - Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 Comprehensive Medical Services for the Federal Correctional Complex (FCC) Allenwood, Pennsylvania.

Base Year: Effective Date of Award (EDOA) through 12 months from EDOA.

12.000000 MO $____________ $___________________

0002 Comprehensive Medical Services for the Federal Correctional Complex (FCC) Allenwood, Pennsylvania.

Option Year 1: 13 months from Effective Date of Award (EDOA) through 24 months from EDOA.

12.000000 MO $____________ $___________________

0003 Comprehensive Medical Services for the Federal Correctional Complex (FCC) Allenwood, Pennsylvania.

Option Year 2: 25 months from Effective Date of Award (EDOA) through 36 months from EDOA.

12.000000 MO $____________ $___________________

0004 Comprehensive Medical Services for the Federal Correctional Complex (FCC) Allenwood, Pennsylvania.

Option Year 3: 37 months from Effective Date of Award (EDOA) through 48 months from EDOA.

12.000000 MO $____________ $___________________

0005 Comprehensive Medical Services for the Federal Correctional Complex (FCC) Allenwood, Pennsylvania.

Option Year 4: 49 months from Effective Date of Award (EDOA) through 60 months from EDOA.

12.000000 MO $____________ $___________________

0006 Comprehensive Medical Services for the Federal Correctional Complex (FCC) Allenwood, Pennsylvania.

Option to Extend Services as authorized by FAR 52.217-8

6.000000 MO $____________ $___________________

2.1 Contract Pricing/Sub-Contract Certification

Blocks 19 Through 24 - Contract Pricing/Sub-Contract Certification

Overview Services are required to be provided in accordance with the Performance Work Statement included in this solicitation/contract. Offer-ors are required to submit, as a part of their business proposal, a completed copy of Schedule of Items/Sub-Contract Certification.

Pricing Methodologies

Except for services based on session rates, price proposals will be calculated from benchmarks utilizing Medicare reimbursement methodologies. For each category of services to be provided, offerors will be allowed to propose a variance from the benchmark Medicare rate in the form of a discount from or a premium to Medicare rates established by the Centers for Medicare and Medicaid Services. The rates established in the resulting contract shall not be construed as participation in the Medicare program; contract rates will merely be equated to Medicare rates of reimbursement without reductions for deductibles, copayments, or coinsurance. When ap-propriate, outlier payments calculated in accordance with Medicare reimbursement methodologies shall be made in recogni-tion of extremely costly stays. The outlier payment shall be calculated based upon the defined benchmark and will consist of the op-erating portion only. This structuring of the pricing methodology is not intended to be restrictive of any offeror; offerors need only to propose that percentage discount from or premium to the Medicare benchmark rate which will reflect the desired level of payment for the category of services rendered. If during contract performance, it is determined that a necessary contract deliverable is not covered by Medicare reimbursement methodologies, a separate rate shall be negotiated for such deliverable(s).

Medicare Part A. The Medicare benchmark to be utilized for all services covered by Medicare Part A shall be the most current Basic MS-DRG payment (i.e., Operating Federal Rate) established for Core Based Statistical Area (CBSA) 48700, Williamsport, PA. The Basic MS-DRG calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Offerors may propose a discount from or a premium to Basic MS-DRG rates. (Refer to Attachment 1 of this solicitation.)

Medicare Part B Physician Services and Non-physician Services. The Medicare benchmark to be utilized for all physician and

15B20118R00000001 Page 4 of 55 non-physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for Payment Locality 99 for Pennsylvania. The benchmark charges shall be those established for participating providers. Offerors may propose a discount from or a premium to the benchmark charges.

Medicare Part B Facility Services (including hospital outpatient services and ambulatory surgical centers). The Medicare benchmark to be utilized for all facility services covered by Medicare Part B shall be the most current APC and ASC rates calculated for CBSA 48700, Williamsport, PA. Offerors may propose a discount from or a premium to the benchmark charges.

Skilled Nursing Facility Services. The Medicare benchmark to be utilized for skilled nursing facility services covered by Medicare Part A shall be the most current DRG Payment amount (i.e., Federal Rate) established for CBSA 48700, Williamsport, PA.

Estimated Charges

Estimated quantities for the base year and all option years are detailed below. The estimated quantities provided are not a representa-tion to the offeror/contractor that the estimated quantities will be required or ordered or that conditions affecting requirements will be stable or normal.

