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TECHNICAL REQUIREMENTS AND COST PROPOSAL
Vendors are required to indicate yes/no on the following requirements and questions. Vendor must provide a response if the section requests for a response.
| 3.3 Technical Minimum Qualifications |
| Comply? (Yes, No, n/a) |
It is mandatory that each component listed below in the Technical Minimum Qualifications be addressed. Failure to address each component shall result in disqualification of the RFP response. Vendors proposing to receive an award through this RFP shall provide a detailed description of their SOQ, which shall include, at a minimum, the following information
| 3.1 |
| Physical Exams. The purpose of these exams is: |
| 3.1.1 |
| Early identification of pre-disposing health conditions/factors that contribute to the development of heart or lung disease and hearing loss; |
| 3.1.2 |
| Provision of medical instructions to employees to assist in the correction of identified pre-disposing health conditions/factors that are within the ability of the employee to correct, and actions needed to prevent the development of these diseases; |
| 3.1.3 |
| Establishment of legal documentation to either support or contest workers’ compensation claims for these diseases; |
| 3.1.4 |
| Communicate the presence of significant medical conditions identified during the exam that would affect an employee’s fitness for duty; and |
| 3.1.5 |
| Pre-hire medical analysis for the Department of Corrections employees and other agencies upon request. |
| 3.2.1 |
| The basic standard components included in the physical exams are identified in Section 3.3.3 and must be provided in minor variations identified as one (1) of five (5) Panel Exams listed in the Physical Exams attachment, Panel Exams, most of the Panel Exams will be Panel 3. These exams will be identified and requested by each agency for each individual employee based on length of service, and individual agency policy. |
| 3.2.2 |
| When abnormalities are detected during the exam that are potentially indicative of the presence of heart disease, lung disease, cancer in firefighters or hearing loss, the physical exam must be carried through until a diagnosis is confirmed or ruled out. Employees must be referred to their own personal physician for follow-up of all other pre-disposing health conditions that lead to heart disease, lung disease or hearing loss or other identified health conditions. |
| 3.3 |
| Standard Components of Physical Exams |
| 3.3.1 |
| · Audiometry with interpretation-identify air conduction or pure tone test (Panels 1-5); |
· Blood Pressure Monitoring (Panels 1, 3, 4, 5);
· Chest X-Ray (1 view for Panels 1, 4, 5) radiologist over-read (2 view for Panel 3) radiologist over-read;
· Coronary Risk II (CBC + Chem Panel + HDL + LDL) (Panels 1, 3, 5);
· Per-Cent Body Fat (BMI Method) and Waist Circumference (Panels 1, 3, 5);
· Pulmonary Function Test (Spirometry) (Panels 1 – 5);
· Resting EKG (Panels 1, 2, 4, 5);
· Stress EKG- Standard Bruce Protocol (Panel 3 or as otherwise determined by physician when employee presents with medical condition or other test results during the completion of a Panel 1 exam indicating that this test may be needed to evaluate health/medical status or fitness for duty; or if the employee is 40 years or older);
· TB Skin Test (Panel 1, 3, 5) one-step. Two step for baseline exams and converters. Exceptions: Department of Corrections and Lakes Crossing conduct their own TB tests except for pre-placement exams. Pre-placement (Panel 1 exams) NDOC, SNAMHS (Stein Hospital) and Lakes Crossing exams require a two-step test to be performed by the vendor;
· Hepatitis profile screen (Panel 1, 3, 5). Screen for Hep C, only Screen for Hep A and B if employee is not vaccinated;
· Hepatitis A and B vaccinations or Heplisav-B, if negative (Panel 1 or if requested by employer);
· Nicotine test (Cotinine Only) with Quant Levels (Panels 1, 3, 5);
· Urinalysis (Panels 1, 3, 5);
· Heart and Lung Physical Exam (Panels 1, 3, 5);
· Vision screening (Panels 1 – 5).
Can you provide requested exams?
| 3.4 |
| Standard Forms for Physical Exams |
| 3.4.1 |
| · State of Nevada Firemen and Police Medical History Form, Medical History Form (Panels 1, 3, 5). |
· Heart and Lung Physical Examination Attachment
· State of Nevada Report of Results (Panels 1 – 5) must be submitted through Risk Management’s Origami System
Can you provide requested exams?
| 3.5.1 |
| Can be performed by a physician, PA or APRN certified by the American College of Sports Medicine or other certification authority and signed off by the evaluating physician. |
Do you comply?
| 3.5.2 |
| A defibrillator or other appropriate emergency equipment must be available within one minute. |
Do you comply? What is your current practice for an emergency?
