SOLICITATION_CCE_11.17.pdf

PAGES

15A. NAME

AND

ADDRESS

OF

OFFEROR

SEC. PAGE(S) SEC. PAGE(S)

(Date) (Hour)

CALENDAR DAYS

14. ACKNOWLEDGMENT OF AMENDMENTS

(The offeror acknowledges receipt of amend-ments to the SOLICITATION for offerors and related documents numbered and dated:

(Type or Print)

SOLICITATION, OFFER AND AWARD 1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 700)

RATING

PAGE OF

1 70

2. CONTRACT NO.

3. SOLICITATION NO.

2016-N-18001

4. TYPE OF SOLICITATION

SEALED BID (IFB)

X NEGOTIATED (RFP)

5. DATE ISSUED

10/20/2016

6. REQUISITION/PURCHASE

NO.

0000HCCP-2017-03352

7. ISSUED BY CODE 3635 8. ADDRESS OFFER TO (If other than Item 7)

Ctrs for Disease Control & Prevention PGH

Office of Acquisition Services, Branch 4

PO Box 18070, 626 Cochrans Mill Rd

Pittsburgh, PA 15236-0070

Approved as to Form and Legality: _____________________________

NOTE: In sealed bid solicitations “offer” and “offeror” mean “bid” and “bidder.”

SOLICITATION

9. Sealed offers in original and 1 copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if handcarried, in the depository located in submitted via email to ygf3@cdc.gov until 11:00AM local time 12/12/2016

CAUTION -- LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR INFORMATION

CALL:

A. NAME

Abbie Jemmott

B. TELEPHONE (NO COLLECT CALLS)

AREA CODE NUMBER: EXT:

(412) 386-6433

C. E-MAIL ADDRESS

ygf3@cdc.gov

11. TABLE OF CONTENTS

(x) DESCRIPTION (x) DESCRIPTION

PART I – THE SCHEDULE PART II – CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 1 X I CONTRACT CLAUSES 32

X B SUPPLIES OR SERVICES AND PRICES/COSTS 2 PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

X C DESCRIPTION/SPECS./WORK STATEMENT 7 X J LIST OF ATTACHMENTS 41

X D PACKAGING AND MARKING 8 PART IV – REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 9 REPRESENTATIONS, CERTIFICATIONS, AND

X F DELIVERIES OR PERFORMANCE 10 X K OTHER STATEMENTS OF OFFERORS 42

X G CONTRACT ADMINISTRATION DATA 18 X L INSTRS., CONDS., AND NOTICES TO OFFERORS 50

X H SPECIAL CONTRACT REQUIREMENTS 26 X M EVALUATION FACTORS FOR AWARD 65

OFFER (Must be fully completed by offeror) NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

(See Section I, Clause No. 52-232-8)

10 CALENDAR DAYS

20 CALENDAR DAYS

30 CALENDAR DAYS

AMENDMENT NO. DATE AMENDMENT NO. DATE

CODE FACILITY 16. NAME AND ADDRESS OF PERSON AUTHORIZED TO SIGN OFFER

15B. TELEPHONE NO.

AREA CODE NUMBER EXT.

15C. CHECK IF REMITTANCE ADDRESS

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS IN SCHEDULE.

17. SIGNATURE

18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEMS NUMBERED 20. AMOUNT

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION

10 U.S.C. 2304(c)( ) 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTERED BY (If other than Item 7) CODE 3635 25. PAYMENT WILL BE MADE BY CODE 434

Ctrs for Disease Control & Prevention PGH

Office of Acquisition Services, 626 Cochrans Mill Rd

Pittsburgh, PA 15236-0070

Centers for Disease Control and Prevention (FMO)

PO Box 15580 404-718-8100

Atlanta, GA 30333-0080

26. NAME OF CONTRACTING OFFICER (Type or print)

Abbie Jemmott

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT -- Award will be made on this form, or on Standard Form 26, or by other authorized official written notice.

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 33 (REV. 9-97)

PREVIOUS EDITION IS UNUSABLE Prescribed by GSA

FAR (48 CFR) 53.214©

K

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

Base Period:

ITEM COST PLUS FIXED FEE SERVICES ESTIMATED

COST

FIXED

FEE

TOTAL

ESTIMATED

CPFF

0001 Operations & Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Base Period April 1, 2017 – March 31, 2018

1 Year

0002 Member Services

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

0003 Case Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 1:

FIXED

FEE

TOTAL

ESTIMATED

CPFF

0101 Operations & Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 1 April 1, 2018 – March 31, 2019

0102 Member Services

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

0103 Case Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 2:

FIXED

FEE

TOTAL

ESTIMATED

CPFF

0201 Operations & Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 2 April 1, 2019 – March 31, 2020

0202 Member Services

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

0203 Case Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 3:

FIXED

FEE

TOTAL

ESTIMATED

CPFF

0301 Operations & Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 3 April 1, 2020 – March 31, 2021

0302 Member Services

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

0303 Case Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 4:

FIXED

FEE

TOTAL

ESTIMATED

CPFF

0401 Operations & Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

Option Period 4 April 1, 2021 – March 31, 2022

0402 Member Services

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

0403 Case Management

All work to be performed in accordance with the Performance Work Statement.

