0046FBOAttachment.pdf

QUOTER QUESTIONAIRE

Completed Schedule of Services (page 2) with quoted pricing for the base year and 4 Option Years. – (1 page allowed)

☐ Quoter confirms the attached Scope of work has been thoroughly reviewed before submitting a quotation.

☐ Quoter confirms the provision FAR 52.212‐3, the annual representations and certifications, has been electronically completed at www.SAM.gov. The complete provision can be found at https://www.acquisition.gov/far/loadmainre.html.

The registration process at www.SAM.gov has been successfully completed.

Contract Federal Tax ID Number is provided:__________________________

Contractor DUNS number is provided:_________________________

A resume for each proposed Key Personnel and proposed substitute is provided (max 2 pages allowed).

Proof of General Insurance, in accordance with FAR 52.228‐5; ANDMedical Insurance, in accordance with FAR 52.237‐7, ☐ IS provided (1 page allowed each) OR ☐ CAN be provided before contract award.

A copy of the State of Washington license for each proposed Key Personnel is provided (1 page allowed).

☐ A copy of the State of Washington license for the proposed substitute(s) is provided (1 page allowed).

Contractor’s Point of Contact (POC) Information is provided:

Name/Position: Email:

Phone: Fax:

☐ The following questions have been answered as provided below (1 additional page allowed, if necessary):

1. How will your company provide a qualified substitute, when necessary?

2. Do you have any other Job Corp experience? If so, where?

3. Within the past 5 years have you failed to complete any work awarded to you or been terminated for default or breach of contract?

If yes, explain.

4. How many years of experience do your company and any key personnel have in regards to the requirements stated in this solicitation

☐ The following three (3) professional references of similar past work performance is provided:

1. Name: Organization:

Phone: Email:______________________________________

2. Name: Organization:

Phone: Email:______________________________________

3. Name: Organization:

Phone: Email:

☐ I certify that all of the information provided above is complete, true, and correct to the best of my knowledge.

Sign:______________________________________ Date:_______________________________________

SCHEDULE OF SERVICES

Contractor personnel will perform all work required in the Statement of Work (SOW) for the amounts agreed to below, working between Monday – Friday, excluding Federal holidays. Specific days and hours of duty shall be agreed to through coordination with Center personnel.

When Contractor personnel are on vacation, sick leave, or any other absence, qualified substitute(s) shall be provided by the Contractor in accordance with the SOW.

The quantities listed in the following Schedule of Services are based upon the limitations in accordance with the Job Corps Program Requirements Handbook (PRH). The Contractor will be paid based upon the actual work performed pursuant to the SOW. A detailed breakdown of the proposed prices may be requested for evaluation purposes.

19.

ITEM

NO.

20.

SCHEDULE OF SERVICES

21.

ESTIMATED

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

BASE YEAR: November 18, 2013 – November 17, 2014

001 Mental Health Care Specialist 288 HR $ $

Total Base Period $

NO.

20.

SCHEDULE OF SERVICES

21.

ESTIMATED

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR 1: November 18, 2014 – November 17, 2015

101 Mental Health Care Specialist 288 HR $ $

Total Option Year 1 $

NO.

20.

SCHEDULE OF SERVICES

21.

ESTIMATED

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR 2: November 18, 2015 – November 17, 2016

201 Mental Health Care Specialist 288 HR $ $

NO.

20.

SCHEDULE OF SERVICES

21.

ESTIMATED

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR 3: November 18, 2016 – November 17, 2017

301 Mental Health Care Specialist 288 HR $ $

Total Option Year 3 $

NO.

20.

SCHEDULE OF SERVICES

21.

ESTIMATED

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR 4: November 18, 2017 – November 17, 2018

401 Mental Health Care Specialist 288 HR $ $

Total Option Year 4 $

GRAND TOTAL FOR ALL YEARS

SCOPE OF WORK

Mental Health Services Curlew Job Corps Center

1. INTRODUCTION: The USDA Forest Service Job Corps Civilian Conservation Centers (JCCCC) provide academic, vocational, and life‐learning skills to at risk youths and young adults at 28 Job Corps Centers across the United States

(U.S). As part of this program, youths and young adults at the centers are provided healthcare services including the following: medical, dental, mental health, and drug and alcohol intervention. Each Forest Service JCCCC has a need for mental health care services provided by a licensed Center Mental Health Consultant (CMHC) that includes limited assessments, intervention, treatment, monitoring of mental health conditions, and follow‐up care.

