Amendment_4_-_Attachment_J.5__Eastern_Region_Site_Verification_Services_TO_RFP.doc

75FCMC18R0014 Amendment 0004 Attachment J.5

Eastern Region Site Verification Services Task Order RFP

TASK ORDER 0001

PROVIDER ENROLLMENT AND OVERSIGHT

SITE VERIFICATION SERVICES

EASTERN REGION

Eastern Region Site Verification Services Task Order 0001 NOTE: Only those contract sections, which differ from the IDIQ contract terms and conditions, or provide more detailed information specific to this particular task order, are provided below. For those contract sections not identified below, all terms and conditions of the IDIQ contract remain in effect.

Signature of the Contractor below represents acceptance of this task order award.

Signature of Contractor Representative

Title

Date

SECTION B - SUPPLIES OR SERVICES PRICES/COSTS

B.1

DESCRIPTION OF SERVICES

The Contractor shall conduct site verification inspection services for Medicare and/or Medicaid providers/suppliers in the Eastern Region of the United States (see Section 3.3 of the Task Order Statement of Work for details on specific states and US territories). Services include visiting provider locations, conducting internal site visits, taking photographs of the locations visited, and documenting their findings.

B.4

DETERMINATION OF ORDER TYPE/PRICES/COSTS

This is a Firm Fixed Price task order.

B.5

SCHEDULE OF SERVICES

The total fixed price of this task order is __TBD____.

05/19/2019 – 05/18/2020

07/19/2019 – 05/18/2020

07/19/2019 – 05/18/2020

07/19/2019 – 05/18/2020

05/19/2019 – 07/18/2020

04/19/2020 – 04/18/2021

04/19/2020 – 04/18/2021

04/19/2020 – 04/18/2021

04/19/2020 – 04/18/2021

03/19/2021 – 03/18/2022

03/19/2021 – 03/18/2022

03/19/2021 – 03/18/2022

03/19/2021 – 03/18/2022

02/19/2022 – 02/18/2023

02/19/2022 – 02/18/2023

02/19/2022 – 02/18/2023

02/19/2022 – 02/18/2023

01/19/2023 – 01/18/2024

01/19/2023 – 01/18/2024

01/19/2023 – 01/18/2024

01/19/2023 – 01/18/2024

12/19/2023 – 05/18/2024

12/19/2023 – 05/18/2024

12/19/2023 – 05/18/2024

12/19/2023 – 05/18/2024

TBD

All visits billed for a given period or performance must be ordered no later than one month prior to the last day of the period of performance, as follows:

If the minimum quantity guarantee of site visits are not ordered for this period as identified in the tables below, CMS shall pay the difference as if the minimum number of visits were ordered.

CLIN 0001

0001AA – Observational Site Visits SLIN 0001AA Total Per Observational Site Visit

30-Day Observational Site Visit

30,000

15-Day Observational Site Visit

6,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0001AA Total Per Observational Site Visit

30-Day Observational Site Visit

10,000

30,001 – 40,000

15-Day Observational Site Visit

2,000

6,001 – 8,000

7-Day Observational Site Visit

2 – 150

48-Hour Observational Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0001AA Total Per Observational Site Visit

Fixed Price Per Site Visit

Excess Qty

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

0001AB – Detailed Site Visits SLIN 0001AB Total Per Detailed Site Visit

30-Day Observational Site Visit

10,000

15-Day Observational Site Visit

3,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0001AB Total Per Detailed Site Visit

30-Day Detailed Site Visit

5,000

10,001 – 15,000

15-Day Detailed Site Visit

2,000

3,001 – 5,000

7-Day Detailed Site Visit

2 - 150

48-Hour Detailed Site Visit

2 – 20

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0001AB Total Per Detailed Site Visit

Fixed Price Per Site Visit

30-Day Detailed Site Visit

15-Day Detailed Site Visit

7-Day Detailed Site Visit

48-Hour Detailed Site Visit

TOTAL

0001AC– IDTF Site Visits SLIN 0001AC Total Per IDTF Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0001AC Total Per IDTF Visit

30-Day IDTF Site Visit

1,100

901 – 2,000

15-Day IDTF Site Visit

151 – 750

7-Day IDTF Site Visit

2 – 50

48-Hour IDTF Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0001AC Total Per IDTF Visit

Fixed Price Per Site Visit

30-Day IDTF Site Visit

15-Day IDTF Site Visit

7-Day IDTF Site Visit

48-Hour IDTF Site Visit

TOTAL

CLIN 0002

0002AA – Observational Site Visits

SLIN 0002AA Total Per Observational Site Visit

30-Day Observational Site Visit

30,000

15-Day Observational Site Visit

6,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0002AA Total Per Observational Site Visit

