Solicitation_Sections_-_Solicitation_Number_DOL-OPS-15-R-00019.docx

SECTION B – SCHEDULE OF SUPPLIES/SERVICES AND PRICES/COSTS

B.1. General

The contractor shall furnish Medical Second Opinion (SECOP) services and Medical Examination services for the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP), Division of Federal Compensation (DFEC) Seattle District Office in accordance with the terms and conditions as set forth in the Solicitation document (including all amendments), and resulting contract.

B.2 Contract Type

The Government anticipates awarding a single, Firm Fixed Price, Indefinite Delivery / Indefinite Quantity (IDIQ) Contract for one (1) twelve (12) month Base Year and four (4) twelve (12) month Option Years. All options will be exercised at the unilateral discretion of the Government.

B.3 Period of Performance

The anticipated performance periods are as follows:

B.4. Minimum/Maximum Requirements

The Minimum Guaranteed on this contract shall not exceed one (1) during any period of performance in which actual services are not ordered or required. In addition, the total amount estimated for the maximum quantities below shall not exceed the “Total NTE” amounts identified in the Schedule of Supplies/Services.

Note: Due to the fluctuating circumstances surrounding the need for these services and because each case is unique and does not always necessitate the government to schedule SECOP services required by this PWS, the Government estimates the guaranteed minimum for the base and each option period is one (1) each for SECOP, Schedule Awards only, file review only, supplemental report and follow-up report services.

B.5. Payment For Cancellation Of Appointments

Government Cancellations (with notice): When the Government cancels a scheduled appointment with at least 24 hour notice to the Contractor or to the examining physician, no payment shall be made and no liability is incurred by the Government.

Government Cancellations (without notice): When the Government gives less than 24 hour notice in canceling a scheduled appointment, a fixed fee of $50 shall be paid to the Contractor as sole compensation for the cancelled appointment.

Claimant Cancellations (with notice): When a claimant cancels a scheduled appointment with at least 24 hour notice to the Contractor or to the examining physician, no payment shall be made and no liability is incurred by the Government.

Claimant Cancellations (without notice): When a claimant gives less than 24 hour notice in canceling a scheduled appointment, a fixed fee of $50 shall 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 shall be paid to the Contractor as sole compensation for the cancelled appointment.

NOTE: The Government will pay cancellation fees directly to the SECOP contractor. Specific OWCP codes shall be supplied to the SECOP Contractor for invoicing/billing of all services including cancellations, diagnostic testing and procedures, interpretive and transportation. The use of OWCP specific codes shall be strictly prohibited outside the performance of this contract. All canceled appointments shall require documentation to support the reason of cancellation and shall be submitted with the invoice/bill for the Government’s review. The absence of the required documentation (as applicable) shall result in the non-certification of the invoice/bill and non-payment. Interpretive and transportation services also require prior Government notification and approval (when possible) and supporting documentation (as applicable). Transportation will be reimbursed at the GSA Per Diem Rate.

B.6 Payment for Necessary Supplemental Consultations, Diagnostic laboratory Tests and Diagnostic Procedures

Professional consultations, radiology procedures, diagnostic laboratory tests and other diagnostic procedures deemed necessary to complete a second opinion examination will be paid according to the fee schedule limitations provided under 20 CFR 10.805-813. The OWCP medical fee schedule is updated annually.

B.7 Incremental Funding

Funds are not presently available for performance under this contract beyond the base period. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of funds from which payment for contract purposes can be made through the benefits fund. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond the existing period of performance, until funds are made available to the Contracting Officer for performance and until the contractor receives notice of availability which must be confirmed in writing by the Contracting Officer.

