60RRBH20R0010 CMOS RFP Final 09-17-2020.pdf

Document Number: 60RRBH20R0010 PROCESSED Page 1 of 40

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

60RRBH20R0010

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

DATE

09/17/2020

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls) 8. OFFER DUE DATE / LOCAL

TIME

10/15/2020 17:00:00

CODE9. 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

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

(15 CFR 700)

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

CODE15. DELIVER TO CODE16. ADMINISTERED BY

FACILITY

CODE

CODE

Telephone No.

17a. CONTRACTOR/

OFFEROR

CODE18a. PAYMENT WILL BE MADE BY

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. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 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: 60RRBH20R0010 PROCESSED Page 2 of 40

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: 60RRBH20R0010 PROCESSED Page 3 of 40

Table of Contents

Section Description Page Number

I Introduction Overview

II Schedule of Supplies and Services Schedule of Supplies and Services, Continued:

III Statement of Work

SOW

IV General Terms and Conditions 52.252-1 Solicitation Provisions Incorporated by Reference (Feb 1998) RRB.A.01 A. General RRB Provision-1.Technical Direction RRB.A.02 A. General RRB Provision-2.Term of Contract RRB.A.03 A. General RRB Provision-3.Billing RRB.A.04 A. General RRB Provision-4.Conflicts of interest RRB.A.05 A. General RRB Provision-5.Post award meeting RRB.A.06 A. General RRB Provision-6.Notice of Intent to Withhold Payment RRB.A.07 A. General RRB Provision-7.The Role of Government Personnel and Responsibility for Contract Administration RRB.A.08 A. General RRB Provision-8.Hold Harmless and Indemnification Agreement RRB.A.10 A. General RRB Provision-10.News Release RRB.B.01 B. Security Provisions-1.Security Information RRB.B.03 B. Security Provisions-3.Additional Security Requirements RRB.F.0 Performance Acceptance and Consideration RRB.F.01 Consultative Medical Opinion Services Solicitation/Contract Provision- Examination of Records by the Inspector General Addendum #: 1 to RRB.A.04 Conflict of Interest Discussion Addendum #: 2 to RRB.A.04 Medical Evidence Provider Certification Addendum to FAR 52.239-1 Privacy or Security Safeguards Incorporated by Reference in FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders- Commercial Items 52.204-9 Personal Identity Verification of Contractor Personnel (Jan 2011) 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders- Commercial Items (Aug 2020) 52.215-6 Place of Performance (Oct 1997) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 Indefinite Quantity (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.232-18 Availability of Funds (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-3 Continuity of Services (Jan 1991) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

V Proposal Submission Instructions RRB Supplement to FAR 52.212-1 Instructions to Offerors- Commercial Items

VI Evaluation and Award RRB Supplement to FAR 52.212-2 Evaluation of Offers - Commerical Items

VII List of Attachments

Document Number: 60RRBH20R0010 PROCESSED Page 4 of 40

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 program for railroad employees and their families. The RRB was established by the Railroad Retirement Acts of 1937 and 1974. Its benefit program was the forerunner of the more familiar Social Security System. 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 Unemployment Insurance Act, which provides unemployment and sickness benefits to railroad employees. The RRB’s headquarters, is located in Chicago, Illinois. The RRB has a national network of 53 field offices.

B. Objective

The RRB seeks the services of a group of licensed physicians (ref: Section III.D.) who shall provide services for the Disability Benefits Division (DBD). Required services are detailed in the following sections and include: (1) providing medical expertise, advice and consultation in the area of disability benefit and claim matters, (2) preparing advisory medical opinions for all bureaus and offices of the RRB and (3) providing training to the disability staff as required.

C. Background

1. DBD is responsible for making agency decisions related to disability-based benefits under the Railroad Retirement Act (RRA), the Social Security Act (SSA). Similarly, RRB examiners make certain medical decisions IAW aspects of the sickness program under the Railroad Unemployment Insurance Act. The division is responsible for communicating these decisions in language understandable to the public.

2. The Disability unit is comprised of two determination sections (including clerical staff who perform functions for all parts of the office), where medical and vocational expertise is combined to provide claim decisions and advice.

3. Disability entitlement under the Railroad Retirement Act (RRA) may exist based on total disability, with medical and vocational factors considered, for railroad employees, their widows, or their children whom suffer onset of disability prior to the age of 22.

