DOL-OPS-16-R-00058.pdf

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CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

OPS

S4307 200 Constitution Ave, NW Office of Procurment Services US Department of Labor

CODE 16. ADMINISTERED BYCODE

X

X

621111

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OROPS

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

10/03/2016 1000 ES

08/29/2016

202-693-4570ROXANNE YORGASON

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

DOL-OPS-16-R-00058

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 108 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

Washington DC 20210-0001

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Washington DC 20210-0001 S-4307 200 Constitution Ave, NW Office of Procurement Services

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$11.00

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

US Department of Labor

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

The Department of Labor (DOL), Office of Worker's Compensation programs (OWCP), Division of Energy Employees Occupational Illness Compensation (DEEOIC) has a requirement to procure Contract Medical Consultants (CMC) to assist the DEEOIC by reviewing and evaluating the medical evidence of record and providing written medical opinions regarding various aspects of selected compensation cases in accordance with the Performance Work Statement (PWS) and estimated quantities identified in Section B.

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

Kim Stepney

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This requirement will result in the award of a single indefinite delivery indefinite quantity

(IDIQ) contract. Anticipated period of performance: one (1) 12-month base period with four (4) 12-month option periods, to begin on

December 16, 2016.

Clarifying questions are due to the Contract

Specialist via email as identified in the posting on www.FBO.gov.

Quotes are due on the date identified on block 8 of this SF-1449 form.

Period of Performance: 12/16/2016 to 12/15/2021

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

108 2 of

SECTION B - SCHEDULE OF SUPPLIES/

SERVICES AND PRICES/COSTS

B.1 General

The contractor shall furnish Contract Medical Consultants (CMC) to assist the Division of Energy Employees Occupational Illness Compensation (DEEOIC) by reviewing and evaluating the medical evidence of record and providing written medical opinions regarding various aspects of selected compensation cases in accordance with the terms and conditions set forth in the solicitation document (including all amendments/modifications), and the resulting contract.

B.2 Contract Type

The Government anticipates a single award Indefinite Delivery/Indefinite Quantity contract with Firm Fixed Price task orders to be issued, as required by the PWS. The prices listed below in the B.5 Pricing and Estimated Quantities table indicate the sole manner of reimbursement under this solicitation. The price is inclusive of any and all labor, indirect costs, material, pick-up and delivery, ancillary costs, and applicable fees.

B.3 Period of Performance

This contract shall be in effect for a one (1) year base period and four (4) one-year option periods.

Base Period: 12/16/2016-12/15/2017 Option Year 1: 12/16/2017-12/15/2018 Option Year 2: 12/16/2018-12/15/2019 Option Year 3: 12/16/2019-12/15/2020 Option Year 4: 12/16/2020-12/15/2021

B.4 Minimum/Maximum Requirements

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 services that are required by this PWS, the Government estimates the guaranteed minimum for the base and each option period shall not exceed one (1) each for FILE REVIEW, SECOP, IMPAIRMENT, REFEREE, WAGE LOSS, EXPEDITE, DIAGNOIS CLARIFICATION, PHARMACY UTILIZATION REVIEW, MEDICAL

TRANSLATION SERVICES, INTERPRETER SERVICES AND SUPPLEMENTAL referrals.

B.5 Pricing and Estimated Quantities

Base Period: 12/16/2016-12/15/2017 Item Number

Description of Supplies/Services

Minimum Quantity

Maximum Quantities

Unit Unit Price

Total

0001 Causation 1 2500 Each $ $ 0002 Impairment 1 2000 Each $ $ 0003 Diagnosis Clarification 1 100 Each $ $ 0004 Wage Loss 1 50 Each $ $ 0005 Supplemental 1 250 Each $ $

Appointment Cancelation 1 15 Each $ $

0007 Second Opinion 1 200 Each $ $ 0008 Referee File Review 1 25 Each $ $ 0009 Referee Physical

Examination 1 10 Each $ $

0010 Referee Impairment File Review

1 10 Each $ $

0011 Expedite/Terminal 1 100 Each $ $ 0012 Diagnostic Testing 1 80 Each $ $ 0013 Interpreter Services 1 100 Each $ $ 0014 Medical Records

Translation Services 1 100 Each $ $

0015 Pharmacy Utilization 1 360 Each $ $ Total Not to Exceed Amount $

Option Period One: 12/16/2017-12/15/2018 Item Number

Description of Supplies/Services

Minimum Quantity

Maximum Quantities

Unit Unit Price

Total

1001 Causation 1 2500 Each $ $ 1002 Impairment 1 2000 Each $ $ 1003 Diagnosis Clarification 1 100 Each $ $ 1004 Wage Loss 1 50 Each $ $ 1005 Supplemental 1 250 Each $ $ 1006 Appointment