30-Day Observational Site Visit

10,000

30,001 – 40,000

15-Day Observational Site Visit

2,000

6,001 – 8,000

7-Day Observational Site Visit

2 – 150

48-Hour Observational Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0002AA Total Per Observational Site Visit

Fixed Price Per Site Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

0002AB – Detailed Site Visits SLIN 0002AB Total Per Detailed Site Visit

30-Day Observational Site Visit

10,000

15-Day Observational Site Visit

3,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0002AB Total Per Detailed Site Visit

30-Day Detailed Site Visit

5,000

10,001 – 15,000

15-Day Detailed Site Visit

2,000

3,001 – 5,000

7-Day Detailed Site Visit

2 - 150

48-Hour Detailed Site Visit

2 – 20

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0002AB Total Per Detailed Site Visit

Fixed Price Per Site Visit

30-Day Detailed Site Visit

15-Day Detailed Site Visit

7-Day Detailed Site Visit

48-Hour Detailed Site Visit

TOTAL

0002AC– IDTF Site Visits SLIN 0002AC Total Per IDTF Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0002AC Total Per IDTF Visit

30-Day IDTF Site Visit

1,100

901 – 2,000

15-Day IDTF Site Visit

151 – 750

7-Day IDTF Site Visit

2 – 50

48-Hour IDTF Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0002AC Total Per IDTF Visit

Fixed Price Per Site Visit

30-Day IDTF Site Visit

15-Day IDTF Site Visit

7-Day IDTF Site Visit

48-Hour IDTF Site Visit

TOTAL

CLIN 0003

0003AA – Observational Site Visits

SLIN 0003AA Total Per Observational Site Visit

30-Day Observational Site Visit

30,000

15-Day Observational Site Visit

6,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0003AA Total Per Observational Site Visit

30-Day Observational Site Visit

10,000

30,001 – 40,000

15-Day Observational Site Visit

2,000

6,001 – 8,000

7-Day Observational Site Visit

2 – 150

48-Hour Observational Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0003AA Total Per Observational Site Visit

Fixed Price Per Site Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

0003AB – Detailed Site Visits SLIN 0003AB Total Per Detailed Site Visit

30-Day Observational Site Visit

10,000

15-Day Observational Site Visit

3,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0003AB Total Per Detailed Site Visit

30-Day Detailed Site Visit

5,000

10,001 – 15,000

15-Day Detailed Site Visit

2,000

3,001 – 5,000

7-Day Detailed Site Visit

2 - 150

48-Hour Detailed Site Visit

2 – 20

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0003AB Total Per Detailed Site Visit

Fixed Price Per Site Visit

30-Day Detailed Site Visit

15-Day Detailed Site Visit

7-Day Detailed Site Visit

48-Hour Detailed Site Visit

TOTAL

0003AC– IDTF Site Visits SLIN 0003AC Total Per IDTF Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0003AC Total Per IDTF Visit

30-Day IDTF Site Visit

1,100

901 – 2,000

15-Day IDTF Site Visit

151 – 750

7-Day IDTF Site Visit

2 – 50

48-Hour IDTF Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0003AC Total Per IDTF Visit

Fixed Price Per Site Visit

30-Day IDTF Site Visit

15-Day IDTF Site Visit

7-Day IDTF Site Visit

48-Hour IDTF Site Visit

TOTAL

CLIN 0004

0004AA – Observational Site Visits

SLIN 0004AA Total Per Observational Site Visit

30-Day Observational Site Visit

30,000

15-Day Observational Site Visit

6,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0004AA Total Per Observational Site Visit

30-Day Observational Site Visit

10,000

30,001 – 40,000

15-Day Observational Site Visit

2,000

6,001 – 8,000

7-Day Observational Site Visit

2 – 150

48-Hour Observational Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0004AA Total Per Observational Site Visit

Fixed Price Per Site Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

0004AB – Detailed Site Visits SLIN 0004AB Total Per Detailed Site Visit

30-Day Observational Site Visit

10,000

15-Day Observational Site Visit

3,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0004AB Total Per Detailed Site Visit

30-Day Detailed Site Visit

5,000

10,001 – 15,000

15-Day Detailed Site Visit

2,000

3,001 – 5,000

7-Day Detailed Site Visit

2 - 150

48-Hour Detailed Site Visit

2 – 20

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0004AB Total Per Detailed Site Visit

