DOL089RP20579.doc

SECTION

DESCRIPTION

PAGE

B.1. FIXED-PRICE CONTRACT--BASE YEAR PRICING

B-2

B.2. PRICING DURING FIRST OPTION PERIOD OF PERFORMANCE

B-3

B.3. PRICING DURING SECOND OPTION PERIOD OF PERFORMANCE

B-4

B.4. PRICING DURING THIRD OPTION PERIOD OF PERFORMANCE

B-5

B.5. PRICING DURING FOURTH OPTION PERIOD OF PERFORMANCE

B-6

B.6. MINIMUM/MAXIMUM REQUIREMENTS

B-6

B.7. PAYMENT FOR CANCELLATION OF APPOINTMENTS

B-6

B.8. PAYMENT FOR NECESSARY SUPPLEMENTAL CONSULTATIONS,

DIAGNOSTIC LABORATORY TESTS AND DIAGNOSTIC PROCEDURES

B-7

B.9. INCREMENTAL FUNDING

B-7

B.10. CEILING PRICE (FIRM FIXED UNIT PRICE)

B-7

B.1.

FIXED-PRICE CONTRACT (BASE YEAR PRICING)

The Contractor shall provide the medical second opinion services, as specified elsewhere in The Schedule, at the firm, fixed price per unit specified herein;

MIN

MAX

Unit Price Medical Second Opinion Service

Medical Second Opinion Service for

Claimants who reside in Alaska

Schedule Award Only Service

Schedule Award Service for

Supplemental Report

Follow-up Report

File review, only

The above prices indicate the sole manner of reimbursement under this contract. The price is inclusive of any/all labor, indirect costs, materials, pick-up and delivery, ancillary costs and applicable fees.

B.2.

PRICING DURING FIRST OPTION PERIOD OF PERFORMANCE

The Contractor shall provide the medical second opinion services, as specified elsewhere in The Schedule, at the firm, fixed price per unit specified herein;

MIN

MAX

Unit Price Medical Second Opinion Service

Schedule Award Only

The above price indicates the sole manner of reimbursement during the first option period of this contract. The price is inclusive of any/all labor, indirect costs, materials, pick-up and delivery, ancillary costs and applicable fees.

All other terms and conditions of the initial contract shall remain unchanged, except where expressly and formally modified by both parties.

B.3.

PRICING DURING SECOND OPTION PERIOD OF PERFORMANCE

The Contractor shall provide the medical second opinion services, as specified elsewhere in The Schedule, at the firm, fixed price per unit specified herein;

MIN

MAX

Unit Price Medical Second Opinion Service

The above price indicates the sole manner of reimbursement during the second option period of this contract. The price is inclusive of any/all labor, indirect costs, materials, pick-up and delivery, ancillary costs and applicable fees.

All other terms and conditions of the initial contract shall remain unchanged, except where expressly and formally modified by both parties.

B.4.

PRICING DURING THIRD OPTION PERIOD OF PERFORMANCE

The Contractor shall provide the medical second opinion services, as specified elsewhere in The Schedule, at the firm, fixed price per unit specified herein;

MIN

MAX

Unit Price Medical Second Opinion Service

The above price indicates the sole manner of reimbursement during the third option period of this contract. The price is inclusive of any/all labor, indirect costs, materials, pick-up and delivery, ancillary costs and applicable fees.

All other terms and conditions of the initial contract shall remain unchanged, except where expressly and formally modified by both parties.

B.5.

PRICING DURING FOURTH OPTION PERIOD OF PERFORMANCE

The Contractor shall provide the medical second opinion services, as specified elsewhere in The Schedule, at the firm, fixed price per unit specified herein;

MIN

MAX

Unit Price Medical Second Opinion Service

The above price indicates the sole manner of reimbursement during the fourth option period of this contract. The price is inclusive of any/all labor, indirect costs, materials, pick-up and delivery, ancillary costs and applicable fees.

All other terms and conditions of the initial contract shall remain unchanged, except as where expressly and formally modified by both parties.

B.6.

MINIMUM/MAXIMUM REQUIREMENTS

The Government commits to buying the minimum quantities, and will not exceed the maximum requirements specified in Sections B.1. through B.5.

B.7.

PAYMENT FOR CANCELLATION OF APPOINTMENTS

When the Government cancels a scheduled appointment with at least 24 hours notice to the Contractor or to the examining physician, no payment will be made and no liability is incurred by the Government. When the Government gives less than 24 hours notice in canceling a scheduled appointment, a fixed fee of $50 will be paid to the Contractor as sole compensation for the cancelled appointment.

When a claimant cancels a scheduled appointment with at least 24 hours notice to the Contractor or to the examining physician, no payment will be made and no liability is incurred by the Government. When a claimant gives less than 24 hours notice in canceling a scheduled appointment, a fixed fee of $50 will be paid to the Contractor as sole compensation for the cancelled appointment. When a claimant, without prior notice, fails to report for the scheduled appointment, a fixed fee of $50 will be paid to the Contractor as sole compensation for the cancelled appointment.

B.8.

