15B41418R00000001_Attachment.pdf

15B41418R00000001 Attachment 1

ATTACHMENT 1

CONTRACT PRICING AND 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. Offerors 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 appropriate, outlier payments calculated in accordance with Medicare reimbursement methodologies shall be made in recognition of extremely costly stays. The outlier payment shall be calculated based upon the defined benchmark and will consist of the operating 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) 44180, Springfield, MO. 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 6, Computation of Basic MS-DRG Payments (Operating Federal Rate), of this solicitation.)

Medicare Part B Physician Services and Non-physician Services. The Medicare benchmark to be utilized for all physician and 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 Missouri. 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 44180, Springfield, MO. Offerors may propose a discount from or a premium to the benchmark charges.

Long-Term Care Facility Services. The Medicare benchmark to be utilized for Long-Term Care facility services covered by Medicare Part A shall be the most current DRG Payment amount (i.e., Federal rate) established for CBSA 44180, Springfield, MO.

Estimated Charges

Estimated quantities for the base year and all option years are detailed below. The estimated quantities provided are not a representation 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 12 months from EDOA

Inpatient Days: 650 days (estimated) Outpatient Days: 800 days (estimated) Long-Term Care: 30 days (estimated) Autopsies: 12 annual (estimated) Laboratory Director Services: 12 monthly visits – 2 hour duration (estimated)

Option Year 1 – 13 months through 24 months from EDOA

Inpatient Days: 650 days (estimated) Outpatient Days: 800 days (estimated) Long-Term Care: 30 days (estimated) Autopsies: 12 annual (estimated) Laboratory Director Services: 12 monthly visits – 2 hour duration (estimated)

Option Year 2 – 25 months through 36 months from EDOA

Inpatient Days: 650 days (estimated) Outpatient Days: 800 days (estimated) Long-Term Care: 30 days (estimated) Autopsies: 12 annual (estimated) Laboratory Director Services: 12 monthly visits – 2 hour duration (estimated)

Option Year 3 – 37 months through 48 months from EDOA

Inpatient Days: 650 days (estimated) Outpatient Days: 800 days (estimated) Long-Term Care: 30 days (estimated) Autopsies: 12 annual (estimated) Laboratory Director Services: 12 monthly visits – 2 hour duration (estimated)

Option Year 4 – 49 months through 60 months from EDOA

Inpatient Days: 650 days (estimated) Outpatient Days: 800 days (estimated) Long-Term Care: 30 days (estimated) Autopsies: 12 annual (estimated) Laboratory Director Services: 12 monthly visits – 2 hour duration (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 listed 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 Oral Surgery and Optometry services, these categories shall be paid by defined sessions.

Audiology: Visit duration - 3 hours (approximate)

Visit quantity - 12 per contract year

Anesthesiology: Visit duration - 4 hours (approximate)

Visit quantity - 52 per contract year

Burn/Wound Management: Visit duration - 1 hours (approximate)

Visit quantity - 14 per contract year

Cardiology: Visit duration - 2 hours (approximate)

Visit quantity - 12 per contract year

Dermatology: Visit duration - 2 hours (approximate)

Visit quantity - 12 per contract year

EEG/EMG: Visit duration - 2 hours (approximate)

Visit quantity - 12 per contract year

Echocardiology: Visit duration - 3 hours (approximate)

Visit quantity - 52 per contract year

Endocrinology: Visit duration - 1 hour (approximate)

Visit quantity - 14 per contract year

ENT: Visit duration - 1 hour (approximate)

Visit quantity - 14 per contract year

Gastroenterology: Visit duration - 4 hour (approximate)

Visit quantity - 24 per contract year

General Surgery: Visit duration - 5 hours (approximate)

Visit quantity - 24 per contract year

Hematology/Oncology: Visit duration - 3 hours (approximate)

Visit quantity - 24 per contract year

Infectious Disease: Visit duration - 2 hours (approximate)

Visit quantity - 14 per contract year

Nephrology: Visit duration - 5 hours (approximate)

Visit quantity - 24 per contract year

Neurology/Neurosurgery: Visit duration - 2 hours (approximate)

Visit quantity - 12 per contract year

Ophthalmology: Visit duration - 5 hours (approximate)

Visit quantity - 52 per contract year

Optometrist: Session duration - 4 hours (approximate)

Session quantity - 52 per contract year

Orthopedic Surgery: Visit duration - 4 hours (approximate)