B.8 Pricing and Estimated Quantities

The Contractor shall provide the SECOP and medical examination services, as specified elsewhere in The Schedule, at the firm, fixed price per unit specified herein. All terms and conditions of the initial contract shall remain unchanged, except as where expressly and formally modified by both parties, when applicable. The following prices indicate the sole rate 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. In addition, the total amount estimated for the maximum quantities below shall not exceed the “Total NTE” amounts indicated below (excluding services indicated in Sections B.5 and B.6)

Base Period: 11/01/2015-10/31/2016

Quantity

Option Period One: 11/01/2016–10/31/2017

Quantity

Option Period Two: 11/01/2017-10/31/2018

Quantity

Option Period Three: 11/01/2018-10/31/2019

Quantity

Option Period Four: 11/01/2019-10/31/2020

Quantity

SECTION C – PERFORMANCE WORK STATEMENT

PART 1

PERFORMANCE WORK STATEMENT

C.1 Purpose:

This is a non-personal services contract to provide: Medical Second Opinion and Medical Examination Services (SECOP) for the Office of Workers’ Compensation, Division of Federal Employees’ Compensation (DFEC). The contractor’s employees shall remain under the contractor’s direct supervision at all times. Although the Government will coordinate directions within the scope of the contract, detailed instruction for the contractor’s employees and supervision shall remain the responsibility of the contractor. The Government also shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

C.1.2 Background:

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 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.

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 shall 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.

The important elements of this service contract shall be the delivery of a quality, viable medical report(s), the verification and replication of impairment ratings by a reliable, certifiable and standardized process and the timeliness of scheduling medical reports. To be acceptable, the medical reports shall present comprehensive, unequivocal, unbiased and well-reasoned narrative opinions that are consistent with objective medical evidence or testing, physical or psychological findings that are consistent to the framework of the SOAF or provide a clear comprehensive, well-reasoned opinion disputing any of the medical conditions outlined in the SOAF that are unsubstantiated with any medical findings, and that address all questions posed by the claims examiner. The timely scheduling of appointments for examinations shall be maintained within the timeframes set forth in this solicitation and within the government’s acceptance of the number of physicians available by “required” specialty and within the designated Metropolitan Statistical Area (MSA) to limit the inconvenience to FECA claimants. The timely delivery of a quality, viable medical reports contributes to prompt and accurate adjudication of outstanding medical and compensation issues.

C.1.3 Objective

The objective of this requirement shall enable the government to procure Medical Second Opinion (SECOP) and Medical Examinations, Schedule Awards, Supplemental Reports, Follow-up Reports and file reviews for affected claimants who reside within the area served by the OWCP’s District Office. The contract objectives are as follows:

C.1.4 Scope: Claimants Covered and Work to be Performed. Medical second opinion services shall be provided for (see schedule B for estimated quantities) FECA claimants per annum. Additional services to include Schedule award examination services, follow-up reports and supplemental reports for the estimated quantities identified in Section B per annum. The affected claimants reside within the area served by OWCP’s Seattle District Office (Alaska, Idaho, Oregon and Washington) and the claim files are in the custody of the District Office in Seattle. The DFEC District Office will provide to the contractor all necessary information pertaining to covered claimants.

C.1.5 Type of Contract:

The Government anticipates awarding a single, Firm Fixed Price, Indefinite Delivery / Indefinite Quantity (IDIQ) Contract for services required by this PWS. See Section B - Schedule of Supplies/Services for “estimated quantities”.

Note: Due to the fluctuating circumstances surrounding the need for these services and because each case is unique and does not always necessitate the government to schedule SECOP services required by this PWS, the Government estimates the guaranteed minimum for the base and each option period is one (1) each for SECOP, file review, supplemental report, and follow-up report services.

C.1.6 Contract Term:

The contract term will be a one (1) year base period and four one (1) year option periods. The total duration shall not exceed five (5) years, when all options are exercised. The effective date will begin from date of contract award. See Section F for anticipated performance periods. All option periods will be exercised at the unilateral discretion of the Government.

C.1.7 Recognized Holidays:

The contractor shall not schedule examination services on the following holidays:

C.1.8 Hours of Operation:

The contractor shall be responsible for conducting business, between the hours of 8:00 am to 5:00 pm local time (established by the time zone of the DFEC District Office), Monday thru Friday. No direct medical examinations may take place on a Federal holiday. The Contractor shall at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this SOW when the Government facility is not closed for the above reasons.