PAYMENT FOR NECESSARY SUPPLEMENTAL CONSULTATIONS, DIAGNOSTIC LABORATORY TESTS AND DIAGNOSTIC PROCEDURES Professional consultations, diagnostic laboratory tests and other diagnostic procedures deemed necessary to complete a second opinion examination will be paid for according to the fee schedule limitations provided under 20 CFR 10.805-813.

B.9

INCREMENTAL FUNDING

Funds in the amount of ____________________________* are currently available from the Employees' Compensation Fund to fund the minimum value of this contract. Additional funds will be made available for this contract as they are needed up to the maximum number of evaluations (second opinion medical services as priced in Sections B.1 through B.5 above, plus approved supplemental costs as defined in B.8. above.

B.10

CEILING PRICE (FIRM FIXED UNIT PRICE)

The total contract price for all items under this contract shall not exceed $_________________* in unadjusted dollars.

· To be completed by Government at time of award.

PAGE

C.1.

BACKGROUND

C-2

C.2.

SCOPE OF WORK

C-2 A.

Claimants Covered C-2 B.

Delivery Schedule C-3

C.3.

STATEMENT OF WORK

C-3

A.

Summary/Overview C-3

B.

Qualified Medical Specialists C-4

C.

Scheduling Appointments C-5 D.

Delivery of Appropriate Claim File Material, SOAF and

Examiner's Questions C-6 E.

Review of Claim File Material and Physical Examination C-6 F.

Second Opinion Reports C-7 G.

Delivery of Second Opinion Reports to DFEC C-8 H.

Supplemental Reports C-8 I.

Follow-up Reports with Review of Additional Medical Evidence C-9 J.

Schedule Award Examinations and Reports C-9 K.

File Review Only, Without Clinical Examination C-9 L.

Contractor Records Retention C-10 M.

Correction or Reperformance Under the Warranty of Services

Clause, Section I.1 (FAR 52.246-20) C-10 N.

Security, Confidentiality and Care of Claimant Medical Records and DFEC Files C-10 O.

Training for Participating Physician/Specialists C-11 C.4.

WEEKLY REPORTS TO COTR

C-11 C.5.

MONTHLY REPORTS TO COTR

C-11 C.6.

QUARTERLY MANAGEMENT REPORTS

C-12

A. Detail Reports

B. Summary Reports

C.1.

BACKGROUND

A.

The Office of Workers' Compensation Programs (OWCP) is responsible for administration of the Federal Employees' Compensation Act (FECA). The Act provides for medical benefits, wage-loss replacement, survivors' annuities, and other benefits to employees of the United States or their survivors when the employee is injured or dies in the course of employment. The OWCP, through the Division of Federal Employees' Compensation (DFEC), coordinates the activities of twelve District Offices. These District Offices have direct responsibility for processing claims. The District Office functional operations include: adjudicating incoming claims to determine eligibility for compensation payments; managing claims in which eligibility has been established; determining wage-loss compensation payments for covered disability or death; and processing payments for allowed medical and vocational rehabilitation services incurred in the treatment of injured workers covered under the Act.

B.

Under the FECA, medical care and compensation for wage loss and for permanent physical impairment are provided to Federal employees who are injured in the performance of duty. The medical evaluation of workers who submit compensation claims is part of the adjudication and case management process. A medical evaluation may be necessary: (1) to determine the causal relationship between work factors and the disease or injury; (2) to assess the extent and duration of the physical impairment or disability; (3) to determine the appropriateness of therapy, including some surgical procedures; or (4) to determine when recovery has occurred and a return to work is feasible.

In certain instances, the DFEC must refer a claimant to a specialist in an appropriate field for a second medical opinion. The second opinion is based on and will include a review of appropriate claim file material, a physical or psychiatric examination of the claimant, the performance of any clinical or laboratory tests deemed necessary in the diagnostic work-up, and a narrative medical report responding to specific questions posed by a claims examiner. In addition to specific questions, the claims examiner provides a statement of accepted facts (SOAF) which contains the information concerning events, working conditions and employment data accepted as factual by the DFEC. As such, the SOAF is the framework which the physician must use in answering the specific questions and in developing the evaluation report.

C.

The two most important elements of the service to be delivered under this contract are the quality of the medical reports and the timeliness of their delivery. To be acceptable, the medical reports must present comprehensive, unequivocal, unbiased and well-reasoned narratives that are consistent with physical or psychological findings, that are confined to the framework of the SOAF, and that address all questions posed by the claims examiner. The timely scheduling of appointments for examinations limits inconvenience to FECA claimants. The timely delivery of medical reports contributes to prompt and accurate adjudication of outstanding compensation issues.

C.2.

SCOPE OF WORK

A.

Claimants Covered and Work to be Performed. Medical second opinion services shall be provided for approximately 650 FECA claimants per annum, approximately sixty (60) of whom will reside in Alaska. Schedule award examination services shall be provided for approximately 100 FECA claimants per annum, approximately ten (10) of whom will reside in Alaska. Approximately thirty (30) file reviews without examination of the claimants will be required per annum. Approximately fifteen (15) Supplemental Reports will be required per annum. Approximately fifteen (15) Follow-up Report services will be required per annum.