Cancelation 1 15 Each $ $

1007 Second Opinion 1 200 Each $ $ 1008 Referee File Review 1 25 Each $ $ 1009 Referee Physical

Examination 1 10 Each $ $

1010 Referee Impairment File Review

1 10 Each $ $

1011 Expedite/Terminal 1 100 Each $ $ 1012 Diagnostic Testing 1 80 Each $ $ 1013 Interpreter Service 1 100 Each 1014 Medical Records

Translation Services 1 100 Each

1015 Pharmacy Utilization 1 360 Each $ $ Total Not to Exceed Amount $

Option Period Two: 12/16/2018-12/15/2019 Item Number

Description of Supplies/Services

Minimum Quantity

Maximum Quantities

Unit Unit Price

Total

2001 Causation 1 2500 Each $ $ 2002 Impairment 1 2000 Each $ $ 2003 Diagnosis Clarification 1 100 Each $ $ 2004 Wage Loss 1 50 Each $ $ 2005 Supplemental 1 250 Each $ $ 2006 Appointment

Cancelation 1 15 Each $ $

2007 Second Opinion 1 200 Each $ $ 2008 Referee File Review 1 25 Each $ $ 2009 Referee Physical

Examination 1 10 Each $ $

2010 Referee Impairment File Review

1 10 Each $ $

2011 Expedite/Terminal 1 100 Each $ $ 2012 Diagnostic Testing 1 80 Each $ $ 2013 Interpreter Service 1 100 Each $ $ 2014 Medical Records

Translation Services 1 100 Each $ $

2015 Pharmacy Utilization 1 360 Each $ $ Total Not to Exceed Amount $

Option Period Three: 12/16/2019-12/15/2020 Item Number

Description of Supplies/Services

Minimum Quantity

Maximum Quantities

Unit Unit Price

Total

3001 Causation 1 2500 Each $ $ 3002 Impairment 1 2000 Each $ $ 3003 Diagnosis Clarification 1 100 Each $ $ 3004 Wage Loss 1 50 Each $ $ 3005 Supplemental 1 250 Each $ $ 3006 Appointment

Cancelation 1 15 Each $ $

3007 Second Opinion 1 200 Each $ $ 3008 Referee File Review 1 25 Each $ $ 3009 Referee Physical

Examination 1 10 Each $ $

3010 Referee Impairment File Review

1 10 Each $ $

3011 Expedite/Terminal 1 100 Each $ $ 3012 Diagnostic Testing 1 80 Each $ $ 3013 Interpreter Service 1 100 Each $ $ 3014 Medical Records

Translation Services 1 100 Each $ $

3015 Pharmacy Utilization 1 360 Each $ $

Option Period Four: 12/16/2020-12/15/2021

Item Number

Description of Supplies/Services

Minimum Quantity

Maximum Quantities

Unit Unit Price

Total

4001 Causation 1 2500 Each $ $ 4002 Impairment 1 2000 Each $ $ 4003 Diagnosis Clarification 1 100 Each $ $ 4004 Wage Loss 1 50 Each $ $ 4005 Supplemental 1 250 Each $ $ 4006 Appointment

Cancelation 1 15 Each $ $

4007 Second Opinion 1 200 Each $ $ 4008 Referee File Review 1 25 Each $ $ 4009 Referee Physical

Examination 1 10 Each $ $

4010 Referee Impairment File Review

1 10 Each $ $

4011 Expedite/Terminal 1 100 Each $ $ 4012 Diagnostic Testing 1 80 Each $ $ 4015 Pharmacy Utilization 1 360 Each $ $ 4013 Interpreter Service 1 100 Each $ $ 4014 Medical Records

Translation Services 1 100 Each $ $

4015 Pharmacy Utilization 1 360 Each $ $

SECTION C – PERFORMANCE WORK

STATEMENT

Contract Medical Consultants

Department of Labor Office of Workers Compensation Programs

Division of Energy Employees Occupational Illness Compensation

PART 1

GENERAL INFORMATION

1.1 INTRODUCTION

The Energy Employees Occupational Illness Compensation Program (EEOICP) provides worker’s compensation benefits authorized by the Energy Employees Occupational Illness Compensation Program Act (EEOICPA or the Act). Part B of the program went into effect on July 31, 2001 and Part E of the program went into effect on October 28, 2004. The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is responsible for adjudicating and administering claims filed by employees, former employees or certain qualified survivors under the Act.

1.2 BACKGROUND

The EEOICP is a specialized program within the U.S. Department of Labor with specific regulations and causation criteria. The program owes its creation to the situation that arose in the 1940s when nuclear weapons were being developed.