C.1.9 Payment For Cancellation Of Appointments

(a) Government (with adequate notice): When the Government cancels a scheduled appointment with at least 24 hour notice to the Contractor or to the examining physician, no payment shall be made and no liability is incurred by the Government.

(b) Government (without adequate notice): When the Government gives less than 24 hour notice in canceling a scheduled appointment, a fixed fee of $50 shall be paid to the Contractor as sole compensation for the cancelled appointment.

(c) Claimant (with adequate notice): When a claimant cancels a scheduled appointment with at least 24 hour notice to the contractor or to the examining physician, no payment shall be made and no liability is incurred by the Government.

(d) Claimant (without adequate notice): When a claimant gives less than 24 hour notice in canceling a scheduled appointment, a fixed fee of $50 shall be paid to the Contractor as sole compensation for the cancelled appointment.

(e) Claimant (without notice and/or No Show): When a claimant, without prior notice, fails to report for the scheduled appointment, the contractor shall notify the District Office Contracting Officer Representative (COR) within 24 hours of a missed appointment and a fixed fee of $50 shall be paid to the contractor as sole compensation for the cancelled appointment.

Note: Specific OWCP codes shall be supplied to the contractor for invoicing. The use of OWCP specific codes shall be strictly prohibited outside the performance of this contract. All cancelled appointments require prior notification to the District Office. Therefore, contractors shall document notification and provide specific information with bill indicating person (Government) notified and date of notification. The absence of the required documentation shall result in the non-certification of the invoice/bill and non-payment.

C.1.10 Payment for Second Opinion Examinations, Impairment Rating Examinations, File Reviews, Supplemental Reports and Follow-Up Reports.

When all medical examination and report requirements have been rendered and verified accurate, the Contractor shall submit one (1) invoice/bill for services along with a copy of the medical report to the New York District Office. Specific OWCP codes shall be supplied to the Contractor for invoicing. The use of OWCP specific codes shall be strictly prohibited outside the performance of this contract. Once the DFEC District office has reviewed the report for accuracy and viability, the invoice/bill charges shall be reviewed, verified and certified, and the invoice/bill shall be submitted for payment by the District Office. The absence of the required report documentation shall result in the non-certification of the invoice/bill and non-payment. Payment for services shall not be initiated until the Contractor has met all the reporting requirements and DFEC has deemed the report viable. Once DFEC has deemed the report viable, the invoice/bill shall be submitted in accordance with Federal Acquisition Regulation (FAR) Clause 52.232-25 Prompt Payment Act and Attachment J.2.

C.1.11 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 or are necessary to obtain objective medical evidence for the physician to render a comprehensive, unequivocal, unbiased and well-reasoned narrative opinions that are consistent with objective medical evidence or testing, physical or psychological findings that are consistent to the framework of the SOAF or provide a clear comprehensive, well-reasoned opinion disputing any of the medical conditions outlined in the SOAF that are unsubstantiated with any medical findings, and that address all questions posed by the claims examiner shall be paid for according to the OWCP fee schedule limitations provided under 20 CFR 10.805-813. The Contractor shall notify the DFEC Office of any necessity to obtain invasive medical or diagnostic testing required before or no later than one (1) day after the medical testing.

The Contractor shall invoice/bill diagnostic testing and procedures using the appropriate CPT or HCPCS code. Any use of OWCP specific codes outside the requirements of this contract is strictly prohibited and shall have prior DFEC written authorization for each incident. The Contractor shall ensure the physician does not directly invoice/bill the government for medical examination services or medical testing and diagnostics to reduce the chances of duplicate billing/invoicing C.1.12 Performance/Delivery Schedule: The contractor shall perform all elements of the second opinion services within the time frames described in the PWS and Schedule.

The following is the schedule for performance of the contract and delivery of receivables by the Contractor. All days referred to in this solicitation are calendar days, unless otherwise specified. The purpose of the following schedule shall help assure quality and viable 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 or date of first notice that medical services are needed.