Inpatient and Outpatient Facility and Physician Services

Base Year - Effective Date of Award (EDOA) through twelve (12) months from EDOA

Inpatient Days: 900 days (estimated) Outpatient Days: 1,400 days (estimated) Skilled-Nursing Facility: 1,095 days (estimated)

Option Year 1 - Thirteen (13) months through twenty-four (24) months from EDOA

Inpatient Days: 1,000 days (estimated) Outpatient Days: 1,500 days (estimated) Skilled-Nursing Facility: 1,095 days (estimated)

Option Year 2 - Twenty-five (25) months through thirty-six (36) months from EDOA

Inpatient Days: 1,100 days (estimated) Outpatient Days: 1,600 days (estimated) Skilled-Nursing Facility: 1,095 days (estimated)

Option Year 3 - Thirty-seven (37) months through forty-eight (48) months from EDOA

Inpatient Days: 1,200 days (estimated) Outpatient Days: 1,700 days (estimated) Skilled-Nursing Facility: 1,095 days (estimated)

Option Year 4 - Forty-nine (49) months through sixty (60) months from EDOA

Inpatient Days: 1,300 days (estimated) Outpatient Days: 1,800 days (estimated) Skilled-Nursing Facility: 1,095 days (estimated)

Option to Extend Services as authorized by FAR 52.217-8 - Sixty-One (61) months from EDOA to sixty-six (66) months form EDOA.

Inpatient Days: 650 days (estimated) Outpatient Days: 900 days (estimated) Skilled-Nursing Facility: 550 days (estimated)

Outpatient Institution Services

Estimated quantities shall remain constant for the base year and all option years. For Medicare-based services, duration of visits is lis-ted for informational purposes only, as contracted rates will be based upon the Medicare allowable per procedure performed. Because Medicare rates are typically not available for Mobile MRI, Mobile CT, and Oral Surgeon, these categories shall be paid by defined sessions.

Cardiologist: Visit duration - 2 hours (approximate) Visit quantity - 24 visits per contract year

15B20118R00000001 Page 5 of 55

Cardiac Stress Testing Visit duration - 8 hours (approximate) Visit quantity - 8 visits per contract year

Dermatologist: Visit duration - 4 hours (approximate) Visit quantity - 16 visits per contract year

ENT Specialist: Visit duration - 4 hours (approximate) Visit quantity - 16 visits per contract year

EMG Services: Visit duration - 8 hours (approximate) Visit quantity - 16 visits per contract year

Gastroenterologist: Visit duration - 4 hours (approximate) Visit quantity - 36 visits per contract year

General Surgeon: Visit duration - 4 hours (approximate) Visit quantity - 36 visits per contract year

Hematologist: Visit duration - 2 hours (approximate) Visit quantity - 24 visits per contract year

Mobile CT Session duration - 10 exams per clinic (approximate) Session quantity - 16 sessions per contract year

Mobile MRI Session duration - 10 exams per clinic (approximate) Session quantity - 16 sessions per contract year

Nephrologist: Visit duration - 4 hours (approximate) Visit quantity - 16 visits per contract year

Neurologist: Visit duration - 4 hours (approximate) Visit quantity - 16 visits per contract year

Occupational Therapist Visit duration - 4 hours (approximate) Visit quantity - 48 visits per contract year

Oncologist: Visit duration - 2 hours (approximate) Visit quantity - 24 visits per contract year

Ophthalmologist: Visit duration - 4 hours (approximate) Visit quantity - 16 visits per contract year

Oral Surgeon: Session duration - 8 hours (approximate) Session quantity - 8 sessions per contract year

Orthopedic Surgeon: Visit duration - 4 hours (approximate) Visit quantity - 36 visits per contract year

Psychiatrist: Visit duration - 4 hours (approximate) Visit quantity - 16 visits per contract year

Urologist: Visit duration - 4 hours (approximate) Visit quantity - 36 visits per contract year

Note: Session-priced items which exceed the established session or are less than a full session shall be pro-rated to the nearest quarter hour.

Schedule of Items

Offerors shall complete the following Schedule of Items. All proposed pricing and participation targets will be evaluated in accord-ance with Federal Acquisition Regulation (FAR) 52.212-2, Evaluation - Commercial Items, and Section 5.2, Evaluation Proposals, of this solicitation.

