A19_-_1605DC-19-R-00030_Amend_0001_-_Kansas_City_District_-_Medical_Second_Opinion_and_Examination_Services.pdf

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1605DC-19-R-00030

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1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT 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 telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

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Washington DC 20210-0001

OPS

S4307 200 Constitution Ave, NW Office of Procurment Services US Department of Labor

Washington DC 20210-0001

OPS

S-4307 200 Constitution Ave, NW Office of Procurement Services US Department of Labor

05/24/20190001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

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

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

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

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

05/13/2019

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

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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

ORDER NO. IN ITEM 10A.

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

The purpose of this amendment is to:

1. Extend the proposal due date/time to June 5, 2019 at 12pm ES

2. Respond to the clarifying questions received by May 20, 2019 at 12pm ES (see the continuation pages)

3. Upload a revised PWS with the respective corrections in response to the attached clarifying questions (to include the track changes) in FBO.gov

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

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

Kansas City ‐ Medical Second Opinion Services ‐ Question and Answer Spreadsheet Solicitation Number ‐ 1605DC‐19‐R‐00030 Question Title Section Number Offerors Questions Government Responses

1 Due date p. 1, block 8 Given the less than 3‐week turn‐around time with federal holiday falling during that time period, can the due date on this be extended by another two weeks, to June 17?

The due date/time is extended to 06/05/2019 at 1200

ES

2 Required Specialties C.2.1

1. Page 17 states that the required specialties are Orthopedic surgery, Psychiatry, Otolaryngology, Neurology, Neuro‐Surgery, Dermatology, Pulmonology and Physical Medicine and Rehabilitation. However, an additional specialty of Occupational Medicine is mentioned on page 28 under C.5.1.2. Task 2: “No more than 40% will be performed in each area of the following specialties per office:

Orthopedic, Occupational Medicine, Otolaryngologist, and Neurology. Then on page 31, C.5.1.3. Task 3, item e., additional specialties of cardiology, allergy and immunology, internal medicine, oncology, general surgery, and urology are mentioned as “the most commonly required areas of medical expertise or specialty” for which “the Contractor will ensure that sufficient coverage is available.” On page 53, PRS#1, the standard is defined as “The contractor is required to have five (5) “required” physician specialty and ability to arrange examinations with specialties outside the 8 must haves.” Whether there are 5 or 8 (or another number) of required specialties is not clear. It is not clear which medical specialties are required. The difference between “required”, “must have”, and “commonly required” specialties is not clear.

Will you please clarify:

a. What is the difference between “must have”, “required”, and a “commonly required” specialties?

b. What specialties are “required”?

c. What specialties are “must haves”?

d. What specialties are “commonly required”?

CORRECTION: The contractor must have the ability to provide the (8) eight "required" specialties which include orthopedic surgery, otolaryngology, neurology, neuro‐surgery, psychiatry, dermatology, pulmonology and physical medicine and rehabilitation. However, the services may also be required for other medical specialties as idenfied in section C.2.1.

For the purposes of the RFP, the terms "must have" are the same as "required" specialties. In addition, all other medical services that may be required for the region to be served are identified in Section C.2.1 as "other medical specialties for the region to be served."

The term "commonly required" is removed from the

PWS.

A revised PWS with the respective corrections in this spreadsheet (to include the track changes) is uploaded in FBO.gov with this amendment.

3 Task Order Management

C.5.1.2 Task 2

2. Page 29, Task Order Management, bullet point #2 after the second paragraph states “Monitor scheduling to ensure no one provider/specialist shall conduct more than 40% of the examinations in each area of the following specialties per office: Orthopedic, Occupational Medicine, Otolaryngologist, and Neurology in any one MSA per annum.”

However, on page, PRS#1, the Performance Threshold is defined as “The maximum acceptable level is no more than 30% of referred cases can be examined by one particular orthopedic surgeon, one neurologist, one neurosurgeon, or one physical medicine and rehabilitation specialist or no more that 33% for on otolaryngologist, one psychiatrist, one pulmonologist, or one dermatologist per annum.” Between those statements the specialties and percentages do not match.

Will you please clarify:

a. Which specialties shall be limited in the number of exams per annum in any given MSA that a single provider shall be allowed to perform?

b. What percentages of exams shall be allowed to be performed by a single provider of a given specialty in any given MSA?

CORRECTION: The contractor must have the ability to provide the (8) eight "required" specialties which include orthopedic surgery, otolaryyngology, neurology, neuro‐surgery, psychiatry, dermatology, pulmonology and physical medicine and rehabilitation. Other specialties my be required but the 8 "required" specialties are the most commonly used. In addition, the Performance Threshold is defined as The Maximum acceptable level is no more than 33% of referred cases can be examined by one particular orthopedic surgery, otolaryngology, neurology, neuro‐surgery, psychiatry, dermatology, pulmonology and physical medicine and rehabilitation per annum."

4 Security Requirements C.1.6.7 (pgs 9‐10) Please clarify if the vendor will need to access government facilities.

CLARIFICATION: The contractor will need to access government facilties (District Office or National Office) for on‐site meetings with Governent Officials, when required.