The affected claimants reside within the area served by OWCP's Seattle District Office (Alaska, Idaho, Oregon and Washington). The claim files are in the custody of the District Office in Seattle, Washington. The DFEC District Office will provide to the Contractor all necessary information pertaining to covered claimants. The full mailing address for the District Office is given at subsection C.3.G., below.

B.

Delivery Schedule. The Contractor shall perform all elements of the second opinion service within the time frames described in subsection C.3, below and in Section F, PERFORMANCE/ DELIVERY SCHEDULE.

C.3.

STATEMENT OF WORK

All days referred to in this Section and in Section F are calendar days, unless otherwise specified.

A.

Summary/Overview. The Contractor shall:

(1) arrange for qualified and appropriate medical specialists to make these services available within reasonable commuting distance for DFEC claimants. Reasonable commuting distance is defined at subsection C.3.B. and subsection C.3.C.1, below;

(2) arrange timely scheduling of appointments for examinations, forward letters from the responsible claims examiners notifying claimants, their appointed representatives, and their employers of the claimants' responsibilities to appear and cooperate with scheduled medical exams;

(3) assure that a secure website (password protected [https protocol/SSL]) is operational and available for the initiation of referrals and uploading of all pertinent imaged documents supplied by DFEC (including Statement of Accepted Facts (SOAF), examiners' questions to physicians, medical records relevant to the examination, etc.);

(4) assure timely pick-up from the District Office of pertinent documents supplied by DFEC when imaged documents are not available for transmission via secure web site (primarily including medical records relevant to the examination);

(5) assure timely delivery to examining physicians of all pertinent documents supplied by DFEC, including SOAFs, examiners' questions to physicians, medical records, etc.;

(6) assure that each second opinion report is comprehensive, unequivocal, unbiased, well-reasoned, consistent with the physical findings, responsive to all questions posed by the claims examiner, and presented in a form and format specified by OWCP (see details below);

(7) assure timely uploading to the secure website and/or return to the District Office of completed second opinion reports, along with all original claim file materials which may have been sent to the Contractor;

(8) comply with applicable provisions of the Privacy Act of 1974 and otherwise assure the security and confidentiality of claimant medical records and related materials entrusted to the custody of Contractor or examining physician;

(9) coordinate with the Contracting Officer's Technical Representatives (COTR) to prepare and administer all training materials which may be reasonably necessary to allow physician/specialists and DFEC staff to participate effectively;

(10) provide management reports to the Contracting Officer and to the COTR as specified in Sections C.4, C.5., and C.6., below.

(11) provide access to Contractor’s administrative office staff for scheduling and report generation from 8:00 AM to 4:00 PM, Pacific Time. These minimal hours will assure that OWCP District Office staff will have a contact available during their own core business hours;

(12) name a program manager for this project who shall be responsible for effective liaison with the OWCP Contracting Officer and OWCP District Office staff to ensure that performance is in compliance with the contract.

B.

Qualified Medical Specialists. Participating medical providers must be identified by name and business address and shall have the following types of professional qualifications:

(1) Physicians.

a. All physicians must possess an M.D. degree or a D.O. degree.

b. All physicians must hold an unrestricted license to practice medicine in the state in which they will perform examinations or otherwise practice under this contract.

c. All physicians must be Board-certified in their respective specialties by one of the medical specialty Boards recognized by the American Board of Medical Specialties, or by the American Osteopathic Association.

d. All physicians must be engaged in an active medical practice -- a minimum of 240 hours of direct patient care over the previous twelve months.

e. All physicians must be qualified to participate as a medical provider under the Federal Employees' Compensation Act, and as defined in 20CFR10.5(t); and must not be excluded or excludable from payment under the Act as defined in 20CFR10.815-826.

(2) Clinical Psychologists.

a. All clinical psychologists must possess the Ph.D. degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the Council on Post Secondary Accreditation; or they must be listed in a national register of health services providers in psychology which the Secretary of Labor deems appropriate.

b. All clinical psychologists must have completed two years of supervised clinical experience as a psychologist in health service, at least one year of which is after the Master of Science degree.

c. All clinical psychologists must be licensed at the independent practice level of psychology in the state in which they practice.

d. All clinical psychologists must be Board certified and engaged in an active practice, treating patients.

e. All clinical psychologists must be qualified to participate as a medical provider under the Federal Employees' Compensation Act, and as defined in 20CFR10.5(t); and must not be excluded or excludable from payment under the Act as defined in 20CFR10.815-826.

(3) Physicians Performing Examinations for Schedule Awards.

a. In addition to the qualifications set forth in subsection C.3.B.1., above, physicians who perform examinations and provide reports for schedule awards shall have familiarity with and experience in use of the current edition of the American Medical Association Guides to the Evaluation of Permanent Impairment. For 2008, OWCP requires use of the 5th Edition of the Guides, but may require use of newer editions during the life of this contract. The Contractor shall accommodate a requirement for use of newer editions without revision of the price schedule.

(4) Most Needed Specialties and Expected Availability.

a.

While OWCP may require the services of a physician certified by any of the medical specialty Boards recognized by the American Board of Medical Specialties, or by the American Osteopathic Association, most requirements will be concentrated in a few medical specialties. The five clinical specialties for which OWCP has most need in the Seattle Region are orthopaedic surgery, otolaryngology, neurology, neuro-surgery, psychiatry and pulmonology. More detailed estimates of the distribution of required medical specialties are provided at Section L.15. below.

b.