15B20118R00000001 Page 6 of 55

Schedule of Items

Base Year

Effective Date of Award (EDOA) through twelve (12) months from EDOA

1a. Inpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part A 1b. Outpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part B 1c. Skilled-Nursing Facility - ____________ Discount or + _____________ Premium to Medicare Part B 2a. Inpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2b. Outpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2c. Outpatient Institution Services:

2c1. Other Physicians: - ____________ Discount or + _____________ Premium to Medicare Part B 2c2. Oral Surgeon: $__________ per session 2c3. Mobile MRI: $__________ per exam 2c4. Mobile CT: $ __________ per exam

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE "-/+" PERCENT-

AGE. IF NO VARIANCE, ENTER "0".

Option Year 1

Thirteen (13) months through twenty-four (24) months from EDOA

1a. Inpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part A 1b. Outpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part B 1c. Skilled-Nursing Facility - ____________ Discount or + _____________ Premium to Medicare Part B 2a. Inpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2b. Outpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2c. Outpatient Institution Services:

2c1. Other Physicians: - ____________ Discount or + _____________ Premium to Medicare Part B 2c2. Oral Surgeon: $__________ per session 2c3. Mobile MRI: $__________ per exam 2c4. Mobile CT: $ __________ per exam

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE "-/+" PERCENT-

AGE. IF NO VARIANCE, ENTER "0".

Option Year 2

Twenty-five (25) months through thirty-six (36) months from EDOA

1a. Inpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part A 1b. Outpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part B 1c. Skilled-Nursing Facility - ____________ Discount or + _____________ Premium to Medicare Part B 2a. Inpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2b. Outpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2c. Outpatient Institution Services:

2c1. Other Physicians: - ____________ Discount or + _____________ Premium to Medicare Part B 2c2. Oral Surgeon: $__________ per session 2c3. Mobile MRI: $__________ per exam 2c4. Mobile CT: $ __________ per exam

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE "-/+" PERCENT-

AGE. IF NO VARIANCE, ENTER "0".

Option Year 3

Thirty-seven (37) months through forty-eight (48) months from EDOA

1a. Inpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part A 1b. Outpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part B

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1c. Skilled-Nursing Facility - ____________ Discount or + _____________ Premium to Medicare Part B 2a. Inpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2b. Outpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2c. Outpatient Institution Services:

2c1. Other Physicians: - ____________ Discount or + _____________ Premium to Medicare Part B 2c2. Oral Surgeon: $__________ per session 2c3. Mobile MRI: $__________ per exam 2c4. Mobile CT: $ __________ per exam

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE "-/+" PERCENT-

AGE. IF NO VARIANCE, ENTER "0".

Option Year 4

Forty-nine (49) months through sixty (60) months from EDOA

1a. Inpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part A 1b. Outpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part B 1c. Skilled-Nursing Facility - ____________ Discount or + _____________ Premium to Medicare Part B 2a. Inpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2b. Outpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2c. Outpatient Institution Services:

2c1. Other Physicians: - ____________ Discount or + _____________ Premium to Medicare Part B 2c2. Oral Surgeon: $__________ per session 2c3. Mobile MRI: $__________ per exam 2c4. Mobile CT: $ __________ per exam

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE "-/+" PERCENT-

AGE. IF NO VARIANCE, ENTER "0".

Option to Extend Services as Authorized by FAR 52.217-8

Sixty-one (61) months through sixty-six (66) months from EDOA, estimated, if exercised.

1a. Inpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part A 1b. Outpatient Facility Services: - ____________ Discount or + _____________ Premium to Medicare Part B 1c. Skilled-Nursing Facility - ____________ Discount or + _____________ Premium to Medicare Part B 2a. Inpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2b. Outpatient Physician Services: - ____________ Discount or + _____________ Premium to Medicare Part B 2c. Outpatient Institution Services:

2c1. Other Physicians: - ____________ Discount or + _____________ Premium to Medicare Part B 2c2. Oral Surgeon: $__________ per session 2c3. Mobile MRI: $__________ per exam 2c4. Mobile CT: $ __________ per exam

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT APPLICABLE "-/+" PERCENT-

AGE. IF NO VARIANCE, ENTER "0".

