Centennial_Dental.docx

Combined Synopsis/Solicitation No. AG-82A7-S-15-0035 Attachment 1 Page 1 of 10

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 Idaho license for each proposed Key Personnel is provided (1 page allowed).

☐ A copy of the State of Idaho 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 AGAR 452.228-71; 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:

Organization:

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

19.

ITEM NO.

20.

SCHEDULE OF SERVICES

21.

EST.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

BASE YEAR SERVICES – July 01, 2015 through June 30, 2016

(Up to 9 hours per week x 48 weeks per year)

(Up to 9 hours per week x 48 weeks per year)

(Up to 12 hours per week x 48 weeks per year)

OPTION YEAR ONE SERVICES – July 01, 2016 through June 30, 2017

(Up to 9 hours per week x 48 weeks per year)

(Up to 9 hours per week x 48 weeks per year)

(Up to 12 hours per week x 48 weeks per year)

OPTION YEAR TWO SERVICES – July 01, 2017 through June 30, 2018

(Up to 9 hours per week x 48 weeks per year)

(Up to 9 hours per week x 48 weeks per year)

(Up to 12 hours per week x 48 weeks per year)

OPTION YEAR THREE SERVICES – July 01, 2018 through June 30, 2019

(Up to 9 hours per week x 48 weeks per year)

(Up to 9 hours per week x 48 weeks per year)

(Up to 12 hours per week x 48 weeks per year)

OPTION YEAR FOUR SERVICES – July 01, 2019 through June 30, 2020

(Up to 9 hours per week x 48 weeks per year)

(Up to 9 hours per week x 48 weeks per year)

(Up to 12 hours per week x 48 weeks per year)

PERFORMANCE WORK STATEMENT

1. Position: The Contractor Dentist, Dental Hygienist and Dental Assistant shall provide oral health care services for all students on Center, in accordance with applicable Federal laws/regulations, OSHA and HIPAA requirements, state and local laws, and guidelines of the American Dental Association. Dental services are required on a weekly basis to assist students in attaining and maintaining optimal oral health, with the services being provided at the Center. The oral health care services 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 health care possible given available time, resources, and personnel. These services will involve coordinating and integrating the Dental Health Care services program with other H&W components/activities on Center and providing oral health care services to enrollees and established students on Center. Provision of dental services requires, but is not limited to:

0. 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;

0. provision of all procedures authorized by the State Board of Dentistry, with a general emphasis on early detection, diagnosis of oral health problems, basic oral health care, dental hygiene, and prevention/education (e.g. oral hygiene instructions, risk assessments, relationship with employability, oral health and wellness);

0. an elective oral examination, including bitewing x-rays, priority classification, and treatment plan, shall be completed and recorded on the Job Corps approved oral examination form, upon student request, as a follow up to the dental readiness inspection;

0. performing dental procedures to treat oral disease and correct oral health conditions that may represent employability barriers, to include: restorations, extraction of pathological teeth, root canal therapy on anterior/other strategic teeth, replacement of missing upper anterior teeth with a removable prosthesis, and dental hygiene treatment for periodontal disease;

0. complying with Job Corps infection control policies and procedures;

0. ensuring patient privacy for all assessments, exams, and procedures, as mandated by HIPPA;

0. providing written diagnosis and treatment plan for each student with two weeks after completion of the dental readiness inspection and obtaining agreement for voluntary care before proceeding with such treatment;

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

0. availability for 24-hour emergency care by phone consultation;

0. providing student services in such a manner to obtain positive student satisfaction survey results as determined by Job Corps; and

0. furnish the services of one or more dental hygienists to assist in the conduct of dental services; these individuals will be directly supervised by the Contractor Dentist and will be:

10. available to assist the Dentist whenever they are working on-Center;

10. responsible for conducting the initial x-rays on students prior to being seen by the dentist

10. make appointments for students to be seen; and

10. enter data into the Center information database as required by the Health and Wellness Manager.

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

0. 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 Health Insurance Portability and Accountability Act (HIPAA);

0. 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;

0. advising and assisting the health education instructor in the development and implementation of the Dental Health Education Program;

0. ensuring dental equipment is properly cleaned and schedule for maintenance;

0. reporting adverse student behavior incidents to the HSM or COR; and

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

1. Schedule and Availability: Dental 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) for services provided by a dentist, dental assistant, and dental hygienist. Center OBS and the PRH may change at any time; consequently, the quantity of required dental services hours may vary, depending on the needs of the student population. Hours in addition to those stated above 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.

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.

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

4. QUALIFICATIONS OF CONTRACT PERSONNEL:

Contractor personnel:

· must be registered/licensed with the State in which the dental/oral health care services will be provided; all licensing requirements/certification/accreditation of Contractor personnel 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;

· 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:

· Dental Readiness Inspection shall be completed by the Contractor Dentist within 14 days after arrival on Center (consult State regulations) to identify urgent care needs for oral conditions that if not treated are expected to result in dental emergencies in the near future;

· Documentation of all assessments, examinations, procedures, x-rays, etc. on approved Job Corps Health forms to be maintained in students’ health records (SHR);

· 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.

· 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.