Medical specialists must be available in sufficient number and so geographically distributed as to cover the needs of claimants served by the Seattle office. For claimants who reside in urban areas, no examination shall require a claimant to travel more than twenty-five (25) miles, or thirty (30) minutes driving time (whichever is shorter) from the claimant's residence without express permission of the COTR. For purposes of this requirement, the term "urban areas" is defined to include the following Metropolitan Statistical Areas: Anchorage, AK; Boise City-Nampa, ID; Idaho Falls, ID; Pocatello, ID; Corvallis, OR; Eugene-Springfield, OR; Medford, OR; Portland-Vancouver-Beaverton, OR-WA; Seattle-Tacoma-Bellvue, WA; and Spokane, WA.

c.

Within the Metropolitan Areas of Portland-Vancouver-Beaverton, OR-WA, and Seattle-Tacoma-Bellvue, WA, no one orthopedic surgeon shall conduct more than 20% of the examinations for that medical specialty per annum; neither shall one otolaryngologist or one psychiatrist conduct more than 33% of the examinations for those medical specialties per annum.

d.

Claimants who reside in Alaska should not have to travel more than one hundred (100) miles or two hours of driving time (whichever is shorter) from the claimant's residence without express permission of the COTR. When a medical examination cannot be scheduled within this commuting distance, and the claimant’s travel is of sufficient distance to require air travel and/or an overnight stay, the fee paid to the Contractor for the medical second opinion service for the affected claimant will be reduced by $700.

C.

Scheduling Appointments. Upon telephone, written notice or website notification from DFEC of the need for a second opinion by a medical specialist, the Contractor shall do the following:

(1) Make an appointment for the claimant in question with a physician in the appropriate field of medical specialty and forward notice of the appointment to the claimant, the claimant's appointed representative and the employing agency, using a format specified by DFEC. The site of the examination must be within the appropriate commuting distance as defined in the previous sub-section. Exceptions to this travel restriction may be granted only with the express permission of the COTR. The date of the examination must allow the claimant to receive at least fourteen (14) days advance notice of the appointment date.

(2) Within six (6) days from first notice, notify DFEC in writing of the specialist's name, address and phone number, and the date and time of the scheduled appointment.

(3) Reschedule an appointment only once to suit the convenience of an examining physician. The date of the rescheduled examination shall be not more than twenty-eight (28) days from the first notice from DFEC. In the event of a rescheduling to suit the convenience of an examining physician, the completed report shall be delivered to DFEC within thirty-five (35) days from first notice from DFEC. If additional requests for rescheduling the appointment are received from the examining physician/specialist, the Contractor shall schedule an appointment for examination with another physician/specialist.

(4) Notify DFEC within four (4) days of a claimant's request for rescheduling. If a request for rescheduling is received from the claimant, the Contractor or examining physician may not reschedule the appointment without DFEC permission. Rather, the Contractor must notify DFEC so the responsible claims examiner may decide the issue.

(5) Contact the examining physician/specialist within four (4) days after the scheduled appointment date to determine whether the claimant reported and cooperated with the exam. If claimant did not report or did not cooperate, Contractor shall so notify DFEC within seven (7) days of the scheduled appointment date.

D.

Delivery of Claim File Material, SOAF and Examiner's Questions. Before requesting a second opinion, the responsible claims examiner shall prepare a statement of accepted facts (SOAF), a list of pertinent questions to the examining physician which are specific to the issue at hand, a letter notifying the claimant to appear for the scheduled medical examination, and a travel voucher. These materials, along with copies of all appropriate medical reports from the case record and any DFEC reporting forms which are appropriate to the medical issue and the information sought, will be prepared for delivery to the second opinion specialist. To ensure timely delivery of necessary materials to service providers, the Contractor shall arrange for regular pickup of the materials from the District Office in Seattle, and for their delivery to the appointed consultants at least twenty-four (24) hours before the scheduled examination.

E.

Review of Claim File Material and Physical Examination. The physician/specialist's second opinion examination shall constitute a complete evaluation of the claimant. As part of the file review and examination, the Contractor's physician/specialist shall do the following:

(1) review the Office's Statement of Accepted Facts;

(2) review all medical reports including radiology, pathology and other diagnostic reports made available from the claim file;

(3) review all videographic and photographic evidence and any Reports of Investigation or Investigative Memoranda submitted for review;

(4) take claimant's complete medical history including a history of the injury or disease related to the workers' compensation claim;

(5) review claimant's subjective complaints;

(6) perform a complete examination of the claimant, as appropriate to the physician’s medical specialty and professional license;

(7) perform, or arrange to have performed, any further necessary diagnostic procedures or tests specifically required to complete the examination and render a meaningful second opinion report. OWCP authorizes any non-invasive diagnostic procedure that is substantively related to the condition or issue which gave rise to the second opinion referral, and which the examining physician feels is necessary to render a reasoned opinion and full report. No invasive procedure shall be performed without the prior approval of both the individual to be examined and of OWCP. All necessary non-invasive tests shall be conducted unless declined by the individual examined or unless a test is not medically advisable. Upon notification from the examining physician that such a diagnostic procedure is needed, the Contractor shall schedule the procedure(s) according to the delivery schedule set forth in Section F.1.C, below.