All offerors are hereby advised that the successful offeror's unit pricing (to include discount percentage from or premium percentage to the benchmark Medicare rate) for the base year and all option years is public information, in accordance with Federal Acquisition Regulation (FAR) 15.503(b)(1)(iv). Accordingly, all successful unit pricing will be released to unsuccessful offerors with the notifica-tion of award as well as to the general public when requested. Any party who objects to the release of their own unit pricing informa-tion, should they be awarded a contract in response to this solicitation, should not submit proposal in response to the solicitation.

Sub-Contract Certification:

This contract does ________ does not _________ provide for subcontracting possiblities.

If answer is in the affirmative, offeror will submit ________ a sub-contracting plan in accordance with the requirements of FAR 52.219-9, Small Business Subcontracting Plan.

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2.2 Performance Work Statement

I. Background

The Federal Bureau of Prisons (BOP) was established in 1930 to provide more progressive and humane care for Federal inmates, to professionalize the prison service, and to ensure consistent and centralized administration. Today, the BOP is responsible for the cus-tody and care of approximately 185,000, Federal offenders. The Federal prison system is a nationwide system of prisons and detention facilities for the incarceration of inmates who have been sentenced to imprisonment for Federal crimes and the detention of individu-als awaiting trial in Federal court. It is the mission of the Federal BOP to protect society by confining offenders in the controlled en-vironments of prisons and community-based facilities that are safe, humane, cost-efficient, and appropriately secure, and that provide work and other self-improvement opportunities to assist offenders is becoming law-abiding citizens.

As an agency under the Executive Branch of the United States Government, the BOP receives an annual appropriation of funds to ac-complish its assigned mission. The public trust demands that this annual appropriation be prudently managed. Thus, dollars spent to maintain the health of the inmate population must reflect the agency's best efforts to obtain cost-effective health care consistent with community standards.

In meeting the health care needs of a growing inmate population, the BOP provides essential medical, dental, and mental health ser-vices to Federal inmates by BOP staff. When a medical need arises which cannot be provided within prison walls by BOP staff, refer-rals are then made to community-based providers. It is the goal of this solicitation to establish a contractual agreement that will provide necessary professional and facility services for both inpatient admissions and outpatient encounters.

The BOP intends to make a single award to a responsible entity for the provision of Comprehensive Medical Services for the Federal Correctional Complex (FCC) in Allenwood, Pennsylvania. FCC Allenwood currently houses male inmates. FCC Allenwood is a com-plex comprised of three (3) institutions: a Low Security Correctional Institution (LSCI), a Federal Correctional Institution (FCI), and a United States Penitentiary (USP). The FCC is presently identified as a Care Level II BOP facility at its LSCI and as a Care Level III at its FCI and USP locations. Care Level II and III are intermediate classifications on the four-level scale where Care Level I repres-ents the healthiest inmates and Care Level IV represents inmates with serious health issues. Criteria for categorizing an inmate in the Care Level II and III categories are included as Attachment 2. Despite this description of the general health of the inmate population, however, needs for inmate healthcare may arise at varying levels of complexity.

In evaluating offers, the Government will evaluate the proximity of the proposed community-based providers, in addition to other factors, and give preference to those providers located nearest FCC Allenwood. Although a mileage restriction has not been placed on this acquisition, the Government reserves the right to determine that the proposed driving distances/conditions to community-based providers pose an unacceptable cost or security risk and to find such offers unacceptable.

II. Organizational Conflict of Interest

The objective of this solicitation is to satisfy the BOP's requirement for the provision of health care to the inmates of the FCC. A po-tential organizational conflict of interest may arise if the awardee is an entity which also holds or participates in a separate contract/ agreement with the BOP as a medical claims adjudicator. A possible conflict of interest may exist if the awardee has dual responsiblit-ies for the submission of medical claims for services rendered under the resulting contract and for the adjudication of those medical claims under a separate contract/agreement with the BOP.

Offers received from any firm which holds or participates in a separate contract/agreement for BOP medical claims adjudication ser-vices must address any potential organizational conflict of interest that may arise and must provide a detailed explanation of how such conflicts will be avoided. Offers received from any firm which holds or participates in a separate contract/agreement for BOP medical claims adjudication services which fail to adequately address/resolve potential conflict of interest will be rejected without further con-sideration. This limitation on the eligibility of offerors has been imposed as authorized by Federal Acquisition Regulation (FAR) 9.506.