Fixed Price Per Site Visit

30-Day Detailed Site Visit

15-Day Detailed Site Visit

7-Day Detailed Site Visit

48-Hour Detailed Site Visit

TOTAL

0004AC– IDTF Site Visits SLIN 0004AC Total Per IDTF Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0004AC Total Per IDTF Visit

30-Day IDTF Site Visit

1,100

901 – 2,000

15-Day IDTF Site Visit

151 – 750

7-Day IDTF Site Visit

2 – 50

48-Hour IDTF Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0004AC Total Per IDTF Visit

Fixed Price Per Site Visit

30-Day IDTF Site Visit

15-Day IDTF Site Visit

7-Day IDTF Site Visit

48-Hour IDTF Site Visit

TOTAL

CLIN 0005

0005AA – Observational Site Visits

SLIN 0005AA Total Per Observational Site Visit

30-Day Observational Site Visit

30,000

15-Day Observational Site Visit

6,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0005AA Total Per Observational Site Visit

30-Day Observational Site Visit

10,000

30,001 – 40,000

15-Day Observational Site Visit

2,000

6,001 – 8,000

7-Day Observational Site Visit

2 – 150

48-Hour Observational Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0005AA Total Per Observational Site Visit

Fixed Price Per Site Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

0005AB – Detailed Site Visits SLIN 0005AB Total Per Detailed Site Visit

30-Day Observational Site Visit

10,000

15-Day Observational Site Visit

3,000

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0005AB Total Per Detailed Site Visit

30-Day Detailed Site Visit

5,000

10,001 – 15,000

15-Day Detailed Site Visit

2,000

3,001 – 5,000

7-Day Detailed Site Visit

2 - 150

48-Hour Detailed Site Visit

2 – 20

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0005AB Total Per Detailed Site Visit

Fixed Price Per Site Visit

30-Day Detailed Site Visit

15-Day Detailed Site Visit

7-Day Detailed Site Visit

48-Hour Detailed Site Visit

TOTAL

0005AC– IDTF Site Visits SLIN 0005AC Total Per IDTF Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0005AC Total Per IDTF Visit

30-Day IDTF Site Visit

1,100

901 – 2,000

15-Day IDTF Site Visit

151 – 750

7-Day IDTF Site Visit

2 – 50

48-Hour IDTF Site Visit

2 – 25

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0005AC Total Per IDTF Visit

Fixed Price Per Site Visit

30-Day IDTF Site Visit

15-Day IDTF Site Visit

7-Day IDTF Site Visit

48-Hour IDTF Site Visit

TOTAL

CLIN 0006

0006AA – Observational Site Visits

SLIN 0006AA Total Per Observational Site Visit

30-Day Observational Site Visit

13,636

15-Day Observational Site Visit

2,727

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0006AA Total Per Observational Site Visit

30-Day Observational Site Visit

4,546

13,637 – 18,182

15-Day Observational Site Visit

2,728 – 3,636

7-Day Observational Site Visit

2 – 70

48-Hour Observational Site Visit

2 – 10

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0006AA Total Per Observational Site Visit

Fixed Price Per Site Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

0006AB – Detailed Site Visits SLIN 0006AB Total Per Detailed Site Visit

30-Day Observational Site Visit

4,545

15-Day Observational Site Visit

1,364

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0006AB Total Per Detailed Site Visit

30-Day Detailed Site Visit

2,273

4,546 – 6,818

15-Day Detailed Site Visit

1,365 – 2,273

7-Day Detailed Site Visit

2 – 70

48-Hour Detailed Site Visit

2 – 10

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0006AB Total Per Detailed Site Visit

Fixed Price Per Site Visit

30-Day Detailed Site Visit

15-Day Detailed Site Visit

7-Day Detailed Site Visit

48-Hour Detailed Site Visit

TOTAL

0006AC– IDTF Site Visits SLIN 0006AC Total Per IDTF Visit

30-Day Observational Site Visit

15-Day Observational Site Visit

7-Day Observational Site Visit

48-Hour Observational Site Visit

TOTAL

SLIN 0006AC Total Per IDTF Visit

30-Day IDTF Site Visit

411 – 910

15-Day IDTF Site Visit

71 – 340

7-Day IDTF Site Visit

2 – 10

48-Hour IDTF Site Visit

2 – 10

TOTAL

CMS reserves the right to order additional site visits, if needed. Any additional site visits in excess of the stated estimated quantities, shall be for the unit price listed below. Should the need for these site visits arise, CMS will specify the quantity and obligate funding to cover the site visits via task order modification.