This is a Cost Reimbursable CLIN

Period of Performance:

B.1 TYPE OF CONTRACT

This contract is a Cost-Plus-Fixed-Fee type completion form contract as defined in Federal Acquisition Regulation Section 16.306.

SECTION C - DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1 PERFORMANCE OF INHERENTLY GOVERNMENTAL, CRITICAL, OR OTHER FUNCTIONS

“The services contemplated under this contract are considered to be an Other Function as defined by the Office of Federal Procurement Policy in OFPP letter 11-01 and by HHS in Acquisition Policy Memorandum 2012-01.”

Please see Section J for the Performance Work Statement for the

World Trade Center Health Program, Clinical Center of Excellence.

SECTION D - PACKAGING AND MARKING

There are no clauses/provisions included in this section.

SECTION E - INSPECTION AND ACCEPTANCE

FAR SOURCE TITLE AND DATE

52.246-5 Inspection of Services – Cost Reimbursement (Apr 1984)

E.1 INSPECTION AND ACCEPTANCE (JUL 1999)

Inspection and acceptance of the articles, services, and documentation called for herein shall be accomplished by the Contracting Officer, or his duly authorized representative (who for the purposes of this contract shall be the Project Officer) at the destination of the articles, services or documentation.

(End of Clause)

SECTION F - DELIVERIES OR PERFORMANCE

52.242-15 Stop-Work Order (Aug 1989)

F.1 PERIOD OF PERFORMANCE (JUL 1999 REVISED)

The period of performance for this contract is as follows:

Base Period: April 1, 2017 through March 31, 2018 Option Period 1: April 1, 2018 through March 31, 2019 Option Period 2: April 1, 2019 through March 31, 2020 Option Period 3: April 1, 2020 through March 31, 2021 Option Period 4: April 1, 2021 through March 31, 2022

F.2 DELIVERABLE DOCUMENTATION (JUL 1999 REVISED)

(a) Documentation The following is a list of required documentation to be delivered to the Government as a part of contract performance.

PWS Reference

(Attachment #1) Deliverable Title Date Due

C.3.1.1 Project Management Plan Draft with proposal; finalized version within 30 business days of contract award; updates monthly

C.3.1.2 Operations Manual Draft with proposal; finalized version within 60 business days of contract award; updates monthly

C.3.1.3 Communications Plan Draft within 60 business days of contract award; finalized version 2 weeks upon receipt of comments; updates monthly

C.3.1.4 Data Security and Continuity of Operations Plan

Draft within 60 business days of contract award; finalized version 2 weeks upon receipt of comments; updates monthly

C.3.1.5 Risk Management Plan Draft within 60 business days of contract award; finalized version 2 weeks upon receipt of comments; updates monthly

C.3.1.6 Fraud, Waste and Abuse Compliance Plan

Draft within 60 business days of contract award; finalized version 2 weeks upon receipt of comments; updates monthly

C.3.1.7 Quality Assurance and

Internal Audit Plan

Draft with proposal; finalized version within 60 business days of contract award, updates monthly

C 3.1.9 Subcontracting Plan Draft with proposal; finalized version within 30 business days of contract award, updates 30 business days before revision

C.3.1.12 Program Improvement Plan Draft within 60 business days of contract award; finalized version 2 weeks upon receipt of comments; updates monthly

C.3.5

C.3.7.4

Coordination of Benefit Plan Draft with proposal; finalized version within 60 days of contract award;

updates monthly

C.12.2 Monthly Report The 10th business day of the month for the previous month’s information

C.12.3 Quarterly Report The 45th business day reporting on the previous quarter’s activities. The quarterly report shall include other corresponding reports that are due Semi- Annually

C.12.4 Additional Administrative Reports No more than 2 quarterly

IT Reference

(Attachment #2)

Deliverable Title Date Due

7.3 PII Security Plan Draft with proposal; finalized version within 30 business days of contract award; updates monthly

7.3.3 System Security Plan Draft within 45 business days of contract award; finalized version 2 weeks upon receipt of comments; updates monthly

17.3-17-5 FIPS 199; SA&A; SSP; SAR;

POA&M; Contingency Plan

Due within 45 business days of contract award

(1) Monthly Technical/Status Report

(i) Quantity: One (1) electronic copy per month.

(ii) Due Date: On or before ten (10) days after the end of each month.

(a) Report Content

The CCE shall submit monthly status reports on Member Services and Administrative Services activities. The status reports shall provide sufficient detail for the WTC Health Program Administrator to track all significant program activities, operations and progress. The reports shall summarize the activities and accomplishments of the past month (including the associated cost for these services invoiced to the government) and identification of any potential risks to continued program success (along with the plans to mitigate the risk).

The Contractor shall develop and submit Monthly Reports to the COR and Contracting Officer. The Monthly Reports shall include a summary of activities for the month, issues, and goals for the next month. The Monthly Reports shall summarize the Contractor’s accomplishments during the previous month, planned work during the upcoming month and any significant problems or issues requiring resolution, along with proposed corrective actions.