III. Statement of Output

Within this Performance Work Statement (PWS), necessary services are described in terms of output rather than specific task assign-ments. The BOP desires to make an award to the offeror who can provide the best value, considering the diversity of available services and price, among other criteria specified in Section 5.2. Therefore, the Government may award any or all items, may withhold award of any or all line items, or may award to an offeror who proposes less than the full complement of services contained in this solicita-tion. Accordingly, output items 1 and 2 are optional deliverables while output items 3, 4, and 5 are applicable to all services provided.

Offerors are encouraged to submit comprehensive proposals committing to provide all outputs listed in the solicitation. Offerors who propose less comprehensive approaches will be evaluated accordingly.

Output #1: Provide inpatient and outpatient facility services and skilled nursing facility services which conform to community standards and all local, state, and Federal laws and regulations applicable to the delivery of health care to members of the gen-eral public. (Cross-reference pricing categories 1a, 1b, and 1c)

15B20118R00000001 Page 9 of 55

Output #2: Provide professional services which conform to community standards and all local, state, and Federal laws and reg-ulations applicable to the delivery of health care to members of the general public. (Cross-reference pricing categories 2a, 2b, 2c1, 2c2, 2c3, and 2c4)

Output #3: Submit properly-priced invoices for services rendered.

Output #4: Manage medical record information in a manner which promotes continuity of care while observing restrictions on the release of information.

Output #5: Maintain open avenues of communication, facilitating the exchange of information between the contract provider, contract facility, and the Government regarding the contract services.

IV. Compliance with Contract Requirements

The Contractor's efforts under this contract shall be monitored to ensure that the required output is achieved. The Government reserves the right to inspect and evaluate in a reasonable manner all services rendered during the performance of this contract. The Contractor's performance will be measured by the Goverment utilizing the outcome measure indicators provided in Attachment 3.

The Contractor is responsible for all management and quality control actions necessary to meet the quality standards set forth by this contract. Prior to commencing performance, the Contractor shall develop and submit a Quality Control Plan (QCP) for FCC Allen-wood's approval. Once the QCP is approved by FCC Allenwood, the Contractor shall utilize the QCP to guide and rigorously docu-ment the implementation of the required management and quality control actions to achieve the specified output.

V. Specific Requirements

Output #1: Provide inpatient and outpatient facility services and skilled nursing facility services which conform to com-munity standards and all local, state, and Federal laws and regulations applicable to the delivery of health care to mem-bers of the general public.

Output #1 is an optional deliverable. However, if the offeror proposes to provide these services, the following minimum requirements apply. Throughout the performance of this contract, the Contractor shall not utilize any provider that appears on the List of Excluded Individuals/Entities (LEIE) maintained by the Department of Health and Human Services.

If proposed, the Contractor shall provide facility services on an as-needed basis in a manner which adheres to community standards of quality and cost-effective medical care. The services required to satisfy Output #1 may include inpatient facility and outpatient facil-ity, including emergency services. Inpatient visits for non-emergency services shall require private room accommodations with avail-able space for up to three armed or unarmed guards per inmate.

It is FCC Allenwood's preference to obtain the services of facilities that are accredited by the Joint Commission. Offerors utilizing fa-cilities which maintain accreditation by the Joint Commission shall submit a copy of the current accreditation certificate as part of the Offeror's technical proposal. If an offeror intends to utilize a facility which is accredited or certified by any other recognized profes-sional accrediting body, the offeror shall submit documentation validating this accredition or certification as a part of its proposal.

The Offeror's technical proposal shall discuss in detail the diversity of services, as well as the proximity of facility providers to FCC Allenwood, that it is capable to achieve Output #1.

Output #2: Provide professional services which conform to community standards and all local, state, and Federal laws and regulations applicable to the delivery of health care to members of the general public.

Output #2 is an optional deliverable. However, if the Offeror proposes to provide these services, the following minimum requirements shall apply. Throughout the performance of this contrat, the Contractor shall not utilize any provider that appears on the List of Ex-cluded Individuals/Entities (LEIE) maintained by the Department of Health and Human Services.

Community-Based Services

Professional services resulting from a BOP referral are necessary to be performed in a community-based setting (e.g., hospital facility, surgicial center, physician's office, etc.). If proposed, the Contractor shall provide the services of professional medical staff who have appropriate educational qualification, experience, licensure, and board certification (where required) to achieve Output #2. This output specifically excludes the provision of radiological interpretations of BOP-provided films, images, or other media.