SLIN 0006AC Total Per IDTF Visit

Fixed Price Per Site Visit

30-Day IDTF Site Visit

15-Day IDTF Site Visit

7-Day IDTF Site Visit

48-Hour IDTF Site Visit

TOTAL

B.7

SCHEDULE FOR PAYMENT FOR FIXED PRICE

When submitting invoices for payment, the contractor shall submit the following table with each invoice as supporting documentation:

SLINs 0001AA, 0002AA, 0003AA, 0004AA, 0005AA and 0006AA

SLIN 000XAA Observational Site Visits for the Period of __________ to ____________

30-Day Observational Site Visit up to the Min. Qty.

30-day Observational Site Visit over the Min. Qty.

30-day Observational Site Visit over Est. Qty.

15-Day Observational Site Visit up to the Min. Qty.

15-day Observational Site Visit over the Min. Qty.

15-day Observational Site Visit over Est. Qty.

7-Day Observational Site Visit up to the Min. Qty.

7-day Observational Site Visit over the Min. Qty.

7-day Observational Site Visit over Est. Qty.

48-Hour Observational Site Visit up to the Min. Qty.

48-Hour Observational Site Visit over the Min. Qty.

48-Hour Observational Site Visit over Est. Qty.

TOTAL

SLINs 0001AB, 0002AB, 0003AB, 0004AB 0005AB and 0006AB SLIN 000XAA Detailed Site Visits for the Period of __________ to ____________

30-Day Detailed Site Visit up to the Min. Qty.

30-day Detailed Site Visit over the Min. Qty.

30-day Detailed Site Visit over Est. Qty.

15-Day Detailed Site Visit up to the Min. Qty.

15-day Detailed Site Visit over the Min. Qty.

15-day Detailed Site Visit over Est. Qty.

7-Day Detailed Site Visit up to the Min. Qty.

7-day Detailed Site Visit over the Min. Qty.

7-day Detailed Site Visit over Est. Qty.

48-Hour Detailed Site Visit up to the Min. Qty.

48-Hour Detailed Site Visit over the Min. Qty.

48-Hour Detailed Site Visit over Est. Qty.

TOTAL

SLINs 0001AC, 0002AC, 0003AC, 0004AC 0005AC and 0006AC SLIN 000XAA IDTF Site Visits for the Period of __________ to ____________

30-Day IDTF Site Visit up to the Min. Qty.

30-day IDTF Site Visit over the Min. Qty.

30-day IDTF Site Visit over Est. Qty.

15-Day IDTF Site Visit up to the Min. Qty.

15-day IDTF Site Visit over the Min. Qty.

15-day IDTF Site Visit over Est. Qty.

7-Day IDTF Site Visit up to the Min. Qty.

7-day IDTF Site Visit over the Min. Qty.

7-day IDTF Site Visit over Est. Qty.

48-Hour IDTF Site Visit up to the Min. Qty.

48-Hour IDTF Site Visit over the Min. Qty.

48-Hour IDTF Site Visit over Est. Qty.

TOTAL

Minimum Guarantees

If the contractor does not meet or surpass the minimum guarantee, the contractor shall notify the Contracting Officer and Contracting Officer’s Representative no later than 15 days before the period of performance end date. The contractor, after notification, may bill the remaining site visits to the minimum guarantee amount in their final billing for the period of performance. For example, if the contractor conducts 140 15-Day IDTF Site Visits under SLIN 0001AC during the 9-month ordering period of the base year, the contractor may bill for the remaining 10 15-Day IDTF Site Visits to meet the total minimum guarantee of 50 during the final bill of base period (when billing for month 9).

SECTION F - DELIVERIES OR PERFORMANCE

F.2 PERIOD OF PERFORMANCE

The period of performance of this contract is May 19, 2019 through May 18, 2020 (Estimated).

This contract includes the following Option Periods:

April 19, 2020 through April 18, 2021 (Estimated)

March 19, 2021 through March 18, 2022 (Estimated) February 19, 2022 through February 18, 2023 (Estimated) January 19, 2023 through January 18, 2024 (Estimated)

December 19, 2023 through May 18, 2024 (Estimated)

SECTION G - CONTRACT ADMINISTRATION DATA

G.5

GOVERNMENT REPRESENTATIVES AND RESPONSIBILITIES (JUL 2016)

a. Contracting Officer’s Representative (COR) for this Task Order:

Phone Number

E-mail

b. Alternate Contracting Officer’s Representative (ACOR) for this Task Order:

Phone Number

E-mail

G.6

HHSAR 352.242-70 KEY PERSONNEL (DEC 2015)

The key personnel required for this task order are:

Project Manager

Site Inspector Manager

Quality Assurance Manager

Additional requirements of the Key Personnel are provided in the Task Order Statement of Work.

