A19-SOLICITATION-1605C3-22-R-00001-FINAL - 3.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

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

OFFEROR

CAS

S-4307 200 Constitution Ave, NW Customer Acquisition Services US Department of Labor

OWCP DC NAT SHIP CODE 16. ADMINISTERED BYCODE

X

621111

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED ORCAS

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

09/19/2022 05:00 P.M. ES

08/31/2022

202-693-9854John Smithson (No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

1605C3-22-R-00001

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 128 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

Washington DC 20210

TELEPHONE NO.

17a. CONTRACTOR/

WASHINGTON DC 20210

ROOM S3524

200 CONSTITUTION AVE, NW

US DEPARTMENT OF LABOR

15. DELIVER TO

Washington DC 20210 S-4307 200 Constitution Ave, NW Customer Acquisition Services

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$12.0

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

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

US Department of Labor

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

The Department of Labor (DOL), Office of Worker's Compensation programs (OWCP), Division of Energy Employees Occupational Illness Compensation (DEEOIC) has a requirement to procure Contract Medical Consultants (CMC) to assist the DEEOIC by reviewing and evaluating the medical evidence of record and providing written medical opinions regarding various aspects of selected compensation cases in accordance with the Performance Work Statement (PWS) and estimated quantities identified in Section B.

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

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

Elvis R. Colbert

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

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

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This requirement will result in the award of a single award Indefinite Delivery Indefinite

Quantity (IDIQ) contract with Fixed Price (FP) task orders.

Anticipated period of performance: one (1)

12-month base period with four (4) 12-month option periods, to begin on November 1, 2022.

Questions regarding this Request for Proposal

(RFP) shall be submitted via e-mail to Contract

Specialists Smithson.John@dol.gov along with

Severe.Jubner@dol.gov and to the Contracting

Officer, Colbert.Elvis.R@dol.gov by September 7, 2022 at 3:00 pm est.

Contractors shall use the Question and Answer

(Q&A) Excel Spreadsheet (Attachment J3) template to submit all questions.

The subject line of the e-mail containing the Q&A

J3 attachment spreadsheet, shall have the solicitation number.

Responses to questions submitted will be responded via an amendment on SAM.gov.

No questions posed via telephone will be

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

128 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 128

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-22-R-00001 accepted.

Proposals are due on the date identified on block eight (8) of this SF-1449 form.

Period of Performance: 11/01/2022 to 10/31/2027

0001 BASE PERIOD: CONTRACT MEDICAL CONSULTANT SERVICES

Causation Services

Impairment

Diagnosis Clarification

Wage Loss

Supplemental

Appointment Cancelation

Second Opinion

Referee File Review

Referee Physical Examination

Referee Impairment File Review

Expedite/Terminal

Diagnostic Testing

Interpreter Services

Medical Records Translation Services

Product/Service Code: Q999

Period of Performance: 11/01/2022 to 10/31/2023

1001 OPTION PERIOD ONE (1): CONTRACT MEDICAL

CONSULTANT SERVICES

Causation Services

Impairment

Diagnosis Clarification

Wage Loss

Supplemental

Appointment Cancelation

Second Opinion

Referee File Review

Referee Physical Examination

Referee Impairment File Review

Expedite/Terminal

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

4 128

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-22-R-00001

Diagnostic Testing

Interpreter Services

Medical Records Translation Services

(Option Line Item)

(Anticipated Option Exercise Date)11/01/2023

Product/Service Code: Q999

Period of Performance: 11/01/2023 to 10/31/2024

2001 OPTION PERIOD TWO (2): CONTRACT MEDICAL

CONSULTANT SERVICES

Causation Services

Impairment

Diagnosis Clarification

Wage Loss

Supplemental

Appointment Cancelation

Second Opinion

Referee File Review

Referee Physical Examination

Referee Impairment File Review

Expedite/Terminal

Diagnostic Testing

Interpreter Services

Medical Records Translation Services

(Option Line Item)

(Anticipated Option Exercise Date)11/01/2024

Product/Service Code: Q999

Period of Performance: 11/01/2024 to 10/31/2025

3001 OPTION PERIOD THREE (3): CONTRACT MEDICAL

CONSULTANT SERVICES

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

5 128

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-22-R-00001

Causation Services

Impairment

Diagnosis Clarification

Wage Loss

Supplemental

Appointment Cancelation

Second Opinion

Referee File Review

Referee Physical Examination

Referee Impairment File Review

Expedite/Terminal

Diagnostic Testing

Interpreter Services

Medical Records Translation Services

(Option Line Item)

(Anticipated Option Exercise Date)11/01/2026

Product/Service Code: Q999

Period of Performance: 11/01/2026 to 10/31/2027

4001 OPTION PERIOD FOUR (4): CONTRACT MEDICAL

CONSULTANT SERVICES

Causation Services

Impairment

Diagnosis Clarification

Wage Loss

Supplemental

Appointment Cancelation

Second Opinion

Referee File Review

Referee Physical Examination

Referee Impairment File Review

Expedite/Terminal

Diagnostic Testing

Interpreter Services

Medical Records Translation Services

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

6 128

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

1605C3-22-R-00001

(Option Line Item)