F.

Second Opinion Reports. The physician/specialist's second opinion report shall be complete, responsive to all questions posed by the claims examiner, and submitted in the form and format specified by OWCP. In cases where work capacity is being evaluated, the physician/specialist will complete the appropriate OWCP-5 Work Capacity evaluation form as a complement to the narrative. All claimed conditions identified in the Statement of Accepted Facts must be examined. All questions submitted by the OWCP Claims Examiner must be answered. If the answer is neither yes nor no, a clear statement must be included explaining why a definitive answer could not be provided along with a statement of the evidentiary basis for that conclusion. For each condition specified in the examination request, a diagnosis must be provided or a statement included that the claimed condition was not found. If a diagnosis can neither be established nor ruled out, the facts must be documented with a clear statement of why a diagnosis could not be established. A statement that a diagnosis could not be established because additional tests are required will not be an acceptable reason for returning an examination without establishing a diagnosis or providing a statement that the claimed condition was not found, unless the required tests are invasive, are not medically advisable, or are declined by the individual being examined. If a diagnosis is established which differs from the existing diagnosis for the same condition as contained in the Statement of Accepted Facts, the two diagnoses must be reconciled with a statement documenting the basis for change of diagnosis, and whether the new diagnosis represents a progression of an earlier diagnosis, correction of a prior incorrect diagnosis, or a new independent entity.

The Contractor shall:

(1) arrange to have all second opinion reports submitted on the letterhead of the examining physician, in a narrative form, in a legible typeface, and with the claimant's case number at the top of each page;

(2) ensure that all second opinion reports include, as appropriate:

a. a brief synopsis of the clinical history of the case, including a history of the injury incident and treatment to date, as well as an identification of any underlying or preexisting conditions(s);

b. a description of physical or psychiatric findings, as the case requires;

c. a statement of results and their interpretation for laboratory tests (including blood tests, urinalysis, tissue samples, etc), and other diagnostic procedures (including x-ray, computerized tomography [CT], magnetic resonance imaging [MRI], electromyelogram [EMG], electrocardiogram [EKG], audiogram, treadmill stress test, and similar techniques of visualizing or recording physiological conditions) deemed necessary to complete the second opinion examination;

i. Laboratory tests and diagnostic procedures must be performed by or under the supervision of a person licensed to perform them in the state or local jurisdiction where they are performed. Reports of such tests and procedures must be included with the second opinion report and must contain the patient's name, OWCP claim number, date of the test, the objective data obtained, and the signature of the person responsible for performance of the test or procedure;

ii. A report on results of any test requiring cooperation by the patient, such as visual, hearing and pulmonary function tests, should include a comment from the person administering the test on the extent of patient cooperation, to estimate the validity of the results;

d. a diagnosis related to these physical findings and diagnostic procedures (from b. and c., above);

e.

a prognosis, a recommended course of treatment to be followed, and a clinical estimate of the date of partial and/or full recovery;

(3) ensure that all reports fully answer all specific questions posed by the claims examiner; ensure that each answer contains a supporting explanation or rationale based on the actual clinical findings in the case and current medical concepts; ensure that medical opinions expressed are restricted to the physician's area of medical specialty; and ensure that medical opinions are expressed unambiguously and as definitely as the findings in the case allow;

(4) ensure that reports involving the determination of physical impairment levels for schedule award purposes are made in accordance with the current edition of the American Medical Association Guides to the Evaluation of Permanent Impairment and current DFEC program policies. The report should include a “date of maximum medical improvement” and supporting rationale for the chosen date. The Contractor shall assure that reports of physical impairment levels contain the actual measurements, expressed in degrees, obtained during the examination or through clinical or laboratory tests, the resulting level of impairment, and an explanation as to how the level of impairment was calculated; and

(5) ensure that reports involving medically warranted restrictions or limitations on work-related activities are submitted in a form and format specified by DFEC, including objective findings and supporting medical rationale for each stated restriction or limitation.

G.

Delivery of Second Opinion Reports to DFEC. The Contractor shall arrange for receipt of completed medical second opinion reports to the District Office within thirty-five (35) days from the date referral was originated. Reports shall be securely packaged and clearly marked with the words "MEDICAL REPORT". Reports shall be delivered to the District Office at the following address:

U.S. Dept. of Labor, Office of Workers' Compensation Programs

Division of Federal Employees' Compensation

1111 Third Avenue, Suite 650

Seattle, WA 98101-3212

Receipt by DFEC shall be indicated by the signature of _ Kenneth J. Dowdell _* or any other person(s) designated by the Contracting Officer.

H.