1.2.1 PART B

The purpose of Part B is to provide lump sum payment and medical benefits as compensation to covered employees suffering from occupational illness incurred as a result of their exposure to radiation, beryllium, or silica while in the performance of duty for the DOE and certain of its vendors, contractors, and subcontractors.

The legislation also provides for the payment of compensation to certain survivors of these covered employees, as well as for payment of a smaller lump sum to individuals or their survivors who were determined to be eligible for compensation under Section 5 of the Radiation Exposure Compensation Act

(RECA).

1. Part B covers the following population:

a. Employees of the Department of Energy (DOE), its contractors or subcontractors, and atomic weapons employees with radiation-induced cancers.

b. Employees of DOE, its contractors and subcontractors, and designated beryllium vendors who worked at covered facilities where they were exposed to or may have been exposed to beryllium produced or processed for the DOE who developed chronic beryllium disease (Employees exposed to beryllium who developed beryllium sensitivity received medical monitoring) under statutory diagnostic criteria.

c. Employees of the DOE, its contractors and subcontractors who worked at least 250 days during the mining of tunnels at underground nuclear weapons test sites in Nevada or Alaska and who developed chronic silicosis under statutory diagnostic criteria.

d. Uranium workers (or their survivors) previously awarded benefits by the Department of Justice under Section 5 RECA.

2. To determine whether the employee’s cancer is “at least as likely as not” related to exposure to radiation at DOE sites, the program uses a set probability of causation (POC) tables developed by and maintained by the National Institute for Occupational Safety and Health (NIOSH). A compensable POC is one of a 50% or greater probability that occupational radiation was the likely cause of the diagnosed cancer.

3. The Act also created and provides procedures for the designation of Special Exposure Cohort (SEC) for employees of certain DOE facilities (or its contractors and subcontractors) and certain atomic weapons employees who worked at specified facilities. Employees found to be a member of a SEC receive a presumption that certain diagnosed cancers are work-related. Petitions for possible SEC designation are reviewed by NIOSH and submitted to the Advisory Board on Radiation and Worker Health. Upon receiving a recommendation from the Board, the Secretary of Health and Human Services can designate the addition of a class of employees to the SEC if it is not feasible to estimate, with sufficient accuracy, the radiation dose that the class received. After meeting the employment criteria, an employee (or survivor) may be eligible under a SEC class only if the employee suffered from one or more of the following cancers:

1. SEC Cancers

a. Bone cancer (including myelodysplasias and polycythemia vera)

b. Renal cancer

c. Leukemia (other than chronic lymphocytic leukemia) with a latency of at least 2 years

d. Lung cancer (other than in situ discovered after an autopsy)

e. *Multiple myeloma

f. *Lymphomas (other than Hodgkin’s disease)

g. *Primary cancer of:

(1) *Thyroid

(2) *Breast (male or female)

(3) *Esophagus

(4) *Stomach

(5) *Pharynx

(6) *Small intestine

(7) *Pancreas

(8) *Bile ducts

(9) *Gallbladder

(10) *Salivary glands

(11) *Urinary bladder

(12) *Brain

(13) *Colon

(14) *Ovary

(15) *Liver (except if cirrhosis or hepatitis B is indicated)

*Provided onset was at least 5 years after first exposure.

4. Uranium workers and survivors, who have received a lump sum award under Section 5 of the RECA, are entitled to file a claim for benefits under Part B. RECA employees are also eligible for medical benefits in relation to their accepted covered condition.

1.2.2 PART E

1. Part E was created when Congress abolished Part D of the EEOICPA with an amendment signed into law by the President on October 28, 2004. Part E provides compensation in the form of medical benefits, wage loss, and impairment benefits to DOE contractors and subcontractors and certain Section 5 RECA workers. Covered survivors of deceased workers are also eligible to receive compensation if the covered illness aggravated, contributed to, or caused the employee’s death. An additional survivor benefit is payable if the employee sustained wage loss prior to death. Living employees must establish that it is “at least as likely as not” that exposure to a toxic substance at a covered facility was a significant factor in causing, contributing to, or aggravating an illness.

2. An accepted Part E claimant may receive compensation for wage loss based on the number of years, as determined in relation to the Social Security retirement age, that an employee experienced a loss in wages due to his or her covered illness. Impairment benefits, based upon the amount of whole-person impairment of the employee due to an accepted covered illness, are paid to employees. Covered employees will receive an award for each percentage of whole-person impairment attributable to the accepted covered illness.

