ATTACHMENT_1.pdf

PDF 261 KB Posted Mar 27, 2015

Attached to: Medical Services Federal contract opportunity
Solicitation number: AG-82-A7-S-15-0041
Issued by: Department of Agriculture Forest Service Job Corps

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Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 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 Arkansas license for each proposed Key Personnel is provided (1 page allowed).

☐ A copy of the State of Arkansas 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:_______________________________________

Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 Attachment 1 Page 2 of 8

SCHEDULE OF SERVICES

*A detailed breakdown of the Quote may be requested.

19.

ITEM

NO.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNI

23.

UNIT PRICE

24.

TOTAL AMT

BASE YEAR SERVICES – April 20, 2015 through March 31, 2016

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

192 HR $ $

002 Physician Assistant/Nurse Practitioner (Up to 4 hours per week x 48 weeks per year)

192 HR $ $

BASE YEAR SERVICES TOTAL: $

NO.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNI

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR ONE (I) SERVICES – April 01, 2016 through March 31, 2017

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

192 HR $ $

102 Physician Assistant/Nurse Practitioner (Up to 4 hours per week x 48 weeks per year)

OPTION YEAR I TOTAL: $

NO.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNI

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR TWO (II) SERVICES – April 01, 2017 through March 31, 2018

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

192 HR $ $

202 Physician Assistant/Nurse Practitioner (Up to 4 hours per week x 48 weeks per year)

OPTION YEAR II TOTAL: $

NO.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNI

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR THREE (III) SERVICES – April 01, 2018 through March 31, 2019

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

192 HR $ $

302 Physician Assistant/Nurse Practitioner (Up to 4 hours per week x 48 weeks per year)

OPTION YEAR III TOTAL: $

Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 Attachment 1 Page 3 of 8

NO.

20.

SCHEDULE OF SERVICES

21.

QUANTITY

22.

UNI

23.

UNIT PRICE

24.

TOTAL AMT

OPTION YEAR FOUR (IV) SERVICES – April 01, 2019 through March 31, 2020

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

192 HR $ $

402 Physician Assistant/Nurse Practitioner (Up to 4 hours per week x 48 weeks per year)

OPTION YEAR IV TOTAL: $

GRAND TOTAL WITH ALL OPTIONS: $_________________

PERFORMANCE WORK STATEMENT

INTRODUCTION:

The

USDA

Forest

Service

Job

Corps

Civilian

Conservation

Centers

(JCCCC)

provide

academic,

vocational,

and

life‐learning

skills

risk

youth

and

young

adults

Job

Corps

Centers

across

the

United

States

(U.S.).

part

this

program,

youth

and

young

adults

the

Centers

are

provided

healthcare

services

follows:

medical,

dental,

mental

health,

and

drug

alcohol

intervention.

Each

Forest

Service

JCCCC

has

need

for

basic

health

services

provided

licensed

medical

professionals

that

includes

examinations

and

assessments,

treatment,

issuance

prescriptions

and

immunizations,

monitoring

health

conditions,

recommending

hospitalization,

follow‐up

care,

and

prevention

planning

and

intervention.

BACKGROUND:

Job

Corps

U.S.

Department

Labor

(DOL),

Employment

and

Training

Administration

(ETA)

program.

Job

Corps

designed

assist

young

people

who

need

and

can

benefit

from

the

wide‐range

services

provided

Job

Corps

center.

Services

include

the

following:

basic

education,

High

School

Diploma

(HSD)

program;

General

Educational

Development

(GED);

vocational

skills

training;

residential

living

program;

healthcare;

and

support

services.

The

comprehensive

combination

training

and

support

services

designed

help

each

student

become

responsible

and

productive

citizen.

Student

populations

range

from

100

over

300

enrollments

depending

the

Center’s

Board

Strength

(OBS).

Job

Corps

self‐paced

program:

therefore,

student’s

length

enrollment

varies.

Students

may

remain

the

program

for

two

years,

but

the

average

length

enrollment

approximately

eight

months.

3. CONTRACT EFFORT REQUIRED:

a. Position:

Physician

Services

are

required

weekly

basis

assist

students

attaining

and

maintaining

optimal

health

with

the

services

being

provided

the

Center

physician’s

office

determined

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

the

most

efficient

and

cost‐effective

practice

contemporary,

evidence‐based

healthcare

possible

given

available

time,

resources,

and

personnel.