In addition, entitlement is possible if an employee who meets certain age and/or service requirements is unable to perform their regular occupation.

4. Initial medical and vocational evidence development related to disability claims is the joint responsibility of the RRB’s Field Service and Headquarters staff. The development includes accumulation of all pertinent existing medical records (hospital, clinic, etc.), a report from the applicant’s personal physician, and, when appropriate, consultative examinations and ancillary tests arranged by a disability examination services contractor at the request of RRB staff.

5. DBD is involved in requesting and reimbursing claims related and professional services required in connection with the disability program. A number of guides are available and utilized in the claim evaluation including the Railroad Retirement Act, Social Security Act, and Code of Federal Regulations.

6. By its nature, the disability claim workload is difficult to predict. RRB offers the following information to aid interested parties in making projections:

a. In Fiscal Year 2018, there were about 990,000 persons on RRB’s rolls, receiving benefits because of disability. New applications from employees, widow(er)s and children for disability-based benefits under the Railroad Retirement Act currently average about 2100 per year.

b. In the some cases, determination of entitlement is made with both the Railroad Retirement and Social Security Acts.

c. In Fiscal Year 2019, RRB requested approximately 2000 medical opinions. Based on experience and current workloads, RRB expects to request, but does not guarantee, medical opinions for approximately 1700 cases per year to be rendered on disability claims.

i. Approximately 15% (250 cases) opinions may be required for mental impairments.

ii. Approximately 65% (1100 cases) opinions may be required for physical impairments.

iii. Approximately 20% (340 cases) opinions may require a simultaneous mental and physical assessment.

7. Disability claims are most commonly related to cardiovascular, musculoskeletal, mental or neurological impairments. Very often, claims are based on a combination of impairments.

D. Questions pertaining to this solicitation must be submitted in writing and received by this office in sufficient time to allow the timely transmission of written answers by solicitation amendment. To ensure this, the RRB will only answer questions received in this

Document Number: 60RRBH20R0010 PROCESSED Page 5 of 40 office no later than 11:00 AM, Central Time (CT), 09/24/2020. Questions must be sent to proposals@rrb.gov, with the email subject line referencing the RFP number, 60RRBH20R0010, of this solicitation. Offers are due no later than 11:00 AM, CT, 10/15/2020.

Document Number: 60RRBH20R0010 PROCESSED Page 6 of 40

Section II - Schedule of Supplies and Services

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

0001 Medical- Other 0.000000 JOB $0.0000 $0.00

Description: Base Year Consultative Medical Opinion Services to include Claims Related Services and Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010 and SOW section III.

Proposed pricing must be entered in below sub-CLINs only.

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

0001AA Medical- Other 1.000000 CASE $0.0000 $0.00

Period of Performance: 12/01/2020 - 11/30/2021

Description: Provide Base Year Consultative Medical Opinion Services, Claims Related Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as a per/case price.

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

0001BA Medical- Other 1.000000 HR $0.0000 $0.00

Period of Performance: 12/01/2020 - 11/30/2021

Description: Provide Base Year Consultative Medical Opinion Services, Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as an hourly price.

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

0002 Medical- Other 0.000000 JOB $0.0000 $0.00

Description: Option Year One Consultative Medical Opinion Services to include Claims Related Services and Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010 and SOW section III.

Proposed pricing must be entered in below sub-CLINs only.

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

0002AA Medical- Other 1.000000 CASE $0.0000 $0.00

Period of Performance: 12/01/2021 - 11/30/2022

Description: Provide Option Year One Consultative Medical Opinion Services, Claims Related Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as a per/case price.

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

0002BA Medical- Other 1.000000 HR $0.0000 $0.00

Period of Performance: 12/01/2021 - 11/30/2022

Description: Provide Option Year One Consultative Medical Opinion Services, Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as an hourly price.

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

0003 Medical- Other 0.000000 JOB $0.0000 $0.00

Description: Option Year Two Consultative Medical Opinion Services to include Claims Related Services and Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010 and SOW section III.

Proposed pricing must be entered in below sub-CLINs only.

Document Number: 60RRBH20R0010 PROCESSED Page 7 of 40

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

0003AA Medical- Other 1.000000 CASE $0.0000 $0.00

Period of Performance: 12/01/2022 - 11/30/2023

Description: Provide Option Year Two Consultative Medical Opinion Services, Claims Related Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as a per/case price.