3. Any DOE contractor claimant whose claim had been accepted under Part B (including by way of the SEC) is eligible for Part E benefits for the same covered condition. Atomic weapons employees, beryllium vendor employees and Federal employees are not eligible for Part E benefits.

1.2.3 CONTRACT MEDICAL CONSULTANT

Contract Medical Consultants (CMC) assist the Division of Energy Employees Occupational Illness Compensation (DEEOIC) by reviewing and evaluating the medical evidence of record and providing written medical opinions regarding various aspects of selected compensation cases. CMCs do not review every case, rather claims examiners (CEs) seek medical input from CMCs in selected cases. Such input may include:

1. Causality issues involving the work-relatedness of a give disease, whether exposure to particular toxic substances at work caused, contributed to, or aggravated the disease; the role of the covered illness in the death of the claimant; the appearance of secondary or consequential diseases or injuries, etc.

2. The explanation of treatment modalities, the interpretation of clinical test results, assistance with establishing or confirming a diagnosis and the clarification of other physicians’ reports.

3. Determining the level of impairment in a given case in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment.

4. Assessing an individual’s ability to work during a given time period, as it relates to the covered condition.

The medical opinion should be provided by a qualified physician with expertise in treating, diagnosing or researching the illness claimed to be caused or aggravated by the alleged exposure. The CMCs’ written medical opinion is used by CEs to reach adjudication decisions regarding causality, impairment or wage loss in compensation cases. DEEOIC expects these medical opinions to be solidly based on the facts as accepted by the CE and expressed in the Statement of Accepted Facts (SOAF) and on state-of-the-art medical knowledge. Above all, these opinions should be as objective as possible. There will be instances where the CMC will have to make a determination based upon historically incomplete, vague, or contradictory evidence. In these instances, the CMC will have to accept the facts as provided by the CE and formulate a medical opinion based upon the totality of the available medical evidence. However, there is a mechanism for CMCs to ask the CE follow-up questions before they issue their report.

Participating CMCs must be identified by name and business address and have the following types of professional qualifications:

5. Physicians:

a. Possess a M.D. degree or a D.O. degree;

b. Hold an unrestricted license to practice medicine in the state in which they will perform examinations or otherwise practice under this contract;

c. 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. Engaged in an active medical practice – a minimum of 240 hours of direct patient care over the previous twelve months;

e. Possess computer skills;

f. Shall at all times be a “qualified physician” under the Energy Employees Occupational Illness Compensation Program Act, and as defined in 20 CFR § 30.5(ee);

6. Physicians Performing Impairment Evaluations:

a. In addition to the qualifications set forth in subsection 1.2.3.5 above, CMCs who perform impairment evaluations must possess certification by American Board of Independent Medical Examiners (ABIME) or American Academy of Disability Evaluating Physicians (AADEP) in the field of impairment evaluation that establish the physician as a qualified expert.

b. Physicians who conduct impairment evaluations shall have training and experience in the use of the American Medical Association Guides to the Evaluation of Permanent

Impairment. Currently, DEEOIC requires the use of the 5th Edition of the Guides, but may require use of a newer edition during the life of this contract. The Contractor shall meet a request for use of a newer edition with all necessary materials and training of its staff and subcontractors as may be required.

Physicians Performing Second Medical Opinions:

7. The physicians selected to evaluate a patient by directed medical examination is responsible for conducting a thorough physical examination of the patient, including review of any relevant medical records, diagnostic rest results or other factual information. From this examination, the physician is to produce a comprehensive written medical report that describes the results of his or her physical examination and unequivocally responds to any questions posed by the DEEOIC CE. Any offered opinion should be derived from an objective evaluation of the totality of all available evidence, and be rooted in sound, reasonable medical judgment. Physicians who previously evaluated or provided medical care to a claimant cannot perform a second opinion examination (SECOP).

For SECOPs, the clinical specialties for which DEEOIC has the most need are internal medicine, orthopedic surgery, oncology, physical medicine and rehabilitation, pulmonary medicine, and family medicine. Medical specialists must be available in sufficient number and so geographically distributed as to cover the needs of claimants serviced by the four District Offices. No examination shall require a claimant to travel more than two hundred (200) miles from the claimant’s residence without express permission of the District Director or designee.

8. Most Needed Specialties and Expected Availability:

a. While DEEOIC may require the services of CMCs 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. In addition to Occupational Medicine specialists, the program primarily utilizes physicians with expertise in pulmonary diseases, oncology, hematology, neurology, dermatology, pathology, urology, gynecology, Pharm D, medical toxicology, family medicine, internal medicine, and internal medicine subspecialties.

9. The CMC selected for pharmacy utilization review is responsible for conducting a comprehensive review of the claimant’s medication, health history, before, during and after dispensing of medication.