5 Conservation of Utilities C.1.6.8 (pg 10) Please clarify if the vendor will need to access government facilities. CLARIFICATION: Please see response to question 4 above.

6 Required Specialties

C.5.1.3. Task 3 (2.a.(4)) (pg 32) and C.5.1.3.

Task 3 (Government's Minimum

Requirements ‐ Physician/Specialist availability) (pg 35); C.5.1.3, Accuracy of Resumes, item 5 (pg 34); C.5.1.3 (pg 35);

Technical Exhibit 1, PRS #1 (pg 53);

Attachment J.3, QASP (pg 3)

There are multiple references to five (5) medical specialties whereas the required specialties defined in Part 2 identifies eight (8) medical specialties. On C.5.1.3. Task 3 (2.a.(4)) it states "the five (5) medical specialties for which OWCP has most need in the District Office are identified in Part 2 ‐ Definitions and Acronyms ‐ Required Medical Specialties. Additionally, the method described under C.5.1.3. Task 3 ‐ Government's Minimum Requirements ‐ Physician/Specialist availabitility indicates "each offer should include sufficient numbers of the five (5) "required specialties" to meet contract requirements...". And the other Sections contain comparable references to five specialties. Please clarify if the offeror should provide sufficient numbers of physicians/specialists for five (5) or eight (8) specialties and identify the corresponding list of the specialties.

CORRECTION: Please see response to question 2 above.

7 Pricing and Estimated Quantities B.5 Pricing and Estimated Quantities (pg 5)

The price schedule includes a line item for "FTE" with a quantity of five (5) which appears inconsistent with other line items. Please clarify if this is a requirement and if yes, provide a definition of "FTE."

CORRECTION: Line item stating FTE and quantity of five (5) is deleted from section B.5, Pricing and Estimated Quantities.

8 Copies of Physician Documentation L, Submission, C. Page Count, table (pg 114)

It is our assumption that a single (i.e. one) digital copy of the physician/specialists experience and qualification documentation is to be submitted (i.e. not three digital copies). Is this assumption correct? If not, please clarify the instructions.

CORRECTION: Please provide one (1) digital copy of the physician/specialists experience and qualification documentation.

9 Federal Security Training C.1.6.10.1(a) (pg 14) What specific Federal security training requirements are mandated for this contract? Does this requirement only apply to onsite contractors? What about subcontractors who are not employees? What is the process to obtain Government signed waiver agreement?

RESPONSE: The Department of Labor currently mandates that all DOL contractors who require access to Government systems and Privacy information receive Annual Mandatory Information Systems and Privacy Awareness Training regardless of employee status.

10 Percentage of Cases for One Specialist

C.5.1.2, second bullet (pg 28); C.5.1.2, Task Order Management (pg 29); C.5.1.3(4).b (pg

33); Technical Exhibit 1, PRS #1 (pg );

Attachment J.3 ‐ QASP (pg 3)

Please clarify the requirement regarding the percentage of cases which can be supported by an individual specialist within an MSA and the associated specialties. The RFP contains inconsistent language on this topic. For example, the RFP uses "no more than 40% will be performed in each area of the following specialties per office" and "no more than 30% (and 33%) of referred cases can be examined by one particular" specialist.

It is our assumption that this requirement is applied to individual specialists and not to a physician office (i.e. language in the Technical Exhibit 1 and QASP is correct). Application to an office with more than one specialist supporting the contract creates undue restrictions based on the healthcare market and consolidation into medical groups and local supply and demand dynamics especially in rural and remote areas.

CLARIFICATION: The Performance Threshold is defined as The Maximum acceptable level is no more than 33% of referred cases can be examined by one particular specialists per annum. The requirement applies to individual specialists and not to physician offices.

11 Board Certification C.5.1.3(1)c (pg 31); C.5.1.3(4) (pg 32) Can physicians who are board certified by National Board of Physicians and Surgeons (NBPAS) also be used to support the contract? Inclusion can increase the number of potential physician/specialists to support the contract.

There are no additional Board Certifications considered at this time.

12 Common and Uncommon Specialties C.5.1.3(1)e and f (pgs 31‐32); C.5.1.3 (pg 34)

Item e identifies 14 specialties as "common specialty" and Item f identifies 20 specialties as "uncommon specialty" and Part 2 identifies 8 specialties as required.

Please clarify the use and list of specialties defined as "common" and "uncommon" and the relationship to the required specialties.

CORRECTION: Please see response to question 2 above.

13 Physicians/Specialists C.5.1.3(5) (pg 33)

Please clarify the intent of this requirement and provide examples of acceptable and unacceptable scenarios. It is our interpretation that this requirement is not intended to constrain specialists in active practice from providing services that do not create a conflict of interest situation (i.e. claimant is a patient).

It is our interpretation that specialists who provide services on this contract:

(1) Cannot perform workers’ compensation medical second opinion services for other federal government agencies.

(2) May perform workers’ compensation medical second opinion services for private sector entities.

(3) May provide other medical services for other federal government agencies and other entities, e.g. disability exams for military service members.