(Anticipated Option Exercise Date)11/01/2027

Product/Service Code: Q999

Period of Performance: 11/01/2027 to 10/31/2028

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Performance Work Statement (PWS) Solicitation: 1605C3-22-R- 00001 Contract Medical Consultants Department of

Labor Office of Workers Compensation Programs

Division of Energy Employees Occupational Illness Compensation

GENERAL INFORMATION

1.1. Description of Services/Introduction:

The Energy Employees Occupational Illness Compensation Program (EEOICP) provides worker’s compensation benefits authorized by the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or the Act). Part B of the program went into effect on July 31, 2001 and Part E of the program went into effect on October 28, 2004. The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is responsible for adjudicating and administering claims filed by employees, former employees or certain qualified survivors under the Act.

1.2. Background:

The EEOICP is a specialized program within the U.S. Department of Labor with specific regulations and causation criteria. The program owes its creation to the situation that arose in the 1940s when nuclear weapons were being developed.

1.2.1 PART B

The purpose of Part B is to provide lump sum payment and medical benefits as compensation to covered employees suffering from occupational illness incurred as a result of their exposure to radiation, beryllium, or silica while in the performance of duty for the DOE and certain of its vendors, contractors, and subcontractors.

The legislation also provides for the payment of compensation to certain survivors of these covered employees, as well as for payment of a smaller lump sum to individuals or their survivors who were determined to be eligible for compensation under Section Five

(5) of the Radiation Exposure Compensation Act (RECA).

1. Part B covers the following population:

a. Employees of the Department of Energy (DOE), its contractors or subcontractors, and atomic weapons employees with radiation-induced cancers.

Performance Work Statement (PWS) CMC 2022 Contract Medical Consultant Services

b. Employees of DOE, its contractors and subcontractors, and designated beryllium vendors who worked at covered facilities where they were exposed to or may have been exposed to beryllium produced or processed for the DOE who developed chronic beryllium disease (Employees exposed to beryllium who developed beryllium sensitivity received medical monitoring) under statutory diagnostic criteria.

c. Employees of the DOE, its contractors and subcontractors who worked at least 250 days during the mining of tunnels at underground nuclear weapons test sites in Nevada or Alaska and who developed chronic silicosis under statutory diagnostic criteria.

d. Uranium workers (or their survivors) previously awarded benefits by the Department of Justice under Section 5 RECA.

2. To determine whether the employee’s cancer is “at least as likely as not” related to exposure to radiation at DOE sites, the program uses a set probability of causation (POC) tables developed by and maintained by the National Institute for Occupational Safety and Health (NIOSH). A compensable POC is one of a 50% or greater probability that occupational radiation was the likely cause of the diagnosed cancer.

3. The Act also created and provides procedures for the designation of Special Exposure Cohort (SEC) for employees of certain DOE facilities (or its contractors and subcontractors) and certain atomic weapons employees who worked at specified facilities. Employees found to be a member of a SEC receive a presumption that certain diagnosed cancers are work-related. Petitions for possible SEC designation are reviewed by NIOSH and submitted to the Advisory Board on Radiation and Worker Health. Upon receiving a recommendation from the Board, the Secretary of Health and Human Services can designate the addition of a class of employees to the SEC if it is not feasible to estimate, with sufficient accuracy, the radiation dose that the class received. After meeting the employment criteria, an employee (or survivor) may be eligible under a SEC class only if the employee suffered from one or more of the following cancers:

1. SEC Cancers

a. Bone cancer (including myelodysplasias and polycythemia vera)

b. Renal cancer

c. Leukemia (other than chronic lymphocytic leukemia) with a latency of at least two (2) years

d. Lung cancer (other than in situ discovered after an autopsy)

e. *Multiple myeloma

f. *Lymphomas (other than Hodgkin’s disease)

g. *Primary cancer of:

(1) *Thyroid

(2) *Breast (male or female)

(3) *Esophagus

(4) *Stomach

(5) *Pharynx

(6) *Small intestine

(7) *Pancreas

(8) *Bile ducts

(9) *Gallbladder

(10) *Salivary glands

(11) *Urinary bladder

(12) *Brain

(13) *Colon

(14) *Ovary

(15) *Liver (except if cirrhosis or hepatitis B is indicated)

*Provided onset was at least five (5 )years after first exposure.

4. Uranium workers and survivors, who have received a lump sum award under Section 5 of the RECA, are entitled to file a claim for benefits under Part B. RECA employees are also eligible for medical benefits in relation to their accepted covered condition.

