ATTACHMENT_1.docx

Combined Synopsis/Solicitation No. AG-82A7-S-14-0013 Attachment 1 Page 1 of 7

QUOTER QUESTIONAIRE

☐ Completed Schedule of Services (page 2) with proposed 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.

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

☐ 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.

☐ Contract Federal Tax ID Number is provided:__________________________

☐ Contractor DUNS number is provided:_________________________

☐ 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).

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

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 or experience working with disadvantage young adults? 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? Provide a summary of your experience.

☐ 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

*A detailed breakdown of the Quote may be requested.

19.

ITEM NO.

20.

SCHEDULE OF SERVICES

21.

EST.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

BASE YEAR SERVICES

February 1, 2014 to January 31, 2015

19.

ITEM NO.

20.

SCHEDULE OF SERVICES

21.

EST.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

Option YEAR 1 SERVICES – February 1, 2015 to January 31, 2016

19.

20.

SCHEDULE OF SERVICES

21.

EST.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

Option YEAR 2 SERVICES February 1, 2016 to January 31, 2017

19.

20.

SCHEDULE OF SERVICES

21.

EST.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

Option YEAR 3 SERVICES – February 1, 2017 to January 31, 2018

19.

20.

SCHEDULE OF SERVICES

21.

EST.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

Option YEAR 4 SERVICES – February 1, 2018 to January 31, 2019

GRAND TOTAL WITH ALL OPTIONS: $_________________

PERFORMANCE WORK STATEMENT

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. This requirement takes place at the Fort Simcoe Job Corps CCC in White Swan, WA.

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. Fort Simcoe Job Corps has an OBS of 171 students. This center is located approximately 40 miles southwest of Yakima on the Yakama Indian Reservation. The address is Fort Simcoe Job Corps 40 Abella Lane White Swan, WA 98952.

3. PERFORMANCE REQUIRED:

a. Position: The Center Mental Health Consultant (CMHC) shall provide basic mental health services for all students on Center, as well as consultation and training to the staff of the Job Corps Program. Mental Health Consultant services are required on a weekly basis to assist students in attaining and maintaining optimal health, with the services being provided at the Center. The mental health care services must comply with Job Corps policies, requirements, and guidelines and 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 attitude that help make them employable; coordinating and integrating the Mental Health Care services program with other H&W components/activities on Center; and provide mental health consultant services to enrollee’s and established students on Center. Provision of mental health services requires, but is not limited to:

· 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 enrollees to educate them on the services offered, and establish a positive rapport that facilitates student participation in the Mental Health program;

· ensuring patient privacy for all assessments/consultations, as mandated by HIPPA;

· participate 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;

· establishing an appropriate referral system to ensure the receipt of specialty care by students, as defined in the PRH and within budget constraints;

· availability for 24-hour emergency care either by phone consultation or direct patient care in the Wellness Center or private practice office; and

· providing 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 include:

· maintaining, safeguarding, and ensuring the confidentiality of all required student health records when they are in the health 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 meetings & File Applicant Review Team meetings as requested;

· reviewing the Job Corps Health and Wellness website (http://jobcorpshealth.com) and attendance at Job Corps Mental Health Consultant conference calls, webinars, and DOL Training as may be required that does not involve actual travel;

· not engaging in any research projects and/or publications relating to Job Corps health activities without prior written approval from the Job Corps National Office in Golden, CO;

· 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 HSM or COR; and understanding that medical services shall be subject to monitoring and review by Job Corps assessment teams, and cooperation with such teams is required.

b. Schedule and Availability: Mental health services are required on a weekly basis, during days of the week and hours of the day established in coordination with Center personnel. Based on the Center’s current OBS, the Contractor must provide at least the Minimum Staffing Requirements specified in the Program Requirements Handbook (PRH). The quantity of required Mental Health Consultant hours may vary, depending on the needs of the student population. Hours in addition to those specified in the Schedule of Services 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. When Key Personnel are unavailable, the Contractor will provide an acceptable substitute to provide services. Substitute personnel must be approved in advance by the CO.

Off-Center office visits for after-hours care and consultation relating to emergency or urgent student needs shall be provided when required. Key Personnel must be available by telephone 24 hours per day, 7 days per week to provide emergency services. Key Personnel must provide a current emergency contact number to the Center HSM. When Key Personnel is/are unavailable, the Contractor will provide to the Center HSM a current emergency contact number of an acceptable substitute to provide emergency services.

Mental Health Consultant services will not be scheduled on federal Government holidays and are not required during the period of Center-wide student leave (approximately two weeks, twice yearly. In addition, Mental Health Consultant services may be limited during the one to two weeks immediately preceding and following each of these breaks.

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 Contractor staff must be maintained during the entire performance period of the contract, with proof being submitted at the request of the Government;

· are responsible for maintaining their own malpractice/professional liability insurance and general liability insurance;

· must provide a current Drug Enforcement Administration (DEA) registration number, if applicable, to the CO and HWM, for use in procuring necessary supplies in support of the work requirements; and

· may be subject to a criminal background check and drug testing as prerequisites for contract performance.

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 performance period:

· 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 health care annually, in accordance with TAG M: Health Care Guidelines; and

· Reports to the Center Director (CD) and Health Services Manager (HSM) 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.

The federal Government reserves the right to have the Job Corps Regional Health Coordinator and other authorized/qualified personnel conduct audits of Contractor services and student medical records to verify that quality services are being performed. A copy of any 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.

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://www.jobcorps.gov/pdf/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) available upon request by the COR.

9. QUALITY ASSURANCE SURVEILLANCE MATRIX:

In accordance with FAR 37.401, the Government will evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g. professional judgments, diagnosis for specific medical treatment, etc.)

The Contractor will receive performance evaluations in accordance with the Quality Assurance Surveillance Plan for this requirement, which shall be provided to the Contractor by the CO or the COR.

Performance evaluations will include assessment of the following:

Contractor will provide mental health services on a weekly basis on established days of the week for the number of hours required by the PRH.

This requirement is being procured as a Performance-Based Service Acquisition. Accordingly, the Contractor will receive performance evaluations at least annually. Performance evaluations will address, but are not limited to, analysis of the Quality/Performance Standards identified above. Failure to perform to the standards identified in the Quality Assurance Surveillance Matrix will result in a negative impact to the Contractor’s performance evaluations. In addition, the use of the Quality Assurance Surveillance Matrix to evaluate Contractor performance in no way limits the Government’s rights and remedies established under contract regarding the Contracting Officer’s discretion to pursue termination by convenience or default, to exercise (or not) contract options, to accept or reject services provided, etc.