60RRBH18R0015.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

60RRBH18R0015

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

05/23/2018

7. FOR SOLICITATION INFORMATION

CALL:

a. NAME Amber Nevin (amber.nevin@rrb.gov)

b. TELEPHONE NUMBER (No collect calls) 312-751-4538

8. OFFER DUE DATE / LOCAL

TIME

06/27/2018 13:00:00

CODE ACQMGMT

U.S. Railroad Retirement Board Acquisition Management 844 N. Rush St.

Chicago, IL 60611

9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

X

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED 0 Days: 0.00 %

0 Days: 0.00 % 0 Days: 0.00 % 0 Days: 0.00 %

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER DPAS

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

025CODE15. DELIVER TO

U.S. RAILROAD RETIREMENT BOARD

DISABILITY BENEFITS

844 NORTH RUSH ST., 11TH FL.

CHICAGO, IL 60611

CODE 03916. ADMINISTERED BY

U.S.RAILROAD RETIREMENT BOARD

ACQUISITION MANAGEMENT

844 N. RUSH ST., 9TH FL.

CHICAGO, IL 60611

FACILITY

CODE

CODE

Telephone No.

17a. CONTRACTOR/

OFFEROR

CODE18a. PAYMENT WILL BE MADE BY

U.S. RAILROAD RETIREMENT BOARD

FISCAL OPERATIONS

844 N RUSH ST., 5TH FLOOR

CHICAGO, IL 60611

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

(Use Reverse and/or Attach Additional Sheets as Necessary)

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Lines

25. ACCOUNTING AND APPROPRIATION DATA

See Line Item Detail

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4, FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE X ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4, 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) Paul T. Ahern

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 02/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

Document Number: 60RRBH18R0015 PROCESSED Page 1 of 57

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 02/2012) BACK

Document Number: 60RRBH18R0015 PROCESSED Page 2 of 57

Table of Contents

Section Description Page Number

I Introduction Overview

II Schedule of Supplies and Services Schedule of Supplies and Services

III Statement of Work Statement of Work

IV General Terms and Conditions 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.212-3 Offeror Representations and Certifications--Commercial Items (Nov 2017) RRB.A.01 A. General RRB Provision-1.Technical Direction RRB.B.02 B. Security Provisions-1. Privacy Or Security Safeguards (AUG 1996) FAR 52.239-1 (with RRB Fill-ins) RRB.A.8 Remittance Address 52.232-19 Availability Of Funds For The Next Fiscal Year (Apr 1984) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) RRB.A.03 A. General RRB Provision-3.Billing 52.216-22 Indefinite Quantity (Oct 1995) 52.216-19 Order Limitations (Oct 1995) 52.237-3 Continuity Of Services (Jan 1991) 52.246-25 Limitation of Liability - Services (Feb 1997) 52.232-11 Extras (Apr 1984) 52.203-2 Certificate Of Independent Price Determination (Apr 1985) 52.215-6 Place of Performance (Oct 1997) 52.203-11 Certification And Disclosure Regarding Payments To Influence Certain Federal Transactions (Sept 2007) 52.227-15 Representation of Limited Rights Data and Restricted Computer Software (Dec 2007) 52.222-22 Previous Contracts and Compliance Reports (Feb 1999) RRB.B.01 B. Security Provisions-1.Security Information 52.239-1 Privacy or Security Safeguards (Aug 1996) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997) RRB.A.07 A. General RRB Provision-7.The Role of Government Personnel and Responsibility for Contract Administration 52.216-1 Type of Contract (Apr 1984) RRB.A.9 Post Award Conference 52.244-2 Subcontracts (Oct 2010) 52.219-9 Small Business Subcontracting Plan (Jan 2017) 52.216-18 Ordering (Oct 1995) 52.233-2 Service of Protest (Sept 2006) 52.211-11 Liquidated Damages - Supplies, Services, or Research and Development (Sept 2000) 52.242-15 Stop-Work Order (Aug 1989) 52.252-2 Clauses Incorporated by Reference (Feb 1998) 52.212-2 Evaluation - Commercial Items (Oct 2014) SUBCONTRACTING Subcontracting 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders--Commercial Items (Jan 2018)

V Proposal Submission Instructions Submission of Quotations/Proposals

VI Evaluation and Award Evaluation and Award

VII List of Attachments Attachments and Exhibits

Document Number: 60RRBH18R0015 PROCESSED Page 3 of 57

Section I - Introduction

Overview

A. Agency Information

The U.S. Railroad Retirement Board (RRB) is an independent federal agency that administers a retirement and survivor benefit pro-gram for railroad employees and their families. The RRB was established by the Railroad Retirement Acts of 1937 and 1974. Its be-nefit program was the forerunner of the more familiar Social Security system in addition to an occupational disability benefit to in-dustry workers who can no longer meet the demands of their railroad occupation. The Railroad Retirement System is unique inasmuch as it is the only federally administered benefit program covering a single private industry. The RRB also administers the Railroad Un-employment Insurance Act which provides unemployment and sickness benefits to railroad employees. The RRB’s headquarters and the RRB’s Office of the Inspector General are located in Chicago, Illinois. The RRB also has 53 field offices, nationwide.