1.2.2 PART E

1. Part E was created when Congress abolished Part D of the EEOICPA with an amendment signed into law by the President on October 28, 2004. Part E provides compensation in the form of medical benefits, wage loss, and impairment benefits to DOE contractors and subcontractors and certain Section 5 RECA workers. Covered survivors of deceased workers are also eligible to receive compensation if the covered illness aggravated, contributed to, or caused the employee’s death. An additional survivor benefit is payable if the employee sustained wage loss prior to death. Living employees must establish that it is “at least as likely as not” that exposure to a toxic substance at a covered facility was a significant factor in causing, contributing to, or aggravating an illness.

2. An accepted Part E claimant may receive compensation for wage loss based on the number of years, as determined in relation to the Social Security retirement age, that an employee experienced a loss in wages due to his or her covered illness. Impairment benefits, based upon the amount of whole-person impairment of the employee due to an accepted covered illness, are paid to employees. Covered employees will receive an award for each percentage of whole-person impairment attributable to the accepted covered illness.

3. Any DOE contractor claimant whose claim had been accepted under Part B (including by way of the SEC) is eligible for Part E benefits for the same covered condition. Atomic weapons employees, beryllium vendor employees and Federal employees are not eligible for Part E benefits.

1.2.3 CONTRACT MEDICAL CONSULTANT

Contract Medical Consultants (CMC) assist the Division of Energy Employees Occupational Illness Compensation (DEEOIC) by reviewing and evaluating the medical evidence of record and providing written medical opinions regarding various aspects of selected compensation cases. CMCs do not review every case, rather the requestor of the service seeks medical input from CMCs in selected cases. Such input may include:

1. Causality issues involving the work-relatedness of a given disease, whether exposure to particular toxic substances at work caused, contributed to, or aggravated the disease; the role of the covered illness in the death of the claimant; the appearance of secondary or consequential diseases or injuries, etc.

2. The explanation of treatment modalities, the interpretation of clinical test results, assistance with establishing or confirming a diagnosis and the clarification of other physicians’ reports.

3. Determining the level of impairment in a given case in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment.

4. Assessing an individual’s ability to work during a given time period, as it relates to the covered condition.

The medical opinion should be provided by a qualified physician with expertise in treating, diagnosing, or researching the illness claimed to be caused or aggravated by the alleged exposure. The CMCs’ written medical opinion is used by the requestor to reach adjudication decisions regarding causality, impairment, or wage loss in compensation cases. DEEOIC expects these medical opinions to be solidly based on the facts as accepted by the requestor and expressed in the Statement of Accepted Facts (SOAF) and on state-of-the-art medical knowledge. Above all, these opinions should be as objective as possible. There will be instances where the CMC will have to make a determination based upon historically incomplete, vague, or contradictory evidence. In these instances, the CMC will have to accept the facts as provided by the requestor and formulate a medical opinion based upon the totality of the available medical evidence. However, there is a mechanism for CMCs to ask the requestor follow-up questions before they issue their report.

Participating CMCs must be identified by name and business address and have the following types of professional qualifications:

5. Physicians:

a. Possess a M.D. degree or a D.O. degree;

b. Hold an unrestricted license to practice medicine in the state in which they will perform examinations or otherwise practice under this contract;

c. Board Certified in their respective specialties by one of the medical specialty Boards recognized by the American Board of Medical Specialties or by the American Osteopathic Association;

d. Engaged in an active medical practice – a minimum of 240 hours of direct patient care over the previous twelve months;

e. Possess computer skills;

f. Shall at all times be a “qualified physician” under the Energy Employees Occupational Illness Compensation Program Act, and as defined in 20 CFR § 30.5(ee);

6. Physicians Performing Impairment Evaluations:

a. In addition to the qualifications set forth in subsection 1.2.3.5 above, CMCs who perform impairment evaluations must possess certification by American Board of Independent Medical Examiners (ABIME) or International Academy of Independent Medical Evaluators (IAIME) or a successor entity in the field of impairment evaluation that establish the physician as a qualified expert.

b. Physicians who conduct impairment evaluations shall have training and experience in the use of the American Medical Association Guides to the Evaluation of Permanent Impairment. Currently, DEEOIC requires the use of the 5th Edition of the Guides, but may require use of a newer edition during the life of this contract. The Contractor shall meet a request for use of a newer edition with all necessary materials and training of its staff and subcontractors as may be required.

Physicians Performing Second Medical Opinions:

7. The physicians selected to evaluate a patient by directed medical examination are responsible for conducting a thorough physical examination of the patient, including review of any relevant medical records, diagnostic test results or other factual information. From this examination, the physician is to produce a comprehensive written medical report that describes the results of his or her physical examination and unequivocally responds to any questions posed by the DEEOIC requestor. Any offered opinion should be derived from an objective evaluation of the totality of all available evidence, and be rooted in sound, reasonable medical judgment. Physicians who previously evaluated or provided medical care to a claimant cannot perform a second opinion examination (SECOP).