Are these interpretations correct? If not, please clarify.

For additional consideration, in certain geographic areas and specialties there could only be only one provider available that meets the RFP requirements and would then not be eligible because they performed a “medical examination service” for another federal government agency which is not related to DOL worker’s compensation exams.

CLARIFICATION: The intent of this requirement is to ensure no conflict of interest exists with providers and that the work can be performed in a non‐bias manner.

Also, specialists who provide services on this contract:

(1) Cannot perform workers’ compensation medical second opinion services for other federal government agencies.

(2) May perform workers’ compensation medical second opinion services for private sector entities.

(3) May provide other medical services for other federal government agencies and other entities, e.g.

disability exams for military service members.

For additional consideration, in certain geographic areas and specialties there could only be only one provider available that meets the RFP requirements and would then not be eligible because they performed a “medical examination service” for another federal government agency which is not related to DOL worker’s compensation exams. If the “medical examination service” is for the agency’s workers’ compensation purposes, correct. If the agency services are unrelated to workers comp, that doctor can be used.

14 Physicians/Specialists C.5.1.3(5)(pg 33)

Respectfully request removal of the last sentence as the offeror does not maintain the ability to monitor all work performed by a contracted private provider in active practice. Offeror can perform due diligence to address any potential conflicts for medical second opinion services for other federal government agencies.

CLARIFICATION: The offeror must have the ability to monitor all work required by the contract in order to meet contract terms and conditions and have the ability to provide due diligence to ensure no potential conflicts of interest exists.

15 EFT System Enrollment Technical Exhibit 4 (pg 63)

It is our assumption that only the contractor needs to be enrolled in the EFT system (i.e. the individual physician/specialists do not enroll). Is this assumption correct? If not, please clarify.

CLARIFICATION: All contractors/subcontractors must be enrolled in the EFT system in order to receive payment for services. However, only the contractor shall submit medical bills for services through OWCP's Medical Bill Processing System.

16 Certified Statement L.SUBMISSION.D.Volume I (pg 115);

M.Element 2.Required Documents (pg 124)

The RFP states “Offeror’s certified statement acknowledging their obligation to continue due diligence in recruiting sufficient numbers of qualified physicians/specialists in the region to be served in order to meet contract requirements. (Note: Subject to the Governments review and approval).” Please clarify what is required for a “certified” statement. And it is our assumption that the certified statement is provided as an attachment to Volume I and is outside of page count. Is this assumption correct? If not, please clarify.

CLARIFICATION: Please provide a notarized statement that acknowledes the companies obligation to continue due diligence in recruiting sufficient numbers of qualified physician/specialists in the region to be served.

17 Subcontracting Plan L.SUBMISSION (pg 113);

L.SUBMISSION.C, table (pg 114)

It is our assumption that the Subcontracting Plan is provided in Volume III, Price and not with Volume I, Technical Capability as it contains price information. Is this assumption correct? If not, please clarify.

CLARIFICATION: Correct. Offerors shall provide the Subcontracting Plan in Volume III only.

18 FAR 52.215‐2 I.1 (pg 65) Since this is a commercial item contract please delete 52.215‐2, as provided in FAR 15.209(b)(1)(iii). Please also note that no certified cost or pricing data is required here.

CORRECTION: FAR Clause 52.215‐2 is removed from this solicitation

19 Service Contract Clauses I.3 (pg 72); K.8 (pgs 110‐112)

Please delete FAR 52.222‐41, Service Contract Labor Standards, FAR 52.222‐17, FAR 52.222‐42, FAR 52.222‐43, FAR 52.222‐44, FAR 52.222‐55, and FAR 52.222‐52.

This is a contract to be performed overwhelmingly by physicians, who are not “service employees.” In addition, Wage Determination(s) are not provided with the RFP.

CORRECTION: FAR 52.222‐41, FAR 52.222‐17, FAR

52.222‐42, FAR 52.222‐43, FAR 52.222‐44, FAR

52.222‐55, and FAR 52.222‐52 are removed from this solicitation. Therefore, the Wage Determination(s) will not be provided.

20 Flowdown I.3 (pg 73)

Section I.3(e)1 of the RFP requires the Service Contract Act clause as a flow down to subcontractors. Offeror requests removal of the Service Contract Act and related clauses. This is a contract to be performed overwhelmingly by physicians, who are not “service employees.”

Since the Act requires the payment of minimum compensation for work performed under the contract, and recordkeeping to prove that such compensation was paid, the compliance burden for the average medical practice would be burdensome. The flow down of the Act will make it very difficult to obtain medical practices as subcontractors.

The physicians themselves are exempt from the Act as “professionals.” 29 C.F.R. §

541.304 (a) & (b). Moreover, some nurses and physician assistants are also exempt. 29 C.F.R. § 541.301(e). Other nurses and medical technicians are apparently covered, and will have to be paid the minimum compensation in the wage determination applicable to their locality. These individuals may work for the prime and/or a subcontractor. In addition, other individuals performing duties on the contract may be exempt as “administrative” workers.

CORRECTION: Please see response to question 19 above.