B. Project Information

The RRB is seeking competitive proposals from contractors that can, throughout the continental United States, provide consultative medical exam services and/or ancillary tests used as supportive evidence in making a determination of disability under federal guidelines, for either a current or former railroad employee or his or her widow(er) or child.

C. Questions

Offerors may submit questions regarding this RFP to proposals@rrb.gov by June 4, 2018 at 10:00AM CT.

Section II - Schedule of Supplies and Services

Number Supplies or Services Quantity Unit Unit Price Total ( Inc. disc., tax, and fees)

0001 Medical- Other 0.000000 $

Period of Performance: 10/01/2018 - 09/30/2019

Description:

Initial contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the initial year of services.

0002 Medical- Other 0.000000 $

Period of Performance: 10/01/2019 - 09/30/2020

Description:

First option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the first option year of services.

0003 Medical- Other 0.000000 $

Period of Performance: 10/01/2020 - 09/30/2021

Description:

Second option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the second option year of services.

0004 Medical- Other 0.000000 $

Period of Performance: 10/01/2021 - 09/30/2022

Description:

Third option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the third option year of services.

0005 Medical- Other 0.000000 $

Period of Performance: 10/01/2022 - 09/30/2023

Description:

Fourth option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the fourth option year of services.

Document Number: 60RRBH18R0015 PROCESSED Page 4 of 57

Schedule of Supplies and Services

A. Unless specifically identified elsewhere in this contract, the firm fixed unit prices for medical exams set forth in the Attachment B “Price Schedule” reflect all costs associated with the provision of service under this contract. Offerors shall complete and provide a pricing schedule for each contract term listed below. (See Attachment B: Unit Pricing Schedule for Provision of Examination/ Test Services)

Nationwide Coverage CLIN

A. Initial Contract Term (October 1, 2018 – Sept 30, 2019) 0001 B. First Option Term (October 1, 2019 – Sept 30, 2020) 0002 C. Second Option Term (October 1, 2020 – Sept 30, 2021) 0003 D. Third Option Term (October 1, 2021 – Sept 30, 2022) 0004 E. Fourth Option Term (October 1, 2022 – Sept 30, 2023) 0005

B. CONTRACTOR INFORMATION FOR ORDER ADMINISTRATION

1) Order address ______________________

2) Business Size ______________________

3) Federal Tax ID # ____________________ [Submit on IRS Form W9 with offer]

4) DUNS No. ______________________

5) Remit Address ______________________

6) Authorized representatives:

Business Technical

Name:

Phone #:

Fax #:

E-Mail:

7) System for Award Management (SAM) completed*:

Yes [ ] No [ ]

* Offeror must be properly registered, including business size annotation, and in active status in SAM at time of proposal sub-mission in order to be eligible for award of a Federal contract or order. (See www.sam.gov).

PERIOD OF PERFORMANCE

ITEM START END

0001 10/01/2018 09/30/2019

0002 10/01/2019 09/30/2020

0003 10/01/2020 09/30/2021

0004 10/01/2021 09/30/2022

0005 10/01/2022 09/30/2023

Section III - Statement of Work

Statement of Work

Document Number: 60RRBH18R0015 PROCESSED Page 5 of 57

A. Overview

The disability program, administered by the Railroad Retirement Board (RRB), is mandated by the Railroad Retirement Act (RR Act). When a disability decision is rendered by the RRB that decision is based on the regulations as cited in the current edition of 20 Code of Federal Regulations (CFR), Employees' Benefits, Part 220. This nationwide program consists of:

1. initial determinations of disability, which may result in monthly annuity payments;

2. “disability freeze” determinations, which may result in, among other things, early Medicare coverage;

3. continuing disability review (CDR) activity, which determines continuing entitlement to disability benefits; and

4. an appeals process, which affords any applicant who disagrees with a disability determination rendered by the RRB an opportunity for administrative review.

Consultative medical examinations and/or ancillary tests are used as supportive evidence in making a determination of disability under Federal guidelines for either a current or former railroad employee or his/her widow(er) or child.