For SECOPs, the clinical specialties for which DEEOIC has the most need are internal medicine, orthopedic surgery, oncology, physical medicine and rehabilitation, pulmonary medicine, and family medicine. Medical specialists must be available in sufficient number and geographically distributed to serve the needs of the claimants in the program, nationwide. No examination shall require a claimant to travel more than two hundred

(200) miles from the claimant’s residence without express permission of the District Director or designee.

8. Most Needed Specialties and Expected Availability:

a. While DEEOIC may require the services of CMCs certified by any of the medical specialty Boards recognized by the American Board of Medical Specialties, or by the American Osteopathic Association, most requirements will be concentrated in a few medical specialties. In addition to Occupational Medicine specialists, the program primarily utilizes physicians with expertise in pulmonary diseases, oncology, hematology, neurology, dermatology, pathology, urology, gynecology, medical toxicology, family medicine, internal medicine, and internal medicine subspecialties.

1.2.4. THE REQUESTOR

The requestor of services can be a claims examiner (CE), hearing representative (HR), medical benefits examiner, or other designated program staff. We shall refer to all of these roles as “requestors” of services within this document. The requestor maintains responsibility for the case and uses the services of the CMC for direction and clarification. The requestor determines when a CMC referral is required. The requestor identifies the appropriate specialty on the Contact Medical Consultant Form. When referring a case to a CMC, the requestor must provide the following via an email through the secure internet portal:

1. Claimant name

2. Claim number

3. Type of review requested

4. Medical Specialty Requested

5. An electronic image of the following items:

a. A Statement of Accepted Facts (SOAF) including the following:

i. Identifying demographics (name, case number, relevant personal information)

ii. Description of accepted condition and other diagnosed medical conditions

iii. Detailed description of employee’s employment history

iv. For causation opinions, identification of the occupational toxic substance exposures encountered by the employee

v. Brief history of significant events that have transpired in the case

b. List of questions for CMC to address

c. Medical records relevant to the issues for which the CMC is to render an opinion

1.2.5 CMC HANDLING OF CASE MATERIAL

The CMC medical opinion shall constitute a complete review of the case file. As part of the case file review the CMC shall do the following:

1. For causation medical opinions, impairment evaluations, diagnosis clarification, expedite /terminal, SECOP, and Referee:

a. review the SOAF and list of questions to be addressed in the report;

b. review all medical reports including radiology, pathology and other diagnostic reports made available from the case file;

c. review any factual documents including photographic evidence;

d. answer all questions submitted by the requestor. An unequivocal response is to be provided to each question along with sufficient written discussion to clearly describe the evidentiary basis for the response provided. If the answer is neither yes nor no, a clear statement must be included explaining why a definitive answer could not be provided along with a statement of the evidentiary basis for that conclusion.

2. For SECOP and Referee Medical Opinions:

a. take claimant’s complete medical history, including a history of the injury or disease related to the claim;

b. review claimant’s subjective complaints;

c. perform a complete examination of the claimant, as appropriate to the physician’s medical specialty and professional license;

d. perform, or arrange to have performed, any further necessary diagnostic procedures or tests specifically required to complete the examination and render a meaningful second opinion report. DEEOIC authorizes any non-invasive diagnostic procedure that is substantively related to the condition or issue which gave rise to the second opinion referral or referee referral, and which the examining physician feels necessary to render a reasoned opinion and full report. No invasive procedure shall be performed without the prior approval of both the individual to be examined and of DEEOIC.

All necessary noninvasive tests shall be conducted unless declined by the individual examined; or unless a test is not medically advisable. Upon notification from the examining physician that such a diagnostic procedure is needed, the Contractor shall schedule the procedure(s) according to the delivery schedule set forth in this contract.

NOTE: Physical examinations shall be performed by physicians who are licensed to do so.

1.3. Objectives:

The objective of this requirement is to (1) Develop a tool for recruitment and oversight of CMCs providing case review; (2) Utilize CMCs with the appropriate medical specialty for case review; (3) Ensure the participating CMCs meet the professional qualifications;

(4) Coordinate CMC review of case files for the purpose of obtaining medical opinion on causation, impairment, and other relevant medical matters; and (5) Procure medical second opinion physical examinations, referee opinions, interpreter and medical records translation services for affected claimants identified by the District Offices.

1.4. Scope:

1. Claimants Covered and Work to be Performed. The affected claimants reside anywhere in the United States. Cases are managed by the District Offices in Colorado, Ohio, Florida, and Washington. The District Office staff will provide to the Contractor all necessary information pertaining to covered claimants.

2. Causation. Opinions on causation shall be provided for approximately 2,500 DEEOIC claimants per annum, which will be under CLIN 0001 when billing.

a. When a Causation Review requires referee file review (approximately 25 per year), the referee file review should be applied under CLIN 0008 when billing.

b. When a Causation Review requires expedited handling within a 24-hour turnaround (approximately five (5) and up to 40 per year), the causation file review should be applied under CLIN 0001 and CLIN 0011 when billing.