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

0003BA Medical- Other 1.000000 HR $0.0000 $0.00

Period of Performance: 12/01/2022 - 11/30/2023

Description: Option Year Two Consultative Medical Opinion Services, Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as an hourly price.

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

0004 Medical- Other 0.000000 JOB $0.0000 $0.00

Description: Option Year Three Consultative Medical Opinion Services to include Claims Related Services and Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010 and SOW section III.

Proposed pricing must be entered in below sub-CLINs only.

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

0004AA Medical- Other 1.000000 CASE $0.0000 $0.00

Period of Performance: 12/01/2023 - 11/30/2024

Description: Provide Option Year Three Consultative Medical Opinion Services, Claims Related Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as a per/case price.

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

0004BA Medical- Other 1.000000 HR $0.0000 $0.00

Period of Performance: 12/01/2023 - 11/30/2024

Description: Option Year Three Consultative Medical Opinion Services, Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as an hourly price.

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

0005 Medical- Other 0.000000 JOB $0.0000 $0.00

Description: Option Year Four Consultative Medical Opinion Services to include Claims Related Services and Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010 and SOW section III.

Proposed pricing must be entered in below sub-CLINs only.

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

0005AA Medical- Other 1.000000 CASE $0.0000 $0.00

Period of Performance: 12/01/2024 - 11/30/2025

Description: Provide Option Year Four Consultative Medical Opinion Services, Claims Related Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as a per/case price.

Document Number: 60RRBH20R0010 PROCESSED Page 8 of 40

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

0005BA Medical- Other 1.000000 HR $0.0000 $0.00

Period of Performance: 12/01/2024 - 11/30/2025

Description: Provide Option Year Four Consultative Medical Opinion Services, Optional Other Medical Professional Services, as specified in solicitation RFP 60RRBH20R0010, SOW Section III.

Offered price provided must be reflected as an hourly price.

Schedule of Supplies and Services, Continued:

A. Offerors must provide a fully loaded, firm-fixed Case price, or Hourly price as indicated, in the sub-CLINs of CLINs 0001 thru 0005 above, for the provision of services specified in Section III of this RFP, for the Base Year and 4 Option Years. The RRB defines “fully loaded” as the price inclusive of direct wage, fringe benefits, all overheads, general and administrative (G&A) cost, profit and fees. Offerors must also complete the fill-ins below for Sections II. B and C.

Unbalanced offers: Offerors are cautioned that any offer may be rejected as non-compliant if it is materially unbalanced as to prices for the initial and optional services. An offer is considered unbalanced when it is based on prices that are significantly less than the cost for some work and prices that are significantly overstated for other work. Offerors must complete all pricing CLINs indicated in the above Schedule of Supplies and Services.

B. Price quotation is valid thru ______ / ______ 2020. (60 days from the date of offer, unless otherwise stated.)

C. Contractor Information for Order Administration:

1. Authorized representatives:

Business Technical

Name: _______________ _______________

Phone #: _______________ _______________

Fax #: _______________ _______________

E-Mail: _______________ _______________

2. System for Award Management (SAM) FAR 52.204-7 (Jul 2013) registration completed*: Yes [ ] No [ ]

* Offeror must be properly registered, including business size annotation, in the System for Award Management (SAM) to be eligible for award of a Federal contract or order. (See www.sam.gov).

PERIOD OF PERFORMANCE

ITEM START END

0001 AA 12/01/2020 11/30/2021

0001 BA 12/01/2020 11/30/2021

0002 AA 12/01/2021 11/30/2022

0002 BA 12/01/2021 11/30/2022

0003 AA 12/01/2022 11/30/2023

0003 BA 12/01/2022 11/30/2023

0004 AA 12/01/2023 11/30/2024

0004 BA 12/01/2023 11/30/2024

0005 AA 12/01/2024 11/30/2025

Document Number: 60RRBH20R0010 PROCESSED Page 9 of 40

0005 BA 12/01/2024 11/30/2025

Document Number: 60RRBH20R0010 PROCESSED Page 10 of 40

Section III - Statement of Work

SOW

A. Background & Objectives

Under the current contract, the contractor provides consultative medical opinions with the combination of remote and on-site services at the U.S. Railroad Retirement Board headquarters, located at 844 N. Rush St., Chicago, IL 60611. The incumbent contractor currently provides the case-related services with the qualified physician resources remotely. This same contractor provides other medical professional advisory services, including training and direct advice to claims examiners, on-site at RRB headquarters. While conducting operations during the Covid-19 pandemic, RRB authorized remote performance of the above described on-site services.