The primary emphasis in disability claims processing is not on treatment, but rather on identifying the functional limitations that may interfere with the claimant's ability to work. Therefore, the consultative examination and report must be in sufficient detail to permit the claims examiner and/or evaluating physician, who do not see or examine the applicant, to determine the severity and duration of the impairment. This determina-tion is made within set guidelines that require that objective medical findings be documented in a de-tailed manner and with the use of specific testing procedures. These manners and procedures are governed by regulations. Alternative testing methods and procedures must not be used in the disability determination.

The types of medical examinations and tests the RRB will order depends upon the evidence needed for the disability determination.

The RRB will order only the specific medical examinations or ancillary tests needed. If an ancillary test such as an X-ray, blood study, or EKG will furnish the additional evidence needed for the disability determination, RRB may decide to order such test rather than a more comprehensive medical examination.

This solicitation outlines a program whereby ordered consultative medical examinations will be furnished by a contractor who shall establish and maintain systems and procedures necessary to provide consistent quality, timely response and adequate control, cost con-trol, accuracy and utilization of electronic data interchange (EDI), including but not limited to an electronic payment system and re-ceipt of deliverables. The RRB’s current financial system, FMIS (Financial Management Integrated System), provides automated transactions and processes to obligate funding for ordered consultative medical examinations, records the acceptance of the completed examinations and generates a daily payment (direct deposit) to the contractor. Since the daily payment will usually be made up of multiple medical examination payments, the system generates a report for each daily payment identifying the medical examinations paid for. The contractor will be given security access to retrieve the report from a secure server at RRB via FTP (File Transfer Pro-tocol).

B. Ordering Procedures

1. The orders for consultative medical examinations and/or ancillary tests will be initiated by authorized RRB users.

Authorized RRB users include claims examiners, leads, analysts and management from the Disability Benefits Division (DBD), claim specialists from the Reconsideration Section, hearings officers from the Bureau of Hearings and Appeals, and Claims Representatives from RRB field offices.

2. The orders for consultative medical examinations and ancillary tests shall be conveyed from the RRB to the Con-tractor electronically. Ordering data shall be accessed by the Contractor, transmitted over data communication lines and will be downloaded from the RRB’s Financial Management Integrated System (FMIS) into the Contractor’s computer system.

3. Orders for medical examinations and/or ancillary tests will include the following information:

a. Date of request.

b. Order Number – Administrative number assigned to each order.

c. Name of the authorized RRB user.

d. Name of the unit to receive the examination/test reports.

e. Name and date of birth of the person to be examined, the latest address of record and phone number (if available).

f. Identification number. This will include the claim number plus a two character alpha suffix for RRB's internal use. The claim number is usually the social security number in the case of an employee, but it may be different in the case of a widow(er) or a child who is entitled on the employee's earnings record.

g. Name of railroad employee, if different from the person named in "e" above.

h. RRB field office that services the area where the claimant lives.

Document Number: 60RRBH18R0015 PROCESSED Page 6 of 57

i. Special considerations such as but not limited to:

1. Urgent handling required.

2. Physical/mental impairments, impaired speech, poor hearing, etc., that may affect the scheduling.

3. Other limitations, such as illiteracy or difficulty with English. If there is a language barrier, the primary language will then be specified.

4. Name, address and phone number of representative payee (if applicable).

5. Identification as a reconsideration or appeal case. To ensure impartiality, the original examining doctor MUST NOT BE USED FOR REEXAMINA-TION unless specific-ally requested by the RRB. The name of this doctor will be provided.

6. Any other limitations that should be considered by the contractor when scheduling an appointment.

j. The chief complaint(s) as described by the claimant.

k. The consultative medical examinations and/or ancillary tests needed. Currently, we use a three-digit examination number to identify medical examinations and tests. (See Attachment A.)

l. Reason code. This is a numeric code used to identify the reason for the medical examination and the beneficiary type. (See Exhibit 1 for the listing of these codes.)

m. The name of the claimant’s treating physician(s), if known. The consultative medical examination shall not be done by the claimant’s treating physician(s) unless specifically requested by the RRB.

n. Currently, when a psychiatric or neurological examination is ordered, the authorized RRB user will furnish a copy of available medical evidence that must then be forwarded to the physician performing the consultative medical examination for review and to aid in the medical evaluation. Note; if medical evidence is not submitted 3 days prior to the exam, contact RRB for verification of medical availability.

C. Operational Activities

1. Examination Scheduling and Performance Requirements

a. The Contractor shall schedule and perform medical examinations and ancillary tests upon receipt of an order.

b. The Contractor shall follow the medical examination formats and test protocols set forth in Exhibit 2 (consultative medical examinations) and Exhibit 3 (ancillary tests) and shall assure that all required medical examinations and ancillary tests are performed in accordance with sound medical practice and as specified in this solicitation/contract.

c. (i) For cases designated as routine, the Contractor shall contact the claimant/representative by phone call or text if cellphone (or via mail if the claimant cannot be reached by phone) within 7 calendar days after receipt of an order to begin the scheduling process. The examination date shall be no later than 18 calendar days after the claimant has been contacted.