Response:
| 3.5.3 |
| A (Standard Bruce Protocol) must be utilized, unless otherwise agreed to by the physician, agency representative and Risk Management representative. A baseline of 10.1 Metabolic Equivalent Task (METS) at 2 minutes of stage 3 (3.4 mph at a 14% grade) must be achieved to consistently evaluate the employee’s cardiovascular status. It has been determined that the peak physical demands of a police officer or fireman’s job duties require between 14 to 16 METS for effective performance. The physician performing the test must not consider the test completed and stop it automatically when the 10.1 MET level is achieved. Employees should be encouraged to achieve a maximum/safe MET level consistent with peak physical demands when safe to do so. |
Do you comply? What is your current practice?
Response:
| 3.6 |
| Cardiology/Pulmonology/Audiology Consultations; Additional Diagnostic Testing |
| 3.6.1 |
| When abnormalities are found in the EKG exams, chest X-rays, pulmonary function tests or hearing tests, the vendor must make a referral to and schedule an appointment with an appropriate specialist approved by the State within ten (10) working days of the initial physical exam. The employer is responsible to approve diagnostic testing to rule out or confirm the presence of heart or lung disease. The vendor must identify and list the cost of each type of additional diagnostic test that may be utilized in confirming or ruling out these diseases, the related consultation/evaluation fee and identify the specialists that will be utilized. |
| 3.6.2 |
| When a diagnosis of heart or lung disease is identified or if occupational related hearing loss is identified, the vendor must ensure that an Employee’s Report of Injury (C-4) Form is completed within three (3) business days of the diagnosis and forwarded to the State’s workers’ compensation third party administrator, the agency and the Risk Management office., unless the employee documents that he/she chooses not to submit a claim. Explain your method of processing the information within the three (3) business day period. |
Do you Comply?
Response:
| 3.7.1 |
| These will generally be Panel 1 exams or Panel 3 exams (as designated by the requesting agency) and will be coordinated at the request of the individual agency. These exams must be performed in relation to the potential employee’s ability to perform all job duties as outlined in each individual job description. Pre-placement exams must include both the State of Nevada “Medical History Form” and a general health history form supplied by the vendor to review all body systems related to the performance of the specific job. |
| 3.8 |
| Original Components of Physical Exam |
The following listed services may be requested in conjunction with the annual physical exams or as a specific separate service:
| 3.8.1 |
| · Hepatitis/HIV Screening-as requested by agency and agreed to by employee; |
· Hepatitis A inoculations- Baseline exams and as requested by agency and agreed to by employee;
· Hepatitis B inoculations (and boosters) or Heplisav-B. Baseline exams and as requested by agency and agreed to by employee;
· HazMat Exams/medical surveillance-as requested by agency;
· Respirator Clearance Exams-as requested by agency;
· Psychological Screening and Interpretation (Baseline Exams, Pre-hire exams or fitness for duty evaluations);
· CDL Exams –as requested by agency;
· Alcohol/Drug Testing with Medical Officer review-as requested by agency
· Blood Lead
· CT Scan (if abnormalities found in X-ray);
· Physical assessment screening;
· Hemoglobin A1C – when diabetes has been documented;
· QuantiFeron TB Gold Plus
· Other miscellaneous services as identified by an individual agency.
Can you perform all the above tests?