G.7

SUBCONTRACT CONSENT

Consent to subcontract will be in accordance with the IDIQ contract.

e.

Consent is hereby given to issue the following subcontractor(s):

TBD

G.8 SUBCONTRACTING REPORTING (Only for Large Businesses) Large Businesses shall follow the requirements of the IDIQ.

G.8.1

TASK ORDER SUBCONTRACT REPORTING

Within thirty days after the end of each period of performance the contractor shall provide Attachment J.5.B, Eastern Region Site Verification Services TO Subcontract Reporting, to the Contracting Officer and Contract Specialist.

SECTION H - SPECIAL CONTRACT REQUIREMENTS

H.1

CONFLICT OF INTEREST

The Contractor shall follow all requirements under the IDIQ. The Conflict of Interest Certificate submitted for the IDIQ award dated __Entered at Time of Award_ is hereby incorporated by reference.

H.13

WAGE DETERMINATIONS

Incorporated at time of award, if applicable.

SECTION I - CONTRACT CLAUSES

I.1

FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses 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. Also, the full text of a clause may be accessed electronically at the following Internet address http://www.acquisition.gov/far/

I.9

FAR 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within the current performance period; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 45 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 5 years.

SECTION J - LIST OF ATTACHMENTS AND EXHIBITS

J.5.A Eastern Region Site Verification Services (SVS) Task Order (TO) Statement of Work (SOW)

J.5.A.1 - Eastern Region Site Verification Services TO SOW Attachment 1 QASP

J.5.B Eastern Region Site Verification Services Task Order Subcontract Reporting

J.5.C Eastern Region Site Verification Services Business Proposal Template

SECTION L

L.18

VOLUME V - SITE VERIFICATION SERVICES TASK ORDERS – TECHNICAL PROPOSAL

VOLUME V – A

Eastern Region Site Verification Services

Offerors must adhere to the page limits defined below for the task order proposal. Pages provided beyond the limits defined will be discarded and not reviewed or evaluated. The Offeror shall submit the written Technical Proposal for the task order as prescribed below; it shall be separated and labeled accordingly.

Assumptions: The Offeror shall provide any assumptions being made for the technical and business proposal. The Offeror shall use the assumptions located in the Site Verification Services Eastern Region’s Statement of Work when proposing.

Proposal Organization and Content: At a minimum, the Offeror shall present its written technical proposal response to each of the factors identified below. The submission of the Technical Proposal shall be as follows:

Please follow the below format and TAB AND LABEL EACH SECTION (and subsections as applicable) INCLUDING THE TITLE. If the Section is “All Inclusive” and there is additional information then the Offeror should delineate between them with a labeled tab under that section. The Technical Proposal shall consist of the following ONLY:

Section 1:

Executive Summary (Page limit: 1)

Section 2:

Table of Contents (Page limit: unlimited)

Offerors shall include a Table of Contents that identifies and clearly labels the various technical proposal sections.

Section 3:

Technical Factor 1 - Technical Understanding and Approach (Page limit: 10) The Offeror shall demonstrate in a clear, concise, and sound manner how the requirements outlined in the SVS Task Order Statement of Work (SOW), Attachment J.5.A, are to be performed. Offerors shall demonstrate, for each Factor, their understanding and knowledge of, approach to, and processes and procedures for completing the SVS Task Order SOW requirements. The Offeror shall:

· Provide a plan on how the Offeror will conduct all types of site verification inspection services for providers/suppliers in the Eastern Region of the United States for Medicare Parts A, B, C, DME and/or Medicaid.

· The Offeror shall describe the User Management system that will be used to allow the ordering of site visits.

· Describe how site visits will be performed in specified timeframes (e.g., within 48 hrs. 7 days, 15 days, or 30 days).

· Describe how the Offeror will have and be able to utilize the capacity through existing networks, systems, processes, or partnerships to visit and conduct provider/supplier sites, whether urban or rural, at locations in the Eastern Region of the United States for Medicare Parts A, B, C, DME and/or Medicaid.

· Be equipped to perform physical observational or in depth site inspections to determine a provider/supplier’s compliance with Medicare enrollment requirements to include provider, staff and customer interviews as part of the site inspections.