Once the mutually-agreed upon appointment has been set up, the Contractor shall, within 24 hours, re-lease a notice to the claimant including all specifics of the appointment, such as date, time, location, spe-cial instructions including but not limited to request to reschedule if the person is within 90 days of a surgical procedure (pre or post), reason(s) for appointment, types of examinations and/or ancillary tests, etc.

A report must be received by the RRB headquarters no later than 10 calendar days after the medical ex-amination is completed even if medical examination is certified by a State Medical Board Specialist, for a total processing time not to exceed 35 days, for 80% of all orders, and no more than 45 calendar days from the receipt of the order for the remaining 20%.

(ii) The Contractor shall process urgent cases in an expeditious manner when requested by authorized RRB users. In the event of such a request, the contractor shall contact the claimant/representative by phone call or text if cellphone (or via mail if the claimant cannot be reached by phone) within 5 calendar days after receipt of an order to begin the scheduling process. The medical examination shall be sched-uled to occur within 10 calendar days even if medical examination is certified by a State Medical Board Specialist.

Once the mutually-agreed upon appointment has been set up, the Contractor shall, within 24 hours, re-

Document Number: 60RRBH18R0015 PROCESSED Page 7 of 57 lease a notice to the claimant including all specifics of the appointment, such as date, time, location, spe-cial instructions, reason(s) for appointment, types of examinations and/or ancillary tests, etc.

A report must be received by the RRB headquarters no later than 10 calendar days after the medic-al examination is completed even if medical examination is certified by a State Medical Board Special-ist, for a total processing time not to exceed 25 calendar days.

d. For cases designated as routine, the contractor’s processing time from receipt of the order to the re-ceipt at the RRB of an acceptable written medical examination report shall be no more than 35 calendar days for 80% of all orders, and no more than 45 calendar days from the receipt of the order for the re-maining 20%.

e. The mean processing time average for all reports including medical examinations performed by a State Medical Board Certified Specialist shall not exceed 35 calendar days. (See Attachment A for the number of medical examinations and tests ordered in Fiscal Year 2017.)

f. The Contractor shall provide a reminder call to the claimant/representative between 48 and 72 hours prior to the scheduled appointments for all cases.

g. The contract delivery schedule shall be waived and the contract timeliness standards shall be deemed inapplicable in the event that:

1. One of the following circumstances caused an otherwise timely and acceptable medic-al examination report to be submitted late:

(i) Claimant requests that the location of a scheduled appointment be changed,

(ii) RRB requests that the location of a scheduled appointment be changed,

(iii) Claimant requests that the date of a scheduled appointment be changed,

(iv) RRB requests that the date of a scheduled appointment be changed,

(v) The Contractor is unable, through no fault of its own, to contact the claimant in a timely manner (i.e. invalid contact information, or claimant nonresponsive to contact efforts)

AND

2. The Contractor identifies the specific reason (i-v, above) for late submission of the re-port and conveys that information, in a manner mutually agreed to by the RRB and the Contractor, to the RRB at the time of report submission. The RRB shall have final au-thority in determining whether the contract required timelines performance shall be waived with respect to that case.

h. The Contractor's medical offices or sites must be located to provide maximum geographic coverage, minimizing inconvenience to the claimant. The Contractor must make every effort, including the re-cruitment of additional providers, if necessary, to assure that claimants need travel no more than 60 highway miles from their place of residence in order to attend an appointment. In the event scheduling is not possible within 60 highway miles, the Contractor must get consent from claimant prior to scheduling exams further than 60 miles.

i. Whenever feasible, ancillary tests shall be scheduled for the same day as the medical examination and at the same site, thereby reducing inconvenience to the claimant.

j. The Contractor must, at the time of scheduling, furnish the RRB headquarters with an electronic copy of the notice released in accordance with Section III.C.1.l. below.

k. If additional consultative medical examinations or ancillary tests other than those requested by RRB authorized users become necessary during the testing, authorization for these additional services must be obtained from RRB headquarters personnel by telephone. Such contacts must go through the Contract-or's liaison official. Whenever feasible, this authorization shall be obtained while the claimant is still at the examining site. The original order shall be modified by an authorized RRB user to reflect and con-

