Amendment 0001 Signed.pdf

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing items 8 and 15, and returning or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE

RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

E. IMPORTANT: Contractor is not is required to sign this document and return copies to the issuing office.

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

2. AMENDMENT/MODIFICATION NUMBER 3. EFFECTIVE DATE

7. ADMINISTERED BY (If other than Item 6) CODE

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended. is not extended.

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER

NUMBER IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

15C. DATE SIGNED

15A. NAME AND TITLE OF SIGNER (Type or print)

16C. DATE SIGNED

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

PAGE OF PAGES

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (Number, street, county, State and ZIP Code) (X)

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

Previous edition unusable

0001 05/18/2021

4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)

19-343

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

15BFA0

Federal Bureau of Prisons FMC Carswell J Street Building 3000 Fort Worth, TX 76127

BCRW

15B50521R00000001

3/29/2021

X X

X 1

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

Amendment 0001 is established to incorporate the following change: Revise the pricing methodology of on-site chemotherapy services.

Pricing for on-site chemotherapy services shall be proposed utilizing Medicare reimbursement methodologies. Offers shall be proposed in the form of a discount from or a premium to Medicare Part B rates established by the Centers for Medicare and Medicaid Services. Offers are due June 16, 2021 at 2:00 PM CT.

Included with Amendment 0001 are questions and responses submitted for clarification. See attached Amendment of Solicitation Continuation Pages 2-13.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

1 13

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT CONTINUATION

Blocks 19 through 24 – Contract Pricing and 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 and Sub-Contract Certification.

Pricing Methodology

Except for services based on session rate, price proposals will be calculated from benchmarks utilizing Medicare reimbursement methodologies. For each category of service 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) 23104 –Fort Worth – Arlington – Grapevine, TX. 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 5 of this solicitation). Long Term Care Facility Medicare Part A shall be the most current LTC-DRG payment amount (i.e. Federal Rate) established for CBSA 23104-Fort Worth-Arlington- Grapevine, TX.

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 28, Fort Worth, Tarrant County, Texas. 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) 23104 –Fort Worth – Arlington – Grapevine, TX. Offerors may propose a discount from or a premium to the benchmark charges.

Estimated Quantities

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

FMC CARSWELL

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

Inpatient Days: 2000 days (estimated) Outpatient Days: 3200 visits (estimated) Long-Term Care 285 days (estimated)

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

Inpatient Days: 2000 days (estimated) Outpatient Days: 3200 visits (estimated) Long-Term Care 285 days (estimated)

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

Inpatient Days: 2000 days (estimated) Outpatient Days: 3200 visits (estimated) Long-Term Care 285 days (estimated)

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

Inpatient Days: 2000 days (estimated) Outpatient Days: 3200 visits (estimated) Long-Term Care 285 days (estimated)

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

Inpatient Days: 2000 days (estimated) Outpatient Days: 3200 visits (estimated) Long-Term Care 285 days (estimated)

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. Audiology, Optometrist, Oral Surgeon, Orthotics/Prosthetics shall be paid based upon the provision of defined sessions. 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.

Audiology: Visit duration: 6 hours approximately Visit quantity: 6 per contract year

Cardiology: Visit duration: 8 hours approximately Visit quantity: 12 per contract year

Dermatology: Visit duration: 6 hours approximately Visit quantity: 12 per contract year

Endocrinology: Visit duration: 8 hours approximately Visit quantity: 12 per contract year

Gastroenterology: Visit duration: 4 hours approximately Visit quantity: 24 per contract year

General Surgery: Visit duration: 4 hours approximately Visit quantity: 24 per contract year

Infectious Disease: Visit duration: 4 hours approximately Visit quantity: 12 per contract year

Nephrology: Visit duration: 4 hours approximately Visit quantity: 12 per contract year

Neurology: Visit duration: 4 hours approximately Visit quantity: 12 per contract year

Neurosurgery: Visit duration: 4 hours approximately Visit quantity: 6 per contract year