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 shall initiate the referral process and be equal to the date of first notice in which the delivery schedule requirements shall begin.

The Contractor shall do the following:

(1) Schedule an appointment for the claimant in question with a physician type or specialist in the appropriate field of medical specialty and forward notice of the appointment to the claimant using a format specified by DFEC. If it is determined that the DFEC Office requested a physician type or specialist that is inappropriate or unable to address the specific medical reason(s) the case is being referred for a medical examination, the Contractor shall immediately notify the District Office COR and scheduling person. The Contractor shall document their recommendation and any communication with the DFEC Office. If it is determined that the DFEC Office requested the wrong physician type or specialist, the delivery schedule shall be recalculated from the date in which DFEC advises the Contractor of the appropriate physician type or specialist. If it is determined that the Contractor inappropriately returned a request to the DFEC office and no new physician type or specialist resulted, the Contractor shall not be eligible for a new delivery schedule for this examination. The date of the examination shall 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) Rescheduling an appointment shall only occur once to suit the convenience of an examining physician. The date of the rescheduled examination shall be no more than twenty-eight (28) days from the first notice or referral 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 and notify DFEC. A physician cancellation occurring more than three (3) occasions with the same physician shall require the Contractor to notify the District Office COR. The physician’s first and second convenience cancellation shall result in the Contractor’s annotation on the government’s weekly, monthly and quarterly reports. The third physician convenience cancellation shall result in the Contractor’s requirement to notify the District Office COR and discuss the reasons for the cancellations. The government shall determine the physician’s inclusion or exclusion during the remainder of the contract performance period year.

(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 shall not reschedule the appointment without OWCP permission. Rather, the Contractor shall 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, the Contractor shall ensure the claimant’s participation or lack of participation is documented in the medical report or if the claimant failed to report for the examination, the Contractor shall provide written notification to DFEC. Contractor shall ensure DFEC is notified within two (7) business days of the scheduled appointment date.

(6) Ensure that all physicians are aware that the claimant is allowed to have their treating physician present during the examination. However, the claimant’s treating physician is only an observant and shall interact or have any discussions with the second opinion or impairment rating medical examiner. The Contractor shall ensure the physician is provided a means by which he/she can immediately notify the Contractor when the claimant’s treating physician goes beyond an observant party.

Claimant’s requiring interpretive services for the purpose of ensuring the completion of a medical examination shall be provided by the contractor upon the District Office’s approval, or unless otherwise notified at the time the referral is made. The contractor shall arrange the interpretive services once the claims examiner has approved this service. The contractor shall ensure no conflicts of interest exist between the claimant and the interpreter. The Contractor shall ensure that the physician is aware that spouses, family members, friends, or acquaintances shall not be authorized interpreters. The District Office COR will approve all required services prior to performance. The contractor shall invoice/bill the government using OWCP codes when these services are provided in conjunction with a medical examination. All pre-authorized interpretive services will be paid by the Government directly to the contractor.

The Contractor shall ensure that all physicians are aware that the claimant is not authorized to have a spouse, family member, friend or any other person in the examination room or participate in the examination. When physician staff member is an acquaintance or is familiar with the claimant, the Contractor shall ensure the physician refrains from using this person when services are provided under this contract.

The Contractor shall ensure that physicians are aware of these requirements and ensure that each medical report is annotates and documents the attendance of any person during the examination. Unauthorized persons attending the physical examination shall deem the medical report invalid and the Contractor shall be required to re-perform the examination at no additional cost to the government.

(7) The Contactor shall provide a means by which the physician can provide immediate notification of an unauthorized attendant is refusing to leave the medical examination or when the claimant’s treating physician or interpreter is being disruptive. The Contractor shall ensure the physician’s report documents the attendance of anyone other than the claimant present during the medical examination.

(8) During the entire performance of these services, each contractor is expected to demonstrate and utilize maximum cost control measures in order to minimize the need for claimant travel beyond the 100 mile radius and/or outside each urban MSA cluster. A contractor’s failure to demonstrate maximum cost control measures (i.e. routinely scheduling claimants beyond the 100 mile radius and/or outside the urban MSA cluster) may result in adverse performance reporting through the Contractors Performance Assessment Reporting System (CPARS) located at www.cpars.gov or other administrative remedies available to the Government.