Document Number: 60RRBH18R0015 PROCESSED Page 8 of 57 firm the authorization for additional service. Telephone numbers of RRB personnel will be provided to the Con-tractor before the commencement of contract performance. Personnel in DBD, the Reconsider-ation Section, and the Bureau of Hearings and Appeals are generally available from 10:00 a.m. to 2:30 p.m. Central Standard Time each working day. Some personnel in these offices may also be available from 6:00 a.m. to 10:00 a.m. and 2:30 p.m. to 6:30 p.m.

l. Any medical examination or test-related instructions/notifications sent to the claim-ant in advance of the examination or test shall be sent by the Contractor. The specific format for these notifications/letters must be approved by the RRB prior to contract implementation.

m. (1) If the claimant fails to appear for an examination (“no shows”),the Contractor must notify RRB headquarters when it is determined that the claimant was a “no show.” The reason for the missed ap-pointment should be stated, if known. The Contractor shall not reschedule a “no show” without RRB headquarters approval.

(2) The Contractor shall not be reimbursed in the event a claimant fails to appear for an examination or test.

n. The RRB and the claimant shall have the right to object to and refuse any scheduled medical examin-ation with the Contractor's designated physician or psychologist.

o. The Contractor must not use the same doctor who had conducted a previous medical examination for a new consultative medical examination at the reconsideration or an appeal level unless specifically re-quested by the RRB. The RRB will furnish the name(s) of the doctor(s) involved in these cases.

p. The Contractor shall perform repeat medical examinations and/or ancillary tests without additional charges when the RRB determines that upon review the initial medical examina-tions and ancillary tests do not comply with the guidelines shown in Exhibits 2 and 3, which are consistent with Social Security regulations at 20 CFR Part 404, Subpart P, Appendix 1. Any repeated medical examination or ancillary test should be accomplished within the original timeframes and in accordance with the procedures set forth in this contract. The RRB shall have sole authority in determining adequacy of medical examina-tions and/or ancillary tests.

q. The Contractor must ensure that his/her staff will extend proper courtesy throughout the scheduling and examination process to the claimant in order to maintain good public relations.

r. The Contractor shall not charge the claimant for any services contracted by the RRB and shall assure that any subcontractors such as providers or billing services will not bill the claimant for any services.

Neither the RRB nor the claimant shall be responsible for payment for any unauthorized services per-formed by any subcontractor.

s. Examination Duration – Per 20 CFR §220.61(a), in scheduling full consultative examinations, suffi-cient time should be allowed to permit the examining physician to take a case history and perform the examination (including any needed tests).

Specific medical examinations shall be performed within the following timeframes.

(i) A comprehensive internal medical examination including history but excluding ancil-lary testing time (blood drawing, X-rays, etc.) is expected to require at least 30 minutes to complete.

(ii) A psychiatric examination is expected to require at least 60 minutes to complete.

(iii) Musculoskeletal or neurological examinations are expected to require at least 30 minutes to complete.

(iv) Psychological testing is expected to require at least 60 minutes to complete.

2. Medical Examination Report Requirements

The following information shall be included in every medical examination report regardless of specific examinations ordered and shall be typed on official letterhead. (Ref: 20 CFR §220.61 and 220.120.)

a. The claimant's name and address.

Document Number: 60RRBH18R0015 PROCESSED Page 9 of 57

b. The claimant's social security number or railroad retirement claim number, if different. This should be shown on each page of the report.

c. Date examination performed.

d. The major or chief complaints alleged by the claimant as reason for not working.

e. Current medication(s) by name of drug, dose and frequency.

f. A family and social history including a list of any familial diseases, environmental exposure and in-formation regarding the claimant's personal habits with respect to smoking, drug and alcohol consump-tion. A statement regarding the patient's credibility should be included.

g. A review of the affected system(s).

1. Refer to the section in Exhibit 2 that corresponds to the examination ordered as well as the chief complaints for specific information required. Claimants with multiple impair-ments must be evaluated with the protocol that addresses each of the alleged impair-ments. For example, a physician examining a claimant with an alleged cardiovascular impairment and a respiratory impairment must follow the instructions for an internal medi-cine examination as well as the instructions for a cardiovascular examina-tion and a respiratory examination. In most cases, a general internal medicine examination will be ordered for claimants with multiple impairments. However, if one of the multiple impair-ments is musculoskeletal in nature, a specialized internal medicine examination with or-thopedic emphasis may be ordered, rather than a separate general internal medicine ex-amination and a separate orthopedic examination.

2. Any “positive” and “negative” detailed findings based on the examination and ancil-lary tests and from the background information (if provided) must be included. An omis-sion of a specific finding will not be interpreted as a “negative” or normal finding.