RRB requires on-site performance for other professional medical advisory services. These services will resume under the anticipated contract when requested by the RRB and will be conducted twice a week for up to eight hours per week at a minimum. The RRB anticipates requesting on-site non-case related services when the RRB’s CMO is out on scheduled leave, or when specific medical specialty training is required. The RRB is willing to accept proposals that consist of alternative methods for conducting case review and consultation, including digital conversion of case files and subcontracting with local physicians. All proposals offering alternative methods to provide consultative medical opinions must meet the requirements of this solicitation and the privacy and security clauses outlined later in this document.

B. Operational Activities

1. Claims Related Services

The Contractor must provide licensed physicians who are knowledgeable of both the Railroad Retirement Act (RRA), the Social Security Act (SSA), and conversant with the many and varied fields of medicine. The Contractor must organize and train physicians and staff for all functions under this contract. The Contractor must provide the technical assistance of specialists (e.g. ophthalmologist/ optometrist, neurologist, etc.) in the major fields of medicine when such expertise is deemed necessary.

The Contractor must provide consultative medical opinions in writing using the appropriate form(s) in Attachments 1-5, Section VII.

The opinion consists of a narrative explanation of a claimant’s condition, based on objective medical findings, and includes a detailed rationale of any restrictions.

Attachments 6 and 7, Section VII, are examples of the detailed information required in the consultative medical opinions provided by the contractor based on their review of the medical evidence. These reviews may be related to initial determinations, reconsideration determinations, appeal determinations, continuing entitlement determinations, or quality assurance. Reconsideration and appeal cases must be reviewed by a physician who was not involved in the prior determinations for the same individual.

a. Consultative Medical Opinions must include:

1) The Contractor must review medical evidence received in support of disability-based claims and prepare consultative medical opinions clearly communicating, when appropriate: Severity assessment(s) of the physical and mental impairments cited for entire period of review (Reference 20 CFR 220, subpart H);

2) Whether the physical and mental impairments cited are medically disabling and/or meet or equal the Listing of Impairments (Reference 20 C.F.R. §§ 220.110, 404.1525-26, and Part 404, Subpart P, Appendix 1) and/or provide a medical assessment for examiners to use to determine a railroad occupational disability decision (Reference 20 CFR 220.13);

3) A complete, comprehensive and appropriate residual functional capacity (RFC) assessment (also known as the rationale of any restrictions) based on the medical evidence in file and considering RFC assessments from treating or consulting physicians (Reference 20 CFR 220.120 and 220.121a);

4) The resolution, if possible, of conflicting or deceptive evidence and opinions (Reference 20 CFR 220.112(e));

5) The Contractor shall answer specific questions as they arise in the course of case reviews by disability examiners and others.

6) A reasonable disability onset date based on the medical evidence of record, including dates of changes in the severity level of the impairment;

Document Number: 60RRBH20R0010 PROCESSED Page 11 of 40

7) The recommendation of frequency of future medical case reviews in accordance with RRB regulations (Reference 20 CFR 220.186); and

8) In continuing disability review cases, whether significant medical improvement has occurred in physical and mental impairments that existed at the time of the most recent favorable disability decision. (Reference 20 CFR 220.176 through 220.179);

9) The recommendation for additional medical evidence or consultative medical examinations when a medical assessment cannot be provided based on the information in file or if needed for resolution of conflicting evidence and/or opinions. In occupational disability cases, this can include but is not limited to Functional Capacity Examinations. (Reference 20 CFR 220.13(b)(2)(iv)(C) and 220.112(d));

b. The Contractor shall render the consultative medical opinions described above within the timeframes below.

1) Standard opinions within four (4) business days, i.e. opinions requested on Monday are due on Friday. The RRB shall have sole authority in determining acceptability of medical opinions.

2) Urgent opinions identified by RRB personnel will be completed within two (2) business days, i.e. opinions requested on Monday are due on Wednesday. Approximately 10% of cases will be deemed “urgent”.

3) The Contractor shall achieve these timeliness standards in at least 95% of the cases. Timeliness of opinions of the Contractor’s consultative medical opinions returned for correction or clarification must be rendered within two days after return, i.e. Original routine request received Tuesday, needs correction so returned Wednesday, due on Friday.