The Monthly Reports shall include, at a minimum, the following sections:

Member Service Function Information to Be Reported

Monitoring and Initial Health Evaluations Highlights and summary of analysis of monitoring and initial evaluation statistic from the previous two months comparing with billing period (total of three months) and the associated cost for these services invoiced to the government.

Cancer Screening, Diagnostic and Treatment Services Highlights and summary of analysis of cancer screening, diagnostic and treatment services statistic from the previous two months to comparing with billing period (total of three months) and the associated cost for these services invoiced to the government.

Information and Education Highlights and summary of analysis of effectiveness of information and education activities performed during the period and the associated cost for these services invoiced to the government.

Program Benefits Counseling Highlights and summary of analysis of effectiveness of program benefits counseling activities performed during the period and the associated cost for these services invoiced to the government.

Care Coordination and Integrated Case Management Highlights and summary of analysis of effectiveness of high level of clinical and/or non-clinical care being coordinated, including primary and secondary referrals, and transition from acute to sub-acute to local home and community-based services during the period and the associated cost for these services invoiced to the government.

Social Benefits Functions Highlights and summary of analysis of effectiveness of social benefits activities performed during the period and the associated cost for these services invoiced to the government.

Medical Appeals and Reviews Highlights and summary of analysis of effectiveness of Medical Appeals and Reviews performed during the period and the associated cost for these services invoiced to the government.

Assistance with Workers’ Compensation and other Healthcare Benefits

Highlights and summary of analysis of effectiveness of activities related to assistance with workers’ compensation and other healthcare benefits performed during the period and the associated cost for these services invoiced to the government.

Member Transfers Highlights and summary of analysis of member transfer services performed during the period (including the status of all outstanding requests for medical records) and the associated cost for these services invoiced to the government.

Member complaints Highlights and summary of analysis of members’ resolved and unresolved valid complaints related to member services, treatment, and medical decisions during the period and the associated cost for these services invoiced to the government.

Other Member Services Highlights and summary of analysis of other member services performed during the period and the associated cost for these services invoiced to the government.

Administrative Service Function Information to Be Reported

Healthcare Provider Network Highlights and summary of analysis of participation in external providers’ network and managing internal providers’ network performed during the period and the associated cost for these services invoiced to the government.

Pharmacy Benefit Management (PBM) Highlights and summary of analysis of PBM services provided and coordination with the WTC Health Program Pharmacy Benefit Manager performed during the period and the associated cost for these services invoiced to the government.

Records Management Highlights and summary of analysis of records management activities performed during the period and the associated cost for these services invoiced to the government.

HIPAA Compliance Highlights and summary of analysis of HIPAA compliance activities including potential and/or confirmed violations as defined by the WTC Health Program that occurred during the period and the associated cost for these services invoiced to the government.

Attending administrative, steering, benefits, and clinical WTC Health Program meetings

Highlights and summary of analysis of goals and outcomes of meetings/events attended during the period and the associated cost for these services invoiced to the government.

Change Request (CR), Report Writing and Responding to Government Inquiries

Highlights and summary of analysis of activities related to CR, report writing and responding to government inquiries during the period and the associated cost for these services invoiced to the government.

Claims Review, Approval, And Submission Of Clean Claims Appropriate Claims

Highlights and summary of analysis of activities related to claims processing activities performed during the period and the associated cost for these services invoiced to the government.

Healthcare Protocol Development - provide intellectual input on the development and refinement of medical guidance and protocols as needed

Highlights and summary of analysis of activities related to healthcare protocol development during the period and the associated cost for these services invoiced to the government.

Mass Communication, Press and Media Release and Interpretation and Translation Service

Highlights and summary of analysis of activities related to mass communication, press and media release and interpretation and translation services planned and completed during the period and the associated cost for these services invoiced to the government.

Balancing of budget and invoicing Monthly invoice shall include all CLINs itemized balancing sheets and projection of when the 75% of awarded fund is expected to occur.

The CCE is not authorized to operate beyond the approved budget ceiling. A justification shall be provided with unusually low or high invoicing amount. Invoice shall reflect accurate and valid activities required under this contract for the billing period

Key Personnel and Staffing Changes Summary of key personnel and/or staffing changes and analysis of impacts and the associated cost invoiced to the government during the period. A resume of new key personnel shall be provided.

Subcontracting Summary of subcontracting activities and changes with operational impacts and associated cost invoiced to the government during the period.

Other Administrative Services Highlights and summary of analysis of other administrative services, including the nature of these services and the associated cost invoiced to the government during the period.

Operations Manual, Program Management and other Plans Highlights and summary of analysis of any changes required due to new Program policy or operational difficulties encountered and proposed changes are required. All change requests and updates to any approved plans shall be submitted for approval prior to an implementation.

Fraud, Waste, and Abuse (FWA) Report

A) The CCE contractor shall submit monthly the number of complaints of FWA made to the CCE contractor related to covered services that warrant preliminary investigation by the CCE contractor.