3. Quantifiable assessments must be given. Subjective terms such as "frequent" or “significant” are not acceptable. Measurable objective findings should be documented with actual measurements or a quantified assessment. For example, the range of motion information provided in an orthopedic or a musculoskeletal examination of the claimant's affected joint(s) is quantified in degrees. Percentages of normal range of motion or movement measured by inches are not acceptable.

h. Each major or chief complaint should be discussed in detail under the “History of Present Illness.”

The discussion of these complaints must present a detailed longitudinal description of the pertinent past history of the disease stated in addition to the detailed description of the individual's statement of the current complaints. It is important to present, in as much detail as can be obtained from the individual, significant occurrences, including changes in the status of those complaints over time, hospitalizations with dates and names of hospitals, findings, test results and treatment during the hospitalization as un-derstood by the individual, and the ongoing treatment. It is particularly important to provide a detailed description of the individual's current complaints, explaining those factors that increase the problem or impairment and those which may provide relief, and the individual's description of how the impairment limits the ability to function.

i. The physician obtaining the history and performing the physical examination must provide diagnostic and prognostic conclusions based on the claimant's medical history, the physical examination and any laboratory tests obtained in conjunction with the physical examination. All abnormalities should be ex-plained or commented on if a definite explanation cannot be provided.

j. The physician who performs a physical examination should provide a diagnosis and prognosis. There shall be a statement as to what the claimant can still do despite his or her impairment(s). This statement must describe the consultative physician's or psychologist's opinion concerning the claimant's ability, despite his or her impairment(s), to do basic work activities such as sitting, standing, lifting, carrying, handling objects, hearing, speaking, and traveling: and, in cases of mental impairment(s), the consultat-ive physician's or psychologist's opinion as to the claimant's ability to reason or make occupational, per-sonal, or social adjustments (see 20 CFR 220.61(c)(6)). This statement must be substantiated by the ob-jective findings of the examination and should not be based on subjective factors such as the claimant's allegations.

k. The physician/psychologist who performs the psychiatric or psychological examination should also

Document Number: 60RRBH18R0015 PROCESSED Page 10 of 57 provide a statement as to what the claimant can still do despite his or her impairments.

l. When the claimant provides labeled tracing, X-ray interpretations, laboratory findings and graphs for the doctor's review, the examination report should include reference to pertinent information and/or findings.

NOTE: Do not send X-ray film.

m. While the examination is being done, the Contractor should not recommend treatment or a change in treatment directly to the claimant but should include such suggestions in the report. However, in circum-stances where the evidence shows a medical condition that is legally reportable or which could be injuri-ous to the health or safety of the individual or others, or where the individual has made a threat against himself/herself or others, the Contractor should take action consistent with sound and accepted medical practice. Any emergency treatment and/or information provided to the claimant or their treating sources should be specified in the report and reported immediately to the RRB headquarters. There shall be no liability on the part of the RRB, under this contract or otherwise, for any treatment recommended or provided by the Contractor.

n. All reports must be personally reviewed and signed by the physician who actually performed the ex-amination. An electronic signature is acceptable. (Ref. 20 CFR §220.61(d).) A rubber stamp signature or a signature entered by another physician, nurse or any other person is not acceptable. The physician's name must also be typed at the end of the report.

o. The results and interpretation of laboratory findings must be included. When the laboratory studies are done as shown in Exhibit 3 "Ancillary Tests," the physician providing the formal interpretation must be identified. If the interpretation is provided on a separate report form, that report should be forwarded and should show the interpreting physician's name. An electronic signature is acceptable on X-ray re-ports.

D. Administrative Requirements

1. Medical Staff Qualifications

a. All physicians or psychologists performing services under this contract shall be currently licensed in the State in which he or she practices and shall have the training and experience necessary to perform the type of examination or test required. Any such support staff must meet appropriate licensing or cer-tification requirements of the State in which he/she practices. However, examinations must be per-formed by an acceptable medical source identified in RRB regulations at 20 CFR § 220.46. Currently this list includes licensed physicians, licensed osteopaths, licensed or certified psychologists, and li-censed optometrists (for measuring visual acuity and visual fields only), but may be modified. Examin-ations performed by other sources not included in the list of acceptable medical sources at the time of the examination, currently including but not limited to physician assistants, are not acceptable. Psycho-logists may be a Ph.D., M.D., or have at least a Masters degree in clinical psychology.

b. The Contractor shall use medical technicians for ancillary tests who are licensed or certified, if ap-plicable, and have appropriate experience and training in performing specified tests.

c. The Contractor shall ensure that all its medical providers' facilities meet State and local codes for li-censing, insurance, safety and sanitary purposes.

d. The Contractor shall maintain and make available upon request by the RRB's Contracting Officer’s Technical Representative (COR) a list of all medical staff that displays name, title, specialty function, and languages spoken. Curriculum vitae on all medical staff and appropriate copies of medical licenses, specialty ratings and certifications must also be available annually and for periodic spot checks by the RRB's COR.

e. No acceptable medical source performing services under this contract shall have served as a witness in a lawsuit either against or for a covered railroad employer or a railroad employee, or at any time have been an employee of the RRB, an RRB contractor, or a covered railroad employer.

f. The Contractor shall not employ under this contract the services of any individual or entity that is ex-cluded, suspended or otherwise barred from participation in the Medicare, Medicaid or any other Federal or Federally assisted program. (Ref. 20 CFR §220.64.)