Pharmacy utilization review must include screening for potential drug therapy problems due to:

Therapeutic duplication

Drug disease contraindications

Drug interactions

Incorrect dosage or duration of drug treatment

Drug allergy interaction

Clinical abuse/misuse

Pharmacy utilization referrals must be referred to a CMC who has credentials of Pharm D.

1.2.4. FEDERAL CLAIMS EXAMINER

The CE maintains responsibility for the case and uses the services of the CMC for direction and clarification. The CE determines when a CMC referral is required. The CE identifies the appropriate specialty on the Contact Medical Consultant Form. When referring a case to a CMC, the CE must provide the following to the Medical Scheduler (MS) as a complete package:

1. Medical Consultant Referral Form for Case File Review (Example, Exhibit A-1);

2. SOAF format (Example, Exhibit B);

4. List of Questions for the CMC to address (Example, Exhibit C).

1.2.5 FEDERAL MEDICAL SCHEDULER

Each District Director designates a MS who processes, tracks CMC referrals, and ensures prompt payment of the bills. In addition, the MS notifies the Contracting Officer Technical Representative (COR) of any problems dealing with the CMC.

1.2.6. DELIVERY OF CLAIM FILE MATERIAL, SOAF, AND CLAIMS EXAMINER’S

QUESTIONS

Before requesting a medical opinion, the responsible CE shall prepare a SOAF and a list of pertinent questions for the Contractor’s CMC physician which are specific to the issue at hand. These materials, along with copies of all appropriate medical reports from the case file and any DEEOIC reporting forms which are appropriate to the medical issue and the information sought, will be prepared for delivery to the Contractor.

1.2.7 CMC HANDLING OF CASE MATERIAL

The CMC medical opinion shall constitute a complete review of the case file. As part of the case file review the CMC shall do the following:

1. For causation medical opinions, impairment evaluations, diagnosis clarification, pharmacy utilization review, expedite /terminal, SECOP, and Referee:

a. review the SOAF and list of questions to be addressed in the report;

b. review all medical reports including radiology, pathology and other diagnostic reports made available from the case file;

c. review any factual documents including photographic evidence;

d. answer all questions submitted by the CE. An unequivocal response is to be provided to each question along with sufficient written discussion to clearly describe the evidentiary basis for the response provided. 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.

2. For SECOP and Referee Medical Opinions:

a. take claimant’s complete medical history, including a history of the injury or disease related to the claim;

b. review claimant’s subjective complaints;

c. perform a complete examination of the claimant, as appropriate to the physician’s medical specialty and professional license

d. 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. DEEOIC authorizes any non-invasive diagnostic procedure that is substantively related to the condition or issue which gave rise to the second opinion referral or referee referral, and which the examining physician feels 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 DEEOIC. 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 this solicitation.

NOTE: Physical examinations shall be performed by physicians who are licensed to do so.

1.3 OBJECTIVE

The objective of this requirement is to (1) Develop a tool for recruitment and oversight of CMCs providing case review; (2) Utilized CMCs with the appropriate medical specialty for case review; (3) Ensure the participating CMCs meet the professional qualifications; (4) Coordinate CMC review of case files for the purpose of obtaining medical opinion on causation, impairment, and other relevant medical matters; and (5) Procure medical second opinions , referee opinions, pharmacy utilization review, interpreter and medical records translation services for affected claimants identified by the District Offices.

1.4 SCOPE OF WORK

1. Claimants Covered and Work to be Performed. The affected claimants reside anywhere in the United States. Cases are managed by the District Offices in Colorado, Ohio, Florida, and Washington.

The District Office staff will provide to the Contractor all necessary information pertaining to covered claimants.

2. Causation. Opinions on causation shall be provided for approximately 2,500 DEEOIC claimants per annum, which will be under CLIN 0001 when billing.

a. When a Causation Review requires referee file review (approximately 25 per year), the referee file review should be applied under CLIN 0008 when billing.

b. When a Causation Review requires expedited handling within a 24-hour turnaround (approximately 40 per year), the causation file review should be applied under CLIN 0001 and CLIN 0011 when billing.

3. Impairment. Impairment evaluations shall be provided for approximately 2,000 DEEOIC claimants per annum, which will be under CLIN 0002 when billing.

a. When an Impairment Evaluation requires referee file review (approximately 10 per year), the referee file review should be applied under CLIN 0010 when billing.

b. When an Impairment Evaluation requires expedited handling within a 24-turnaround (approximately 35 per year), the impairment evaluation should be applied to CLIN 0002 and CLIN 0011 when billing.