Section 4:

Technical Factor 2 - Program Management (page limit: 5 pages) The proposed contractor shall have the capacity to provide management and oversight of the site verification requirements. The Offeror shall provide their:

· Plan on how they will establish a user interface for requests or request updates, a request management and prioritization system, for the actual site verifications.

· Solution for the planning, coordinating and monitoring of the site verifications in the Region.

· Plan on how they will manage quality control of site visit records, to address and troubleshoot issues as they arise, and to provide routine progress or status reporting.

· Solution for training site verification inspectors during ramp up and ongoing.

Section 5:

Technical Factor 3 - Key Personnel and Staffing Plan (Page limit: 5 pages with the exception of the Organizational Charts and Resumes for Key Personnel which will be a maximum of 2 pages each.)

The Offeror shall propose qualified personnel to be designated as key personnel and shall propose their staffing plan in accordance with the below:

1. Key Personnel:

The Offeror shall provide a resume (2-page maximum each not included in the overall page count for Key Personnel and Staffing Plan) for each proposed Key Personnel as well as a narrative that demonstrates the experience and education of the proposed key personnel to meet the qualifications of the SVS Task Order SOW. Also demonstrate how the experience and education of Key Personnel will help meet or exceed the government’s requirement.

2. Staffing Plan The Offeror shall propose a staffing plan and address the following:

a. Organizational Chart (Page limit: two pages not included in the overall page count for Key Personnel and Staffing Plan): The organizational chart should be sufficient to provide an understanding of the roles and responsibilities and placement of proposed personnel. In the event that the Offeror utilizes Subcontractors, the organizational chart shall identify which staff are Subcontractors. Please also include location of each personnel (city, state) and the FTE that person represents).

b. Identify the total number of FTEs required for all CLINs and task order periods of performance inclusive of both the prime and subcontractor(s) broken out by labor category;

c. If the staffing plan includes hiring additional employees, subcontracting work, or any other form of labor acquisition, give examples of similar situations where you have been successful in acquiring the necessary labor to successfully perform a contract of similar size and complexity;

d. An explanation supporting the proposed FTE’s (hours) per labor category as reasonable and realistic for the required effort.

For example purposes only:

per year

e. Summary of FTEs and Hours Proposed in the following format:

TOTAL PROPOSED FTEs:

SVS Eastern Region FTEs

OY1

Direct

Subs

Total

TOTAL PROPOSED HOURS:

SVS Eastern Region Hours

OY1

Direct

Subs

Total

Section 6:

Technical Factor 4 - Past Performance (Page limit: 5 pages) The Offeror shall only provide past performance references/contracts that were submitted in accordance with the MA IDIQ instructions that they would like CMS to utilize in the evaluation of relevant past performance for the task order.

· The Prime Offeror, including any teaming partner/joint venture partner/affiliate, and any significant subcontractor proposed for this effort shall provide a list of past performance references/contracts that were submitted for the MA IDIQ submission that are relevant to this task order. The past performance references/contracts listed in this section of the Offeror’s proposal will be utilized to evaluate past performance for the task order under this evaluation criteria.

· Provide a summary describing the roles and efforts to be performed on this task order by the Prime Offeror and each significant subcontractor/teaming partner/joint venture partner/affiliate for which past performance information is provided.

Section 7:

Technical Factor 5 - Small Business Utilization (Page limit: unlimited)

Small Business: Small businesses will receive an automatic “Very Good” rating for this evaluation criteria.

Small businesses are eligible to receive an “Exceptional” rating for this evaluation criteria if they subcontract with other small businesses. In order to receive the Exceptional rating, the small business Offeror shall submit the following for each small business they are subcontracting with:

1) Subcontractor Name, Point of Contact information and DUNS

2) Type of Small Business if applicable, i.e. WoSB, SDVoSB

3) Description of Services being performed for the prime and demonstrate how it will fit into the overall organizational structure and strengths.