B) The CCE contractor shall also submit to the WTC Health Program the following on an ongoing basis for each confirmed case of fraud, waste, or abuse it identifies through complaints, organizational monitoring, contractors, subcontractors, providers, and members, etc.

related to covered services:

1) The name of the individual or entity that committed the fraud, waste, or abuse;

2) The source that identified the fraud, waste, or abuse;

3) The type of provider, entity or organization that committed the fraud, waste, or abuse;

4) A description of the fraud, waste, or abuse;

5) The approximate dollar amount of the fraud, waste, or abuse;

6) The legal and administrative disposition of the case including actions taken by law enforcement officials to whom the case has been referred; and

7) Other data/information as prescribed by the WTC Health Program.

Such report shall be submitted when cases of fraud, waste, and abuse are confirmed, and shall be reviewed and signed by an executive officer of the CCE contractor.

Upon request by the Contracting Officer, the CCE contractor shall prepare and submit other operational data reports.

Such requests will be limited to situations in which the desired data is considered essential and cannot be obtained through existing CCE reports. Whenever possible, the CCE will be provided with ninety (90) days’ notice and the opportunity to discuss and comment on the proposed requirements before work is begun. However, the COR on behalf of the Program Administrator reserves the right to give five (5) days’ notice in circumstances where time is of the essence. The CCE contractor shall prepare and submit to the Contracting Officer and Program Administrator, through the COR, the other operational data reports in e-mail format.

Format - Except as otherwise specified herein, the CCE shall prepare and submit to the WTC Health Program Administrator the reports required under this section in an agreed-upon media format on the 10th business day of the month for the previous month’s activities.

The WTC Health Program Contracting Officer may extend due dates or modify report requirements or formats upon a written request by the CCE to the WTC Health Program Contracting Officer, where the CCE has demonstrated a good and compelling reason for the extension or modification. The determination to grant a modification or extension of time shall be made by the WTC Health Program Contracting Officer.

(2) Quarterly, Semi-Annually, and Annual Reports

(i) Quantity: One (1) electronic copy per month.

(ii) Due Date: On or before the 45th business day of the quarter following the reporting period.

(a) Report Content

The Quarterly, Semi-Annually, and Annual Reports shall include, at a minimum, the following sections:

Administrative Service Function Information to Be Reported Frequency

Targeted Health Care Compliance audit shall focus on evaluating the adequacy of the procedures used by the CCE to ensure that only approved WTC-related health conditions and approved health care services (including provider visits, procedures, medication and durable medical equipment) are reimbursed by the program. This includes a review of documentation justifying payment history for medically associated

The CCE shall report on Quality Assurance activities performed (including analysis of data and quality improvement) to ensure the CCE follows appropriate authorization channels for all treatment services, including medications, and coordinates referrals for treatment to ensure that the treatment being provided is for a qualifying, certified condition, is consistent with the program treatment protocols and that the treatment is

Element to be reported every quarter health conditions after approval is given by the WTC Health Program Administrator.

medically necessary.

Drug Utilization Review (DURs) and Analysis of PBM Reports:

• Percentage of generic medications vs.

brand name medications filled.

• Analysis of controlled substance use.

• Individual prescriber analysis.

• Preferred vs. non-preferred medications filled.

The CCE shall conduct DURs according to policy guidance issued as part of the technical guidance and/or the PPM and coordinate with the WTC Health Program to obtain reports for analysis of its members’ pharmacy benefits usages.

There must be medical necessity documented for all prescriptions reviewed retrospectively and they must meet all requirements stated in the formulary and PPM and other related technical guidance. If a medication is found to be inappropriately filled through the WTC Health Program by the CCE, the CCE shall ensure that the Program is notified in accordance with procedures stated in the PPM and technical guidance prepared to ensure future fills of that medication will no longer be billed to the WTC Health Program.

Pharmacy claims history audit shall focus on irregularities in the claims history of any particular provider or member.

The CCE shall coordinate with the WTC Health Program PBM to weekly obtain and review 100% of all covered cancer certified patients’ medications claims for adherence to NCCN guidelines.

The CCE shall also conduct DUR for members certified for only non-cancer conditions by reviewing a 5% sample of the total number of paid claims to assess whether the certification of categories of health conditions on file matches the therapeutic class of medication dispensed.

CCE shall ensure that claims from internal and external providers are processed within WTC Health Program policy timeframes. All claims for internal services must be submitted as clean claims within 30 days of the dates of service.

Claims from external providers must be reviewed and approved or denied within one week of external provider claims being posted for review. The CCE shall submit 95% of all internal services as clean claims within 30 days of the dates of service. The CCE shall describe the specific methodology used for review which will be consistent with the treatment protocols pre-authorized by the CCE and standards of care for the certified health conditions. Each month, a random sample of 25 claims or 100%, whichever is less, will be evaluated and no more than 1 claim will be submitted later than 30 days.

Any deviation shall be reported along with the CCE’s improvement plan.