Supplemental Reports. When an acceptable second opinion report raises new issues not previously considered in the adjudication of a claim, a supplemental report may be required. The supplemental report will answer one or more additional questions posed by the responsible claims examiner. The supplemental report will not require further examination of the claimant. Neither will it require further diagnostic procedures, nor will it require review of additional medical evidence. Rather, it will be based upon the examination already performed by the second opinion physician and the medical records available to the physician at the time of that examination. A request for supplemental report, with the question(s) to be answered, will be sent in writing to the Contractor via Contractor's chosen overnight delivery service or via Contractor’s secure website. Upon receipt of the request, the Contractor shall forward same to the original second opinion examining physician. The Contractor shall have twenty-one (21) days from the date the request is received to respond to OWCP with a complete supplemental report. The Contractor shall assure that each supplemental report is comprehensive, unequivocal, unbiased, well-reasoned, consistent with the clinical findings and responsive to all questions posed by the claims examiner.

Supplemental reports shall be submitted to OWCP according to the instructions at subsections C.3.F. & G., above. For each supplemental report, the Contractor shall submit one invoice according to the instructions at Section G.2., below. Approximately twenty-five (25) supplemental reports will be required in any contract year.

I.

Follow-up Reports with Review of Additional Medical Evidence. A follow-up report may be required when new medical or vocational rehabilitation evidence becomes part of a claim file subsequent to the Office's receipt of an acceptable second opinion report. The follow-up report will require the second opinion examining physician to read through and respond to the new evidence in order to answer one or more additional questions posed by the responsible claims examiner. The follow-up report will not require further examination of the claimant, nor will it require further diagnostic procedures, but it will be based upon the examination already performed by the second opinion physician, the medical records available to the physician at that time, and the physician's full consideration of the new evidence submitted.

A request for follow-up report with the new evidence and the question(s) to be answered will be sent in writing to the Contractor via Contractor's chosen overnight delivery service. Upon receipt of the request, the Contractor shall forward the material submitted to the original second opinion physician. The Contractor shall have twenty-one (21) days from the date the request is received to respond to OWCP with a complete follow-up report. The Contractor shall assure that each follow-up report is comprehensive, unequivocal, unbiased, well-reasoned, consistent with the clinical findings, and responsive to the new evidence presented as well as to all questions posed by the claims examiner.

Follow-up reports shall be submitted to OWCP according to the instructions at subsections C.3.F & G., above. For each follow-up report, the Contractor shall submit one invoice according to the instructions at Section G.2., below. Approximately twenty-five (25) follow-up reports will be required in any contract year.

J.

Schedule Award Examinations and Reports. Requests limited to schedule award examination and reports will be sent to the Contractor in the same manner as requests for medical second opinion examinations. The Contractor shall arrange for a schedule award examination with an appropriate physician (as described in section C.3.B.3.) Scheduling and delivery of reports shall be consistent with the timeframes set forth in subsection C.3.C. and subsection C.3.G. Schedule award examinations shall be performed according to the standard methods and procedures set forth in the current edition of the A.M.A. Guides to the Evaluation of Permanent Impairment. For 2008, OWCP requires use of the 5th Edition of the Guides. The Contractor shall assure that reports of physical impairment for schedule awards contain all of the items listed at Section 2.6.a of the Guides (5th Edition).

Reports for schedule awards shall be submitted to OWCP according to the instructions at subsections C.3.F. & G., above. For each schedule award report, the Contractor shall submit one invoice according to the instructions at Section G.2., below. Approximately two hundred (200) schedule award reports will be required in any contract year.

If questions from the claims examiner which are included with a referral address issues beyond the schedule award evaluation, including but not limited to causation or treatment recommendation, the request will not fall within this subsection and will be treated as a request for second opinion examination under subsection C.3.F, above.

K.

File Review Only Without Clinical Examination of the Claimant. Requests limited to a review of the medical record may arise for several different reasons. The reviewing physician may be requested to provide a well-reasoned opinion or recommendation on:

(1) the appropriateness of proposed medical treatment, including but not limited to surgical procedure(s), invasive diagnostic procedure(s), medical supplies or equipment, or other treatment programs;

(2) future treatment or alternatives to the current treatment regimen;

(3) whether the medical evidence of record establishes a clinical diagnosis;

(4) the medical connection between a claimed condition and the accepted condition(s), including how treatment for the accepted condition may have affected the claimed condition, or;

(5) the causal relationship of death to the accepted condition and the work-related incident or exposure that gave rise to the accepted condition;

The size of records to review for these cases would be similar to those included with a full second opinion referral, and could range from looking at just one report to reviewing a case history covering years of treatment. The questions which physicians would be asked to respond to would cover issues similar to those covered in a full second opinion referral, except that neither diagnostics nor work restriction evaluations would be required.

The Contractor shall assure that each report, based on review of the medical record only, is comprehensive, unequivocal, unbiased, well-reasoned, consistent with the evidence presented, and responsive to all questions posed by the claims examiner. Approximately twenty-five (25) file reviews will be required in any contract year. No more than two hundred (200) file reviews will be required per contract year.

L.

Contractor Records Retention. Contractor shall retain a copy of each referral package for ninety (90) days after submitting a completed report in case of need for a supplemental or follow-up report or for reperformance under the terms of Section L, below. Contractor shall retain a copy of each report described in subsections C.3.F, H, I and/or J for twelve (12) months after the date submitted to OWCP.

M.