4) Percentage of work being performed – include how the prime calculated the percentage of work

Large Businesses:

The Offeror shall submit Attachment J.5.B - Eastern Region Site Verification Services (SVS) Task Order Subcontract Reporting with their proposal. CMS will perform a subjective assessment based on consideration of all relevant facts and circumstances. The Government is seeking to determine whether the Offeror demonstrates a commitment to use Small Businesses (SBs) for the work that it will assign and oversee as the prime contractor. In addition, the Offeror will need to address the following in a narrative:

1) Identify the subcontractors proposed under the prime for this task order and provide:

· Subcontractor Name, Point of Contact information and DUNS

· Type of Small Business if applicable, i.e. WoSB, SDVoSB

· Description of Services being performed for the prime

· Percentage of work being performed – include how the prime calculated the percentage of work

2) Past performance of the offeror in complying with requirements of the clauses at FAR 52.219-8, Utilization of Small Business Concerns, and 52.219-9, Small Business Subcontracting Plan. CMS will utilize the Electronic Subcontracting Reporting System (eSRS) provided with Factor 5 of the MA IDIQ technical proposal to review compliance of the offeror.

3) Provide the rationale for their small business allocations, how it relates to their core competencies and how it enhances the overall value proposition for the Government.

4) Demonstrate how the proposed strategy fits with their overall organizational structure and strengths.

L.19

VOLUME VI - SITE VERIFICATION SERVICES’ TASK ORDER(S) – BUSINESS PROPOSAL

Volume VI – A

Eastern Region Site Verification Services

Offerors shall provide a cover page (first page of the volume) to Volume VI to indicate if they are bidding on the Eastern, Western, or both task orders.

Section 1:

Table of Contents

Offerors shall include a Table of Contents that identifies and clearly labels the various business proposal sections for the Site Verification Services Eastern Region Task Order.

Section 2:

Task Order Forms (Prime Only)

The Offeror shall complete the following fill-in sections of the Task Order (TO) Request for Proposal (RFP), Attachment J.5:

TO RFP Section B.5 – Note that CLIN 0007 is added for the future PECOS 2.0 transition, since costs are unknown at this time, an optional CLIN has been established and all Offerors will propose $5,000 for this CLIN.

TO RFP Section G.6 TO RFP Section H.13, if applicable (provide the WD number, labor category, county and state)

Section 3:

Business Proposal Spreadsheets (Attachment J.5.C)

Business proposals shall be submitted utilizing Attachment J.5.C and following the CLIN structure provided with the TO RFP and in accordance with the Statement of Work (SOW) and the solicitation instructions.

The business proposal is presumed to represent an Offeror’s best effort to respond to the solicitation. Any significant inconsistency, if not explained, raises a fundamental issue of the understanding of the nature and scope of the work required and of the Offeror’s financial ability to perform the contract and may be grounds for rejection of the offer. The burden of proof for price credibility is with the Offeror.

Any inconsistency between the proposed technical performance and price shall be explained in the proposal. For example, if unique and innovative approaches are the basis for the estimate, the nature of these approaches and their impact on price must be explained. A significant inconsistency, if unexplained, may cause the proposal to be unrealistic, unbalanced or unreasonable. The information requested in the proposal is required to enable the Government to determine that the proposed price is balanced, realistic, fair and reasonable.

The Offeror shall use the business proposal spreadsheet (see Attachment J.5.C) provided.

· The Offeror shall not make the business proposal spreadsheets submitted “Read Only”

· All spreadsheets shall be compatible with Office 2013 Excel, be fully functional, and unlocked.

· The Offeror SHALL submit excel documents with active formulas that can be reviewed and traced using Microsoft excel functions.

· Offerors are instructed to review all excel formulas for accuracy prior to submitting a proposal, as the Offerors are responsible for the accuracy of all formulas within the spread sheet provided.

· The Offeror’s Spreadsheet will take PRECEDENT FOR COST INFORMATION, if discrepancies are found.

· Offerors are instructed NOT to print excel sheets as part of their business proposal submission. It is only necessary to provide these with the electronic copies of your business proposal.

· Cost proposal spreadsheets shall be submitted in Microsoft Excel and rounded to the whole dollar.

· In any subtotal or total field, please insert a rounding formula to prevent unseen cent(s) amounts. For Example: Enter “=ROUND(AR68+AR71,0)” into a subtotal or total field as opposed to “=AR68+AR71.”

· ***The Offeror shall not format the cell by setting the decimal place to “0” to display the whole dollar as this will not prevent unseen cent(s) amounts.*** The Offeror shall use the business proposal spreadsheet (Attachment J.5.C Eastern Region Site Verification Services Business Proposal Template), including all tabs, for all price and shall include the below.

Tab 1 – Summary – Provide the final totals for each CLIN and the Grand Total for all CLINs.

Tabs 2 - 7 – CLINs 0001 to 0006 - Offerors shall provide the build-up of the price per site visit for each type and length of site visit for those site visit prices up to the minimum quantity (Tab 2) only. For example, if an Offeror proposes $10 for SLIN 0001AA up to the Minimum Quantity under Tab 2 then the Offeror shall show the build-up of the rate under CLIN 0001.