2. BACKGROUND: Job Corps is a U.S. Department of Labor (DOL), Employment and Training Administration (ETA) program. Job Corps is designed to assist young people who need and can benefit from the wide‐range of services provided at a Job Corps center. Services include: basic education, High School Diploma (HSD) program; General

Educational Development (GED); vocational skills training; residential‐living program; healthcare; and related support services. The comprehensive combination of training and support services is designed to help each student become a responsible and productive citizen. Student populations range from 100 to over 300 enrollments according to On Board

Strength (OBS). Job Corps is a self‐paced program: therefore, a student’s length of enrollment varies. Students may remain in the program for up to two years, but the average length of enrollment is approximately eight months.

3. CONTRACT EFFORT REQUIRED:

a. Position: The Center Mental Health Consultant (CMHC) shall provide basic mental health services for all students on center, and consultation and training to the staff of the Job Corps program. Center Mental Health Consultant (CMHC) services are required on a weekly‐basis to assist students in attaining and maintaining optimal mental health with the services being provided at the center. The mental health care services must comply with Job Corps policies, requirements, and guidelines and must engage in the most efficient and cost‐effective practice of contemporary, evidence‐based health care possible given available time, resources, and personnel. These services will involve the monitoring of the Health and Wellness (H&W) Program to ensure that students acquire the health‐ related skills, knowledge, and attitudes that help make them employable; coordinating and integrating the mental health care services program with other Health and Wellness (H&W) components/activities on‐center; and provide mental health consultant services to new enrollee’s and established students on center to include the following:

The ability to work both independently and as a member of a healthcare team to provide optimal services to a population of financially disadvantaged youth, ranging from 16 to 24 years in age;

Provision of a basic mental health presentation to all new enrollees to educate them on the services offered and establishment of a positive rapport that facilitates student participation in the mental health program

Assurance of patient privacy for all assessments/consultations, as mandated by Health Insurance Portability and Accountability Act (HIPPA);

Participation in the management of (providing written diagnosis and treatment plan) a Chronic Care Management Plan for students with chronic conditions/disabilities related to mental health conditions;

Establishment of an appropriate referral system to ensure the receipt of specialty care by students as defined in the DOL Policy and Requirements Handbook and provision within budgetary constraints;

Assurance of availability for 24‐hour emergency care either by phone consultation or direct patient care in the Health and Wellness Center or private practice office;

Provision of student services in such a manner to obtain positive student satisfaction survey results as determined by Job Corps

Additional services required in support of the Job Corps Center’s Health and Wellness Program follow:

Maintaining, safeguarding, and ensuring the confidentiality of all required Student Health Records (SHR) when they are in the health and wellness clinic or in the possession of health and wellness team members, according to the federal Health Insurance Portability and Accountability Act (HIPAA)

Providing specialized staff training related to mental health, on an annual basis

Participating in Reasonable Accommodation Committee (RAC) meetings & file applicant review team meetings as requested;

Reviewing of the Job Corps Health and Wellness website (http://jobcorpshealth.com), and attending the Job Corps Mental Health Consultant conference calls, webinars, and DOL training as may be required (actual travel expenses will be reimbursed for approved training requiring travel);

No engagement in any research projects and/or publications relating to Job Corps health activities without proper prior clearance from the Job Corps National Office in Washington, DC.