3. Impairment. Impairment evaluations shall be provided for approximately 2,000 DEEOIC claimants per annum, which will be under CLIN 0002 when billing.

a. When an Impairment Evaluation requires referee file review (approximately 50 and up to 100 per year), the referee file review should be applied under CLIN 0010 when billing.

b. When an Impairment Evaluation requires expedited handling within a 24-turnaround (approximately five (5) and up to 35 per year), the impairment evaluation should be applied to CLIN 0002 and CLIN 0011 when billing.

4. Diagnosis Treatment. Approximately 250 and up to 500 file reviews providing an explanation of treatment modalities, the interpretation of clinical test results, assistance with establishing or confirming a diagnosis, and the clarification of other physicians’ reports shall be provided per annum, which will be under CLIN 0003 when billing.

a. When a Diagnosis Treatment requires expedited handling within a 24-turnaround (approximately five (5) per year) the diagnosis treatment evaluation should be applied to CLIN 0003 and CLIN 0011 when billing.

5. Wage Loss. Approximately 10 and up to 50 opinions assessing an individual’s ability to work during a given time period as it relates to a covered condition shall be provided per annum, which will be under CLIN 0004 when billing.

a. When a Wage Loss referral requires expedited handling within a 24-turnaround (approximately five (5) per year), the wage loss referral should be applied to CLIN 0004 and CLIN 0011 when billing.

6. Supplemental. Supplemental Reports shall be provided for approximately 125 and up to 250 per annum, which will be under CLIN 0005 when billing.

a. When a Supplemental referral requires expedited handling within a 24 hour turnaround (approximately ten (10) per year), the supplemental referral should be applied CLIN 0005 and CLIN 0011 when billing.

7. Cancellation. Appointment cancellation shall be provided for approximately fifteen

(15) per annum, which will be under CLIN 0006 when billing.

8. Second Opinion. Medical second opinion services shall be provided for approximately 200 DEEOIC claimants per annum, which will be under CLIN 0007 when billing.

1. When a SECOP evaluation requires a Referee Physical Examination Referral, it should be applied under CLIN 0009 when billing. It is estimated that approximately ten (10) will require a referee physical examination referral.

9. Referee Medical Opinion. For examples, see 2. a., 3.a., and 8.a.

10. Diagnostic Testing. Diagnostic testing services shall be provided for approximately five (5) but up to eighty (80) DEEOIC claimants per annum for Second Opinion examination and Referee examination, which will be under CLIN 0012 when billing. All diagnostic testing will be paid based on the OWCP fee schedule. Refer Section 2.2

(PAYMENT FOR DIAGNOSTIC LABORATORY TESTS AND DIAGNOSTIC

PROCEDURE FOR IMPAIRMENT EVALUATIONS, SECOND MEDICAL

OPINION EXAMINATIONS, AND REFEREE MEDICAL EXAMINATIONS)

11. Interpreter Services: Interpreter services shall be provided for approximately 5- 100 DEEOIC claimants per annum, which will be under CLIN 0013 when billing.

12. Medical Records Translation Services: Medical Records Translation services shall be provided for approximately 5 but up to 100 DEEOIC claimants per annum, which will be under CLIN 0014 when billing.

For the expedited/terminal cases, the processing time shall be no more than 24 hours from receipt of referral for requests received Monday through Thursday, and the Government will pay an increase above the current service price.

For the expedited/terminal cases received by the Contractor on a Friday, on or before 10:00 am PST, the Contractor shall process the referrals and return to the issuing District Office the same day within two (2) hours of receipt of the referrals; and the Government will pay an increase above the current service price.

For the expedited/terminal cases received by the Contractor on a Friday, after 1:00pm ET the process time shall be 24 hours from receipt of the referral and return to the issuing District Office no greater than the same time on the next business day; and the Government will pay an increase above the current service price.

For all expedited/terminal cases, the physician report shall be electronically submitted through the secure online portal. The 1:00 pm ET cut-off time on Friday will be checked against the District Office’s submission of the request through the Client Portal.

Submission will not be based upon when the request was retrieved by the Contractor, but when the request was submitted by the District Office and received in the Client Portal at the Contractor’s office.

DEEOIC will notify the Contractor of the submission of a referral via the secure online portal using the steps laid out in the “Client Portal User Guide.” Upon receipt of a submission confirmation from the Contractor, DEEOIC will notify the requestor via email that the referral is complete.

1.5. SCHEDULING MEDICAL OPINIONS, IMPAIRMENT EVALUATIONS,

SECOPS, OR REFEREE MEDICAL OPINIONS

Upon telephone, written notice or website notification from the District Office of the need for a medical opinion, impairment evaluation, SECOP, or Referee Opinion by a medical specialist, the Contractor shall do the following:

1. Review the District Office SOAF and the list of questions to be addressed by the CMC and determine if the referral is for causation, impairment, SECOP, or Referee Medical Opinion.