Tab 8 – Min to Est Qty Pricing - Offerors shall provide the price per site visit for each type and length of site visit for those visits over the minimum quantity up to the estimated quantity.

Tab 9 - > Est Qt Pricing - Offerors shall provide the price per site visit for each type and length of site visit for those visits over the estimated quantity. In order to evaluate an Offeror’s price, Offerors shall assume that the site visit price proposed for each type and length of site visit shall be equal to or less than the price proposed for the site visit price proposed between the “Min to Est Qty Pricing.” For example, if an Offeror proposed the SLIN 0001AA site visit price under Tab 3 at $10.00 per visit, the Offeror shall propose the SLIN 0001AA site visit price on Tab 4 at or lower than $10.00 per visit.

Please note that the information is to be filled out PER SITE VISIT for each CLIN and multiplied by the estimated number of site visits at the end.

· Labor: Offerors shall provide the hours and labor price per site visit and labor hours per site visit that is expected to be used in the performance of the contract.

· Travel: The Contractor shall provide the price of travel per site visit.

· Other Direct Costs (ODCs): These include materials, equipment, etc. The Contractor shall provide the price of ODCs per site visit.

· Subcontracts: The Offeror shall provide the price of subcontracts per site visit.

Section 4: Business Proposal Narrative Organization

4.1 Prime Proposal Information Checklist (Exhibit E.2) – note this will be the same checklist submitted under the IDIQ

4.2 Basis of Estimate (BOE)

The Offeror shall provide a basis of their price for the 60-day Start-Up Period (CLIN 0006) including labor, travel, ODCs, etc.

For all other proposed price elements (Labor, Travel, ODC’s, Subcontracts) it is incumbent on the Offeror to clearly describe the BOE used to establish prices as fair and reasonable. This includes providing all assumptions used to establish proposed prices and any and all empirical data which can provide further support to the proposed prices as fair and reasonable. The Government needs to understand how you determined the prices per element and how that correlates with the technical approach.

4.3 Labor – provide the labor category(s) that make up the “Labor” price per site visit. At a minimum, provide the duties and responsibilities of this labor category(s) in performing each specific type of site visit.

Escalation - If the proposed price elements are escalated, the Offeror shall provide the escalation rate and the rationale for the proposed escalation of each price element (Labor, Travel, ODC’s, Subcontracts).

The Offeror and Subcontractor productive labor hours for exempt and non-exempt employees used to calculate FTEs (i.e. 2080 hours = 1 FTE).

4.4 Travel - provide the types of travel that make up the “Travel” price per site visit. At a minimum, explain how the Offeror calculated the travel per site visit price.

4.5 ODCs – provide the ODCs that make up the “ODC” price per site visit. At a minimum, explain how these are necessary to the performance of the site visit.

4.6 Subcontracts – provide the name of the subcontractor(s) proposed and what services they are offering per site visit.

The Offeror’s business proposal narrative submission shall include the following subcontract information, as applicable, to be evaluated for each subcontractor:

a. Subcontract Checklist (Exhibit E.3)

b. Consent to Subcontract (Exhibit E.10), if applicable

Section 5:

Service Contract Act

The Offeror should identify those proposed labor categories subject to the Service Contract Act of 1965, as Amended (FAR 22.10) and provide a crosswalk to the labor category including the Wage Determination number in the applicable Wage Determination for their place of performance. The Offeror may obtain Wage Determinations at www.wdol.gov (click on “selecting SCA WDs” to obtain wage determination).

SECTION M

SECTION M.9

VOLUME V SITE VERIFICATION SERVICES’ TASK ORDER(S) – TECHNICAL PROPOSAL EVALUATION Volume V – A

Eastern Region Site Verification Services

The Government will use a Trade-off Source Selection Process to make an assessment for a best value award decision. This trade-off technique allows the Government to consider award to other than the lowest priced Offeror or other than the highest technically rated Offeror. It permits tradeoffs among price and non-cost/price evaluation factors. In making this comparison, the Government is more concerned with obtaining superior technical/management features than with making an award at the lowest overall cost to the Government. However, the Government will not make an award at a significantly higher overall cost to the Government to achieve slightly or moderately superior technical or management features.

This may result in an award to a higher rated, higher priced offeror, where the decision is consistent with the evaluation factors, and the Contracting Officer reasonably determines that the technical and/or past performance of the higher price offeror outweighs the price difference.