The Contractor shall be required to document primary source verification of medical education, residency and fellowship, hospital af-filiations, previous work experiences, references, licensure, board certification, DEA, insurance, National Practitioner Database, OIG, EPLS, and background screening as appropriate. Initial appointment and reappointment requires review by the FCC Allenwood Exec-utive and Chief Medical Officer, to include FCC Allenwood's governing body. The Contractor's credentialing office will be respons-

15B20118R00000001 Page 10 of 55 ible for performing the credentialing and privileging functions to ensure all physicians also maintain a current Pennsylvania medical license, DEA registration, and board certification, as applicable. The annual letter of good standing will be provided to FCC Allen-wood to confirm clinical privileges, staff status, and employment information has been verified by the contractor for the Contractor's physicians. The Contractor's credentialing and privileging processes must conform to the regulatory requirements of the Joint Com-mission, the Centers for Medicare and Medicaid Services (CMS), and applicable state and federal agencies. Contractor must provide a copy of their credentialing policies and procedures to FCC Allenwood.

Whenever possible, appointments for specialty care should be available within 14 calendar days from the date of referral to the spe-cialty provider. This practice promotes the safety and security of the Federal prisoner, the escorting correctional staff, and the general public. The medical urgency of any referral must receive consideration in the scheduling and delivery of professional services.

For prescriptions to be filled by FCC Allenwood's pharmacy, contract providers shall only prescribe pharmaceutical drugs that are lis-ted in the approved BOP Formulary. The BOP Formulary can be accessed at https://www.bop.gov/resources/pdfs/formulary.pdf. Re-quests for exemptions shall be submitted to the Contracting Officer's Representative (COR), who shall obtain the required approvals.

As part of the Discharge Instructions, the issuance of sample medication to any Federal inmate shall be prohibited.

The Offeror's technical proposal shall discuss in detail the diversity of services, as well as the proximity of professional providers to FCC Allenwood, that it is capable of providing to achieve Output #2.

Institution-Based Services

As an additional tool to satisfy Output #2, professional services may be performed within the confines of FCC Allenwood. If the res-ulting contract does not provide for telemedicine consultation or all of the on-site clinics listed, FCC Allenwood reserves the right to pursue such contracts. FCC Allenwood also reserves the right to determine the manner of an inmate's referral, i.e., via on-site clinic, via community-based referral, via telemedicine consult, or any other method FCC Allenwood determines to be reasonable and appro-priate.

If the Contractor performs on-site specialty clinics at FCC Allenwood, the following minimum requirements shall apply. Contract ser-vices shall be provided on-site within the Health Services Unit of FCC Allenwood. Consultations shall be limited to the chief com-plaint on the BOP consultation form. Services shall include diagnosis and treatment of medical conditions with appropriate referral, if necessary, to a specialist at the contract medical facility. Scheduling of clinics shall be subject to the mutual agreement of FCC Allen-wood and the contract provider. Scheduling of inmates for on-site clinics shall be performed by FCC Allenwood.

Providers performing institution-based services shall hold an appropriate current license to practice medicine in the State of Pennsylvania. Providers performing institution-based (and/or telemedicine) services shall apply for clinical privileges at FCC Allen-wood. All clinical privileges shall be appropriate to the qualifications of the provider and the resources of the facility where care is provided. Any clinical privileges granted due to the award of this contract shall be contingent upon the continuation of this contract and upon the provider's continued affiliation with the Contractor or any subcontractor. Continuation of privileges at FCC Allenwood shall be at the sole discretion of FCC Allenwood. Non-physician providers shall maintain active licenses from the State of Pennsylvania, as applicable.

The following specialty clinics/sessions may be conducted at FCC Allenwood, contingent upon an acceptable offer. The BOP reserves the right to award some, all, or none of the following on-site clinics:

Cardiac Stress Testing Cardiology Dermatology EMG Services ENT Specialist Gastroenterology General Surgery Hematology Mobile CT Mobile MRI Nephrology Neurology Occupational Therapy Ophthalmology Oncology Oral Surgery Orthopedic Surgery Psychiatry Urology

Specific On-Site Clinic Requirements:

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Mobile MRI/CT. The Contractor shall provide MRI and CT services for FCC Allenwood. The Contractor shall provide, without limitation, readings, interpretations, make diagnosis, and provide clinical recommendations and modalities deemed essential and clin-ically necessary for these services.