2. Other Adjudicative Case work

a. The Contractor shall assist in contacting medical sources as may be considered required or desired in the administration of the laws under which the RRB has responsibility.

b. The Contractor shall assist the RRB in determining the appropriateness of releasing copies of medical evidence to sources other than SSA and VA.(Reference 20 CFR 200.8(g).

3. Expert Testimonial/Affidavit Opinions

When live testimony or a sworn evidentiary affidavit by a licensed physician is requested by the RRB, the Contractor will provide the requested expert affidavit or make the requested expert available for testimony within timeframes specified in the RRB’s request, but the Contractor must acknowledge receipt of the RRB’s request within 3 business days.

4. Optional Other Medical Professional Services

The Contractor shall provide trained physicians and staff who in the past have trained non-medical professionals at all levels of expertise.

The Contractor shall render optional non-case related other Medical Professional Services when and as requested by the RRB. These activities include, but are not limited to the following:

a. Introductory Disability Examiner Training

Since 2016, the Disability Benefit Division has historically conducted an introductory Disability Examiner Training biennially. Each training had less than 10 participants. The training has been conducted over a two-week period. Each day’s training consisted of a pre-approved topic and agreed upon time. See attachment 5 titled Sample Training Outline.

1) Conduct medical training sessions for new or newly-promoted disability examiners as needed while these examiners are training.

2) Training can be in-person or via live video conferencing by qualified staff. The Contractor shall provide trained physicians and staff who in the past have trained non-medical professionals at all levels of expertise.

3) Each training class of new disability examiners requires approximately 30 hours of medical training including allotted time for DBD examiner questions and Instructor answers. The RRB may order contractor services to provide some of this training.

4) Training must include visual aids, address all requested objectives, and be consistent with both the Railroad Retirement Act and the current listings covered by the Social Security Act. Training objectives may include but are not limited to, body system structure, body system functionality, medical tests and results related to the body system, and associated limitations (i.e. residual functional capacity) and impact onto other body systems.

Document Number: 60RRBH20R0010 PROCESSED Page 12 of 40

5) Training materials must be presented for review within 3 days of scheduled training for approval. Attachment 5 includes sample outlines and materials of the training program previously used.

b. Refresher Disability Examiner Training

1) Conduct medical training sessions for disability examiners on a periodic basis upon request.

2) Training can be in-person or via live video conferencing by qualified staff as approved by RRB staff. The Contractor shall provide trained physicians and staff who in the past have trained non-medical professionals at all levels of expertise.

3) Each training session will be approximately an hour and half by the Contractor and allot time for questions. For an approximate total of at least 12 hours a year. Training subjects include information found in 20 CFR 220, Appendix 3, 20 CFR 404, subpart P, Appendix 1, human body systems as defined in aforementioned Appendix 1, regulatory changes, and medical advances in therapy, technology, diagnostic and evaluative techniques.

4) Training must include visual aids, address all requested objectives, and be consistent with both the Railroad Retirement Act and the current listings covered by the Social Security Act. Training objectives may include but are not limited to, body system structure, body system functionality, medical tests and results related to the body system, and associated limitations (i.e. residual functional capacity) and impact onto other body systems.

5) Training materials must be presented to the Contracting Officer’s Representative for review within 3 business days of scheduled training for approval. Attachment 5 includes sample outlines and materials of the training program previously used.

c. Medical Review - Policy Interpretation, Consultation and Development;

1) Provide expertise in medical policy clarification and interpretation as it relates to the RRB’s disability program under the Railroad Retirement Act and Social Security Act and sickness program under Railroad Unemployment Insurance Act.

2) Provide input upon request in development and interpretation of standards, regulations, procedures, and forms related to disability claims development and evaluation.

3) Conduct on–site or virtual visits up to 2 days per week and upon request with advance 14 day notice. Each onsite or virtual visit will be for up to 4 hours per day to meet with claims examiners and other staff one-on-one to answer questions on specific cases and medical issues of a general nature.

a) Examples of visit questions include but are not limited to:

i. Specific questions regarding the type of test to be ordered.

i. Specific questions related to the medical in the file, e.g. what test results mean.

ii. Specific questions regarding sufficiency of medical evidence to make a final determination for both physical and mental impairments.

iii. Specific questions (with tabbed medical) related to impairments that may be medically disabling (see 20 C.F.R. § 220.110) or meet or equal criteria in SSA’s Listing of Impairments in 20 C.F.R. Part 404, Subpart P, appendix 1.

iv. Clarification requests (i.e. what does this mean) related to Residual Functional Capacity (RFC) and Mental Residual Functional Capacity (MRFC) already provided by that consultant.

b) The Contractor is expected to produce a written record of responses to all onsite or virtual consultations consistent with Section III.