Advising and assisting the health education instructor in the development and implementation of the Mental Health Education Program;

Reporting adverse student behavior incidents to the Health and Wellness Manager (HWM) or Contracting Officer’s Representative (COR);

Understanding that medical services shall be subject to monitoring and review by Job Corps assessment teams, and cooperation with such teams is required.

b. Hours: Center Mental Health Consultant (CMHC) services are required on a weekly‐basis, during established days of the week. Additional hours may be needed on an occasional basis and will be requested in writing by the Contracting Officer (CO) in advance. The contractor is required to provide 24‐hours advanced notice to cancel scheduled services. Hours may vary, depending on the needs of the student population. Center Mental Health Consultant (CMHC) services hours are dependent upon the student enrollment/On‐Board Strength (OBS) of the center:

OBS Less than 200 students: 6 hours per week

OBS 200‐299 students: 12 hours per week

OBS 300+ students: 18 hours per week

c. Presence: Center Mental Health Consultant (CMHC) services will not be scheduled on federal government holidays and are not required during the period of center‐wide student leave. In addition, CMHC services may be limited during the one to two weeks immediately preceding and following each center‐wide break. The contracted Center Mental Health Consultant (CMHC) must provide a current emergency contact number to the Center Health and Wellness Manager (HWM).

4. QUALIFICATIONS OF CONTRACT EMPLOYEES:

The Contract employee must possess the following:

Must be registered/licensed with the state in which the mental health services will be provided; All licensing requirements/certification/accreditation of the contractor staff must be maintained during the entire performance period of the contract with proof being submitted prior to award and at the exercise of each option period;

Must be responsible for maintaining their own malpractice insurance;

Must undergo a criminal background check and drug testing as prerequisites for employment.

5. MATERIALS, EQUIPMENT, TRAINING, AND UTILITIES.

A. The government shall furnish the following: Adequate work space, equipment, supplies, and materials as needed to accomplish the work requirements outlined herein, including a private assessment area, private storage area for confidential student information, telephone, computer, and a fax machine. These supplies and property shall be utilized during the performance of this contract only while providing student care. The contractor will provide an itemized list of needed to the Health and Wellness Manager (HWM) at least 30 days in advance of the desired delivery date to allow for adequate time for ordering and receiving.

B. The contractor shall furnish the following: All labor, services, permits, licenses, transportation of contractor personnel (as necessary), and incidentals (other than those provided by the government) as needed to fulfill the work requirements herein, for the hours specified based on the center’s OBS. In addition, the contractor shall insure that mental health consultants are covered by professional liability (malpractice) insurance during their performance under this contract and agrees to indemnify and hold harmless, the Job

Corps center from any actions taken by, for, or against the contractor or their agents that could result in additional expenses, fees, or lawsuits.

C. Security: The space, equipment, and supplies used by the Center Mental Health Consultant (CHMC)

MUST be secured at all times, per center requirements. The contractor shall review security procedures with the Center Health and Wellness Manager and Contracting Officer Representative.

6. RECORDS, REPORTS, AND REQUIRED SUBMITTALS:

The following submittals are required during the period of performance of this contract:

Documentation of all assessments/consultations on approved Job Corps Health forms to be maintained in Students’ Health Records (SHR);

Review and authorization of standing orders for healthcare annually in accordance with TAG M: Health Care Guidelines;

Report to the Center Director (CD) and Health and Wellness Manager (HWM) on all health related matters including student medical separations, justifications for and costs of special services, Health and Non‐Health Care Guidelines, and other areas deemed appropriate.

7. THE ROLE OF GOVERNMENT PERSONNEL AND RESPONSIBILITY FOR CONTRACT ADMINISTRATION

A. Contracting Officer: The Contracting Officer (CO) has the overall responsibility for the administration of this contract. The CO alone, without delegation, is authorized to amend, modify, or deviate from the contract.

Other responsibilities may be delegated to authorized‐representatives.

B. Contracting Officer's Representative (COR): The COR will be designated in writing at the time of award to assist the CO in the day‐to‐day on‐site administration of the contract requirements. The responsibilities of the COR include, but are not limited to the following:

(1) Determining the compliance and adequacy of performance by the contractor in accordance with the terms and conditions of this contract;

(2) Requesting removal of unsuitable contractor employees;

(3) Ensuring adequacy of schedule and Quality Control Plan (QAP), including changes;

(4) Ordering re-performance of unacceptable work or performance by other means, etc.