For services provide at FCC Allenwood, the mobile unit will enter and park at the rear Sallyport. The units must be capable of passing through two gates that are a 13'6" maximum height. Electrical hook ups for 480v 3 Phase is provided at the USP and FCI. Contract-ors shall provide their own power source (i.e., generator or mobile power source) at the LSCI and supplies necessary to provide ser-vices, to include, but not limited to table paper, privacy gowns, contrast dye, etc.

All expendable supplies and/or contrast media will be supplied by the Contractor unless otherwise agreed upon in advance in FCC Al-lenwood. All supplies intended for use inside the secure perimeter by the Contractor will be listed on an inventory sheet and approved by FCC Allenwood in advance. Items required for services and not permitted on the Contractor's inventory will be supplied by FCC Allenwood.

Cardiac Stress Testing. All equipment necessary to perform Cardiac Stress Testing, including testing equipment and monitoring equipment, shall be supplied by the Contractor unless otherwise agreed upon in advance with FCC Allenwood. All supplies intended for use inside the secure perimeter by the Contractor will be listed on an inventory sheet and approved by FCC Allenwood in ad-vance. Items required for services and not permitted on the Contractor's inventory will be supplied by FCC Allenwood.

Oral Surgeon. All equipment necessary to perform Oral Surgery (including without limitation, anesthetics, hand and rotary instru-ments, disposables and evacuation products, bone regeneration materials, infection control barrier, disinfectants, sterilants and soaps, oral surgery fact masks, shields, and gloves, sterilization products, intravenous solutions, pharmaceuticals and dental medicaments, cotton, gauze, sponges, sharps, and sutures, x-ray film, and solution) shall be supplied by the Contractor unless otherwise agreed upon in advance with FCC Allenwood. All supplies intended for use inside the secure perimeter by the Contractor will be listed on an in-ventory sheet and approved by FCC Allenwood in advance. Items required for services and not permitted on the Contractor's invent-ory will be supplied by FCC Allenwood.

Ophthalmologist. All equipment necessary to perform ophthalmologic testing and treatment, including, without limitation, a portable retinal imaging system, retinoscope, ophthalmoscope, transilluminator, autorefractor/keratometer, and portable slit lamp, shall be sup-plied by the Contractor unless otherwise agreed upon in advance with FCC Allenwood. All supplies intended for use inside the secure perimeter by the Contractor will be listed on an inventory sheet and approved by FCC Allenwood in advance. Items required for ser-vices and not permitted on the Contractor's inventory will be supplied by FCC Allenwood.

EMG Services. All equipment necessary to perform Electromyograph testing, including testing equipment and monitoring equip-ment, shall be supplied by the Contractor unless otherwise agreed upon in advance with FCC Allenwood. All supplies intended for use inside the secure perimeter by the Contractor will be listed on an inventory sheet and approved by FCC Allenwood in advance.

Items required for services and not permitted on the Contractor's inventory will be supplied by FCC Allenwood.

Conditions Applicable to All On-Site Clinics:

In the event it becomes necessary for the Government to cancel a scheduled visit, FCC Allenwood will provide the contract provider with 48-hour written notice or verbal notice prior to canceling a visit. However, certain circumstances beyond the control of FCC Al-lenwood (e.g., fog or other Acts of God, instiution disturbances, etc.) may dictate the cancellation of a scheduled visit with less than 48 hours written or verbal notice. In the event it becomes necessary for the contract provider to cancel a scheduled visit, the Contractor may provide qualified replacement professional staff or may reschedule a mutually agreed upon replacement session. Prior to utilizing replacement staff, the Contractor must obtain preliminary clearance from the Contracting Officer or COR, in accordance with the se-curity and privileging requirements of this contract.

All contract personnel providing services within the confines of FCC Allenwood shall have a complete background investigation con-ducted in accordance with BOP Program Statement 3000.03, Human Resource Management Manual. See also "Contract Security/ Investigative Requirements" contained in Section 4.1 of this solicitation/contract. All contract providers and other applicable staff who enter FCC Allenwood to perform services on a recurring basis shall be required to attend a four-hour institution orientation course held at FCC Allenwood or a mutually acceptable site. A "refresher" orientation must be completed annually. The Contractor's costs for contract staff to attend this training shall be the responsibility of the Contractor. The Contracting Officer or COR will be responsible for scheduling training for all applicable contract staff.

Output #3: Submit properly-priced invoices for services rendered.