Correction or Reperformance Under the Warranty of Services Clause, (FAR 52.246-20). Should any delivered report require clarification, correction, completion, or reperformance under Clause I.46 Warranty of Services, such will take the form of an addendum report. The Contractor shall submit an acceptable addendum report within twenty-one (21) days and without additional charge, except for such additional diagnostic procedures as may be required.

N.

Security, Confidentiality and Care of Claimant Medical Records and DFEC Files. DFEC files, claimant medical records and related materials remain the property of the U.S. Department of Labor, and no property right in them is conferred on the physician or medical facility providing service. All DFEC files and related materials, as well as the reports which are generated in fulfillment of this contract, must be treated in a confidential manner and may be made available only to persons who have a need for them in order to provide services under this agreement. The Contractor shall:

(1) assure that no excerpts are taken from any compensation file except as necessary to accomplish the purposes of this contract;

(2) assure that no medical case history be used for publication of any paper or book or in lectures without written permission of the Director of the Office;

(3) assure that, when not in actual use, all DFEC files and related material in the Contractor's possession be kept in locked storage, accessible only to those individuals who have a need for them;

(4) assure that no DFEC files, related materials, medical second opinion reports, or facsimiles thereof, are released to any claimant, attorney, employing agency or other party at interest without express written permission of the Contracting Officer; and

(5) assure that all DFEC files and related materials supplied to the contractor per Section C.3.D. are returned to DFEC at the same address and according to the same schedule indicated in Section C.3.G for return of Reports.

(6) assure that copies of DFEC files or related materials which may have been retained by the Contractor, and copies of reports retained under the requirement at Section C.3.K, are destroyed by burning, shredding or another technique that will preserve claimant confidentiality and privacy.

O.

Training for Participating Physician/Specialists. In coordination with the COTR, the Contractor shall:

(1) prepare all training materials which may be reasonably necessary to allow physician/specialists to participate effectively; and

(2) train or instruct participating physician/specialists with regard to DFEC performance requirements regarding timeliness of scheduling and reporting, quality of reports, form and format of reports, and the case adjudication issues which give rise to the need for second opinions.

P.

Training for OWCP District Office Staff. In coordination with the COTR, the Contractor shall prepare all training materials and provide training which may be reasonably necessary to guide staff in navigating the secure website, to initiate referrals, upload imaged documents, download completed reports, and initiate addendum, supplemental and follow-up reports.

C.4.

WEEKLY REPORTS TO COTR.

On a weekly basis, the Contractor shall provide to the COTR by internet email a report of all referrals not yet scheduled that exceed the time frame of four (4) days from initial receipt. The report shall be sorted by referring Claims Examiner and contain the following data:

-- Case number, -- Claimant name (last, first), -- Medical specialty requested, -- Age of the referral (days since initial receipt).

C.5.

MONTHLY REPORTS TO COTR.

On the first business day of each month, the Contractor shall provide to the COTR by internet email a report detailing the status of all cases that are outstanding and exceed the delivery standard of 35 days. The report shall be sorted by referring Claims Examiner and contain the following data:

-- Case number, -- Claimant name (last, first), -- Medical specialty requested, -- Age of the referral (days since initial receipt), -- Explanation for non-completion within 35 day standard, -- Expected date of delivery.

C.6.

QUARTERLY MANAGEMENT REPORTS.

For each calendar quarter, the Contractor shall provide to the Contracting Officer and to the COTR, quarterly management reports in two parts, DETAIL and SUMMARY, as follows:

A.

DETAIL REPORTS shall include both electronic (Microsoft EXCEL or Lotus 123) and hard copy listing of all second opinion and schedule award reports requested during the quarter, sorted by date delivered to OWCP and showing for each:

(1) claimant's name (first and last)

(2) claim number;

(3) medical specialty referred to;

(4) indication whether referral was for SECOP or schedule award;

(5) date referral was received;

(6) date of the appointment for the examination;

(7) whether the physician/specialist postponed or cancelled the exam;

(8) whether claimant reported for the examination;

(9) date the specialist's report was delivered to OWCP;

(10) current status of the referral if not yet delivered to OWCP

(11) description and billed cost of any required supplemental diagnostic tests or procedures;

(12) an indication of whether the report was returned for completion or clarification, and if so, the total days required from initial referral to submission of acceptable report.

B. SUMMARY REPORTS shall include the following:

(1) the number of referrals pending completion at the beginning of the quarter, the number of referrals received during the quarter, and the number of those referrals still pending completion on the 36th day after the end of the quarter;

(2) the mean, minimum and maximum completion times, i.e., elapsed times from first receipt of a request for second opinion examination until receipt of the acceptable report by OWCP;

(3) the number of reports, and percent of total completed, for which completion times exceeded 35 days, and the case numbers associated with those reports;

(4) the number of claimants, and percent of total referred, who failed to appear for their examination appointments, and the case numbers for those claimants;

(5) the number of times each physician canceled or postponed an appointment for a second opinion examination, and the associated case numbers;

(6) the number of second opinion examinations, and percent of total completed, which required diagnostic tests or procedures;

(7) the number of second opinion reports, and percent of total completed, which had to be returned for completion or clarification, and the case numbers associated with those reports;

(8) the number of second opinion reports, and percent of total completed, which required supplemental and/or follow-up reports, and the case numbers associated with those reports;

(9) the number of reports, and percent of total referred, which required reperformance under Section C.3.L., and the case numbers associated with those reports; and

(10) the number of physician/specialists used to deliver medical second opinion services during the quarter, and the number of reports delivered by each.

