QASP_Questions_and_Answers_Rev2.pdf

HSCEDM-16-R-00002

Amendment 12

QASP QUESTIONS AND ANSWERS

NUMBER QUESTION RESPONSE

1 The QASP states: “The government will deduct an amount equal to the contractual value of the unfilled position code(s).” Our interpretation is that ICE will deduct the value of the unfilled positions from a starting point equal to our submitted price for 100% staffing coverage. Is this correct?

The Deduction or Withholding Criteria has been modified. See QASP Amendment 12.

2 Is the following example accurate?

a. We staff the ICE contract at 95% of contracted hours (a level far better than the corrections industry average).

b. ICE calculates the contractual value of our 5% unfilled positions.

c. ICE deducts this “5% unfilled” dollar amount from our proposed cost for 100% coverage.

d. We receive net payment (after deductions) for exactly the cost of the hours we provide, i.e., 95% of contracted hours.

The standards applicable to staffing this contract are more rigid due to the unique requirements of detention environments. The Government has relaxed the Deduction Criteria, but it is critical that the Contractor have the capacity to provide the staffing levels identified in the resulting contract.

3 If the preceding example is not accurate, please correct it and indicate how ICE would calculate our net payment (after deduction).

Please see below example of how a deduction is calculated and how that deduction is applied to an invoice.

Example:

Site X Staffing Report Required Actual Week

Pct.

Week

Actual Week 2

Pct.

Week 2

Actual Week 3

Pct.

Week 3

Actual Week 4

Pct.

Week 4

Monthly Pct.

Percentage Withholdings

LVN 23 22 95.65% 22 95.65% 20 86.95% 23 100.00% 95% 0.00%

RN 36 31 86.11% 31 86.11% 31 86.11% 31 86.11% 86% 0.25%

MLP 13 12 92.31% 12 92.31% 13 100% 13 100% 96% 0.00%

MHP 20 17 85.00% 16 80.00% 16 80.00% 15 75.00% 80% 0.50%

Techs/Assist 18 17 94.44% 16 88.88% 16 88.88% 17 94.44% 92% 0.00%

MD/DO/DDS/PharmD. 9 4 44.44% 4 44.44% 4 44.44% 4 44.44% 44% 5.00%

NUMBER QUESTION RESPONSE

Functional Area

Summary of Deficiency Position Level of

Deduction Invoiced Amount

Recommended Deduction Amount Payable

Staffing All position codes at Site X were not fully staffed

RN 0.25% $100,000.00 $250.00 $99,750.00

MHP 0.50% $300,000.00 $1,500.00 $298,500.00

MD/DO/DDS/PharmD. 5.00% $100,000.00 $5,000.00 $95,000.00

TOTAL DEDUCTION FOR FUNCTIONAL AREA: $6,750.00

4 We understand performance metrics for the contract will be reported in CPARS.

Please confirm the actual deduction/withholding criteria will remain the same as in previous iteration of the QASP.

The QASP issued under Amendment 12 supersedes all prior QASPs released under this

RFP.

5 If not, what are the new deduction/withholding criteria? Deductions are as specified in QASP Amendment 12.

6 Individual shifts filled for greater than 50% of the allotted time will be considered filled and not subject to any deductions. Is this correct?

The Backfill for Nursing Staff Functional Area no longer has a deduction criteria associated with

it. However, CPARS will be reported for the Contractor’s consistent or repeated failures to meet acceptable quality levels.

7 With reference to the critical staffing level, can the Government quantify how fees for contracted, unused bedspace will be calculated by facility? How would this work?

The Deduction or Withholding Criteria has been modified. See QASP Amendment 12.

8 Why did the Government shift away from the previously specified deduction targets in Amendment 0005 (e.g. LVNs/LPNs, <85% = 0.25% invoice deduction) to a 100% fill target for all positions at all times before a penalty is assessed?

The Government had incurred significant losses and additional costs as the result of critically low medical staffing levels at some of the more remote locations.

The Government has relaxed the Deduction Criteria, but it is extremely important that the Contractor have the capacity to provide the staffing levels identified in the resulting contract.

9 Level: Less than Full Performance, Deduction: “The government will deduct an amount equal to the contractual value of the unfilled position code(s).” Please clarify if this means that there will be an invoice deduction for all unfilled position codes identified on the J-1 Site Staffing Matrix, based upon a monthly staffing average for each position code at each site? For example, a LPN is scheduled to work 160 hours in a month but only works an average of 80 hours. The invoice shall only reflect the 80 hours actually worked. As no unworked hours may be charged under a T&M contract, further deduction of 80 hours would result in CHSi receiving no payment for the LPN services provided, despite 80 hours of work having been performed. As another example. Site A requires 10 LPN’s and the contractors only fills and invoices for 5 LPN’s. The government will deduct for the 5 vacancies, therefore the contractor will receive no payment. Is it the intent of the Government to provide such punitive deductions for all position codes?

The Deduction or Withholding Criteria has been modified. See QASP Amendment 12.

10 Level: Critical, Deduction: “The government will deduct an amount equal to the contractual value of the unfilled position code(s) plus the cost, if any, of contracted and unused bed-space due to a medically understaffed facility directly associated with the vendors’ poor performance to meet this functional area.” Please clarify how the costs associated with “unused bed-space” will be calculated and provide an estimate what the current bed space cost is by location?. Is this deduction based on the overall facility cost per head? Is this punitive deduction to be levied despite any actual harm to services provided (e.g. bed space that is not, and would not have been, used in any regard due to low patient levels)?

The Deduction or Withholding Criteria has been modified. See QASP Amendment 12.

11 Performance Measure: “Monthly staffing percentages are determined by averaging the weekly percentages presented by the vendor. The monthly staffing percentage is used to determine the deductions.” How are the weekly percentages calculated?