Overview. Upon completion of a treatment encounter, the Contractor shall prepare and submit proper invoices for services rendered under this contract. For the purpose of this contract, a specific definition for what documentation constitutes an invoice is provided be-low. A proper invoice shall include the information specified in FAR clause 52.212-4, Contract Terms and Conditions -- Commercial Items, paragraph (g). Services shall be invoiced in accordance with the terms and conditions of the contract, including the payment rate structures specified in the contract.

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Invoice/Medical Claims Adjudication. FCC Allenwood will employ a process of invoice/medical claims adjudication to ensure, at a minimum, that the services billed by the Contractor were properly authorized and ordered by FCC Allenwood, are appropriately coded in compliance with Medicare coding policies (where applicable), are properly priced in accordance with the terms and conditions of the contract, and do not represent duplicate billings for payments already made. In addition, FCC Allenwood may utilize the services of a third-party medical claims adjudicator to review medical claims submitted by the Contractor under this contract. When requested by FCC Allenwood, the Contractor shall comply with all reasonable requests for additional invoice/medical claim/medical record doc-umentation. All invoice payments shall be made by FCC Allenwood and any disagreements regarding the paid amount of any invoices shall be resolved directly with FCC Allenwood.

Invoice Definitions. Line Items 1a. - Inpatient Facility Services, 1b. - Outpatient Facility Services, 1c. - Skilled Nursing Facil-ity, 2a. - Inpatient Physician Services, 2b. - Outpatient Physician Services, and 2c1. - Outpatient Institution Services - Other Physicians: At the outset of this contract, an invoice for services rendered under Line Items 1a, 1b, 2a, 2b, and 2c1. shall be a paper version of an invoice containing not more than 50 individual medical claims. Each invoice shall be supported with paper copies of Universal Billing (UB)-04 forms or Centers for Medicare and Medicaid Services (CMS) 1500 forms, as applicable, for each medical claim included in the invoice.

Following written notification to the Contractor by the Contracting Officer that a third-party medical claims adjudication services will be utilized by FCC Allenwood, an invoice for services rendered under Line Items 1a, 1b, 1c, 2a, 2b, and 2c1 shall be a paper invoice detailing not more than 50 individual medical claims which have been electronically trasmitted to the BOP's medical claims adjudicat-or via American National Standards Institute (ANSI) 837 format that also conforms to Medicare and Health Insurance Portability and Accountability Act of 1996 (HIPAA) electronic billing standards. For each medical claim included on the invoice, the Contractor shall reference, at a minimum, the following information: YREGDOC number, inmate name and register number, date of service, provider of service, billed code, and contract amount billed. Medical claims detailed in the invoice shall be listed first in descending order by the YREGDOC number, second in alphabetic order by the inmate's last name, and third by ascending date of service (i.e., earliest to latest) when more than one medical claim is present for the same inmate within the same invoice.

If the Contractor's proposal encompasses the provision of Oral Surgery and/or dental procedures, only those medical claims which represent adjunctive dental care will be submitted by the Contractor to the medical claims adjudication contractor for processing. Oral Surgery and/or dental procedures which are not considered to be adjunctive dental care will be submitted to FCC Allenwood for veri-fication.

The Contractor shall not submit a medical claim for processing that the Contractor knows, or has reason to believe contains inaccurate, incomplete, or misleading information. Medical claims which contain inaccurate, incomplete, or misleading information shall be held by the Contractor and not submitted until such time as all lines are deemed to be accurate and complete. At that time, the Contractor may proceed with submitting the medical claim for processing and invoicing FCC Allenwood for all services represented by that med-ical claim.

Line Items 2c2, 2c3, and 2c4 - Outpatient Institution Services - Oral Surgeon, Mobile MRI, and Mobile CT: An invoice for ser-vices rendered under these line items shall be a paper invoice detailing the date(s) sessions were provided, the number of sessions provided, the unit pricing applied, and the extended total amount due. The BOP will not use the services of a third party medical claims adjudicator for verification of these services.

Provider Information.

Submission of Provider Data to the BOP's Medical Claims Adjudicator. Within ten calendar days after notification that a third party medical claims adjudication service will be utilized by FCC Allenwood, the Contractor shall provide the BOP's medical claims adjudication with a complete list of provider information, which will enable the medical claims adjudicator to accurately identify the correct payable amount for any provider performing services under the contract. Specific informational requirements are provided in Attachment 4.