2. For CMC Medical Opinion and Impairment Evaluation case file review:

a. Match the request for the necessary medical expertise with the appropriate CMC. There are several different types of questions that arise that require an opinion from a CMC with specific medical expertise. Some cases may require input from more than one CMC. The requestor considers the following when requesting a CMC opinion:

i. For questions regarding causation or wage-loss – these questions are usually handled by occupational medicine specialists. Occupational medicine specialists can also evaluate the diagnosis and treatment of common, classic occupational lung conditions; i.e., asbestosis, silicosis, chronic beryllium disease, pneumoconiosis, chronic obstructive pulmonary disease, and asthma, among others.

ii. For questions regarding diagnosis or treatment – these questions are usually best handled by a medical specialist for the condition or procedure being considered (see example list below).

Internal Medicine and subspecialties, Family Practice, Emergency Medicine, Pulmonary, Hematology, Oncology, Geriatric Medicine, Neurology, Dermatology, Surgery, Rehabilitation Medicine, Obstetrics-Gynecology, Pathology, Toxicology, Pain Medicine

iii. For questions regarding impairment – these evaluations are best performed by those CMCs with specific impairment experience for the particular organ system. Cases that require impairment ratings in more than one organ system should be completed by a CMC who has “whole body” expertise. Cases that require impairment expertise regarding specific organ systems should be completed by a CMC who has expertise in the specific organ system; e.g., Whole Body (All organ systems), Musculoskeletal, Pulmonary, Neurology, Cardiovascular, Skin, Ears, Nose, Throat, Eye, Psychiatric.

iv. Cases that require evaluation of the diagnosis and an impairment – evaluation for the same condition might require one specialist to render an opinion on the first question and an impairment specialist for that organ system to perform the impairment evaluation.

b. Within two (2) days from the first notice, select and confirm a CMC with the appropriate medical specialty as identified on the Contract Medical Consultant Form, and notify the requestor via the electronic report management portal of the selection.

3. For Second Medical Opinions:

a. Make an appointment for the claimant in question with a physician in the appropriate field of medical specialty and forward notice of the appointment to the claimant, the claimant’s appointed representative and to the DEEOIC requestor, using a format specified by DEEOIC. The site of the examination must be within the appropriate commuting distance as defined in subsection 1.2.3.7 above, or as approved by the requestor.

Exceptions to this travel restriction may be granted only with the express permission of the District Director or designee. The date of the examination must allow the claimant to receive at least fourteen (14) days advance of notice of the appointment date.

b. Within five (5) days from the first notice, notify DEEOIC, in writing, of the specialist’s name, address and phone number, and the date and time of the scheduled appointment.

c. Reschedule an appointment only once to suit the convenience of an examining physician. The date of the rescheduled examination shall be not more than fourteen (14) days from the first notice form DEEOIC. In the event of a rescheduling to suit the convenience of an examining physician, the completed report shall be delivered to DEEIOC within twenty-eight

(28) days from the first notice from DEEOIC. If additional requests for rescheduling the appointment are received from the examining physician/specialist, the Contractor shall schedule an appointment for examination with another physician/specialist.

d. Notify DEEOIC within four (4) days of a claimant’s request for rescheduling. If a request for rescheduling is received from the claimant, the Contractor or examining physician may not reschedule the appointment without DEEOIC permission. Rather, the Contractor must notify DEEOIC so the responsible requestor may decide the issue.

e. Contact the examining physician/specialist within four (4) days after the scheduled appointment date to determine whether the claimant reported and cooperated with the exam. If the claimant did not report or did not cooperate, the Contractor shall so notify DEEOIC within seven (7) days of the scheduled appointment date.

4. When assigning cases to a CMC, the Contractor shall distribute cases by specialty or expertise and availability. The Contractor has twenty-one (21) days from the date of receipt of the referral package to return a completed report to the responsible District Office. The CMC report is accepted by the District Office when the Contractor receives payment for the report. At that point, the case materials should be deleted or destroyed according to the guidelines of this contract and HIPAA regulations. It is expected that this period will not be longer than thirty (30) days.

a. If the District Office determines that the report submitted by the Contractor is not properly responsive to the questions posed, is incomplete or incorrect, the District Director will return the report to the Contractor and request the Contractor provide an additional report to correct the situation. The CMC shall provide the additional report within fourteen

(14) days of receipt of the request without additional charge. The District Office will notify the Contractor, in writing, of the request for the additional report.

5. Not assign one CMC to conduct more than 33% of the medical opinions, impairment evaluations, SECOPs, or Referee Medical Opinions per annum.

6. Not set a minimum number of cases to be referred to an individual CMC; no minimum number of cases is guaranteed to each CMC.