Element to be reported every quarter

Member Retention The CCE contractor will report the number of members who have updated contact information within the 12-month period ending at the previous quarter. As an example, for the 12-month period ending on March 31, 2017, the June 30, 2017, report will give the number of members with updated contact information on or after April 1, 2017. All members will be accounted for in at least one of the three categories above, that their contact information has been verified/updated, that there was no response from the member, or

Element is to be reported at least quarterly.

that the required effort to contact the member was not made. There will be no more than 0.5% of members for whom the required annual contacting effort was not made.

Personnel Training: The Personnel Training audit shall focus on ensuring that all performing work under the CCE contract are properly trained and credentialed.

The CCE contractor shall be responsible for ensuring that the health care providers who provide diagnostic and treatment services meet all requirements of the CCE contract, credentialed according to WTC Health Program standards, currently the National Committee for Quality Assurance (NCQA) and to ensure that all providers in the CCE’s provider network (whether internal or external) are properly licensed and insured under applicable state laws and/or regulations. The CCE contractor shall report to the WTC Health Program the number of providers that were reviewed and found to be properly licensed and insured on a quarterly basis.

Element is to be reported at least quarterly.

Quality Assurance Projects: the CCE shall report on activities in various program areas where Quality Assurance, Quality Improvement have been performed.

The CCE shall select program areas to monitor and document findings and improvement plans. Once satisfactory results are achieved in a program area, a new area of focus shall be monitored.

Element is to be reported at least quarterly. A new QA project should be selected every year.

Program Management and Improvement The CCE shall assess overall program management effectiveness and provide any improvement plan or recommendation to the WTC Health Program. Any performance rating below satisfactory in the Contractor Performance Assessment Reporting System (CPARS) shall be addressed and included in a corrective action plan.

Element is to be reported at least Semi- Annually.

Quality Assurance Surveillance Plan (QASP) /Services Summary Matrix and Audit Findings

The CCE shall conduct analysis and provide a summarized report of each QASP item with relevant actions according to its own findings and/or government’s audit in accordance with CPARS.

Element is to be reported at least Semi- Annually

Medical Management Review The CCE shall assess to ensure that medical practice guidelines that have been developed are being followed, All findings that are not consistent with program policies shall be reported along with the CCE’s improvement plan.

Element is to be reported at least Semi- Annually.

The Medical Records Review audit shall focus on determining if appropriate procedures have been developed and are being followed for collecting, reviewing, maintaining and securely storing medical records in compliance with HIPAA law and regulations.

Collecting, reviewing, maintaining and securely storing medical records in compliance with HIPAA law and regulations. Performing quality assurance checks, reviewing medical records for completeness and to ensure protocols are followed for: Monitoring and Initial Health Evaluations, Treatment Services, Member Services and other services in alignment with WTC Health Program policies.

Obtaining relevant medical records for members previously served by another CCE or the NPN. Ensure the provisions of the policy of member transfers between CCEs and the NPN are followed, which includes obtaining signatures of members for needed medical release forms and sending the complete well-documented medical records to the designated party within 2 weeks of

Element is to be reported at least Semi- Annually.

receiving the signed release, 100% of the time. The sending clinical location must follow-up to verify the delivery of records is made within 1 week to the receiving clinical location 100% of the time.

Point of Service and Annual comprehensive customer satisfaction survey

In addition to offering a customer satisfaction survey at the initial and annual monitoring evaluations, diagnostic and treatment visits, and case management interventions, the CCE shall conduct an annual comprehensive customer satisfaction survey and provide an analysis report with a plan of action corresponding to the results of the survey. A total rating of all surveyed categories scored below 95% and or any categories rated below 90% shall be further analyzed and a corrective action plan provided.

Point of Service Satisfaction Survey shall be reported quarterly by month or quarter of analysis.

Annual Satisfaction Survey is to be reported annually.

(b) Report Approvals

(1) Draft Reports

The Government shall be allowed fourteen (14) days to review the draft and notify the Contractor in writing of approval or of recommended changes to be made in the final copy. If the Government does not approve or recommend changes within fourteen (14) days of receipt of the draft report, the report shall be deemed approved.

(2) Final Reports

Within fourteen (14) days of receipt of a notice of approval from the Government of any contract related document, the Contractor shall furnish the Government with 508 compliant Portable Document Format (PDF) file versions of the reports and additionally a reproducible master hard copy of the instructor’s guides in final form.

(c) Reporting Period

(1) All monthly reporting periods shall end on the last day of a calendar month.

For contracts awarded (i.e., effective date) on or before the fifteenth (15th) of a calendar month, the initial reporting period shall end on the last day of the calendar month during which the contract became effective.

For contracts awarded (i.e., effective date) on or after the sixteenth (16th) of a calendar month, the initial reporting period shall end on the last day of the month immediately following the month during which the contract became effective.

(2) All quarterly, Semi-Annually, and annual reporting periods shall end on the last day of the calendar month of the previous quarter.