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 if needed 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, shall 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), shall be delivered to OWCP within twenty-one (21) days of notification by the examining physician that such a diagnostic procedure was needed. The Contractor shall ensure that the examining physician includes the diagnostic results in his medical report and provides a reasoned opinion of the findings and the relatedness to the medical condition. The Contractor shall demonstrate the capability to schedule diagnostic procedures to ensure a timely medical report is submitted.

D. Delivery of Second Opinion Reports, Including Schedule Award Reports, to DFEC. The Contractor shall arrange for delivery of a complete, quality and viable medical report to the District Office within seven (35) 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 a complete, quality and viable Supplemental and/or Follow-up Reports to the DFEC Office that originated the request within twenty-one (21) days after first notice from DFEC.

F. Delivery of Addendum Reports to DFEC. When a correction or re-performance in the form of an addendum report is identified by the District Office COR, the Contractor shall deliver the completed addendum within twenty-one (21) days of first notice from DFEC of need for such a correction or re-performance. The Contractor shall ensure that no additional cost to the government is incurred for the correction or re-performance of an addendum report.

G. Delivery of File Review Reports to DFEC. The Contractor shall arrange for delivery of a complete, quality, and viable report to the DFEC Office which originated the request for file review within thirty-five (35) days after first notice from DFEC.

C.1.13 Claimants Covered and Work to be Performed.

Medical second opinion services (SECOP) estimates are subject to fluctuations due to the number of claims filed, claims requiring medical opinions and impairment ratings, the number of file reviews or legislation. However, the contractor shall be capable of providing medical examinations approximately 1,000, FECA claimants per annum of whom reside within the states handled by the Seattle District Office (Alaska, Idaho, Oregon and Washington. This is an estimate of the number of medical second opinion services that may be needed. This estimate does not constitute a guarantee, as the minimum number of services shall be equal to one (1). The contractor shall exhibit a sufficient network of physicians and shall have the ability to schedule medical second opinion examination services second opinion examinations in the states handled by the Seattle District Office and within the Metropolitan Statistical Area listed in Section M. The referring DFEC Office shall provide to the Contractor all necessary information pertaining to covered claimants.

Schedule award examination services shall be provided for approximately 50 FECA claimants per annum. Approximately 50 Supplemental Reports may be required per annum. Approximately 90 follow-up Report services may be required per annum. Schedule Award examinations, file reviews, supplemental reports and follow-up reports are an estimate of the number of medical services that may be needed. This estimate does not constitute a guarantee, as the minimum number of services shall be equal to one (1).

The affected claimants reside within the area served by the Seattle OWCP's District Office. These claimants live in Alaska, Idaho, Oregon and Washington. Claim files for these claimants are in the custody of the District Office in Seattle. The DFEC staff in each District Office shall provide to the Contractor all necessary information pertaining to covered claimants. The full mailing address for this District Office is provided in C.1.15(G).

The contractor shall have the ability to schedule medical examination services in areas outside the Seattle District Office. Claim files may be under the jurisdiction of the District Office, but the claimant may reside in another state other than the states listed.

C.1.14 Performance Work Statement

Seattle DFEC District Office SECOP services include providing the services identified below. All days referred to in this Section and in Section F are calendar days, unless otherwise specified.

A. Summary/Overview. The Contractor shall:

· Perform all related supervisory and project management/control activities;

· Arrange for qualified and appropriate “qualified” physicians and medical specialists within the appropriate MSA.

· Make these services available within a reasonable commuting distance for DFEC claimants. Reasonable commuting distance is defined in Part 2 “Definitions and Acronyms”.