Visit quantity - 36 per contract year

Otolaryngology: Visit duration - 3 hours (approximate)

Visit quantity - 12 per contract year

Pain Management: Visit duration - 3 hours (approximate)

Visit quantity - 12 per contract year

Pathology: Visit duration - 1 hour (approximate)

Visit quantity - 4 per contract year

Plastic Surgery: Visit duration - 2 hours (approximate)

Visit quantity - 12 per contract year

Podiatry: Visit duration - 1 hour (approximate)

Visit quantity - 24 per contract year

Pulmonology: Visit duration - 4 hours (approximate)

Visit quantity - 12 per contract year

Radiology: Visit duration - 3 hours (approximate)

Visit quantity - 52 per contract year

Rheumatology: Visit duration - 1 hour (approximate)

Visit quantity - 12 per contract year

Sleep Studies: Visit duration - 8 hours (approximate)

Visit quantity - 24 per contract year

Speech Therapist: Visit duration - 3 hours (approximate)

Visit quantity - 52 per contract year

Urology: Visit duration - 3 hours (approximate)

Visit quantity - 12 per contract year

Oral/Facial Surgery: Session duration - 2 hours (approximate)

Session quantity - 12 per contract year (approximate)

Vascular Surgery: Visit duration - 2 hours (approximate)

Visit quantity - 12 per contract year (approximate)

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 accordance with Federal Acquisition Regulation (FAR) 52.212-2, Evaluation - Commercial Items, and Section 5.2, Evaluation Proposals, of this solicitation.

Base Year Effective Date of Award (EDOA) through 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. Long-Term Care Services: - _____ Discount or + _____ Premium to Medicare Part A

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 Surgery: $__________ per session 2c3. Optometry: $__________ per session

3a. Laboratory Director Services: $__________ per session 3b. Autopsies: $__________ per autopsy

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE,

INSERT APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Option Year 1 13 months through 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. Long-Term Care Services: - _____ Discount or + _____ Premium to Medicare Part A

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 Surgery: $__________ per session 2c3. Optometry: $__________ per session

3a. Laboratory Director Services: $__________ per session 3b. Autopsies: $__________ per autopsy

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE,

INSERT APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Option Year 2 25 months through 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. Long-Term Care Services: - _____ Discount or + _____ Premium to Medicare Part A

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 Surgery: $__________ per session 2c3. Optometry: $__________ per session

3a. Laboratory Director Services: $__________ per session 3b. Autopsies: $__________ per autopsy

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE,

INSERT APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Option Year 3 37 months through 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 1c. Long-Term Care Services: - _____ Discount or + _____ Premium to Medicare Part A

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 Surgery: $__________ per session 2c3. Optometry: $__________ per session

3a. Laboratory Director Services: $__________ per session 3b. Autopsies: $__________ per autopsy

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE,

INSERT APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Option Year 4 49 months through 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. Long-Term Care Services: - _____ Discount or + _____ Premium to Medicare Part A

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 Surgery: $__________ per session 2c3. Optometry: $__________ per session

3a. Laboratory Director Services: $__________ per session 3b. Autopsies: $__________ per autopsy

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE,

INSERT APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Option to Extend Services 52.217-8

1a. Inpatient Facility Services: - _____ Discount or + _____ Premium to Medicare Part A 1b. Outpatient Facility Services: - _____ Discount or + _____ Premium to Medicare Part B 1c. Long-Term Care Services: - _____ Discount or + _____ Premium to Medicare Part A

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 Surgery: $__________ per session 2c3. Optometry: $__________ per session

3a. Laboratory Director Services: $__________ per session 3b. Autopsies: $__________ per autopsy

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE,

INSERT APPLICABLE "-/+" PERCENTAGE. 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 notification of award as well as to the general public when requested. Any party who objects to the release of their own unit pricing information, 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 possibilities.

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.

Attachment 2

ATTACHMENT 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 custody 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 detention of individuals awaiting trial in Federal court. It is the mission of the Federal Bureau of Prisons to protect society by confining offenders in the controlled environments 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 in 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 accomplish 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 services to Federal inmates with BOP resources. When a medical need arises which cannot be provided within prison walls by BOP resources, referrals 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 United States Medical Center for Federal Prisoners, located in Springfield, Missouri (USMCFP Springfield), intends to make a single award to a responsible entity for the provision of Comprehensive Medical Services as set forth in this solicitation/contract. USMCFP Springfield is presently identified as a Care Level IV BOP facility. Care Levels are administrative classifications, which provides for the designation of inmates with similar health needs within a BOP facility. The classification is based on a four-level scale system where Care Level I represents the healthiest inmates and Care Level IV represents inmates with serious health issues. Criteria for categorizing an inmate in the Care Level categories are included as Attachment 7, Medical Classification - Care Level Criteria. Despite this description of the general health of the inmate population, however, needs for inmate healthcare may arise at varying levels of complexity. USMCFP Springfield currently houses male inmates.