These

services

will

involve

the

monitoring

the

Health

and

Wellness

(H&W)

program

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

Center;

and

providing

basic

healthcare

enrollees

and

established

students

Center.

Provision

physician

services

requires,

but

not

limited

to:

Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 Attachment 1 Page 4 of 8

the

ability

work

both

independently

and

member

healthcare

team

provide

optimal

services

population

financially

disadvantaged

youth,

ranging

from

years

age;

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

HIPPA;

providing

written

diagnoses

and

treatment

plans

part

Chronic

Care

Management

Plan

for

students

with

chronic

conditions/disabilities

providing

on‐center

immunization

enrollees

for

prevention

and

control

communicable

disease

specified

PRH‐6,

Appendix

601

and

TAG

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

appropriate

referral

system

ensure

the

receipt

specialty

care

students,

defined

the

DOL

Job

Corps

Policy

and

Requirements

Handbook

and

within

budget

constraints;

ensuring

availability

for

24‐hour

emergency

care

phone

consultation;

where

feasible,

providing

physician

services

those

students

who

require

hospitalization;

and

providing

student

services

such

manner

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

all

required

student

health

records

when

they

are

the

health

clinic

the

possession

health

and

wellness

team

members

according

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

may

required

that

does

not

involve

actual

travel.

Ensure

that

regular

preventive

maintenance

performed

the

medical

equipment

through

the

Health

and

Wellness

Manager

(HWM);

not

engage

any

research

projects

and/or

publications

relating

Job

Corps

health

activities

without

prior

written

approval

from

the

Job

Corps

National

Office

Golden,

CO;

Advise

and

assist

the

health

education

instructor

the

development

and

implementation

the

health

education

program;

Report

adverse

student

behavior

incidents

the

HWM

Contracting

Officer’s

Representative;

understand

that

medical

services

shall

subject

monitoring

and

review

Job

Corps

assessment teams and that cooperation with such teams is required.

b. Schedule

and

Availability:

Physician

services

are

required

weekly

basis,

during

days

the

week

and

hours

the

day

established

coordination

with

Center

personnel.

Based

the

Center’s

current

OBS,

the

Contractor

must

provide

least

the

Minimum

Staffing

Requirements

specified

the

Program

Requirements

Handbook

(PRH).

Center

OBS

and

the

PRH

may

change

any

time;

consequently,

the

quantity

required

physician

services

hours

may

vary,

depending

the

needs

the

student

population.

Additional

hours

may

needed

occasional

basis,

and

will

requested

writing

the

Contracting

Officer

(CO)

advance.

Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 Attachment 1 Page 5 of 8

NOTE:

The

PRH

currently

requires

that

half

the

physician

services

provided

licensed

physician,

and

the

other

half

provided

physician

assistant

nurse

practitioner.

The

Contractor

required

provide

hours

advanced

notice

cancel

scheduled

services.

When

Key

Personnel

are

unavailable,

the

Contractor

will

provide

acceptable

substitute

provide

services.

Substitute

personnel

must

approved

advance

the

CO.

Key

Personnel

must

available

telephone

hours

per

day,

days

per

week

provide

emergency

services.

Key

Personnel

must

provide

current

emergency

contact

number

the

Center

HSM.

When

Key

Personnel

is/are

unavailable,

the

Contractor

will

provide

the

Center

HSM

current

emergency

contact

number

acceptable

substitute

provide

emergency

services.

Physician

services

will

not

scheduled

federal

Government

holidays

and

are

not

required

during

the

period

Center‐wide

student

leave

(approximately

two

weeks,

twice

yearly.

addition,

physician

services

may

limited

during

the

one

two

weeks

immediately

preceding

and

following

each

these

breaks.