4. Diagnosis Treatment. Approximately 100 file reviews providing an explanation of treatment modalities, the interpretation of clinical test results, assistance with establishing or confirming a diagnosis, and the clarification of other physicians’ reports shall be provided per annum, which will be under CLIN 0003 when billing .

a. When a Diagnosis Treatment requires expedited handling within a 24-turnaround (approximately 5 per year) the diagnosis treatment evaluation should be applied to CLIN 0003 and CLIN 0011 when billing.

5. Wage Loss. Approximately 50 opinions assessing an individual’s ability to work during a given time period as it relates to a covered condition shall be provided per annum, which will be under CLIN 0004 when billing.

a. When a Wage Loss referral requires expedited handling within a 24-turnaround (approximately 5 per year), the wage loss referral should be applied to CLIN 0004 and CLIN 0011 when billing.

6. Supplemental. Supplemental Reports shall be provided for approximately 250 per annum, which will be under CLIN 0005 when billing.

a. When a Supplemental referral requires expedited handling within a 24 hour turnaround (approximately 10 per year), the supplemental referral should be applied CLIN 0005 and CLIN 0011 when billing.

7. Cancellation. Appointment cancellation shall be provided for approximately 15 per annum, which will be under CLIN 0006 when billing.

8. Second Opinion. Medical second opinion services shall be provided for approximately 200 DEEOIC claimants per annum, which will be under CLIN 0007 when billing.

a. When a SECOP evaluation requires a Referee Physical Examination Referral, it should be applied under CLIN 0009 when billing. It is estimated that approximately 10 will require a referee physical examination referral.

9. Referee Medical Opinion. For examples, see 2. a., 3.a., and 8.a.

10. Diagnostic Testing. Diagnostic testing services shall be provided for approximately 80 DEEOIC claimants per annum for Second Opinion examination and Referee examination, which will be under CLIN 0012 when billing. All diagnostic testing will be paid based on the OWCP fee schedule. Refer Section 2.2 (PAYMENT FOR DIAGNOSTIC LABORATORY TESTS AND DIAGNOSTIC

PROCEDURE FOR IMPAIRMENT EVALUATIONS, SECOND MEDICAL OPINION

EXAMINATIONS, AND REFEREE MEDICAL EXAMINATIONS).

11. Interpreter Services: Interpreter services shall be provided for approximately 100 DEEOIC claimants per annum, which will be under CLIN 0013 when billing.

12. Medical Records Translation Services: Medical Records Translation services shall be provided for approximately 100 DEEOIC claimants per annum, which will be under CLIN 0014 when billing.

13. Pharmacy Utilization Review. Pharmacy Utilization review services shall be provided for approximately 360 DEEOIC claimants per annum, which will be under CLIN 0015 when billing.

For the expedited/terminal cases, the processing time shall be no more than 24 hours from receipt of referral for requests received Monday through Thursday, and the Government will pay an increase above the current service price.

For the expedited/terminal cases received by the Contractor on a Friday, on or before 10:00 am PST, the Contractor shall process the referrals and return to the issuing District Office the same day within 2 hours of receipt of the referrals; and the Government will pay an increase above the current service price.

For the expedited/terminal cases received by the Contractor on a Friday, after 10:00 am PST, the process time shall be 24 hours from receipt of the referral and return to the issuing District Office no greater than the same time on the next business day; and the Government will pay an increase above the current service price.

For all expedited/terminal cases, the physician report shall be faxed to the issuing District Office, in addition to returning the report through the Client Portal. The 10:00 am PST cut-off time on Friday will be checked against the District Office’s submission of the request through the Client Portal. Submission will not be based upon when the request was retrieved by the Contractor, but when the request was submitted by the District Office and received in the Client Portal at the Contractor’s office.

DEEOIC will notify the Contractor, via e-mail, phone and fax for expedited requests that have been entered through the Client Portal.

1.5. SCHEDULING MEDICAL OPINIONS, IMPAIRMENT EVALUATIONS, SECOPS, OR

REFEREE MEDICAL OPINIONS

Upon telephone, written notice or website notification from the District Office of the need for a medical opinion, impairment evaluation, SECOP, or Referee Opinion by a medical specialist, the Contractor shall do the following:

1. review the District Office SOAF and the list of questions to be addressed by the CMC and determine if the referral is for causation, impairment, SECOP, or Referee Medical Opinion.

2. for CMC Medical Opinion and Impairment Evaluation case file review:

a. Match the CE request for the necessary medical expertise with the appropriate CMC. There are several different types of questions that arise that require an opinion from a CMC with specific medical expertise. Some cases may require input from more than one CMC. The CE considers the following when requesting a CMC opinion:

(1) For questions regarding causation or wage-loss – these questions are usually handled by occupational medicine specialists. Occupational medicine specialists can also evaluate the diagnosis and treatment of common, classic occupational lung conditions; i.e., asbestosis, silicosis, chronic beryllium disease, pneumoconiosis, chronic obstructive pulmonary disease, and asthma, among others.