| 3.9 |
| Pre-Hire Psychological Screening and Interpretation for Police/Correctional Officer Employees |
| 3.9.1 |
| As requested by an individual agency based on need and budgetary allocations. The vendor should provide information on the type, scope and availability of these services. Currently the following agencies utilize this service - Department of Corrections, Division of Public Safety, and POST. Other agencies may also be included in the future. |
| 3.10 |
| Medical Surveillance/Follow-up Physician Review |
| 3.10.1 |
| This will occur upon request of an agency and in conjunction with established procedures. This is intended to allow for follow-up on significant medical conditions identified during the exam which affect fitness for duty issues, and correction of significant pre-disposing health conditions. The vendor’s physician must instruct the employee to return appropriate documentation from their personal physician within a specified period for review and concurrence for release to full duty (or) coordinate with the Health Program Specialist with the Risk Management Division. If applicable, the vendor’s physician must resolve any unclear issues directly with the employee’s physician. |
Do you comply with this? Describe method
Response:
| 3.11.1 |
| Post exposure treatment/counseling/preventive care as required by OSHA 1910.1030. |
| 3.12 |
| Independent Medical Exams/Fitness for Duty Exams – Upon Request |
| 3.12.1 |
| This type of exam is often initiated to determine an employee’s fitness for duty related to non-occupational condition or potential workplace violence situations. These exams will often require a referral to a psychologist or psychiatrist for completion of the exam. The vendor may be asked to secure an appointment with an appropriate physician within five (5) working days of receipt of a request. The documentation provided to the agency representative must clearly communicate work status recommendations. A verbal report must be provided to the agency representative immediately following the initial evaluation. Subsequent referrals to a specialist (generally psychologist or psychiatrist) must be scheduled and completed within five (5) working days. The vendor must limit the number of psychologists and psychiatrists utilized for referral to not more than three of each specialty, who have documented and verifiable experience and expertise in dealing with occupational situations and who will provide specific recommendations regarding fitness for duty. |
| 3.13.1 |
| · The vendor must provide the services of an occupational therapist or other specialist who can perform on-site job evaluations to establish objective and specific physical work requirements of a specific job position. The service must be provided upon request by an agency. |
· Annual Wellness Evaluations NRS 289.510, Subsection 6
| 3.14.1 |
| The results of the physical exam and all diagnostic tests must be reviewed and explained, in person, by the physician with each employee, unless otherwise agreed to by the agency representative and the Risk Management representative. This process generally requires a two-part exam. The first part to include blood draws, chest x-rays and other diagnostic tests; the second part to include the physician exam and/or stress test and review of all findings. Exceptions to the two-part exam must be approved by a designated Risk Management representative. |
| 3.14.2 |
| The State of Nevada – “Report of Results” Form must be completed, reviewed in person with the employee and signed by the physician and employee on the same date, unless otherwise requested by the agency representative and Risk Management representative. |
| 3.14.3 |
| All documentation must be clearly legible and entered correctly into the Origami System. |
| 3.14.4 |
| Physicians must ‘order’ (not just recommend or advise) the employee to correct pre-disposing conditions, that are within the ability of the employee to correct, that lead to heart or lung disease or hearing loss and clearly document such ‘order’ (example: employee who is obese shall be referred to a dietician or other specialist). The physician must provide specific and detailed instructions on the actions that need to occur. |
| 3.14.5 |
| The employee must be provided a copy of this form at the time of the exam. A copy of the Report of Results will automatically be available to the evaluating physician, the agency, and Risk Management when the Report of Results is input into the Origami System. All other paperwork related to the exam must be uploaded upon the completion of the exam. |
| 3.14.6 |
| Guidelines for predisposing risk factors that employees are required to correct will be provided and revised, as necessary by the Risk Management representative. Refer to Risk Factor Levels for Various Conditions attachment. |
| 3.14.7 |
| The vendor shall agree to follow the established guidelines. The goal is to ensure consistency statewide regarding this document. The physician must identify any risk factors that he/she is ordering the employee to correct in the “You are Ordered to take the following action(s) to correct predisposing risk factors:” section of the Report of Results. Any additional comments or directions from the physician may be entered in the comment box on the Report of Results. |
| 3.14.8 |
| Physicians referring Officers to a Specialist, or their PCP, must identify the type of specialist in the drop-down box on the Report of Results entitled Specialty referrals. |
| 3.15 |
| Fitness for Duty issues must be determined with consideration of the ‘peak physical demands’ of each position as described below: |
| 3.15.1 |
| Police /Correctional Officer |
| 3.15.1.A |
| Ability to sprint up to 40 yards; lift or drag an offender short distances and possess the ability to perform a full force arrest or physical take down which requires the following: Up to three (3) minutes of full force physical exertion, full mobility of all joints, manual grip strength of 70-90 lbs., ability to sustain striking blows to the head and torso while maintaining physical and mental performance and the ability to lift, push, press and pull 75% of the officer’s own body weight. |
| 3.15.2.A |
| Pack test regulations three (3) to six (6) mile hike over steep, rough terrain while carrying 45 lb. pack for firefighting; carry or drag up to 100 lbs. for up to 100 feet; ability to perform under adverse conditions including 16 hr. shifts for two (2) to seven (7) days, while enduring heat, cold, altitude, smoke, insufficient food, sleep deprivation, noise and fatigue. |
| 3.15.3.A |
| As identified within specific job descriptions. |
Do you Comply with section 3.15?