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 USMCFP Springfield. Community-based providers shall be located within a 100-mile radius of USMCFP Springfield. USMCFP Springfield may approve limited exceptions for specialized services which cannot be obtained with the 100 mile radius.

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 USMCFP Springfield. A potential 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 responsibilities 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 services 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 fails to adequately address/resolve potential conflicts of interest will be rejected without further consideration. 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 assignments. 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 Attachment 5, Submission and Evaluation of Proposals. Therefore, the Government may award any or all line 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 solicitation. 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 facility, outpatient facility, and long-term care 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. (Cross-referencing pricing categories 1a, 1b, and 1c.)

Output #2: Provide professional services, including Laboratory Director services, and autopsy 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. (Cross-referencing pricing categories 2a, 2b, 2c, 3a, and 3b.)

Output #3: Submit properly-priced invoice 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 Government utilizing the outcome measure indicators provided in Attachment 8, Performance-Based Outcome Measures.

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 USMCFP Springfield's approval. Once the QCP is approved by USMCFP Springfield, the Contractor shall utilize the QCP to guide and rigorously document the implementation of the required management and quality control actions to achieve the specified output.

V. Specific Requirements

Output #1: Provide inpatient facility, outpatient facility, and long-term care 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. (Cross-referencing pricing categories 1a, 1b, and 1c.)

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 in the List of Excluded Individuals/Entities (LEIE) maintained by the U.S. Department of Health & 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, outpatient facility, including emergency room services, direct admission, and telemedicine services. Inpatient visits for non-emergency services shall require private room accommodations with available space for up to three armed or unarmed guards per inmate.

All facilities proposed by the Offeror must maintain accreditation from a nationally recognized hospital accrediting organization. It is USMCFP Springfield’s preference to obtain the services of facilities that are Joint Commission accredited. Additionally, Offerors will submit documents validating this accreditation or certification as 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 USMCFP Springfield, that it is capable of providing to achieve Output #1.

Contractor shall document primary source verification of the credentials for each provider including: current license from the appropriate State Board of Medical Examiners, education from professional schools or universities, evidence of completion of internships and/or residence, DEA registration, National Practitioner Data Bank (NPDB) information, and peer review completion. Additionally, the Contractor will provide to USMCFP Springfield an annual letter of good standing for each provider, confirming and verifying clinical privilege, staff status, and employment information. The Contractor will provide copies of these documents to USMCFP Springfield.

The Contractor shall perform all credentialing and privileging for all providers. The credentialing and privileging processes and procedures shall conform to requirements of the Joint Commission, the Centers for Medicare and Medicaid Services (CMS), and applicable state and Federal agencies. A copy of Contractor’s credentialing policies and procedures shall be provided to USMCFP Springfield.

USMCFP Springfield’s Executive Staff, Chief Medical Officer, and Governing Body shall review each provider’s initial appointment and subsequent reappointments.

All discharged patients must be released prior to 2:00 p.m. in order to allow USMCFP Springfield to ensure continuity of care.

Output #2: Provide professional services, including Laboratory Director services, and autopsy 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. (Cross-referencing pricing categories 2a, 2b, 2c, 3a, and 3b.)

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 contract, the Contractor shall not utilize any provider that appears in the List of Excluded Individuals/Entities (LEIE) maintained by the U.S. 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, surgical 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.

The Contractor shall document primary source verification of the credentials for each provider including: current license from the appropriate State Board of Medical Examiners, education from professional schools or universities, evidence of completion of internships and/or residence, and an annual letter of good standing which will include a statement that a peer review has been completed.

Whenever possible, appointments for specialty care should be available within 14 calendar days from the date of referral to the specialty 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 USMCFP Springfield pharmacy, contract providers shall only prescribe pharmaceutical drugs that are listed in the approved BOP Formulary. The BOP Formulary can be accessed at https://www.bop.gov/resources/pdfs/formulary.pdf. Requests 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 USMCFP Springfield, that 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 USMCFP Springfield. USMCFP Springfield 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 USMCFP Springfield determines to be reasonable and appropriate. If the resulting contract does not provide for telemedicine clinics or all of the on-site clinics listed, USMCFP Springfield reserves the right to pursue such contracts.