Obstetrics and Gynecology: Visit duration: 8 hours approximately Visit quantity: 12 per contract year

Oncology: Visit duration: 4 hours approximately Visit quantity: 12 per contract year

Ophthalmology: Visit duration: 4 hours approximately

Visit quantity: 12 per contract year

Orthopedic Surgery: Visit duration: 4 hours approximately Visit quantity: 24 per contract year

Orthotics/Prosthetics: Visit duration: 4 hours approximately Visit quantity: 6 per contract year

Otorhinolaryngology (ENT): Visit duration: 4 hours approximately Visit quantity: 4 per contract year

Pain Management: Visit duration: 4 hours approximately Visit quantity: 12 per contract year

Podiatry: Visit duration: 4 hours approximately Visit quantity: 4 per contract year

Pulmonary Medicine: Visit duration: 4 hours approximately Visit quantity: 6 per contract year

Radiologist (fluoroscopy and Diagnostic mammograms only): Visit duration: 4 hours approximately

Visit quantity: 104 per contract year

Rheumatology: Visit duration: 4 hours approximately Visit quantity: 6 per contract year

Urology: Visit duration: 8 hours approximately Visit quantity: 12 per contract year

Pathology/Laboratory Director: Session duration: 3 hours approximately Session quantity: 8 per contract year

Optometry: Session duration: 6 hours approximately Session quantity: 104 per contract year

Dialysis: Treatments: 2016 per contract year

Chemotherapy: Treatments: 260 per contract year

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 Attachment 4, Submission and Evaluation of Proposals, of this solicitation.

Base Year – FMC CARSWELL

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. Long-Term Care Services - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2a1. Inpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - ___Discount or +___ Premium to Medicare Part B 2b1. Outpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - ___Discount or +___ Premium to Medicare Part B 2c2. Audiology: $_____________ per session 2c3. Optometry: $_____________ per session 2c4. Orthotics/Prosthetics: $_____________ per session 2c5. Pathology/Laboratory Director: $_____________ per session 2c6. In-House Physician Services: $_____________ per session 3a. Dialysis Treatments: ***************************************** 3a1. Hemodialysis: $_____________ per treatment 3b. Chemotherapy - Discount or + Premium to Medicare Part B

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

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

Option Year 1 – FMC CARSWELL

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. Long-Term Care Services - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2a1. Inpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - ___Discount or +___ Premium to Medicare Part B 2b1. Outpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - ___Discount or +___ Premium to Medicare Part B 2c2. Audiology: $_____________ per session 2c3. Optometry: $_____________ per session 2c4. Orthotics/Prosthetics: $_____________ per session 2c5 Pathology/Laboratory Director.: $_____________ per session 2c6. In-House Physician Services: $_____________ per session 3a. Dialysis Treatments: ***************************************** 3a1. Hemodialysis: $_____________ per treatment 3b. Chemotherapy - Discount or + Premium to Medicare Part B

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

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

Option Year 2 – FMC CARSWELL

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. Long-Term Care Services - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2a1. Inpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - ___Discount or +___ Premium to Medicare Part B 2b1. Outpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - ___Discount or +___ Premium to Medicare Part B 2c2. Audiology: $_____________ per session 2c3. Optometry: $_____________ per session 2c4. Orthotics/Prosthetics: $_____________ per session 2c5. Pathology/Laboratory Director.: $_____________ per session 2c6. In-House Physician Services: $_____________ per session 3a. Dialysis Treatments: ***************************************** 3a1. Hemodialysis: $_____________ per treatment 3b. Chemotherapy - Discount or + Premium to Medicare Part B

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

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

Option Year 3 – FMC CARSWELL

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 1c. Long-Term Care Services - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2a1. Inpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - ___Discount or +___ Premium to Medicare Part B 2b1. Outpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - ___Discount or +___ Premium to Medicare Part B 2c2. Audiology: $_____________ per session 2c3. Optometry: $_____________ per session 2c4. Orthotics/Prosthetics: $_____________ per session 2c5 Pathology/Laboratory Director.: $_____________ per session 2c6. In-House Physician Services: $_____________ per session 3a. Dialysis Treatments: ***************************************** 3a1. Hemodialysis: $_____________ per treatment 3b. Chemotherapy - Discount or + Premium to Medicare Part B