(2) For questions regarding diagnosis or treatment – these questions are usually best handled by a medical specialist for the condition or procedure being considered (see example list below).

Internal Medicine and subspecialties, Family Practice, Emergency Medicine, Pulmonary, Hematology, Oncology, Geriatric Medicine, Neurology, Dermatology, Surgery, Rehabilitation Medicine, Obstetrics-Gynecology, Pathology, Toxicology, Pain Medicine

(3) For questions regarding impairment – these evaluations are best performed by those CMCs with specific impairment experience for the particular organ system. Cases that require impairment ratings in more than one organ system should be completed by a CMC who has “whole body” expertise. Cases that require impairment expertise regarding specific organ systems should be completed by a CMC who has expertise in the specific organ system; e.g., Whole Body (All organ systems), Musculoskeletal, Pulmonary, Neurology, Cardiovascular, Skin, Ears, Nose, Throat, Eye, Psychiatric.

(4) For questions regarding pharmacy utilization– these evaluations are best performed by those CMCs with doctorate degree in pharmacy.

(5) Cases that require evaluation of the diagnosis and an impairment – evaluation for the same condition might require one specialist to render an opinion on the first question and an impairment specialist for that organ system to perform the impairment evaluation.

b. within two (2) days from the first notice, select and confirm a CMC with the appropriate medical specialty as identified on the Contract Medical Consultant Form.

c. within two (2) days from the first notice, notify the District Office in writing of the CMC’s name, address, telephone number, and e-mail address. The District Office designee will place this information in the case file for tracking purposes. The District Office will either mail a copy of the CMC referral package or upload a copy of the referral package, via a secured portal, to the Contractor.

3. for Second Medical Opinions:

a. 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 to the DEEOIC CE, using a format specified by DEEOIC. The site of the examination must be within the appropriate commuting distance as defined in subsection 1.2.3.7 above. Exceptions to this travel restriction may be granted only with the express permission of the District Director or designee. The date of the examination must allow the claimant to receive at least fourteen (14) days advance of notice of the appointment date.

b. within five (5) days from the first notice, notify DEEOIC, in writing, of the specialist’s name, address and phone number, and the date and time of the scheduled appointment.

c. reschedule an appointment only once to suit the convenience of an examining physician. The date of the rescheduled examination shall be not more than fourteen (14) days from the first notice form DEEOIC. In the event of a rescheduling to suite the convenience of an examining physician, the completed report shall be delivered to DEEIOC within twenty-eight

(28) days from the first notice from DEEOIC. 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.

d. Notify DEEOIC within for (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 DEEOIC permission. Rather, the Contractor must notify DEEOIC so the responsible CE may decide the issue.

e. 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 the claimant did not report or did not cooperate, the Contractor shall so notify DEEOIC within seven (7) days of the scheduled appointment date.

4. when assigning cases to a CMC, the Contractor shall distribute cases by specialty or expertise and availability. The Contractor has twenty-one (21) days from the date of receipt of the referral package to return a completed report to the responsible District Office. The CMC report is accepted by the District Office when the Contractor receives payment for the report. At that point, the case materials should be destroyed by the use of a shredder or burning, if shredding is not an option. It is expected that this period will not be longer than thirty (30) days.

a. If the District Office determines that the report submitted by the Contractor is not properly responsive to the questions posed, is incomplete or incorrect, the District Director will return the report to the Contractor and request the Contractor provide an additional report to correct the situation. The CMC shall provide the additional report within fourteen (14) days of receipt of the request without additional charge. The District Office will notify the Contractor, in writing, of the request for the additional report.

5. not assign one CMC to conduct more than 33% of the medical opinions, impairment evaluations, SECOPs, or Referee Medical Opinions per annum.

6. not set a minimum number of cases to be referred to an individual CMC; no minimum number of cases is guaranteed to each CMC.

7. contact either the Medical Scheduler or the CE with any questions regarding the case.

8. contact the District Office within seven (7) days of receipt of the referral package, if the Contractor’s CMC identifies exposure issues that require further development before a medical opinion can be rendered. The CE will determine whether to pursue further exposure data or whether an industrial hygiene (IH) referral is warranted. After development, the District Office will submit the IH report or additional exposure information to the Contractor for referral to the same CMC. The Contractor’s CMC will then have twenty-one (21) days from the date of receipt of the IH report or additional exposure information to return a completed report to the District Office.