USMCFP Springfield prefers to obtain on-site services through telemedicine clinics. All telemedicine equipment and associated communications devices shall be reviewed and approved by the BOP prior to use. Contractors shall use a BOP-approved bridge provider to facilitate videoconference calls. The Contractor will bear the costs and expenses related to the use of the BOP-approved bridge provider.

If the Contractor’s telemedicine equipment and network environment complies with Federal IT security standards, the BOP may facilitate a direct IP connection to the provider’s telemedicine connection point to facilitate IP-to-IP calls. If the direct connection option is used, the https://www.bop.gov/resources/pdfs/formulary.pdf

Contractor will certify compliance with all applicable Federal policies. Additionally, the Contractor will agree to allow the BOP to audit its facilities for security and safety.

Additionally, the Contractor shall provide a Vendor Coordinator to manage the USMCFP Springfield on-site telemedicine clinics. Duties of the Vendor Coordinator shall include:

• Scheduling of all telemedicine clinics;

• Troubleshooting telemedicine clinic equipment, including audio and video communication of those clinics;

• Compiling statistics and schedules;

• Confirming visits;

• Submitting payments;

• Retrieving USMCFP Springfield medical records on inmate patients prior to visits;

• Sharing USMCFP Springfield medical records on inmate patients with physicians; and

• Obtaining consult reports for submission into the USMCFP Springfield electronic medical record.

If the Contractor performs on-site specialty clinics at USMCFP Springfield, the following minimum requirements shall apply. Contract services shall be provided on-site within the Health Services Unit of USMCFP Springfield. Consultations shall be limited to the chief complaint on the BOP consultation form. Additional patient complaints shall be immediately referred to USMCFP Springfield medical staff for review. Providers performing consultations shall immediately notify USMCFP Springfield prior to addressing any additional complaints brought forth by the patient to allow for review of care against stated criteria. Services shall include diagnosis and treatment of medical conditions with appropriate referral, if necessary, to a specialist at the contrct medical facility. Scheduling of clinics shall be subject to the mutual agreement of the USMCFP Springfield and the contract provider. USMFCP Springfield shall schedule inmates for on-site clinics.

Providers performing institution-based services shall be licensed to practice medicine in the State of Missouri. Providers performing on-site services, including telemedicine services, shall apply for clinical privileges at USMCFP Springfield. 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 physician's continued affiliation with the Contractor or any subcontractor. Continuation of privileges at USMCFP Springfield shall be at the sole discretion of USMCFP Springfield. Non-physician providers shall maintain active licenses from the State of Missouri, as applicable.

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

Anesthesiology Audiology Burn and Wound Management Cardiology Dermatology Echocardiology

EEG/EMG

Endocrinology

ENT

Gastroenterology (Liver and general) General Surgery Hematology/Oncology Infectious Disease Nephrology Neurology/Neurosurgery Ophthalmology Optometrist Oral/Facial Surgery Orthopedic Surgery Otolaryngology Pain Management Pathology Plastic Surgery Podiatry Pulmonology Radiology Rheumatology Sleep Studies Speech Therapy Urology Vascular Surgery

In the event it becomes necessary or the Government to cancel a scheduled visit, USMCFP Springfield will provide the contract provider with 48-hour written or verbal notice prior to canceling a visit. However, certain circumstances beyond the control of USMCFP Springfield (e.g., fog or other Acts of God, institution 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 security and privileging requirements of this contract.

Additional Requirements for Services Provided On-Site at USMCFP Springfield:

Autopsies. Contractor shall perform non-forensic autopsies for all patients who expire at USMCFP Springfield. Additionally, the Contractor shall provide a preliminary and final autopsy report to USMCFP Springfield within 25 calendar days from the date the patient expired.

Laboratory Director Services. Contractor must provide a Pathologist certified in anatomic or clinical pathology, or both, by the American Board of Pathology of the American Osteopathic Board of Pathology and is licensed in the state of Missouri. The Contractor's Pathologist will serve as USMCFP Springfield's high-complexity Medical Referral Laboratory's (MRL) Laboratory Director, to include having their name on USMCFP Springfield's MRL's CLIA license. Responsibilities and oversight duties may in part be delegated, in writing, to designees such as Clinical Consultants and Technical Supervisors whose education and experience have been deemed acceptable from a regulatory perspective.