8. GOVERNING REGULATIONS, HANDBOOKS, AND REFERENCES:

The Contractor shall provide health and wellness services as specified in the following:

Job Corps Federal Regulations (Title 20 Code of Federal Regulations, Part 638.510) Part 684 as amended, Job Corps Program under Title TV‐B of the Job Training Partnership Act

Job Corps Policy and Requirements Handbook (PRH) Chapter 6 (Section 6.10, 6.11 and 6.12, revised July 23, 2007) http://fsweb.jc.wo.fs.fed.us/program‐mgr/PRH.pdf

Applicable Technical Assistance Guides (TAG s). ‐ Job Corps Policy and Requirement Handbook (PRH), Physician’s Desk Reference

Job Corps Physician Desk Reference revised January 2010 ET Handbook 330, Website for the Job Corps Health & Wellness information and Department of Labor Policy and Requirements Handbook (PRH):

www.jobcorpshealth.com/directives/in01‐22a.pdf.

QUALITY ASSURANCE PLAN /TECHNICAL REQUIREMENTS: The government reserves the right to have the Job

Corps regional health coordinator and other authorized/qualified personnel, conduct audits of the contractor services and student medical records to verify that quality services are being performed. A copy of any minimally acceptable or worse audit report shall be provided to the contractor and Contracting Officer (CO) within two weeks of the audit.

Within two weeks after receipt of the audit report, the contractor shall submit a performance plan for improving services to the Contracting Officer (CO) for approval. The contractor shall implement the approved performance plan immediately.

Critical

Task Quality/Performance Standards Acceptable

Quality

Level

Means of

Measurement Penalties

Poor for

Performanc e.

Incentives for

Quality

Performance

3A – 1

Working in accordance with Job Corps

Policy and Requirements Handbook (PRH), Program Instructions and Health and

Wellness Program Technical Assistance

Guide (TAG). Environment of the service facility shall be such as to provide the patient with privacy as mandated by the

HIPPA.

100 % compliance to

Guidelines

Observation, communications with HSM and

COR, and review of documentation.

Contractor failure = could lead to default or deduction in contractor payment.

Positive performance evaluation, used for exercise of additional option periods, if appropriate.

3A – 2

Performing mental health services on a weekly basis on established days of the week for 6 hours per 100 students per week.

Contractor contacts the COR 24 hours in advanced for cancellation of services.

90 % compliance to

Guidelines

Observation, review of documentation.

Contractor failure = could lead to default or deduction in contractor payment.

Allows for timely processing of payments.

3A – 3

Providing mandatory CPP Presentation, assessments/consultations, and data recording on the forms required by Job

Corps within the established time frame.

100 % compliance to

Guidelines

Communications with HSM and

COR, and review of documentation.

Contractor failure = could lead to default or deduction in contractor payment.

Positive performance evaluation, used for exercise of additional option periods, if

3A – 4

Obtaining CO prior written approval when specialized, medical care is required by student that exceeds the usual amount required by a student.

100%

Compliance approval by

CO.

Review of documentation and verification with CO.

Non‐approval by CO, Contractor will bear expense.

Allows for timely processing of

3A – 5

Providing a written diagnosis and treatment plan as part of a Chronic Care

Management Plan for students with chronic conditions/ disabilities in an effort to maintain the condition in a status of stable.

100 % compliance to the Guidelines

Communications with HSM and

COR, and review of documentation.

Contractor failure = could lead to default or deduction in contractor payment.

Positive performance evaluation, used for exercise of additional option periods, if

3A – 6

Providing a copy of current license, malpractice insurance upon each renewal period; must provide a current emergency telephone number to the Center HSM;

providing a copy of a current DEA registration to the CO and HSM.

100 % submission compliance

Review of documentation.

Contractor failure = possible suspension of

Contract and payments.

N/A

3A – 7

Availability to attend DOL training for medical contractor as may be required.

75 % compliance

Communications with HSM and

COR.

N/A N/A

3A – 8

Providing student services in such a manner to obtain positive student satisfaction survey results as determined by

Job Corps.

90 % satisfaction rate

Student satisfaction survey results and communication with COR

Contractor failure = options not exercised.

3A – 9

Ensuring that space, equipment, and supplies used by Physician are secured per

Center guidelines.

100% compliance

Review by HSM and COR

Contractor failure = possible suspension of

Contract and