(d) Delivery of Reports

The contractor shall submit one (1) hard copy and one (1) electronic copy of each of the reports, unless designated otherwise, as required by the contract to:

Centers for Disease Control and Prevention Attn: Abbie Jemmott, Contracting Officer Office of Acquisition Services 626 Cochrans Mill Road Pittsburgh, PA 15236

Abbie Jemmott – ygf3@cdc.gov

All remaining copies of deliverables/reports shall be delivered as an email attachment concurrent with shipping hard copies, prepaid, as required by the contract to the Contracting Officer’s Representative (COR) to invoice_deliverable@cdc.gov .

SECTION G - CONTRACT ADMINISTRATION DATA

G.1 CONTRACTING OFFICER (JUL 1999)

(a) The Contracting Officer is the only individual who can legally commit the Government to the expenditure of public funds. No person other than the Contracting Officer can make any changes to the terms, conditions, general provisions, or other stipulations of this contract.

(b) No information, other than that which may be contained in an authorized modification to this contract, duly issued by the Contracting Officer, which may be received from any person employed by the United States Government, or otherwise, shall be considered grounds for deviation from any stipulation of this contract.

G.2 CONTRACTING OFFICER’S REPRESENTATIVE (COR) TECHNICAL GUIDANCE (SEP 2009

REVISED)

Performance of the work hereunder shall be subject to the technical directions of the designated COTR for this contract. For purposes of this contract, any reference to a Project Officer (PO) or Contracting Officer’s

Technical Representative (COTR), shall mean the COR.

As used herein, technical directions are directions to the Contractor which fill in details, suggests possible lines of inquiry, or otherwise completes the general scope of work set forth herein. These technical directions must be within the general scope of work, and may not alter the scope of work or cause changes of such a nature as to justify an adjustment in the stated contract price/cost, or any stated limitation thereof. In the event that the Contractor feels that full implementation of any of these directions may exceed the scope of the contract, he or she shall notify the originator of the technical direction and the Contracting Officer in a letter separate of any required report(s) within two (2) weeks of the date of receipt of the technical direction and no action shall be taken pursuant to the direction.

If the Contractor fails to provide the required notification within the said two (2) week period that any technical direction exceeds the scope of the contract, then it shall be deemed for purposes of this contract that the technical direction was within the scope. No technical direction, nor its fulfillment, shall alter or abrogate the rights and obligations fixed in this contract.

The Government COR is not authorized to change any of the terms and conditions of this contract. Changes shall be made only by the Contracting Officer by properly written modification(s) to the contract.

The Government will provide the Contractor with a copy of the delegation memorandum for the COR. Any changes in COR delegation will be made by the Contracting Officer in writing with a copy being furnished to the Contractor.

(End of Clause)

G.3 CONTRACT COMMUNICATIONS/CORRESPONDENCE (JUL 1999)

The Contractor shall identify all correspondence, reports, and other data pertinent to this contract by imprinting thereon the contract number from Page 1 of the contract.

(End of Clause)

G.4 PAYMENT BY ELECTRONIC FUNDS TRANSFER (DEC 2005) (REVISED)

(a) The Government shall use electronic funds transfer to the maximum extent possible when making payments under this contract. FAR 52.232-33, Payment by Electronic Funds Transfer – System For Award Management, in Section I, requires the contractor to designate in writing a financial institution for receipt of electronic funds transfer payments.

(b) In addition to Central Contractor Registration, the contractor shall make the designation by submitting the form titled “ACH Vendor/Miscellaneous Payment Enrollment Form” to the address indicated below. Note: The form is either attached to this contract (see Section J, List of Attachments) or may be obtained by contacting the Contracting Officer or the CDC Financial Management Office at (404)-718-8100.

(c) In cases where the contractor has previously provided such designation, i.e., pursuant to a prior contract/order, and been enrolled in the program, the form is not required unless the designated financial institution has changed.

(d) The completed form shall be mailed after award, but no later than 14 days before an invoice is submitted, to the following address:

The Centers for Disease Control and Prevention Financial Management Office (FMO) P.O. Box 15580 Atlanta, GA 30333 Or – Fax copy to: 404-638-5342

G.5 NON-PERSONAL SERVICES (APRIL 2013)

(a) Personal services shall not be performed under this contract. Although the Government may provide sporadic or occasional instructions within the scope of the contract, the Contractor is responsible for control and supervision of its employees. If the Contractor (including its employees) believes any Government action or communication has been given that would create a personal services relationship between the Government and any Contractor employee, the Contractor shall promptly notify the Contracting Officer of this communication or action.

(b) The contractor shall comply with, and ensure their employees and subcontractors comply with, CDC Policy titled “Identification of Contractors' Employees and Safeguarding Government Information.” No Contractor employee shall hold him or herself out to be a Government employee, agent, or representative. No Contractor employee shall state orally or in writing at any time that he or she is acting on behalf of the Government. In all communications with third parties in connection with this contract, Contractor employees shall identify themselves as Contractor employees and specify the name of the company for which they work. . The contractor is limited to performing the services identified in the contract statement of work and shall not interpret any communication with anyone as a permissible change in contract scope or as authorization to perform work not described in the contract.