The Laboratory Director is responsible for the overall operation and administration of the laboratory, including the employment of personnel who are competent to perform test procedures, record and report test results promptly, accurately and proficiently, and for assuring compliance with applicable regulations.

The Laboratory Director will attend the Annual Strategic Planning Meeting, the Quarterly Infection Control Meeting, the monthly Blood and Tissue meetings, and monthly Laboratory Meetings. Duties of the Laboratory Director shall include:

• Testing systems developed and used for each of the tests performed in the laboratory provide quality laboratory services for all aspects of test performance, which includes the pre-analytic, analytic, and post-analytic phases of testing;

• The physical plant and environmental conditions of the laboratory are appropriate for the testing performed and provide a safe environment in which co-workers are protected from physicial, chemical, and biological hazards;

• Test methodologies selected have the capability of providing the quality of results required for patient care;

• Verification procedures used are adequate to determine the accuracy, precision, and other pertinent performance characteristics of the method;

• Laboratory personnel are performing the test methods as required for accurate and reliable results;

• The Laboratory is enrolled in an approved Proficiency Testing (PT) program for testing performed:

o PT samples are tested as required under Subpart H of the CLIA regulations;

o Results are returned within the timeframes established by the PT program;

o All PT reports received are reviewed by the appropriate staff to evaluate the laboratory's performance and to identify any problems that require corrective action;

o An approved corrective action plan is followed when any PT result is found to be unacceptable or unsatisfactory;

• All quality control and quality assessment programs are established and maintained to assure the quality of the laboratory services provided and to identify failures in quality as they occur;

• The establishment and maintenance of acceptable levels of analytical performance for each test system;

• All necessary remedial actions are taken and documented whenever significant deviations from the laboratory's established performance characteristics are identified; and that patient test results are reported only when the system is functioning properly;

• Reports of test results include pertinent information required for interpretation;

• Consultation is available to the laboratory's clients on matters relating to the quality of the test results reported and their interpretation concerning specific patient conditions;

• A sufficient number of laboratory personnel are employed with the appropriate education and either experience or training to provide appropriate consultation, properly supervise and accurately perform tests and report tests results in accordance with personnel responsibilities describe in Subpart M of the CLIA regulations;

• Prior to testing patients' specimens, all personnel have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operation reliably to provide and report accurate results;

• Policies and procedures are established for monitoring individuals who conduct pre-analytical, analytical, and post-analytical phases of testing to assure that they are competent and maintain their competency to process specimens, perform test procedures and report test results promptly and proficiently, and whenever necessary, identify needs for remedial training or continuing education to improve skills;

• An approved procedure manual is available to all personnel responsible for any aspect of the testing process. The Laboratory Director can delegate to the technical supervisor the responsibility of making the procedure available, but cannot delegate the responsibility for the signing new and revised procedure;

• The responsibilities and duties of each consultant and each supervisor must be specified in writing by the Laboratory Director, as well as each person engaged in the performance of the pre-analytic, analytic, and post-analytic phases of testing, that identifies which examinations and procedures each individual is authorized to perform, whether supervision is required for specimen processing, test performance or result reporting and whether supervisory or director review is required prior to reporting patient test results.

• Consultative services are available to the laboratory co-workers either in person or by telephone or electronic means (e.g. e-mail, fax) in cases where on-site interaction is not practical. Additionally, the Laboratory Director can delegate to qualified personnel specific responsibilities as provided in the regulations.

In the event that the Laboratory Director needs to delegate on-site visits to a qualified designee, the qualified designee will review the meeting documentation for concurrence with the Laboratory Director after each monthly meeting. However, the annual Strategic Planning Meeting can only be delegated in an emergency. In the event the Laboratory Director chooses to reapportion performance of their responsibilities, as Laboratory Director, he/she remain responsible for ensuring that all duties are properly performed. It is the responsibility of the Laboratory Director to ensure that persons performing delegated functions are qualified to do so.

A Qualified Designee may attend monthly meetings at USMCFP Springfield to review processes, procedures, proficiency testing reports, performance and quality improvement documents, and address other laboratory needs as appropriate; provide off-site supervision and consultation via telephone, fax, or e-mail if not available in person; and attend meetings and participate in USMCFP Springfield conference calls and WebEx presentations as needed.

