01 Questions and Answers Amendment 0002.pdf

Questions Answers are in Bold and underlined.

Contracting Questions

Can you extend the deadline of proposal submission by 2 weeks?

No

Will DHA please consider changing the set-aside to SDVOSB? If not, will the Government add rating credit for Veterans (SDVOSB-VOSB) in the evaluation factors?

No

Are you planning to award the contract to a single vendor or multiple vendors? Will this contract be awarded to a single vendor?

Single Vendor

Who is currently performing these services? Which radiologists? Who is currently performing these services? Which radiologists?

This contract will be the first one for these services DoD wide. Currently the separate services and sites have different contractors.

Would you consider a 10% price evaluation difference for HubZone small business? Do you consider hub zone small businesses to bid more than the max order limitation? (but no more than 10% above of the max order limitation) No

We are a physician-owned small business and would joint venture with a larger group to bid on this project; is that acceptable? We are a physician-owned small business and would joint venture with a larger group to bid on this project; is that acceptable?

Proposals that are compliant with the terms of the solicitation and applicable law and regulations as to small business joint ventures will be considered. We recommend that you reach out to your servicing Small Business Administration office for assistance.

Do you accept a separate pricing for the IT infrastructure costs? There are significant IT costs involved especially if this needs multiple HL7 integrations.

No it needs to be included in the proposal.

Will DHA make the referenced, embedded PDF, Word, and Excel files on page 159, Part 7, and Appendix C available? They are not openable.

Yes

May offeror use its own Past Performance Questionnaire template or will DHA provide a preferred template?

Offeror can use their own template, and must include references for verification purposes.

Additionally, it must be consistent with the terms and requirements of the solicitation.

Page 105 says, "At a minimum the culminations of the five (5) past performance references must include the following: a) Work that involved the credentialing of radiologists within an MTF." In lieu of an MTF can this be for another Federal Government agency or private hospital?

If no MTF privileging experience exists, yes.

Do sub-contractor consent letter(s) count towards the 15-page limit for Past Performance?

No

On page 105, can the “Limited to no more than 5 past performance references…” include past performance of the Prime and Subcontractor? And, can the Prime and Subcontractor each submit up to 5 past performance references, so up to 10 references for a prime with one sub?

The stated limitation in the solicitation applies. No more than 5 past performance references, including any references for subcontractors, will be submitted

Will DHA make the referenced, embedded PDF, Word, and Excel files on page 159, Part 7, and Appendix C available? They are not openable.

Yes

For PART I, do elements b (SF 1449), c (Fill-ins), and d (amendments), count towards the10-page limit?

No

For PART II, do the approximately 38 SF 1449 pricing pages count towards the 7 page limit? Or should Offerer reformat the SF 1449 pricing pages so that it fits within a 7-page limit?

No

Page 106, the table that summarizes the proposal submission asks that Past Performance have a file name of "Part IV". Is this in error and does DHA request that Past Performance have a file name of "Part III"?

Yes, it should read “Part III.”

Page 161 says "The Contractor shall complete and submit all sections of the Medical Device Equipment Risk Assessment (MDERA Questionnaire)(See attachment in para 7.5 of this PWS), provided by the Government, with proposal." Please confirm that the MDERA Questionnaire is required to be submitted with proposal, and if so, which Part is it to be included in?

The Medical Device Equipment Risk Assessment (MDERA Questionnaire) is required and it should be included in Past Performance.

Can the agency confirm if Parts I, II, and III are to be separate sections of one master proposal?

Or are these Parts intended to be submitted as 3 separate, individual attachments/files?

Yes, each part needs to be a separate file.

In Addendum to FAR 52.212-2 Commercial Items, (2) Past Performance Factor (pages 108- 109), Can the agency confirm how past performance PPQs are to be submitted (e.g. directly from the customer or included with the submission)?

PPQs should be included with the submission.

Can the agency provide the blank PPQ forms they wish vendors to use, as referenced on page 105 of the solicitation document?

Offerors provide their own template.

We understand that this is an IDIQ contract and that section 53.216-19 (a) specifies that an order less than $1500 does not need to be honored. However, this contract requires significant upfront investment in terms of IT work, infrastructure and credentialing of contractors at the various MTFs. There is also a large potential number of exams that would require additional radiology personnel be scheduled on a daily basis. Therefore, we request that a substantial number of exams be guaranteed on a monthly basis and an estimated daily number of exams be provided.

This solicitation is in fact for an IDIQ. The minimum guarantee and related terms apply as stated.

Solicitation pages 3 to 38 Pricing schedule What is the Estimated Total Annual Cost? How is it calculated?