B.1.a.

c) Onsite or virtual consultations may include priority requests as identified by RRB to include, but not limited to Board Office, Congressional, Dire Need at the time of consultation.

C. Location and Manner of Performance of Claims Related Services

Document Number: 60RRBH20R0010 PROCESSED Page 13 of 40

1. The Contractor shall provide claims related services either on-site at the RRB’s headquarters located at 844 North Rush Street, Chicago, Illinois, at mutually agreed upon off-site location, or as mutually agreed through virtual secure electronic means.

2. The Contractor shall ensure the privacy, confidentiality and safety of all files while the files, no matter the form, are in the possession of the Contractor and shall not remove, alter, copy or otherwise damage file material.

3. The Contractor shall designate a primary contract liaison, and an alternate, to coordinate activities, resolve day-to-day problems, and answer questions from RRB staff. The liaison will be available during RRB core business hours of 9:00 a.m. to 3:00 p.m. central time.

4. If the Contractor provides such services on-site, service may be performed during the hours of 6:00 a.m. to 6:30 p.m. central time. The work schedule may be modified as approved in advance by the Contracting Officer Representative or Director of DBD.

Office space, equipment, supplies and clerical (but not secretarial) support will be furnished by the RRB for on-site services only.

5. If the Contractor provides such services off-site or virtually, the Contractor shall be responsible for the daily pick-up or arranging for secure electronic transmission of files from the RRB headquarters and for the delivery of consultative medical opinions to the RRB headquarters within the time frames prescribed in this contract (Ref: Section lll.A.1.b). The Contractor shall bear all costs associated with the pick-up and delivery, or secure electronic transmission of case files and related materials.

6. The RRB must send and the contractor must receive any PII or PHI, whether sent to obtain medical expertise, advice and consultation to disability claims examiners or to obtain a professional medical case review, via a secure electronic means. RRB uses both an electronic and paper based adjudication system. As RRB continues to improve electronic processing, the Contractor must fulfill all electronic and paper security program safeguards as required by FAR 52.239-1 Privacy or Security Safeguards, RFP Section

IV.

7. If services are performed off-site, the Government reserves the right to inspect the off-site facility.

D. Ordering Procedures

1. The orders for consultative medical opinions will be initiated by authorized RRB users. Authorized RRB users includes claims examiners, leads, analysts and management from the Disability Benefits Division (DBD), claim specialists from the Reconsideration Section in Program Evaluation and Management Services (PEMS) Division , and hearings officers from the Bureau of Hearings and Appeals.

2. The orders for consultative medical opinions shall be conveyed from the RRB to the Contractor electronically through RRB’s current financial system, Financial Management Integrated System (FMIS). It provides automated transactions and processes to obligate funding for ordered consultative medical opinions, records the acceptance of the completed medical opinion and generates a daily payment (direct deposit) to the contractor. Since the daily payment will usually be made up of multiple medical opinion payments, the system generates a report for each daily payment identifying the medical opinions paid for. The contractor will be given security access to retrieve the report from a secure server at RRB via FTP (File Transfer Protocol).

3. Orders for consultative medical opinions will include the following information:

a. Type of opinion requested, physical, mental, or both.

b. Date of request.

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

d. Name of the authorized RRB user.

e. Name of the unit to receive the medical opinion.

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 and social security number of railroad employee.

h. Name and social security number of applicant (i.e. widow(er) or a child who is entitled on the employee’s earnings record).

Document Number: 60RRBH20R0010 PROCESSED Page 14 of 40

i. Special considerations such as but not limited to:

1) Urgent handling required.

2) Identification as a reconsideration or appeal case.