| 3.16 |
| Physicals must be documented “incomplete”, and employees identified as ‘unfit for duty’ if the following occurs: |
| 3.16.1 |
| Employee is unable to achieve the 10.1 MET level at 2 minutes into Stage 3 on the stress EKG test due to a medical condition; |
| 3.16.2 |
| Employee has a medical condition that prevents him/her from participating in the stress EKG exam or, if other than a Panel 3 exam is performed, would reasonably prevent him from doing so; |
| 3.16.3 |
| Employee refuses to participate in any of the diagnostic tests without a valid physician’s excuse; |
| 3.16.4 |
| Employee exhibits a medical or health condition, at the time of the exam, that the physician reasonably determines would place the employee at risk of injury or accident; or could compromise the employee’s ability to effectively perform the peak physical demands of their position and affect public safety. This requirement shall be considered in all Panel Exams, not just the Panel 3 Exam (that includes the stress test and measures the employees MET levels capability). |
| 3.16.5 |
| Employees who are identified as ‘unfit for duty’ must be given work restrictions unless a life-threatening condition is identified. The employee must be ordered to seek the appropriate follow-up care with his or her own private physician unless referred to a cardiologist, pulmonologist or audiologist as noted in Section 3.16. The evaluating physician shall instruct the employee to provide objective documentation within a specific time frame (not to exceed 30 days) to be cleared for full duty. This date must be identified in the comment box on the “Report of Results. If the employee does not report back to the evaluating physician within the agreed upon time frame, the evaluating physician shall notify the appropriate agency contact and Risk Management, within five (5) days of the deadline. The evaluating physician must provide documentation for the employee to present to the agency that identifies work level status. |
| 3.16.5.A |
| · Typical Work Restrictions for Police Officers: Administrative duties only, no arrests or pursuits. |
· Typical Work Restrictions for Correctional Officers: No physical altercations, no running or pursuits.
· Typical Work Restrictions for Firemen: No firefighting or emergency response-light to medium work only
Do you Comply with section 3.16?
| 3.17 |
| ‘Not Physically Fit’- Status |
| 3.17.1 |
| Employees who are unable to achieve 10.1 METS on a stress EKG exam or a graded exercise test due to de-conditioning issues - not medical factors must be identified on the State of Nevada “Report of Results as ‘Not Physically Fit’ in lieu of ‘Unfit for Duty’. This exam must be identified as incomplete, until such time as the employee can achieve 10.1 METS so that the cardiovascular status in relation to peak physical demands can be determined. The employee must be scheduled within 30 days to repeat the stress EKG. The evaluating physician must provide documentation for the employee to present to the agency that identifies work level status. Do you Comply? |
| 3.17.1.A |
| · Typical Work Restrictions for Police Officers: Administrative duties only, no arrests or pursuits. |
· Typical Work Restrictions for Correctional Officers: No physical altercations, no running or pursuits.