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

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

Option Year 4 – FMC CARSWELL

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. Long-Term Care Services - Discount or + Premium to Medicare Part A 2a. Inpatient Physician Services: - Discount or + Premium to Medicare Part B 2a1. Inpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - ___Discount or +___ Premium to Medicare Part B 2b1. Outpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - ___Discount or +___ Premium to Medicare Part B 2c2. Audiology: $_____________ per session 2c3. Optometry: $_____________ per session 2c4. Orthotics/Prosthetics: $_____________ per session 2c5 Pathology/Laboratory Director.: $_____________ per session 2c6. In-House Physician Services: $_____________ per session 3a. Dialysis Treatments: ***************************************** 3a1. Hemodialysis: $_____________ per treatment 3b. Chemotherapy - Discount or + Premium to Medicare Part B

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

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

Option to Extend Services as Authorized by FAR 52.217-8 – FMC CARSWELL

Sixty one (61) months through sixty (66) 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 2a1. Inpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2b. Outpatient Physician Services: - ___Discount or +___ Premium to Medicare Part B 2b1. Outpatient Anesthesia Physician Srv: - Discount or + Premium to Medicare Part B 2c. Outpatient Institution Services: ***************************************** 2c1. Other Physicians: - ___Discount or +___ Premium to Medicare Part B 2c2. Audiology: $_____________ per session 2c3. Optometry: $_____________ per session 2c4. Orthotics/Prosthetics: $_____________ per session 2c5. Pathology/Laboratory Director: $_____________ per session 2c6. In-House Physician Services: $_____________ per session 3a. Dialysis Treatments: ***************************************** 3a1. Hemodialysis: $_____________ per treatment 3b. Chemotherapy - Discount or + Premium to Medicare Part B

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 pubic 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.

Questions and Responses

1. Question: On Page 12 and 13, the solicitation states: "The contractor shall be responsible for determining the professional and administrative staffing required to operate Dialysis Unit. Staffing shall include but not limited to the following: Nephrologist, Nurses and/or Dialysis Technicians and Dietician. "

FMC Carswell currently provides Biomedical Equipment Technician Services for the on-site Dialysis Services Unit. Please clarify if these services will be provided by the FMC as part of this new contract.

Response: Yes. FMC will continue to provide these services for the On-site Dialysis Services Unit.

2. Question: On Page 13, the solicitation states: "The Government will provide the required equipment, pharmaceuticals and needles needed to provide dialysis treatment."

The current contract dialysis company has provided saline as part of the treatment rate for on-site hemodialysis services. Will offerors be required to provide this as part of the new contract? Please clarify.

Considering the cost of supplies and equipment necessary to provide on-site hemodialysis treatment services, could the FMC please provide a general list of items that will be provided by the FMC as well as those items the offeror will be responsible for providing as part of the new contract. This information will help offerors propose the most cost-effective price for these on-site hemodialysis treatment services.

Response: The contract dialysis company will supply the following: Saline, Dialysate, Acid, bloodline cartridge, bicarbonate, clamps (fistula and blue clamps) ND caps, re-circulators, bleach strips, Phoenix meter with cleaning solution.

FMC Carswell will provide the following: Operational hemodialysis machines, water treatment system and supplies, patient reclining chair, electrodes and monitoring equipement, clinical lab testing, including STAT services, non-invasive blood pressure machine, I.V infusion pumps and tubing, I.V. administration sets, Heparin lock caps, thermometers and covers, syringes as needed, hypodermic needles as needed, iodine swab sticks and alcohol swabs, tape as needed, gauze pads ( sterile or non-sterile), gloves, surgical masks, blood administration sets and blood filters, pressure wrap bandages, bed pans, drinking cups, audiovisual aids, telephone with connection, and all other support supplies and items normally found in a community dialysis facility.