7. Contact the requestor with any questions regarding the case.

8. Contact the District Office within seven (7) days of receipt of the referral package, if the Contractor’s CMC identifies exposure issues that require further development before a medical opinion can be rendered. The requestor will determine whether to pursue further exposure data or whether an industrial hygiene (IH) referral is warranted. After development, the District Office will submit the IH report or additional exposure information to the Contractor for referral to the same CMC. The Contractor’s CMC will then have twenty-one (21) days from the date of receipt of the IH report or additional exposure information to return a completed report to the District Office.

1.6 CONTRACT MEDICAL CONSULTANT REPORTS

Case File Review Reports: The CMC report must be typed and contain the physician’s name and signature. The CMC’s professional address, telephone number, and state medical license number should be on file with the Contractor and District Offices. The medical report should be clear and convincing to medical and non-medical personnel. It should follow a logical progression from premise to evidence and conclusions, leaving the reader clear on what was said and convinced of the conclusions. It should be thorough and well-rationalized. In addition, each CMC report must include a certification statement as determined by DEEOIC regarding potential conflicts of interest. In writing a report, the CMC should use the following outline:

1. Case Identification. The CMC should identify the case using the claimant’s full name and case number. In addition, the conditions or diagnoses accepted by the program (if any) should be mentioned. This information is found in the SOAF.

2. Clinical History or Summary. The requestor should include a brief clinical summary of the case based on the medical evidence on file and in the SOAF.

3. Response to the Requestor’s Questions. The CMC should write the opinion clearly, explaining complex medical terminology, using only standard abbreviations and defining any abbreviations used. When the requestor asks more than two (2) questions, the questions should be numbered and the CMC should number and answer each question separately.

4. Conclusions. The responses to the requestor’s questions involve medical conclusions. Such conclusions should be developed from the available medical data in a logical, step-by-step manner and written in a fashion that allows a non-medical staff person to follow the CMC’s reasoning. Each case should be evaluated on its unique set of facts. Using findings, conclusions or other rationale from similar case situations should not be the basis for forming a position on the case under review. Conclusions should be as definite as possible, given the available information. The physician should avoid such terms as “perhaps”, “rule out”, etc. If the medical evidence is insufficient to reach a more definitive conclusion, the CMC should ask the requestor to request additional medical information from the claimant or the treating physician. The CMC should ask the requestor for specific reports or information.

5. The Use of References. The CMC should cite published studies to make a point or support a conclusion. When doing so, the CMC should be aware that saying “according to current medical literature…” is not sufficient alone. The CMC should reference all documents used in decision-making, either in the text of the report or in a separate list.

1.7 SECOND OPINION PHYSICAL EXAMINATION REPORTS

The physician/specialist’s second opinion physical examination report shall be complete, responsive to all questions posed by the requestor, and submitted in the form and format specified by DEEOIC. All claimed conditions identified in the SOAF must be examined.

All questions submitted by the DEEOIC requestor must be answered. If the answer is neither yes nor no, a clear statement must be included explaining why a definitive answer could not be provided along with a statement of evidentiary basis for that conclusion. For each conclusion specified in the physical examination request, a diagnosis must be provided or a statement included that the claimed condition was not found. If a diagnosis can neither be established nor ruled out, the facts must be documented with a clear statement of why a diagnosis could not be established. A statement that a diagnosis could not be established because additional tests are required will not be an acceptable reason for returning an examination without establishing a diagnosis or providing a statement that the claimed condition was not found, unless the required tests are invasive, are not medically advisable, or are declined by the individual being examined. If a diagnosis is established which differs from the existing diagnosis for the same condition as contained in the SOAF, the two diagnoses must be reconciled with a statement documenting the basis for change of diagnosis, and whether the new diagnosis represents a progression of an earlier diagnosis, correction of a prior incorrect diagnosis, or a new independent entity.

The Contractor shall:

1. Arrange to have all second opinion reports submitted on the letterhead of the examining physician, in a narrative form, in a legible typeface, and with the claimant’s case number at the top of each page.

2. Ensure that all second opinion reports include, as appropriate:

a. a brief synopsis of the clinical history of the case, including a history of treatment to date, as well as an identification of any underlying or preexisting condition(s);

b. a description of physical or psychiatric findings, as the case requires;

c. a statement of results and their interpretation for laboratory tests (including blood tests, urinalysis, tissue samples, etc.), and other diagnostic procedures (including x-ray, computerized tomography [CT], magnetic resonance imaging [MRI], electro myelogram [EMG], electrocardiogram [EKG], audiogram, treadmill stress test, and similar techniques of visualizing or recording physiological conditions) deemed necessary to complete the second opinion physical examination;

i. Laboratory tests and diagnostic procedures must be performed by or under the supervision of a person licensed to perform then in the state or local jurisdiction where they are performed. Reports of such tests and procedures must be included with the second opinion report and must contain the patient’s full name, DEEOIC whole claim number, date of the test, the objective data obtained, and the signature of the person responsible for performance of the test or procedure.

ii. A report on results of any test requiring cooperation by the patient, such as visual, hearing and pulmonary function tests, should include a comment from the person administering the test on the extent of patient cooperation, to estimate the validity of the results.

d. a diagnosis related to these physical findings and diagnostic procedures (from

b. and c. above);

e. a prognosis, a recommended course of treatment to be followed, and a clinical estimate of the date of recovery, if expected.