E. Administrative Requirements

1. Medical Staff Qualifications - All physicians performing services under this contract shall be currently licensed in the State in which contractual services are rendered and shall have training and experience necessary to perform the functions outlined in Section III A and B. In addition, all medical personnel should have current medical liability insurance at the physician level.

a. The Contractor will provide physicians knowledgeable of regulations, policies and guidelines related to disability based benefits under the Railroad Retirement Act (RRA) and Social Security Act (SSA) as those Acts are currently stated and as they may change during the lifetime of this contract.

b. No physician performing services under this contract shall have served as a witness in a lawsuit either against or for a railroad employer, or be an employee of a railroad, of the RRB, or subcontractor of an RRB contractor for disability related examinations services. In addition, no physician shall perform services under this contract for any case where they have provided medical or RFC assessments as a treating or consulting physician per 20CFR 220.63.

c. The Contractor shall not employ, under this contract, the services of any individual or entity who is excluded, suspended, or otherwise barred from participating in Medicare, Medicaid or any other Federal or Federally-assisted program; who has been convicted, under Federal or State law, in connection with the delivery of health care services, of fraud, theft, embezzlement, breach of fiduciary responsibility or financial abuse; who has been convicted under Federal or State law of unlawful manufacture, distribution, prescription, or dispensing of a controlled substance; whose license to provide health care services is revoked or suspended by any State licensing authority for reasons bearing on professional competence, professional conduct, or financial integrity; who has surrendered such a license while formal disciplinary proceedings involving professional conduct were pending; or who has had a civil monetary assessment or penalty imposed on such individual or entity for any activity described in this section or as a result of formal disciplinary proceedings per 20 CFR 220.64.

2. Contractor Management

a. The Contractor shall deliver consultative medical opinions to the RRB headquarters on a daily basis using secure electronic transmission accessible by all RRB designated officials and Contractor contacts that comply with all applicable federal laws, rules and regulations.

b. The Contractor shall implement an RRB accessible real-time system that tracks the status of each medical opinion ordered under this contract.

c. The Contractor shall designate a contract performance liaison person and backup to coordinate activities, resolve day-to-day problems, and answer questions from RRB personnel. In addition, the contractor shall identify administrative staff that will be involved in the implementation and on-going administration 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. The Contractor shall provide contract management in the form of monthly and quarterly reports related to quality and timeliness of opinions and services including identifying and recommending subject matter for training.

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.

Document Number: 60RRBH20R0010 PROCESSED Page 15 of 40

c) Opinion requestor and date requested.

d) Date report sent to RRB.

e) Reasons for delays or exclusions from contract timeliness standards.

f) Indicate type of opinion specialty i.e. physical, mental or both.

g) Indicate if opinion was ordered routine or urgent.

h) Number of days from request to deliverable, including the number of days between each specialty opinion (if both physical and mental opinions are requested).

2) All reports provided should be sortable, including by month and fiscal year. The reporting 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. RRB claim number and sorting capabilities shall organize each report. Note: all reports below must include data in Section f).

a) Deliverables: cases where the RRB has issued an opinion order and the Contractor has completed the opinion.

b) Pending: cases where the RRB has issued an opinion order but the Contractor has not completed the opinion.

c) Untimely: all opinions ordered routine or urgent that are not completed by the due dates. Note: This report should include opinions not meeting the timeframe allotted and reason why.

d) Reject: cases where RRB has issued an opinion order, the Contractor completed a report, but RRB returned the report for clarification or change.

e) Consolidated Report- reflecting items (2(f)(1)(a) through (h) shown above.

4) The following report 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 E.2.f.1.

a) Unpaid Invoice: all opinions completed, reports delivered and awaiting payment more than 20 days. Note, the report must include RRB Claim Number, Claimant’s Name, opinion type (routine or urgent), and opinion delivery date.

5) Generally, RRB will give 2 days’ notice for ad hoc reports. In addition to RRB requesting reports, 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 E.2.f.1

6) At the end of the fiscal year (September 30), 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.

3. Program Safeguard Requirements

a. Quality Control Plan – The Contractor shall maintain an ongoing quality control plan to ensure that the requirements of this contract are satisfied. The plan shall include methods for identifying, resolving and preventing deficiencies in the quality and timeliness of services performed under this contract to ensure the level of performance meets the contract’s requirements.

b. Quality Assurance Plan – The RRB shall use the following methods to ensure that the RRB receives the quality of service specified in the contract.

1) Timeliness of Initial Medical Opinions: The RRB will measure the timeliness of the Contractor’s consultative medical opinions based on the time frames listed below. In 95% of the cases, routine medical opinions shall be rendered within four (4) business days, Document Number: 60RRBH20R0010 PROCESSED Page 16 of 40 i.e. opinions requested on Monday are due Friday. Similarly, medical opinions for cases deemed “Urgent” by RRB personnel, shall be rendered within two (2) business days, i.e. opinions requested on Monday are due on Wednesday.