4. QUALIFICATIONS OF CONTRACTOR PERSONNEL:

Contractor personnel:

must

registered/licensed

with

the

state

which

physician

services

will

provided;

all

licensing

requirements/certification/accreditation

the

contractor’s

staff

must

maintained

during

the

entire

performance

period

with

proof

being

submitted

the

request

the

Government;

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

must

provide

current

Drug

Enforcement

Administration

(DEA)

registration

number

the

and

HWM

for

use

procuring

necessary

supplies

support

the

work

requirements;

possible,

must

have

admitting

rights

hospital

within

reasonable

traveling

distance

from

the

center

ensure

ability

provide

services

hospitalized

center

students;

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

5. MATERIALS, EQUIPMENT, TRAINING, AND UTILITIES:

The

Government

shall

furnish

the

following:

Adequate

work

space,

equipment,

supplies,

and

materials

needed

accomplish

the

work

requirements

outlined

herein,

including

examination

rooms

and

furniture,

assessment

equipment,

telephone,

computer,

fax

machine,

prophylaxis

supplies,

gloves,

masks,

and

similar

items

(unless

services

are

provided

the

physician’s

office).

Prescription

and

over‐the‐

counter

medications

will

provided

the

Center.

These

supplies

and

property

shall

utilized

during

the

performance

this

contract

only

while

providing

student

care.

The

contractor

will

provide

itemized

list

items

needed

the

HWM

least

days

advance

the

desired

delivery

date

allow

for

adequate

time

for

ordering

and

receiving.

The

Contractor

shall

furnish

the

following:

All

labor,

services,

permits,

licenses,

transportation

Contractor

personnel

(as

necessary),

and

incidentals

(other

than

those

provided

the

federal

Government)

needed

fulfill

the

work

requirements

herein,

for

the

hours

required

based

the

Center’s

Board

Strength

(OBS).

addition,

the

Contractor

shall

insure

that

all

Contractor

personnel

and

their

agents

are

covered

professional

liability

(malpractice)

insurance

and

general

liability

insurance

Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 Attachment 1 Page 6 of 8

during

the

entire

performance

period

and

agrees

indemnify

and

hold

harmless

the

Job

Corps

Center

from

any

actions

taken

by,

for,

against

the

Contractor

their

agents

that

could

result

additional

expenses,

fees,

lawsuits.

Security:

The

space,

equipment,

and

supplies

used

contractor

personnel

MUST

secured

all

times,

per

Center

requirements.

The

Contractor

shall

review

security

procedures

with

the

Center

HWM

and

COR.

6. RECORDS, REPORTS, AND REQUIRED SUBMITTALS:

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

Documentation

all

examinations,

tests,

treatments,

medications,

referrals,

etc.

approved

Job

Corps

Health

and

Wellness

Program

forms

maintained

Students’

Health

Records

(SHR);

Review

and

authorization

standing

orders

for

healthcare

annually,

accordance

with

Technical

Assistance

Guide

Health

Care

Guidelines;

and

Reports

the

Center

Director

(CD)

and

Health

and

Wellness

Manager

(HWM)

all

health‐

matters

including

student

medical

separations,

justifications

for

and

costs

special

services,

Health

and

Non‐Health

Care

Guidelines,

equipment

repair

and

replacement

needs,

depletion

medical

supplies

and

medications,

and

other

areas

deemed

appropriate.

The

federal

Government

reserves

the

right

have

the

Job

Corps

Regional

Health

Coordinator

and

other

authorized/qualified

personnel

conduct

audits

Contractor

services

and

student

medical

records

verify

that

quality

services

are

being

performed.

copy

any

audit

report

shall

provided

the

Contractor

and

Contracting

Officer

(CO)

within

two

weeks

the

audit.

Within

two

weeks

after

receipt

the

audit

report,

the

Contractor

shall

submit

performance

plan

for

improving

services

the

Contracting

Officer

(CO)

for

approval.

The

Contractor

shall

implement

the

approved

performance

plan

immediately.

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

Contracting

Officer:

The

Contracting

Officer

(CO)

has

the

overall

responsibility

for

the

administration

this

contract.

The

alone,

without

delegation,

authorized

to:

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.

Contracting

Officer's

Representative

(COR):

The

COR

will

designated

writing

the

time

award

assist

the

day‐to‐day

on‐site

administration

the

contract

requirements.

The

responsibilities

the

COR

include,

but

are

not

limited

the

following:

Determining

the

compliance

and

adequacy

performance

the

Contractor;

Ensuring

adequacy

schedule

and

Quality

Assurance

Plan

(QAP),

well

coordination

changes to the schedule and QAP if necessary.