3. Question: There are several Institution-Based Services that are currently provided at FMC Carswell but were not included in this solicitation. These include Psychiatry, Ultrasound Technician and Mammography Technician Services. In addition, the current contract Radiologist is reading and interpreting CAT Scans for imaging studies performed onsite at the FMC as well as Ultrasound procedures performed on-site by the contract Ultrasound Technician. Please clarify whether these services and contract line items (CLINs) will be added to this solicitation.

Response: These services will not be added to the current solicitation.

4. Question: Attachment 2 - Page 14, General Information - Paragraph 4, the solicitation states:

"Pharmaceuticals will be ordered by Carswell, but managed, maintained and mixed by offeror staff onsite at FMC Carswell. "

FMC Carswell does not currently have appropriate clinical facilities to mix chemotherapy agents (i.e., compounding) on-site consistent with the United States Pharmacopeia Convention (USP) current standards, specifically USP 800 — Hazardous Drugs — Handling in Healthcare Setting referenced at the following website: https://www.uspnf.com/notices/qeneral-chapter-hazardous-druqs-handlinq healthcare-settings. Please clarify the solicitation requirement.

Response: Pharmaceuticals will be ordered, managed, maintained and delivered pre-mixed by the offeror.

5. Question: Attachment 2 - Page 14, Paragraph 2, the solicitation states: "The contractor is responsible for providing all necessary pharmaceuticals, supplies and training for the Chemotherapy Unit."

It appears that Paragraph 1 under "Equipment and Supplies" and Paragraph 4 under "General Information" conflict with this requirement that offerors will be responsible for providing all necessary pharmaceuticals and supplies. Please clarify.

Response: The contractor is responsible for providing all necessary pharmaceuticals and assigned supplies needed to mix and transport the medication (i.e. saline, needles, syringes, supplies needed for transport).

FMC Carswell will provide all equipment and supplies for the infusion of the medication (IV kits, spill kits, IV pole with pump, reclining chair).

The contractor is responsible for contract staff training for the Chemotherapy Unit.

6. Question: Attachment 1 Pages 3 - 8, the solicitation requires offerors to propose Chemotherapy Services on a "per treatment" basis for each of the performance periods.

If the offeror is required to provide all pharmaceuticals for on-site chemotherapy services, it is not reasonable for offerors to propose a "per treatment rate" based on the wide variance in cost of chemotherapy agents that could be ordered by our contract oncologist for each chemotherapy treatment.

Requiring offerors to include high cost chemotherapy agents as part of the per treatment rate would artificially escalate the price for these services and not allow the FMC to realize cost savings when the contractor uses lower cost pharmaceuticals. Therefore, we recommend the FMC revise this CLIN under the Outpatient Institution Services in the Schedule of Items to allow offerors to propose a percentage discount/premium to the current Medicare Fee Schedule for these on-site chemotherapy treatments.

Response: See box 14 of the SF-30.

7. On Pages 20 and 21, the solicitation states: "The BOP has the authority to pay for immediate postnatal care of a child born to a female inmate when the BOP finds itself responsible for the cost by default (no other resource can be compelled to pay). The BOP may assume financial responsibility for the medical expenses of a child for the first three (3) days after a routine vaginal birth or up to seven (7) days for a Caesarean section. This financial responsibility may be extended for a limited time for extenuating circumstances on a case-by-case basis. The Contractor shall bill the BOP according to established contract rates."

FMC Carswell is the only female Federal Medical Center within the Federal Bureau of Prisons.

As a result, this facility receives a majority of the high-risk female obstetric cases from other female federal institutions in the BOP. It is evident that accepting these high-risk cases creates potential catastrophic financial risk on the contractor who is required to coordinate care for these inmate infants who typically require long term stays in a Neonatal Intensive Care Unit (NICU).