All contract changes will be incorporated by a modification signed by the Contracting Officer.

(c) The Contractor shall ensure that all of its employees and subcontractor employees working on this contract are informed of the substance of this clause. The Contractor agrees that this is a non-personal services contract; and that for all the purposes of the contract, the Contractor is not, nor shall it hold itself out to be an agent or partner of, or joint venture with, the Government. The Contractor shall notify its employees that they shall neither supervise nor accept supervision from Government employees. The substance of this clause shall be included in all subcontracts at any tier.

(d) Nothing in this clause shall limit the Government's rights in any way under any other provision of the contract, including those related to the Government's right to inspect and accept or reject the services performed under this contract.

G.6 BILLING INSTRUCTIONS FOR NEGOTIATED COST-TYPE CONTRACTS (MAR 2006)

(Applicable only to the following CLINs: 0002, 0003, 0102, 0103, 0202, 0203, 0302, 0303, 0402, 0403)

Centers for Disease Control and Prevention

Introduction

Reimbursement procedures related to negotiated cost-type contracts require that Contractors submit to the Government adequately prepared claims. The instructions that follow are provided for Contractors’ use in the preparation and submission of invoices or vouchers requesting reimbursement for work performed. The preparation of invoices or vouchers as outlined below will aid in the review and approval of claims and enable prompt payment to the Contractor.

1. Forms to Be Used

In requesting reimbursement, Contractors may use the regular Government voucher form, Standard Form 1034, “Public Voucher for Purchases and Services Other Than Personal,” and Standard Form 1035, “Continuation Sheet,” or the Contractor’s own invoice form. If the Contractor desires to use the Government’s standard forms, a request for the forms should be submitted to the Contracting Officer. If the Contractor uses his own invoice, the billing must conform with the instructions set forth herein.

2. Submission of Invoices or Vouchers

Invoices or vouchers shall be submitted per Section G of the contract. All original invoices or vouchers shall also be submitted via email to the following:

Financial Management Office (FMO): FMOAPINV@CDC.GOV Contracting Officer: ygf3@cdc.gov Contracting Officer’s Representative: invoice_deliverable@cdc.gov

REMINDER: Failure to submit vouchers in the proper format will delay your payment.

3. Preparation of Invoices or Vouchers

a. Summary of All Costs

As shown on Standard Form 1034, a summary of all current costs must be shown. This summary consists of a list identifying the general categories and the amounts incurred during the period covered by the billing, together with the portion of fixed fee (if any) payable for that period. The reimbursable costs incurred and the dates of the period for which the charges are claimed must fall within the period specified in the contract.

b. Details of Costs Claimed

As shown on Standard Form 1035, a detailed breakdown must be provided to substantiate the categories shown on the summary of costs. The following describes some of the categories that might appear on your billings:

(1) Direct Labor

Direct Labor costs consist of salaries and wages paid for scientific, technical, and other work performed directly for the contract and pursuant to the contract terms. Labor costs, excluding fringe benefits and overtime premium pay, will be billed as follows:

List the titles and amounts for employees whose salaries or wages, or portions thereof, were charged to the contract; show the rate (or hours) worked, and amount for each individual. The cost of direct labor, which is charged directly to the contract, must be supported by time records maintained in the contractor’s office.

(2) Fringe Benefits

If it is the Contractor’s established practice to treat fringe benefits as a direct cost, such costs should be billed separately as a single item.

NOTE: Fringe benefits, bonuses, etc., are usually treated as indirect costs for inclusion in the overhead pool;

however, they may be treated as direct labor costs or as an “Other Direct Charge” if such treatment is in accordance with the Contractor’s established accounting procedures.

(3) Premium Pay

Premium pay is the difference between the rates and amounts paid for overtime or shift work and amount normally paid on a straight time basis. Generally such pay is not included in the direct labor base and should not be included in the billing for “direct labor” unless the Contractor has consistently followed this practice in the past as a matter of policy. Premium pay of any kind unless provided for in the contract must be authorized by the Contracting Officer in advance. Billings for unauthorized premium pays have caused frequent delays in payment due to suspensions and exchange of correspondence. Citations of authorization for premium pay will avoid delays in payment. Authorized premium pay may be shown as a single item on the summary of costs. However, it must be separately itemized for each position, or job category, showing the amount, and a citation of the Contracting Officer’s letter of authorization on the continuation sheet of the invoice or voucher.

(4) Materials and Supplies

Only those items, which the Contractor normally treats as “direct costs”, should be claimed under this heading.

Major classifications of material only should be billed separately under appropriate classification. Items costing less than $25.00 may be listed by category of materials or supplies. Show the description and dollar amount of individual classifications. All such charges must be supported by the Contractor’s office records.

(5) Travel

When authorized in the contract as a direct cost, travel costs that are directly related to specific contract performance may be billed as a direct cost. Travel cost detail should show:

(a) Name of traveler and official title,

(b) Purpose of trip,

(c) Dates of departure and return to starting point (station or airport),

(d) Transportation costs, identified as to rail, air, private automobile (including mileage and rate) and taxi.