2) Timeliness of Corrective Opinions: The RRB will measure the timeliness of the Contractor’s consultative medical opinions returned for correction or clarification must be rendered within two days after return, i.e. Original routine request received Tuesday, needs correction so returned Wednesday, due on Friday.

3) Acceptable Medical Opinions: All medical opinions rendered shall be consistent with 20 CFR 220.Subpart H, Subpart I, and Subpart J as described in Section III. B. 1.A. The RRB shall have the sole authority in determining acceptability of medical opinions.

Those medical opinions that are not considered to be acceptable by the RRB personnel will be returned to the Contractor for correction or clarification. The RRB shall withhold payment on any given case until that medical opinion is determined to be acceptable to the RRB, consistent with the RRB’s right to inspect tendered supplies and services and to require re-performance of nonconforming services at no cost to the RRB under FAR 52.212-4(a).

Document Number: 60RRBH20R0010 PROCESSED Page 17 of 40

Section IV - General Terms and Conditions

52.252-1 Solicitation Provisions Incorporated by Reference (Feb 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

www.acquisition.gov [Insert one or more Internet addresses]

(End of provision)

(a) The folowing federal acquisition regulation (FAR) solicitation provisions are herby incorporated by reference:

52.204-7, System for Award Management (Oct 2018).

52.204-13, System for Award Management Maintenance (Oct 2018).

52.204-22, Alternative Line Item Proposal (Jan 2017).

52.212-4, Contract Terms and Conditions – Commercial Items (Oct 2018).

52.232-39, Unenforceability of Unauthorized Obligations (Jun 2013).

RRB.A.01 A. General RRB Provision-1.Technical Direction

Performance of the work under this contract shall be subject to the technical direction of the Contracting Officer Representative (COR). The term “technical direction” includes the following:

(a) Directions to the contractor which redirect the contract effort, shift work emphasis between work areas or tasks, require pursuit of certain lines of inquiry, fill in details or otherwise serve to accomplish the contractual statement of work.

(b) Provisions of information to the contractor which assist in the interpretation of drawings, specifications or technical portions of the work description.

(c) Review and, where required by the contract, approve technical reports, drawings, specifications and technical information to be delivered by the Contractor to the Government under this contract.

(d) Technical directions must be within the general scope of work stated in the contract. The COR does not have the authority to and may not issue any directions which (1) constitutes an assignment of additional work outside the general scope of the contract;

(2) constitutes a change as defined in the contract article entitled “Changes”; (3) in any manner causes an increase or decrease in the estimated cost or the time required for contract performance; or (4) changes any of the expressed terms, conditions, or specifications of the contract.

The Contractor shall proceed promptly with the performance of technical directions duly issued by the COR in the manner prescribed by this Section and within his authority under the provisions of this Section. If, in the opinion of the Contractor, any instruction or direction issued by the COR is within one of the categories as defined in (d)(1) through (4) above, the Contractor shall not proceed but shall notify the Contracting Officer within five (5) working days after receipt of any such instruction or direction and shall request the Contracting Officer to modify the contract accordingly. Upon receiving such notification from the Contractor, the Contracting Officer shall issue an appropriate contract modification or advise the Contractor in writing that, in his opinion, the technical direction is within the scope of this Section and does not constitute a change under the Changes article of the contract. The Contractor shall thereupon proceed immediately with the direction given.

RRB.A.02 A. General RRB Provision-2.Term of Contract

Document Number: 60RRBH20R0010 PROCESSED Page 18 of 40

The term of this contract shall consist of 1 Base Year and 4 Option Years. Work under this contract is expected to commence no later than 12/01/2020.

RRB.A.03 A. General RRB Provision-3.Billing

Contractor shall submit detailed invoices with quantities for work completed and pricing as designated in Section II and indicating actions, dates and deliverables completed.

However, due to operations conducted under the Agency's response to COVID-19 pandemic, contractors must submit their invoices electronically (i.e. via email to BFOAccountsPayable@rrb.gov) in order to enable RRB to process your invoice timely for payment in accordance with the Prompt Payment Act.

RRB.A.04 A. General RRB Provision-4.Conflicts of interest

The offeror agrees not to have any direct or indirect financial or familiar interest, or engage in any activity, which conflicts substantially, or appears to conflict substantially, with the offeror’s duties under this contract. The offeror further agrees that the RRB shall have the exclusive right to determine whether such a conflict of interest exists, and whether it is substantial.