1.6 CONTRACT MEDICAL CONSULTANT REPORTS

Case File Review Reports. The CMC report must be typed and contain the physician’s name and signature. The CMC’s professional address, telephone number, and state medical license number should be on file with the Contractor and District Offices. The medical report should be clear and convincing to medical and non-medical personnel. It should follow a logical progression from premise to evidence and conclusions, leaving the reader clear on what was said and convinced of the conclusions. It should be thorough and well-rationalized. In addition, each CMC report must include a certification statement as determined by DEEOIC regarding potential conflicts of interest. In writing a report, the CMC should use the following outline:

1. Case Identification. The CMC should identify the case using the claimant’s full name and last four digits of the case number of the employee. In addition, the conditions or diagnoses accepted by the program (if any) should be mentioned. This information is found in the SOAF.

2. Clinical History or Summary. The CE should include a brief clinical summary of the case based on the medical evidence on file and in the SOAF.

3. Response to the CE’s Questions. The CMC should write the opinion clearly, explaining complex medical terminology, using only standard abbreviations and defining any abbreviations used. When the CE asks more than two (2) questions, the questions should be numbered and the CMC should number and answer each question separately.

4. Conclusions. The responses to the CE’s questions involve medical conclusions. Such conclusions should be developed from the available medical data in a logical, step-by-step manner and written in a fashion that allows a non-medical staff person to follow the CMC’s reasoning. Each case should be evaluated on its unique set of facts. Using findings, conclusions or other rationale from similar case situations should not be the basis for forming a position on the case under review. Conclusions should be as definite as possible, given the available information. The physician should avoid such terms as “perhaps”, “rule out”, etc. If the medical evidence is insufficient to reach a more definitive conclusion, the CMC should ask the CE to request additional medical information from the claimant or the treating physician. The CMC should ask the CE for specific reports or information.

5. The Use of References. The CMC should cite published studies to make a point or support a conclusion. When doing so, the CMC should be aware that saying “according to current medical literature…” is not sufficient alone. The CMC should also include some specific references in the body of the report or in a separate list of references. The CMC should reference all documents used in decision-making, either in the text of the report or in a separate list.

1.7 SECOND OPINION REPORTS

The physician/specialist’s second opinion report shall be complete, responsive to all questions posed by the CE, and submitted in the form and format specified by DEEOIC. All claimed conditions identified in the SOAF must be examined. All questions submitted by the DEEOIC CE 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 evidentiary basis for that conclusion. For each conclusion 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 SOAF, 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 (last four digits) 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 treatment to date, as well as an identification of any underlying or preexisting condition(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;

(1) Laboratory tests and diagnostic procedures must be performed by or under the supervision of a person licensed to perform then 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 full name, DEEOIC whole claim number, date of the test, the objective data obtained, and the signature of the person responsible for performance of the test or procedure.

(2) 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 recovery, if expected.

3. ensure that all reports fully answer all specific questions the CE posed; 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. if the request from the CE also requires an impairment evaluation, ensure that reports are written in accordance with the 5th Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment and current DEEOIC 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.

1.8 HANDLING CASES OF REFEREE MEDICAL OPINION REFERRALS

1.8.1 BACKGROUND

The Office of Workers’ Compensation Programs (OWCP), Division of Energy Employees Occupational Illness Compensation (DEEOIC) is responsible for adjudicating claims associated with Part B and Part E of the Act. According to 20 CFR § 30.411(b) under the EEOICPA Regulations, if a conflict exists between the medical opinion of the employee’s physician and the medical opinion of either a second opinion physician or an OWCP medical adviser or consultant, or a qualified physician submitting an impairment evaluation, the OWCP shall appoint a third physician qualified in the appropriate specialty who conforms to the standards regarding conflicts of interest adopted by OWCP to make an examination or an impairment evaluation. This is called a referee examination.

1.8.2 SERVICES

A Referee Medical Examiner is a CMC who will review and evaluate relevant medical evidence to resolve a conflict in medical opinion. Referee Medical Examiners (RME) assist the DEEOIC by reviewing and evaluating the medical evidence of record and providing written medical opinions that serve to resolve conflicts in medical opinion. To obtain the RME written opinion, the DEEOIC may choose to have a RME conduct a physical examination of a claimant, or limit the evaluation to available medical or other records from a case file.

1. Under the DEEOIC claims adjudication process, conflicts of medical opinion may arise for a variety of reasons including:

a. causality issues involving the work-relatedness of a given disease; e.g., whether exposure to particular toxic substances at work caused, contributed to, or aggravated the disease; the role of the covered illness in the death of a claimant, or the appearance of secondary or consequential diseases or injuries, etc.

b. the…