(e) If claim for subsistence is on per diem basis, show number of days, rate and amount, as authorized in contract.1 If claim is based on actual cost of subsistence, show, on a daily basis, the amounts claimed for lodging and meals separately.

(f) Reference to Contracting Officer’s letter of authorization if required by contract.

(6) Consultant Fees

Identify the consultant by name, number of days utilized, and amount of fee.

(7) Equipment

Nonexpendable personal property must be specifically approved in writing by the Contracting Officer or authorized by the terms of the contract. Billing data should include a description of item, make model, quantity, unit cost, total cost, and date approved by the Contracting Officer, if applicable. A copy of the vendor’s bill may be submitted in lieu of the identifying information.

(8) Burden

Pending establishment of final contract indirect cost rates for each of the Contractor’s fiscal years, the Contractor will be reimbursed based on his submittal of provisional rates as set forth in the contract. The contract may provide for more than one type indirect cost rate, such as overhead rate, and general and administrative expense rate, in which case the direct cost bases (e.g., direct labor, total direct cost, etc.)

1 For purposes of computing per diem charges in lieu of actual subsistence charges, unless otherwise provided in the contract, a day is divided into four quarters that begin at 12 midnight, 6:00 AM, 12 noon, and 6:00 PM. For example, at an authorized per diem rate of $35.00 per day, a traveler who departed at 9:15 AM on July 15 and returned at 6:45 PM on July 18 would be entitled to $131.25.

(9) Fixed Fee

Ordinarily the fixed fee is stated in the contract as a lump sum and may be billed in the ratio of incurred costs to total estimated cost as set forth in the contract, with the final 15 percent to be billed on the final invoice or voucher.

Contract terms govern the method of payments.

(10) Cumulative Amount Claimed

As shown on Standard Form 1035, the Contractor must show the cumulative amounts claimed by categories from the contract award date through the date of the current invoice or voucher, as well as the estimated cost to complete per category.

(11) Remaining Balance

Remaining balance shall be shown as part of the summary of the expenses for each cost-reimburseable CLIN.

QUICK CHECKLIST FOR INVOICE SUBMISSION:

• Standard Forms 1034 and 1035 recommended. If submitting own forms, statement must conform to billing instructions

• Quarterly billing as a minimum

• Invoice or Voucher must contain the minimum requirements per Voucher/Invoice Submission in Section G of the contract

• Vouchers should be collated

• Detail of Cost Claimed

• Cummulative expenses and remaining balance for each CLIN

* All invoices shall be submitted in conjunction with the monthly report. *

G.7 INVOICE SUBMISSION (Mar 2006 revised) (Applicable only to the following CLINs: 0001, 0101, 0201, 0301, 0401)

(a) The Contractor shall submit an original hard-copy contract invoice/voucher to the address shown below:

The Centers for Disease Control and Prevention Financial Management Office (FMO) P.O. Box 15580 Atlanta, GA 3033

Or – The Contractor may submit the original invoice/voucher via facsimile or email:

Fax: 404-638-5324

Email: FMOAPINV@CDC.GOV

NOTE: Submit to only one (1) of the above locations.

(b) The contractor shall submit 2 copies of the invoice/voucher to the cognizant contracting office previously identified in this contract. These invoices/voucher copies shall be addressed to the attention of the Contracting Officer.

(c) The Contractor is , is not required to submit a copy of each invoice directly to the Project Officer concurrently with submission to the Contracting Officer.

(d) In accordance with 5 CFR part 1315 (Prompt Payment), CDC's Financial Management Office is the designated billing office for the purpose of determining the payment due date under FAR 32.904.

(e) The Contractor shall include (as a minimum) the following information on each invoice:

(1) Contractor’s Name & Address

(2) Contractor’s Tax Identification Number (TIN)

(3) Purchase Order/Contract Number and Task Order Number, if Appropriate

(4) Invoice Number

(5) Invoice Date

(6) Contract Line Item Number and Description of Item

(7) Quantity

(8) Unit Price & Extended Amount for each line item

(9) Shipping and Payment Terms

(10) Total Amount of Invoice

(11) Name, title, and telephone number of person to be notified in the event of a defective invoice

(12) Payment Address, if different from the information in (c)(1).

(13) DUNS + 4 Number

G.8 EVALUATION OF CONTRACTOR PERFORMANCE UTILIZING CPARS

In accordance with FAR 42.15, the Centers for Disease Control and Prevention (CDC) will review and evaluate contract performance. FAR 42.1502 and 42.1503 requires agencies to prepare evaluations of contractor performance and submit them to the Past Performance Information Retrieval System (PPIRS). The CDC utilizes the Department of Defense (DOD) web-based Contractor Performance Assessment Reporting System (CPARS) to prepare and report these contractor performance evaluations. All information contained in these assessments may be used by the Government, within the limitations of FAR 42.15, for future source selections in accordance with FAR

15.304 where past performance is an evaluation factor.

The CPARS system requires a contractor representative to be assigned so that the contractor has appropriate input into the performance evaluation process.