Attachment M - Proposal Form Updated.pdf

ATTACHMENT M - PROPOSAL FORM

Office of Medical-Legal Risk Management (MLRM) External Clinical Review

Proposal Files for Solicitation 36C10X24R0038

Instructions: Offeror must complete the following information as instructed.

Page Limitations for each section are provided within each section.

Basis for Award- Technical Approach, Past Performance, Socioeconomic Considerations, and Price: The Government requires contractors capable of simultaneously meeting unique and highly complex peer reviews across all provider disciplines with expertise in conducting reviews of selected episodes of care. The Government requires a provider panel of sufficient size in each discipline to meet the volume and demand of the VA. The Government will conduct a comparative evaluation of the Offeror’s written response.

Solicitation 36C10X24R0038 Offeror Name:

Technical Approach

Complete the Technical Approach and Past Performance questions below in full detail, as outline in section E.2 of the Solicitation.

Responses are limited to the space provided for each area.

Recruitment Strategy (2,000 Character limit on this page and 4,000 Characters limit on the next)

(continue on next page)

The Government will evaluate Technical Approach as follows:

The Government will therefore evaluate the Offeror to determine whether their Technical Approach is fully capable recruitment strategy, depth in all labor categories (LCATs), offers providers in all identified specialties and sub-specialties as described in Attachment A - Specialties, provides on-boarding support including IT troubleshooting for staff and reviewers, and has sound contract management processes with the ability to administer orders in an efficient manner.

Recruitment Strategy cont. (4,000 Character limit)

Depth in all Labor Categories (LCATs)(4,000 Character limit)

Offers providers in all identified specialties and subspecialties as described in Attachment A - Specialties(4,000 Character limit)

Provides onboarding support including IT troubleshooting for staff and reviewers (4,000 Character limit)

Contract Management processes with the ability to administer orders in an efficient manner (4,000 Character limit.)

Area for additional details, if needed(4,000 Character limit)

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Past Performance #1

2. Past Performance Name of Contracting Organization:

Contract Number and Task Order Number:

WORK WAS PERFORMED AS THE: PRIME SUBCONTRACTOR

Total Awarded Price/Cost:

Final or Projected Final Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer’s Name, Email, and Telephone Number:

Program Manager’s Name, Email and Telephone Number

North American Industry Classification System (NAICS) Code:

Was there a CPARS? : YES NO UNKNOWN

Description of the Requirement (5,000 Characters)

Past performance will be evaluated to determine whether each reference is relevant (based on size, scope, and/or complexity to this requirement), recent (within the past three years), and reflects performance which is satisfactory or better.

Past Performance #1 cont.

< Narrative of timely completion and declined cases> (5,000 Characters)

The Government will also evaluate the rate of timely completion of deliverables on similar size contracts and if cases were ever declined. If cases were ever declined, offeror shall provide the percentage of declined cases.

Past Performance #2

2. Past Performance Name of Contracting Organization:

Contract Number and Task Order Number:

WORK WAS PERFORMED AS THE: PRIME SUBCONTRACTOR

Total Awarded Price/Cost:

Final or Projected Final Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer’s Name, Email, and Telephone Number:

Program Manager’s Name, Email and Telephone Number

North American Industry Classification System (NAICS) Code:

Was there a CPARS? : YES NO UNKNOWN

Description of the Requirement (5,000 Characters)

Past performance will be evaluated to determine whether each reference is relevant (based on size, scope, and/or complexity to this requirement), recent (within the past three years), and reflects performance which is satisfactory or better.

Past Performance #2 cont.

< Narrative of timely completion and declined cases> (5,000 Characters)

The Government will also evaluate the rate of timely completion of deliverables on similar size contracts and if cases were ever declined. If cases were ever declined, offeror shall provide the percentage of declined cases.

Past Performance #3

2. Past Performance Name of Contracting Organization:

Contract Number and Task Order Number:

WORK WAS PERFORMED AS THE: PRIME SUBCONTRACTOR

Total Awarded Price/Cost:

Final or Projected Final Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer’s Name, Email, and Telephone Number:

Program Manager’s Name, Email and Telephone Number

North American Industry Classification System (NAICS) Code:

Was there a CPARS? : YES NO UNKNOWN

Description of the Requirement (5,000 Characters)

Past performance will be evaluated to determine whether each reference is relevant (based on size, scope, and/or complexity to this requirement), recent (within the past three years), and reflects performance which is satisfactory or better.

Past Performance #3 cont.

< Narrative of timely completion and declined cases> (5,000 Characters)

The Government will also evaluate the rate of timely completion of deliverables on similar size contracts and if cases were ever declined. If cases were ever declined, offeror shall provide the percentage of declined cases.

Offeror Name:

SF 1449, AMENDMENTS, OTHER DOCUMENTS

Instructions: The following shall be submitted in addition to this proposal form:

1. Signed SF 1449 and amendment(s), if any. An authorized official of the offeror submitting the response shall sign the SF 1449, amendment(s) and all certifications requiring signature.

2. Offeror’s statement(s) as required by paragraph b. of the VAAR Clause, E.2 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST and any applicable OCI Mitigation Plans.

3. Paragraph b of 52.212-3, Offeror Representations and Certifications.

4. Additional Details: The Offeror may submit up a maximum of 10 pages (Single Space – 12-point font) of additional details as a continuation of page 8, Attachment M.

5. Any proposed terms and conditions and/or assumptions upon which the proposal is predicated.

Offerors are hereby advised that any offeror-imposed terms and conditions and/or assumptions which deviate from the Government’s material terms and conditions established by the solicitation, may render the offeror’s proposal unacceptable, and thus ineligible for award.

6. Completed Price Schedule (Section B.4 of this solicitation)

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