· Arrange timely scheduling of appointments for examinations, forward letters from the responsible claims examiners notifying claimants, their appointed representatives, and their employing agency of the claimants' responsibilities to appear and cooperate with scheduled medical exams;

· Assure that a secure website (password protected [https protocol/SSL]) is operational and available for the initiation of referral and uploading of all pertinent imaged documents supplied by DFEC ( including but not limited to the Statement of Accepted Facts (SOAF), examiners’ questions to physicians, medical records relevant to the examination, etc.);

· 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), when DFEC has determined document transmission is dysfunctional or unsecure, at the discretion of DFEC or when electronic transmission is not in the best interest of the government. The Contractor shall have a contingency plan in place;

· Assure timely delivery to examining physicians of all pertinent documents supplied by DFEC, including SOAFs, examiners' questions to physicians, medical records, etc. The Contractor shall ensure that any electronic transmissions to physicians or medical specialists conform to the government’s secure website requirements;

· 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;

· Assure that all medical reports and impairment ratings are verified for accuracy and content.

· Assure that reports for any medical examination service or file review that does not conform to the government’s report requirements shall result in re-performance.

· Assure timely delivery or uploading to the secure website and/or return to the District Office of completed second opinion reports, along with all original claim file materials that may have been sent to the Contractor;

· 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 the Contractor or examining physician;

· Assure that a plan or process to destroy electronic images or medical documentations conform with government regulations.

· Coordinate with the Contracting Officer's Representatives (COR) to prepare and administer all training materials that may be reasonably necessary to allow physician/specialists and DFEC staff to participate effectively;

· Provide management reports to the Contracting Officer via the National Office COR and to the District Office COR as specified in Part 5 – Specific Tasks (5.6.10; 5.6.11 and 5.6.12).

Tasks areas 1 through 6 (See Part 5 for specific tasks).

· Task Area 1 – Contract-Level and Task Order Management

· Task Area 2 – Operational Support Services for OWCP/DFEC District Office.

· Task Area 3 – Qualified and Appropriate Medical Specialists.

· Task Area 4 – SECOP Reports to include Follow-up Reports and Supplemental reports.

· Task Area 5 – Scheduling of Appointments for Examinations.

· Task Area 6 – Additional Support Services for DFEC District Office.

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, the American Osteopathic Association and American Board of Foot and Ankle Surgery (ABFAS) (formerly known as the American Board of Podiatric Surgery (ABPS).

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 and 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.

f. All psychologist providing psychological testing and referees must also meet all certification requirements.

(3) Physicians Performing Examinations for Schedule Awards.

a. In addition to the qualifications set forth in subsections C.1.15(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 2013, OWCP requires use of the 6th 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.

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, the American Osteopathic Association and American Board of Foot and Ankle Surgery (ABFAS) (formerly known as the American Board of Podiatric Surgery (ABPS American Board of Medical Specialties), most requirements will be concentrated in a few medical specialties. The clinical specialties for which OWCP has most need in the Seattle Region are found in Section C.1.31. More detailed estimates of the distribution of required medical specialties are provided at Section L. 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 thirty (30) miles, or forty five (45) minutes driving time (whichever is shorter) from the claimant's residence without express permission of the COR. Claimants who reside in rural areas should not have to travel more than sixty (100) miles or one and a half hours of driving time (whichever is shorter) from the claimant's residence without express permission of the COR. For purposes of this requirement, the term "urban areas" is defined to include the urban areas as defined at http://www.dol.gov/owcp/regs/feeschedule.html and http://www.omb.gov.

Within these listed Metropolitan Areas, 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.

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 COR. 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 via email 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, as appropriate:

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

(2) review all medical reports to include diagnostic reports and pathology testing 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 physical or psychological examination of the claimant, as required;

(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 the individual to be examined and the 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.

NOTE: It will not be considered appropriate for a non-physician, such as a clinical psychologist receiving a second opinion referral, to perform a physical examination of the claimant. Physical examinations shall be performed only by physicians who are licensed to do so.

F. Second Opinion Reports. The physician/specialist's second opinion report shall be complete, responsive to all questions posed by the claims examiner, supported by medical rationale 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 or 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. All answers must be provided using well-rationalized, objective evidence. 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 findings;

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…