All contract personnel providing services within the confines of USMCFP Springfield shall have a complete background investigation conducted in accordance with BOP Program Statement 3000.03, Human Resource Management Manual. See also "Contract Security/Investigative Requirements" contained within Attachment 3, Special Contract Conditions, of this solicitation/contract. All contract providers and other applicable staff who will enter USMCFP Springfield to perform services on a recurring basis shall be required to attend a four-hour institution orientation course held at USMCFP Springfield 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 below. A proper invoice shall include the information specified in FAR 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. Only invoices from the awarded Contractor will be accepted. Any third-party subcontractors used by the Contractor must submit invoices to the Contractor, who will then process the invoices according to the contract with USMCFP Springfield.

Invoice/Medical Claims Adjudication. USMCFP Springfield reserves the right to 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 USMCFP Springfield, 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, USMCFP Springfield 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 USMCFP Springfield, the Contractor shall comply with all reasonable requests for additional invoice/medical claim/medical record documentation. All invoice payments shall be made by USMCFP Springfield and any disagreements regarding the paid amount of any invoice shall be resolved with USMCFP Springfield.

Medical Claims Adjudicator. The Government anticipates the implementation of a Medical Claims Adjudication service following the award of this procurement. Once the BOP executes an agreement with a Medical Claims Adjudicator service, the Contractor providing Comprehensive Medical Services to USMCFP Springfield shall participate in the medical claims adjudication process. The Contractor will agree to abide by all terms pertaining to any BOP medical claims adjudication agreement. Information associated with the procedures for submission of physician data, technical data for medical claims, protocol for submitting corrected facility and physician claims will be distributed to the Contractor once it becomes available.

Invoice Definitions.

Line Items 1a - Inpatient Facility Services, 1b - Outpatient Facility Services, 1c – Long- Term Care Facility Services, 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, 1c, 2a, 2b, and 2c1 shall be an invoice containing not more than 50 individual medical claims. Each invoice shall be supported with copies of Universal Billing (UB)-04 forms or Centers for Medicare and Medicaid Services (CMS) 1500 form, as applicable, for each medical claim included in the invoice. Contractors shall provide invoices electronically to USMCFP Springfield.

Following written notification to the Contractor by the Contracting Officer that a third-party medical claims adjudication service will be utilized by USMCFP Springfield, an invoice for services rendered under Line Items 1a, 1b, 1c, 2a, 2b, and 2c1 shall be an invoice detailing not more than 50 individual medical claims which have been electronically transmitted to the BOP's medical claims adjudicator 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 community-based oral surgery and/or dental procedures, only those medical claims which represent adjunctive dental care will be submitted by the Contractor to any potential 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 USMCFP Springfield for verification.

The Contractor shall not submit a medical claim for processing that the Contractor knows nor 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 USMCFP Springfield for all services represented by that medical claims.

Line Item 2c2, 2c3, 3a, and 3b - Outpatient Institution Services - Oral Surgery, Outpatient Institution Services – Optometry, Laboratory Director Services, and Autopsies: An invoice for services rendered under Line Item 2c2, 2c3, 3a, and 3b shall be an invoice detailing the date(s) sessions were provided, the number of sessions provided, the unit pricing applied, and the extended total amount due. Additionally, an invoice for services rendered under Line Item 3a and 3b, shall be an invoice detailing the date(s) services were provided, the number of services 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.

National Provider Identifier (NPI) Numbers: The Contractor shall utilize only providers who have a current National Provider Identifier (NPI) number.

Procedures for Filing Corrected Medical Claims

Facility Services. If it becomes necessary to file a corrected medical claim for facility services, the Contractor shall electronically transmit the information found on each individual corrected medical claim to the BOP. After the Contractor's electronic transmission, it shall promptly submit a copy of the invoice or credit memo, as applicable, to USMCFP Springfield. Invoices for corrected medical claims shall be clearly marked as such and shall be separate from routine invoices. Invoices or credit memos for corrected medical claims shall detail information pertaining to the original medical claim submission (including any amount(s) previously paid and the associated invoice numbers) and shall bill only for the corrected medical claim submission or reflect the credit amount due for the corrected medical claim submission.

Physician/Professional Services. If it becomes necessary to file a corrected medical claim for physician/professional services, the Contractor shall submit the corrected medical claim in hard copy (i.e., paper or electronic) format to the BOP. The word "CORRECTED" shall be prominently displayed on the medical claim. The Contractor shall promptly submit a copy of the invoice or credit memo, as applicable, to USMCFP Springfield. Invoices for corrected medical claims shall be clearly marked as such and shall be separate from routine invoices.