(11) percentage of referrals that were for SECOP or schedule award only.

[FOR THIS SOLICITATION, THERE ARE NO CLAUSES IN THIS SECTION]

E.1

NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

E-2

E.1 NOTICE LISTING CONTRACT CLAUSES INCORPORATED BY REFERENCE

The following contract clauses pertinent to this section are hereby incorporated by reference (by Citation Number, Title, and Date) in accordance with the clause at FAR "52.252-2 CLAUSES INCORPORATED BY REFERENCE" in Section I of this contract. See FAR 52.252-2 for an internet address (if specified) for electronic access to the full text of a clause.

NUMBER

TITLE

DATE

52.246-4

INSPECTION OF SERVICES--FIXED-PRICE

AUG 1996

***** 'SCHEDULE' Replaced with Text Document *****

Text for SCHEDULE is missing.

***** End Text Document - 'SCHEDULE' *****

***** Begin Text Document - 'SOW' *****

Text Document for 'SOW' is missing.

***** End Text Document - 'SOW' *****

F.1

PERFORMANCE DELIVERY SCHEDULE

F-2

F.2

WEEKLY REPORTS TO COTR.

F-3 F.3

MONTHLY REPORTS TO COTR

F.4

QUARTERLY MANAGEMENT REPORTS

F.5

STOP-WORK ORDER. (AUG 1989) 52.242-15

F.1.

PERFORMANCE/DELIVERY SCHEDULE

The following is the schedule for performance of the contract and delivery of receivables by the Contractor. All days referred to in this Section and in Section C, are calendar days, unless otherwise specified. The purpose of the following schedule is to help assure that acceptable medical reports are delivered timely. In this context, except where otherwise specified, timely means within thirty-five (35) days from the date of initial referral.

A.

Scheduled Appointments. Upon notice from DFEC (by phone, FAX, e-mail or other written means) of the need for a second opinion by a medical specialist, the Contractor shall do the following:

(1) Make an appointment for the claimant in question with a specialist in the appropriate field of medical specialty and forward notice of the appointment to the claimant using a format specified by DFEC. The date of the examination must allow the claimant at least fourteen (14) days advance notice of the appointment date.

(2) Within six (6) days from first notice, notify DFEC in writing of the specialist's name, address and phone number, and the date and time of the scheduled appointment.

(3) Reschedule an appointment only once to suit the convenience of an examining physician. The date of the rescheduled examination shall be not more than twenty-eight (28) days from the first notice from DFEC. In the event of a rescheduling to suit the convenience of an examining physician, the completed report shall be delivered to DFEC within thirty-five (35) days from first notice from DFEC. If additional requests for rescheduling the appointment are received from the examining physician/specialist, the Contractor shall schedule an appointment for examination with another physician/specialist.

(4) Notify DFEC within four (4) days of a claimant's request for rescheduling. If a request for rescheduling is received from the claimant, the Contractor or examining physician may not reschedule the appointment without OWCP permission. Rather, the Contractor must notify DFEC so the responsible claims examiner may decide the issue.

(5) Contact the examining physician/specialist within four (4) days after the scheduled appointment date to determine whether the claimant reported and cooperated with the exam. If claimant did not report or did not cooperate, Contractor shall so notify DFEC within seven (7) days of the scheduled appointment date.

B.

Delivery of Claim File Materials, SOAF and Examiner's Questions. Before requesting a second opinion, the responsible claims examiner shall prepare a statement of accepted facts (SOAF), a list of questions to the examining physician which are specific to the issue at hand, a letter notifying the claimant to appear for the scheduled medical examination, and a travel voucher. These materials, along with copies of all appropriate medical reports from the case record and any DFEC reporting forms which are appropriate to the medical issue and the information sought, will be prepared for delivery to the second opinion specialist. The Contractor shall deliver these materials to the appointed consultants at least twenty-four (24) hours before the scheduled examination.

C.

Initiation and Completion of Diagnostic Tests. OWCP authorizes all non-invasive diagnostic procedures that are substantively related to the condition or issue which gave rise to the second opinion referral, and which the examining physician feels are necessary to render a reasoned opinion and full report. Upon notification from the examining physician that such a diagnostic procedure is needed, the Contractor shall schedule the procedure(s) so that the claimant shall have at least fourteen (14) days advance notice of the appointment. The full report, based on the diagnostic procedure(s), will be delivered to OWCP within twenty-one (21) days of notification by the examining physician that such a diagnostic procedure was needed

D.

Delivery of Second Opinion Reports, Including Schedule Award Reports, to DFEC. The Contractor shall arrange for delivery of completed reports to the District Office within seven (7) days after the examinations and diagnostic procedures are completed.

E.

Delivery of Supplemental and Follow-up Reports to DFEC. The Contractor shall arrange for delivery of completed Supplemental and/or Follow-up Reports to the DFEC Office which originated the request within twenty-one (21) days after first notice from DFEC (See C.3.H & C.3.I, above.)

F.

Delivery of Addendum…