· Typical Work Restrictions for Firemen: No firefighting or emergency response-light to medium work only
| 3.17.2.A |
| Employees who are under the care of a personal physician (generally cardiac, pulmonary or oncology) for a condition that could place them at risk of injury during a stress EKG exam or other diagnostic test, shall have the option to present an appropriate release and justification, from their personal physician to the vendor’s physician to allow the specific diagnostic test and possibly the general work status recommendation to be performed by their own physician. However, when the release and justification is received from the employee, the vendor is responsible to obtain and review the results of the diagnostic tests performed and medical reports. The vendor will provide a statement regarding fitness for duty based on the results of the testing performed by the employee’s personal physician. The vendor must immediately notify the appropriate agency representative when an employee presents them with such documentation. |
| 3.18 |
| Agency Reports/Time Frames/Penalties/Schedule |
| 3.18.1 |
| Unfit for Duty’ Status or “Not Physically Fit for Duty” |
| 3.18.1.A |
| A verbal report, followed by a fax or email copy of the “Report of Results”, shall be provided to both the agency contact and the Risk Management representative within 24 hours of the determination. The penalty for non-compliance shall be $100 deducted from the cost of the exam unless prior approval has been received from Risk Management or the agency. |
| 3.18.2 |
| State of Nevada ‘Report of Results’ and ‘Medical History’ Forms, and copies of all diagnostic tests shall be uploaded into the Origami System on the date of the exam. |
| 3.18.3 |
| If required reports are not uploaded or forwarded to the agency and Risk Management within the required time frames in 3.18.2 of the exam, the penalty for non-compliance shall be $100 deducted from the cost of the exam. |
| 3.18.4 |
| If the documentation identified above is not completed, critical areas of the forms are not properly completed, and/or appropriate employee/evaluating physician signatures not obtained, the penalty for non-compliance shall be $100 deducted from the exam. The evaluating physician is responsible to correct and/or obtain the necessary documentation. The corrected/completed forms shall be forwarded to the appropriate agency contact and Risk Management not later than five (5) working days from the date of request for clarification. The penalty for non-compliance shall be $100 deducted from the exam. |
| 3.18.5.A |
| The vendor shall have the discretion to bill an agency up to $100 for each scheduled appointment with a physician that the employee does not attend, without giving a 48-hour notification of cancellation (excluding emergencies, unavoidable work-related circumstances or miscommunications in scheduling.) The vendor must notify the agency immediately of a no-show for which a penalty will be assessed. This will not apply to pre-employment or pre-placement exams. |
| 3.18.6 |
| Copies of any and all records requested by the Risk Management Division must be made available within ten (10) working days of the request |
| 3.19 |
| Customer Service Liaison |
| 3.19.1 |
| The vendor shall assign not more than two (2) representatives to act as liaisons with agency representatives and Risk Management to coordinate services, scheduling and billing and to resolve problems or concerns as they arise. |
| 3.19.2 |
| Vendors with locations in the North and South shall assign a liaison in the North and one in the South. The designated liaison(s) must be familiar with the contract requirements and not be assigned to a position that is subject to excessive turnover. The vendor must identify the customer service liaison(s) and provide a resume with the original proposal. Changes in the assigned liaison must be communicated to the Risk Management representative within ten (10) days of the change. |
| 3.20.1 |
| All meetings between State Agencies and vendors must be scheduled and coordinated through Risk Management at least 5 days prior to the date of the meeting. This includes in-person meetings and phone conferences other than meetings to discuss the scheduling of physicals. Do you Comply? |
| 3.21.1 |
| The vendor shall provide an invoice to each individual agency-broken down by individual employee, panel number of exam and a list of the components administered within each exam by the 15th day of the next month, unless a different option is requested by an individual agency through written documentation. Do you Comply? |
| 3.22 |
| Confidentiality of Records |
| 3.22.1 |
| The vendor is responsible for the confidentiality of all records associated with the physicals whether it be electronic, on paper or oral. The information contained in a heart and lung physical are medical records and are protected health information under the Health Insurance Portability and Accountability Act (HIPAA). Do you Comply? |
| 3.22.2 |
| A breach of protected health information by the vendor shall result in a fine of $1,000.00 - $2,500.00 per incident, depending on the severity of the breach. Nevada State Purchasing will investigate the breach and assess the fines. The fines are to be paid to State Purchasing within 45 days of the assessment. Do you Comply? |
| 3.23 |
| Record Keeping/Reports |
| 3.23.1 |
| The vendor shall create and maintain a database to include the following components and must create and provide summary and statistical reports within ten (10) working days of the request. Do you Comply? |
· A listing of all exams administered per agency, broken down into specific panels and other services not affiliated with a panel exam;
· A listing of “No Shows” for scheduled physicals by department/agency upon request.
· Work status results of each exam (Fit for Duty, Not Fit for Duty-Medical, Not Physically Fit.);
· A billing aging report for each department, agency or division upon request.
· Monthly costs per agency, per type of service.
· Referrals made for cardiology, pulmonary and audiology consults.
COST PROPOSAL
All pricing shall include the servicing of accounts and complying with all contractual requirements. Only one Unit Price is acceptable.
*Purchasing to insert Cost Proposals here.
(Any deviation from this format may result in disqualification of proposal.)