The estimated total contract value is $66,855,348. This amount was calculated based on historical quantities, costs, and allowances for future increase.

Is there a maximum total amount for the contract per year and/or in total for the contract duration?

Total maximum value is $66,855,348.

Section 52.216-19 Order Limitations (OCT 1995), page 85 Is the amount “Any order for a single item in excess of $66,855,348.00” referring to the annual total maximum contract value for the contractor or is it the per year amount?

Maximum total contract value.

MTF Questions

How many total MTFs are there in this contract?

Unknown exactly how many will eventually utilize it. Currently about 30 MTFs use similar separate contracts.

Which states are these MTFs located in?

Images are currently coming from MTFs in these states: AK, AZ, CA, CO, FL, GA, KS, KY, LA, MD, MO, MS, NC, NV, NY, OH, OK, PA, SC, TX, VA, WA. Additional states are likely to be added in the future.

Can the agency provide an example of a site map for all locations?

No, not at this time.

Can DHA provide updated MTF site map with anticipated study volumes per site, and/or by state, and/or country?

No.

Will DHA provide anticipated volumes by MTF by Day of Week and by Time of Day? If not available by MTF, is it possible to provide this info by State? Approximate annual historical volumes by state in which the patient was imaged is provided by for reference:

OCONUS 9397

AK 4306

AZ 49

CA 15034

CO 6297

FL 12427

GA 17223

KS 11100

KY 9609

LA 4827

MD 5643

MO 2557

MS 8134

NC 11316

NV 4075

NY 1684

OH 6129

OK 397

PA 21

SC 5556

TX 66081

VA 4732

WA 3273

Can we get a more details on the exact states we have to provide service? Then for each state what the exam volume would be by imaging modality and hours of service needed. This will help with strategy and planning a schedule of radiology coverage to understand our needs before we can speak to anyone.

Unable to provide a complete breakdown, but historically, the distribution of examinations by modality has been 50% radiography, 32% CT, 10% MR, 7% US, and 1% NM.

MTF PACS Questions

Do all MTFs connect to one main PACS system? Do we need to create an individual HL7 interface for each MTF separately? OR one main bidirectional HL7 interface is adequate for all the hospitals?

For each CHCS site a separate HL7 connection is required. It may be possible to use a common interface for all sites on MHS GENESIS, but this remains to be determined.

Do all MTFs connect to one main PACS system?

No. There are about 50 different PACS servers.

Do we need to create an individual HL7 interface for each MTF separately? OR one main bidirectional HL7 interface is adequate for all the hospitals?

See above.

Page 142 says there is a 30-day retention of data limit. If the Contractor wants to keep prior studies for longer than 30 days in its PACS to improve patient care and efficiency of future reads, is this permitted?

Prepare the proposal based on the current PWS. The program will research whether this limit can be extended.

Do you anticipate transition of CHCS to MHS GENESIS may also change the PACS system? Do you expect vendors to redo or modify the HL7 with the change in EMR system?

Currently MHS GENESIS deployment is not coupled with PACS updates. In the future we hope to have all MTFs on the same PACS, but timeline is uncertain and this will probably take several years.

Is vendor required to store the imaging and reporting data in our PACS system/cloud? If so, how many years?

Prepare the proposal based on the current PWS. The program will research whether image and report storage in your PACS/cloud is required, and for how long.

Can the agency confirm if the Contractor required to provide one central PACS system for all regions, or if we are to use the agency’s preferred system?

There are no architectural restrictions on how the contractor decides to use its PACS to generate interpretations, but from the point of view of the government preference is that it appear as one system.

If we operate our own private, in-house, on-premise PACS and do not provide access except to our authorized staff, are we required to go through the RMF process and obtain an

ATO?

Determination of full RMF process versus a services process is usually contingent upon contractor hardware being required at the MTF, but this decision will depend on all the details of the contractor’s proposed solution.

Radiologists Certification Questions

Does the agency require the vendor to submit proof of board certification, education, and training, at the time of proposal submission?

No. Ability to privilege board certified radiologists will be evaluated in Past Performance.)

Which credentials of the radiologists must be included in the proposal?

None

Do you accept board eligible radiologists too?

See paragraph 1.11.3.3

Will DHA consider allowing one license where the radiologist is interpreting images to suffice vs also needing to have a license where the images originate?

This has been considered, but is not approved at this time.

Will DHA please make it a requirement that the Prime Contractor is Joint Commission accredited?

No.

Will DHA consider following the VHA example and require licenses only in the state where the examinations are interpreted?

This has been considered, but is not approved at this time.

Must a list of proposed radiologists be included with the proposal?