8. GOVERNING REGULATIONS, HANDBOOKS AND REFERENCES:

Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 Attachment 1 Page 7 of 8

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

Job

Corps

Federal

Regulations

(Title

Code

Federal

Regulations,

Part

638.510)

Part

684

amended,

Job

Corps

Program

under

Title

TV‐B

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,

Handbook

330,

Website

for

the

Job

Corps

Health

Wellness

information

and

Department

Labor

Policy

and

Requirements

Handbook

(PRH):

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

9. QUALITY ASSURANCE SURVEILLANCE MATRIX:

accordance

with

FAR

37.401,

the

Government

will

evaluate

the

quality

professional

and

administrative

services

provided,

but

retains

control

over

the

medical,

professional

aspects

services

rendered

(e.g.

professional

judgments,

diagnosis

for

specific

medical

treatment,

etc.)

The

Contractor

will

receive

performance

evaluations

accordance

with

the

Quality

Assurance

Surveillance

Plan

for

this

requirement,

which

shall

provided

the

Contractor

the

COR.

Performance evaluations will include assessment of the following:

Quality/Performance Standards Acceptable Quality Level

Means of Measurements

Contractor	will,	in	accordance	with	Job	Corps	Policy
and	Requirements	Handbook	(PRH),	Program
Instructions	and	Health	and	Wellness	Program
Technical	Assistance	Guide	(TAG),	maintain	patient
privacy	as	mandated	by	the	HIPPA.

100%

Observation, communications

with	HSM	and	COR,
and	review	of

documentation

Contractor	will	provide	Physician	Services	weekly	on
established	days	of	the	week	for	the	number	of	hours
required	by	the	PRH	and	will	be	available	to	provide
Emergency	Services	as	needed	throughout	the
performance	period.

90%

Observation,	review
of	documentation

Contractor	will	provide	the	Center	HSM	a	current
emergency	contact	number	for	emergency	services.

100%

Communications

with	HSM	and	COR,
and	review	of

documentation

Contractor	will	contact	the	COR	24	hours	in	advanced
for	cancellation	of	services.		For	planned	absences,	the
Contractor	will	coordinate	with	Center	staff	and	the	CO

100% Communications

with	HSM,	CO	and
COR,	and	review	of

Combined Synopsis/Solicitation No. AG‐82A7‐S‐15‐0041 Attachment 1 Page 8 of 8

to	provide	an	approved	substitute,	as	well	as	a	current
emergency	contact	number.

documentation

Contractor	will	provide	mandatory	physical	exams,
recording	on	the	forms	required	by	Job	Corps	within
the	established	time	frame.

100%

Communications

with	HSM	and	COR,
and	review	of

documentation

Contractor	will	provide	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%

Communications

with	HSM	and	COR,
and	review	of

documentation

Contractor	will	provide	proof	of	current	professional
license,	professional	liability	and	general	liability
insurance,	and	current	DEA	registration	to	the	CO	and
HSM	upon	request.

100% Review of documentation

Contractor	will	attend	DOL	training	for	medical
contractor	as	may	be	required.

75% Communications with HSM and COR

Contractor	will	ensure	that	space,	equipment,	and
supplies	used	by	Contractor	personnel	are	secured	per
Center	guidelines.

100% Review by HSM and

COR

This

requirement

being

procured

Performance‐Based

Service

Acquisition.

Accordingly,

the

Contractor

will

receive

performance

evaluations

least

annually.

Performance

evaluations

will

address,

but

are

not

limited

to,

analysis

the

Quality/Performance

Standards

identified

above.

Failure

perform

the

standards

identified

the

Quality

Assurance

Surveillance

Matrix

will

result

negative

impact

the

Contractor’s

performance

evaluations.

addition,

the

use

the

Quality

Assurance

Surveillance

Matrix

evaluate

Contractor

performance

way

limits

the

Government’s

rights

and

remedies

established

under

contract

regarding

the

Contracting

Officer’s

discretion

pursue

termination

convenience

default,

exercise

(or

not)

contract

options,

reject

services

provided,

etc.

File details come from the government source that posted it. Updated Nov 14, 2017.