3. Ensure that all reports fully answer all specific questions the requestor posed;

ensure that each answer contains a supporting explanation or rationale based on the actual clinical findings in the case and current medical concepts; ensure that medical opinions expressed are restricted to the physician’s area of medical specialty; and ensure that medical opinions are expressed unambiguously and as definitely as the findings in the case allow.

4. If the request from the requestor also requires an impairment evaluation, ensure that reports are written in accordance with the edition of the AMA guides required by the most current edition of the Federal (EEOICPA) Procedure Manual (https://www.dol.gov/agencies/owcp/energy/regs/compliance/PolicyandProcedures/Cons olidatedProcedureManual ) and current DEEOIC program policies. The report should include a “date of maximum medical improvement” and supporting rationale for the chosen date. The Contractor shall assure that reports of physical impairment levels contain the actual measurements, expressed in degrees, obtained during the examination or through clinical or laboratory tests, the resulting level of impairment, and an explanation as to how the level of impairment was calculated.

1.8 HANDLING CASES OF REFEREE MEDICAL OPINION REFERRALS

1.8.1 BACKGROUND

The Office of Workers’ Compensation Programs (OWCP), Division of Energy Employees Occupational Illness Compensation (DEEOIC) is responsible for adjudicating claims associated with Part B and Part E of the Act. According to 20 CFR § 30.411(b) under the EEOICPA Regulations, if a conflict exists between the medical opinion of the employee’s physician and the medical opinion of either a second opinion physician or an OWCP medical adviser or consultant, or a qualified physician submitting an impairment evaluation, the OWCP shall appoint a third physician qualified in the appropriate specialty who conforms to the standards regarding conflicts of interest adopted by OWCP to make an examination or an impairment evaluation. This is called a referee examination.

1.8.2 SERVICES

A Referee Medical Examiner is a CMC who will review and evaluate relevant medical evidence to resolve a conflict in medical opinion. Referee Medical Examiners (RME) assist the DEEOIC by reviewing and evaluating the medical evidence of record and providing written medical opinions that serve to resolve conflicts in medical opinion. To obtain the RME written opinion, the DEEOIC may choose to have a RME conduct a physical examination of a claimant, or limit the evaluation to available medical or other records from a case file.

1. Under the DEEOIC claims adjudication process, conflicts of medical opinion may arise for a variety of reasons including:

a. Causality issues involving the work-relatedness of a given disease; e.g., whether exposure to particular toxic substances at work caused, contributed to, or aggravated the disease; the role of the covered illness in the death of a claimant, or the appearance of secondary or consequential diseases or injuries, etc.

b. The explanation of treatment modalities, the interpretation of clinical test results, assistance with establishing or confirming a diagnosis and the clarification of other physicians’ reports.

c. Determining the level of impairment in a given case in accordance with the edition of the AMA guides required by the most current edition of the Federal (EEOICPA) Procedure Manual (https://www.dol.gov/agencies/owcp/energy/regs/compliance/PolicyandProce dures/ConsolidatedProcedureManual ) and current DEEOIC program policies.

d. Assessing the effects of a covered illness or an individual’s ability to earn wages.

2. Most Needed Specialties and Expected Availability:

a. For referee medical opinions, the clinical specialties for which DEEOIC has the most need are internal medicine, orthopedic surgery, oncology, physical medicine and rehabilitation, pulmonary medicine, neurology, and family medicine.

b. Medical specialists must be available in sufficient numbers and geographically distributed as to cover the needs of claimants served by the DEEOIC program, distributed nationwide. No examination shall require a claimant to travel more than two hundred (200) miles from the claimant’s residence without express permission of the requestor’s management.

3. Physicians who may not be used as referees include:

a. Physicians previously connected with the claim or the claimant, or physicians in partnership with other parties connected to the claim.

Note: The mere fact that a physician has conducted a second opinion examination in connection with the DEEOIC does note eliminate that physician from serving as an impartial referee physician in another case.

The physician selected for a referee medical opinion file review is responsible for conducting a thorough review of any relevant medical records, diagnostic test results or other factual information provided to the Contractor by DEEOIC. All claimed conditions identified in the SOAF must be reviewed. All questions submitted by the DEEOIC requestor must be answered. If the questions cannot be addressed by the RME, a clear statement must be included explaining why a definitive answer could not be provided along with a statement of the evidentiary basis for that conclusion. From this review, the physician is to produce a comprehensive written medical report that unequivocally responds to any questions posed by the DEEOIC requestor.