See answer to Question 3 above. A simple calculation of dividing the number of positions filled by the number of positions required establishes the weekly fill rate.

12 Please confirm the percentages are calculated on filled/vacant positions and not on hours worked.

The statement is correct.

13 Can a contractor avoid a deduction by covering a vacant position code with personnel from another position code with the same skill set as long as the additional cost is not billed to the government?

Yes. As clarified in QASP Amendment 12, Staffing, the Contractor, upon acceptance of a waiver by the COR/CO, may fill a vacant position code on a temporary basis using other qualified staff.

14 Based on the timeline anticipated for the receipt of answers to our questions and the potential changes required to our proposal, will the government please consider extending the submission due date?

The proposal due date has been extended.

15 Withholdings/deductions – Our internal assessment shows that the new QASP applies an unbilled amount for each vacancy under the defined unrealistic maintainable staffing levels. Through our initial assessment, we have determined that by applying this new deduction proposing contractors would see a deduction increase of over 4200% applied to the monthly invoice, refer to the example below.

These costs would be paid back to the Government through pure operating costs of the vendor that would most likely lead to unforeseeable impacts to the vendor’s organization. This withholdings methodology aligns with appropriately with a cost plus contract model. Since this is a time and materials contract and this methodology does not align with withholdings metrics we suggest the Government revise the methodology to a more traditional surveillance plan based on appropriate fill rates in line with industry standards for time and material labor contracts. Whereas, the Contractor is penalized for services provided and costs previously incurred.

The Government has not found a question in this statement.

16 Staffing Threshold Levels have increased from 85% to 100% for field site positions. – Given the historical staffing levels provided by the Government, the new requirements are unrealistic from a staffing and human capital perspective.

According to a survey done by Compdata, the national attrition rate for healthcare workers is 19.2%. With the increasing demand for healthcare professionals rising, we expect the number to grow exponentially therefore adding significant risks on the out years of this contract.

At the elevated levels of 100%, this sets any Contractor up for failure from the inception through the life span of this program. It is highly likely that a Contractor will never be and can never be compliant with this requirement.

The Government has not found a question in this statement. The standards applicable to staffing this contract are more rigid due to the unique requirements of detention environments. The Government has relaxed the Deduction Criteria, but it is critical that the Contractor have the capacity to provide the staffing levels identified in the resulting contract.

17 Critical Staffing Levels – The Critical Staffing Level document provided by the Government is incomplete and missing data. Please revise with the correct information for Krome, Washington DC and York. Could the Government please provide missing data points?

QASP Amendment 12 provides a revised QASP Addendum.

18 Critical Staffing Levels Deductions – This deduction is not applicable to labor hour contracts. The cost for operating a bed is unknown, has not been given to industry, and is not tied to a labor hour contract. There is no methodology that has been given to the vendor community that clearly identifies the assessment of cost per bed has been calculated and verified. There is no rationale behind the labor not being present and the operating costs.

Can the Government provide additional information surrounding the methodology for calculating the costs of closing a bed and what terms and conditions would have to occur in order for a bed to be closed?

- How often does this happen?

- Please provide historical data on your cost projections on how this would affect us?

- Who within IHSC will certify that cost as correct?

See response below.

Response:

The Government had incurred significant costs as the result of critically low levels of medical staffing at some of the more remote locations. When staffing levels at IHSC facilities dropped below the levels required to provide the minimum level of medical care, the facilities were no longer permitted to accept intake of additional detainees and those individuals were transported to other facilities of greater distance and at additional costs. In addition, the Government was required to relocate those detainees already housed at the facilities. Additional costs associated with relocating detainees included transportation, guards, meals and housing.

Since the Government is committed to paying for a minimum number of bed space at a number of facilities, after detainees were removed from the facilities that dropped below critical staffing levels and housing paid for elsewhere, the Government was still required to pay those guaranteed minimum costs.

The following is an example of the Government’s liability as the direct result of medical staffing levels falling below critical levels:

1. Detainee population was reduced to 500. The Government was required to pay the minimum guaranteed amount for 1,600 bed spaces (approximately $2.5M per month for two months)

2. Detainees residing at the facility were transferred to a different facility. The Government incurred transportation costs (vehicle, gas, driver) and costs for additional guard services to relocate the detainees.

3. Detainees remanded into custody were taken to facilities at a greater distance, resulting in additional costs for gas, and additional labor hours for drivers and guards.

4. The Government’s liability can be summarized by this equation: Bed space x #days x #detainees + transportation costs = costs for critical medical staffing shortages

Challenges faced by the Contractor:

1. When an IHSC facility is in a remote location, qualified personnel are not always available in the local population and in the numbers required.

2. The state of Georgia does not have a compact license, so all medical providers are required to be licensed in that state.

Qualified and otherwise cleared personnel cannot be temporarily transferred to the facility from other IHSC facilities outside the state of Georgia unless they also hold a license for the state.

In the ten years since establishing contracts for the required services, the Government has only had to stop intake at an IHSC facility once.

19 CPARS –The Government intends to express failure based on unreasonable metrics (100% for nursing backfills, e-QIP submissions, start dates, credentialing, Licensing and privileging, and competency assessments) as identified in the amended QASP.

CPARS is the Government’s performance system meant to highlight positive and negative performance. The way the QASP is written the Government is intending to document negative performance based on unrealistic metrics (100%). Please define how the Government will assess performance and document in CPARS?

For Functional Areas noting CPARS reporting: (a) CPARS will be reported for the Contractor’s overall successes in maintaining acceptable quality levels; and (b) CPARS will be reported for the Contractor’s consistent or repeated failures to meet acceptable quality levels.