2. Contractor Management

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a. The Contractor shall deliver the medical examinations and ancillary test results to the RRB headquar-ters on a daily basis using electronic transmission.

b. The Contractor shall implement an RRB accessible real-time system that tracks the status of each and every examination and ancillary test ordered under this contract.

c. The Contractor shall designate a contract performance liaison person and backup to coordinate activ-ities, resolve day-to-day problems, and answer questions from RRB personnel. In addition, the contract-or shall identify administrative staff that will be involved in the implementation and on-going adminis-tration of this contract. Staff changes after award must be coordinated with the RRB.

d. The Contractor shall revise systems and procedures in response to changes in laws and regulations as described and communicated to the Contractor by the RRB.

e. The Contractor shall provide an organized and trained staff to provide all required functions under this contract.

f. Reporting Requirement:

1. The Contractor shall provide certain basic management information to the RRB on all reports. Such information shall include, but not be limited to, the following data:

(a) RRB Claim Number

(b) Claimant’s Name

(c) Examinations Requested including name and number

(d) Field Office number

(e) Exam requestor

(f) Reason for exam

(g) Dates such as

(i) order request date,

(ii) dates, times and methods of contact to claimant,

(iii) date notice released to claimant for examination,

(iv) examination date

(v) date contractor receives report

(vi) date report sent to RRB

(vii) Reasons for delays or exclusions from contract timeli-ness standards

(viii) Indicate if exam was ordered routine or urgent

(ix) Number of days at each step i.-viii. including since or-der received

2. All reports provided should be sortable, including by month and fiscal year. The re-porting period for routine reports shall begin on the first day of each month. All reports shall be furnished and delivered to the Contracting Officer's Representative (COR) within two workdays after the end of the reporting period. Secure Electronic Data Interchange technology must be employed to transmit reporting data to the RRB.

3. The following reports should be provided on a monthly basis. Each report shall be or-ganized by RRB claim number and have sorting capabilities. Note: all reports below must include data in Section D.2.f.(1).

a. Deliverables reflects cases where an examination order has been issued by the RRB but the Contractor has not scheduled an exam. Note: This re-port must include documentation regarding initial contacts with the claimant.

b. Scheduled reflects those cases where the Contractor has scheduled the examination but it has not yet been conducted.

c. Reports Pending reflects those cases where the examination has been conducted but the report has not yet been submitted to the RRB. Note:

This report should include date of examination, any dates demonstrating follow-up with the provider and provider’s response.

d. Reports Submitted reflects those cases where the examination report has been submitted to the RRB. Note: This report should include date of ex-amination, any follow-ups with provider to obtain report, and date de-

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e. Untimely Reports reflects all exams ordered routine or urgent that are not completed by the due dates. Note: This report should include exams not meeting the timeframe allotted and reason why.

f. No Show Reports reflects all cases where the examination order has been issued by the RRB, the Contractor scheduled, but the claimant did not show for the exam. Notification should include the RRB claim number including the alpha suffix, the claimant's name, the examination code for the examination/ ancillary tests missed, and the reason for the “no-show,” if known. The specific notification process must be approved by the RRB prior to contract implementation.

g. Consolidated Reports reflect items (i) through (ix) shown above.

4. The following reports should be provided twice a month on the 1st and 15th of each month. Note if the day falls on a weekend or holiday, the next business day is acceptable.

Each report shall be organized by RRB claim number and have sorting capabilities. Note:

all reports below must include data in Section D.2.f.(1).

a. Unpaid Invoice Reports reflects all exams conducted, reports delivered and awaiting payment more than 20 days. Note, the report must include RRB Claim Number, Claimant’s Name, Exams requested, exams delivery date.

b. Unable to Contact Reports reflects exam orders where claimant was un-responsive after the 7 days and RRB has not responded to assistance re-quest.

5. Generally, RRB will give 2 days’ notice for ad hoc reports. In addition to RRB mak-ing requests, the Office of Inspector General may also request data and or information.