Considering this risk, the solicitation does not clearly assign appropriate financial responsibility or offers any guarantee that payment will be made by the BOP when high cost postnatal NICU care is medically necessary. The solicitation language only states the BOP "may/' assume financial responsibility for specified deliveries, time periods and case-by-case extensions. Please provide the criteria that the BOP will use in making a financial responsibility determination and who will notify the contractor of this decision.

The solicitation also states that BOP has the authority to pay for immediate postnatal care when the BOP finds itself responsible for the cost by default (no other resources can be compelled to pay). Please explain who will be responsible for identifying "other resources" that can be compelled to pay, who defines the timeframe when this needs to be completed and at what point does the BOP assume responsibility for these costs by default.

On Page 21, the solicitation states: "In the event the infant's medical needs exceed the BOP's authority for financial responsibility, the Contractor shall coordinate the application for financial assistance (e.g., Medicaid) for the infant."

The solicitation requires the contractor to coordinate the application for financial assistance when an inmate infant's medical needs exceed the BOP's authority for financial responsibility. Please provide the circumstances when the medical needs of the inmate infant exceed the BOP's authority for financial responsibility.

Please note that State of Texas Medicaid regulations have changed since the last Comprehensive Medical Services contract was awarded for FMC Carswell back in 2013. State of Texas Medicaid now requires individuals (e.g., inmates and guardians) who reside outside of Texas to file Medicaid application with their respective State.

Attached is the State of Texas Medicaid eligibility criteria that is used by hospitals to enroll newborns for neonatal care (See Attachment 1). The following are two websites that provide current State of Texas Medicaid regulations and enrollment requirements for Texas and non-state residents:https://www.benefits.qov/benefit/1640 https://hhs.texas.qov/services/health/medicaid-chip/about-medicaid-chip/state-plan In addition, attached is a copy of the current regulations regarding "Applications for Babies Born to Women in Prison" within the State of Texas prison system (See Attachment 2). This provides background on how the State of Texas handles inmate infants born to women in State prison who are non-Texas residents and whose guardian does not reside in the State of Texas.

Since the contractor will have no direct connection or knowledge of the guardian designated by the BOP, it is reasonable for the FMC to be responsible for coordinating completion of the application for financial assistance from the "other resource" (e.g., Medicaid, TRICARE, or commercial insurance). Although the contractor can assist with this process, it is recommended this responsibility be assumed by the FMC Social Worker. This will ensure all contract health care https://hhs.texas.qov/services/health/medicaid-chip/about-medicaid-chip/state-plan https://hhs.texas.qov/services/health/medicaid-chip/about-medicaid-chip/state-plan providers and facilities involved in providing postnatal care for an inmate infant are compensated accordingly. Please clarify.

If it is determined that "other resources" will assume financial responsibility for neonatal care for an inmate infant, then payment is usually made by the other resource retroactive to birth. Since the contractor is responsible for providing all of the postnatal care for inmate infants, it is reasonable for the BOP to compensate the contractor for administrative costs and risk associated with providing these services even though "other resources" assumed the financial responsibility for this neonatal care (i.e., a negotiated percentage premium amount based on Medicare).

Considering the above and the financial risk associated with catastrophic inmate infant cases, it is recommended the BOP add a separate CLIN for inmate infant deliveries and postnatal care for Inpatient Facility Services. Please clarify.

Response: If an infant requires an extended stay in the NICU/Hospitals for any medical reason, the BOP Regional Director may approve an extra seven days of medical coverage to be paid by the BOP (a total of 10 days for vaginal birth and 14 days for a Caesarean birth). If the infant still required further medical stay after the seven (7) days extension, the contractor, subcontractor, and FMC will work together to apply for Medicaid coverage which shall be retroactive to birth. Regardless of the state in which the infant will reside, the infant is considered a Texas resident because of the length of stay is undeterminable.

The FMC Social Worker will coordinate placement of infants with the inmate's designated care giver prior to discharge from the hospital. Should financial assistance be required, the FMC Social Worker will act as a liaison between the designated caregiver and the contractor and its agents in obtaining the necessary signed documentation.