ATTACHMENT_1.docx

Combined Synopsis/Solicitation No. AG-82A7-S-14-0044 Attachment 1 Page 1 of 8

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).

☐ A copy of the Drug Enforcement Administration (DEA) registration for each proposed Key Personnel is provided (1 page allowed). ☐ A copy of the DEA registration 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.

☐ A resume for each proposed Key Personnel is provided (1 page allowed).

☐ A resume 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 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.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

BASE YEAR SERVICES – July 01, 2014 through June 30, 2015

(Up to 4 hours per week x 48 weeks per year)

(Up to 4 hours per week x 48 weeks per year)

19.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR ONE (I) SERVICES – July 01, 2015 through June 30, 2016

(Up to 4 hours per week x 48 weeks per year)

(Up to 4 hours per week x 48 weeks per year)

19.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR TWO (II) SERVICES – July 01, 2016 through June 30, 2017

(Up to 4 hours per week x 48 weeks per year)

(Up to 4 hours per week x 48 weeks per year)

19.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR THREE (III) SERVICES – July 01, 2017 through June 30, 2018

(Up to 4 hours per week x 48 weeks per year)

(Up to 4 hours per week x 48 weeks per year)

19.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR FOUR (IV) SERVICES – July 01, 2018 through June 30, 2019

(Up to 4 hours per week x 48 weeks per year)

(Up to 4 hours per week x 48 weeks per year)

GRAND TOTAL WITH ALL OPTIONS: $_________________

PERFORMANCE WORK STATEMENT

a. Position: Physician Services are required on a weekly basis to assist students in attaining and maintaining optimal health with the services being provided at the Center or physician’s office as determined by the Contracting Officer (CO), Contracting Officer’s Representative (COR), and Contractor. Physician services provided must comply with Job Corps policies, requirements, and guidelines, and must also include analysis and use of the most efficient and cost-effective practice of contemporary, evidence-based healthcare 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 Basic H&W program with other H&W components/activities on Center; and providing basic healthcare to enrollees and established students on Center. Provision of physician 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;

· ensuring patient privacy for all examinations, procedures, and consultations as mandated by HIPPA;

· providing written diagnoses and treatment plans as part of a Chronic Care Management Plan for students with chronic conditions/disabilities

· providing on-center immunization of enrollees for prevention and control of communicable disease as specified in PRH-6, Appendix 601 and TAG B, Immunization and Communicable Disease Control;

· providing maintenance of chronic conditions; treatment of acute conditions; promotion and maintenance of a family planning program for students (including prescription birth control medications);

· establishing an appropriate referral system to ensure the receipt of specialty care by students, as defined in the DOL Job Corps Policy and Requirements Handbook and within budget constraints;

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

· where feasible, providing physician services to those students who require hospitalization; and

· providing student services in such a manner as to obtain positive Student Satisfaction Survey (SSS) results as determined by Job Corps.

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

· Maintain, safeguard, and ensure 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);

· Develop, support, and ensure compliance with infection control policies and procedures, per Occupational Safety and Health Administration (OSHA) and other Job Corps safety guidelines;

· Participate in the Reasonable Accommodation Committee (RAC) meetings and file applicant review team meetings as requested;

· Review the Job Corps Health and Wellness website (http://jobcorpshealth.com) and attend Job Corps’ physician conference calls, webinars, and DOL physicians’ training as may be required that does not involve actual travel.

· Ensure that regular preventive maintenance is performed on the medical equipment through the Health and Wellness Manager (HWM);

· Do not engage 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;

· Advise and assist the health education instructor in the development and implementation of the health education program;

· Report adverse student behavior incidents to the HWM or Contracting Officer’s Representative;

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

b. Schedule and Availability: Physician 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). Center OBS and the PRH may change at any time; consequently, the quantity of required physician services hours may vary, depending on the needs of the student population. Additional hours may be needed on an occasional basis, and will be requested in writing by the Contracting Officer (CO) in advance.

NOTE: The PRH currently requires that half the physician services provided be provided by a licensed physician, and the other half be provided by a physician assistant or nurse practitioner.

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.

Physician 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, physician services may be limited during the one to two weeks immediately preceding and following each of these breaks.

4. QUALIFICATIONS OF CONTRACTOR PERSONNEL:

Contractor personnel:

· must be registered/licensed with the state in which physician services will be provided; all licensing requirements/certification/accreditation of the contractor’s staff must be maintained during the entire performance period 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 to the CO and HWM for use in procuring necessary supplies in support of the work requirements;

· if possible, must have admitting rights to a hospital within a reasonable traveling distance from the center to ensure ability to provide services to hospitalized center students;

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

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

· Documentation of all examinations, tests, treatments, medications, referrals, etc. on approved Job Corps Health and Wellness Program forms to be maintained in Students’ Health Records (SHR);

· Review of and authorization of standing orders for healthcare annually, in accordance with Technical Assistance Guide M: Health Care Guidelines; and

· Reports 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, equipment repair and replacement needs, depletion of medical supplies and medications, 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.

· Amend, modify, or deviate from the contract;

· Request removal of unsuitable Contractor personnel;

· Order re-performance of unacceptable work or performance by other means.

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:

· Determining the compliance and adequacy of performance by the Contractor;

· Ensuring adequacy of schedule and Quality Assurance Plan (QAP), as well as coordination of changes to the schedule and QAP if necessary.

8. GOVERNING REGULATIONS, HANDBOOKS AND REFERENCES:

The Contractor shall provide Health and Wellness (H&W) services as specified in the following documents:

· 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) http://www.jobcorps.gov/Libraries/pdf/prh.sflb.

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

· Job Corps Physician Desk Reference, 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

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:

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.