The Contractor must respond to both RRB and OIG within 2 days as to report status at a minimum if report not immediately available. Such reports must include data in Section D.2.f.(1). Examples include but not limited to the following:

a. Distance Travelled Reports reflects distance claimants have travelled to attend exams. If attended multiple exams, each ought to be listed. Such re-ports will include but not be limited to the RRB claim number, claimant’s name, claimant’s address, facility name, facility address, the examination/ test date, and the distance between the claimant’s residence and the facil-ity.

b. Providers Identified Reports reflects frequency of medical exam pro-viders used by exam types for designated time period.

c. Similar Exam Orders Reports reflects exams ordered and/or delivered for the same claimant i.e. orthopedic and orthopedic specialist for a desig-nated time period. Note: this report should be by claimant SSN and in-clude date ordered and types of exams ordered.

d. Average Exam Time Reports reflects the time claimant spent in an ex-am, starting with the time being seen by the provider.

6. At the end of the fiscal year, only the orders not delivered should be carried over to the next fiscal year's reports where they will be carried, along with all new activity, for the entire fiscal year.

g. The Contractor shall maintain an ongoing quality assurance plan to ensure that the requirements of this contract are satisfied. The plan shall include methods for identifying, resolving and preventing defi-ciencies in the quality and timeliness of service performed under this contract before the level of per-formance becomes unacceptable.

E. Program Safeguard Requirements

1. The Contractor agrees to either host or visit RRB annually to review quality and timeliness of deliverables.

2. The Contractor agrees not to have any direct or indirect financial or familial interest, or engage in any activity, which conflicts substantially, or appears to conflict substantially, with the Contractor's duties under this contract.

3. The Contractor will not in any case solicit, for the purpose of providing medical services, any individual referred by the RRB for examination.

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The Contractor further agrees that the RRB shall have the exclusive right to deter-mine whether such a conflict of in-terest exists, and whether it is substantial. The Contractor shall ensure that the records it maintains of all RRB orders are kept confidential and are only released when instructed to do so by the RRB. Records include medical examination reports, orders, financial data and quality assurance findings. All records must be retained by the Contractor for 3 years after final payment under this contract. The RRB is a social insurance agency. Privileged information is available in paper form, data disks, and data tapes throughout the Chicago headquarters facility and all of the remote sites. (See Section IV for privacy act information and security safeguards)

4. Any requests, including subpoenas, for information pertaining to services performed under this contract, shall be coordinated with the RRB COR prior to fulfillment. The Contractor shall notify the requester that this action has been taken. This includes but is not limited to the Contractor responding to any RRB audit and/or inspections including OIG investigations.

5. The Contractor shall devise a disaster contingency plan covering operational and management activities.

6. The contractor’s staff involved in accessing RRB systems shall be required to periodically complete security aware-ness training as designated by the RRB.

7. The contractor must comply with the following information technology security requirements:

a. Federal Information Security Management Act

b. OMB’s implementing policies including Appendix III of OMB Circular A-130

c. NIST standards and guidelines

8. The contractor will submit the following system security deliverables, to the RRB:

a. An initial risk assessment

b. An initial System Security Plan

c. An initial Plan of Actions and Milestones

d. A provisional Authority to Operate (ATO) for their information system (in support of RRB contract operations) as required by NIST Special Publication 800-37 Revision 1; Guide for Applying the Risk Management Framework to Federal Information Systems.

Thereafter, the contractor will submit an updated Risk Assessment, updated System Security Plan, and updated Plan of Actions and Milestones annually.

Section IV - General Terms and Conditions

52.224-1 Privacy Act Notification (Apr 1984)

The Contractor will be required to design, develop, or operate a system of records on individuals, to accomplish an agency function subject to the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Viola-tion of the Act may involve the imposition of criminal penalties.

(End of clause)

52.224-2 Privacy Act (Apr 1984)

(a) The Contractor agrees to--

(1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, develop-ment, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies--

(i) The systems of records; and

(ii) The design, development, or operation work that the contractor is to perform;

(2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcon-tract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or oper-ation of a system of records on individuals that is subject to the Act; and

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(3) Include this clause, including this paragraph (3), in all subcontracts awarded under this contract which requires the design, devel-opment, or operation of such a system of records.

(b) In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on indi-viduals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on in-dividuals to accomplish an agency function, the Contractor is considered to be an employee of the agency.

(c)(1) "Operation of a system of records," as used in this clause, means performance of any of the activities associated with maintain-ing the system of records, including the collection, use, and dissemination of records.

(2) "Record," as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person's name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a fingerprint or voiceprint or a photograph.

(3) "System of records on individuals," as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular as-signed to the individual.

(End of clause)

52.212-3 Offeror Representations and Certifications--Commercial Items (Nov 2017)

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certifica-tion electronically via the System for Award Management (SAM) website located at https://www.sam.gov/portal.