No.

Will credentialing be centralized?

No. However, only one privileging action is required for each of your company’s radiologists. Their privileges will be accepted by proxy by all other MTFs as part of this contract, although you will still need to verify and provide evidence of maintenance of appropriate state licensure and malpractice insurance in the state jurisdiction of every MTF they are supporting.

How do Contractors add or delete physicians from our privileging list with the MTF privileging authority?

This is specified in PWS para 1.11.3.8 and sub-paragraphs.

Does the company need to be group privileged?

Each individual radiologist must be privileged by at least one MTF.

1.11.3.7 Licensure. Would you change the licensure requirement for Radiologists to hold an unrestricted license in the state where they read images from? (instead of where images originate from).

No.

How long does physician credentialing take once all the applications and documents are submitted?

See para 1.11.3.8

Is there a CVO / centralised verification office where we can submit credentialing applications to one place? OR Do we have to submit credentialing applications to each MTF? Do you accept delegated credentialing from JCAHO accredited CVOs?

Each radiologist must be privileged at an MTF. Once they are privileged at one MTF, privileges will be accepted by proxy by all other MTFs as part of this contract. The contractor will still need to verify and provide evidence of maintenance of appropriate state licensure and malpractice insurance in the state jurisdiction of every MTF they are supporting.

Regarding the radiologists requirement, will the DoD consider using the VA model for medical licensure. One valid state medical license will suffice to be able to read for other states considering we are still in challenging times in healthcare and need to be able to provide service nationwide as required for patient care.

This has been considered, but is not approved at this time.

IT Questions

What are the limits of cyber liability insurance that you need for this contract?

This is not a government requirement.

Will studies be sent to a central DHA Server and the sent to the contractor's server?

No, although this may become possible in a few years.

Will the Contractor be expected to host data, or will they be granted access? If so, how does the Contractor gain access?

No requirement for the contractor to host data.

Page 124 of the solicitation document details that a Position of Trust is the minimum eligibility for Information Assurance Technical level II (IAT-II) which is required for B2B Gateway/DoD network access. Can the agency define the Position of Trust and what this entails?

It will be what is called a T3 investigation or National Agency Check, Local credit/check (NACLC). Refer to para 1.44.3 for security clearance instructions.

CT Questions

For CT Cardiac/Coronary Angiography STAT, which MTFs (States or countries) are most likely to send these types of studies and during what time of day, business hours or after business hours?

We do not currently send cardiac CTs to teleradiology contractors and may not in the future, but wanted to leave this option available for this contract. Only our larger MTFs would be capable of performing these examinations.

Since CT Abdomen and Pelvis counts as one CT, how many CT A/P are expected per Period of Performance (POP)?

Approximately 20,000 annually.

Since CT liver with pre-contrast and multiple post-contrast phases counts once, how many of these studies are expected per POP?

Less than 1,000 annually.

Per 5.3.6.5. CT Cardiac/Coronary Angiography - Contractor shall be responsible for post-processing of DICOM raw data required for interpretation. This is uncommon. Would you consider having the raw data processed at MTF?

We do not currently send cardiac CTs to teleradiology contractors and may not in the future, but wanted to leave this option available for this contract. Only our larger MTFs would be capable of performing these examinations.

How many STAT CT cardiac / coronary angiography studies are done between 8P-8A as radiologists need special privileges for this imaging and have to be adequately staffed during this time?

We do not currently send cardiac CTs to teleradiology contractors and may not in the future, but wanted to leave this option available for this contract. Only our larger MTFs would be capable of performing these examinations.

How many CT scans and MRIs are done without contrast versus with and without contrast?

Specific information is not available, but ratio is expected to be similar to that seen in the community.

General Questions

How was the maximum pricing determined?

Based on average historical quantities and costs from select contracts from each service (Army, Navy, Air Force).

In our team’s experience obtaining an ATO would be extremely challenging within 180 days of award. Often times an ATO will take more than one year to accomplish. Can this contract be modified to allow a min of 365 days post award to obtain ATO?

No

We see a total of more than 2 million readings per year. Can a vendor expect these numbers to be accurate within the 10% range?

No. The estimated workload data in the PWS is total for the life of the contract. Annually, that equates to approximately 400,000 annually.

Do you expect Vendor to read all the imaging studies (2 million per year) from all MTFs starting April 2020? OR Is there a gradual step up approach where 1-2 MTFs are added slowly over a period of few months?

As MTFs have the need, task orders will be awarded, and studies will step up. This is an Indefinite Delivery/Indefinite Quantity contract.

What is the meaning of w/30% Contingency on Page 175? (estimated workload data).

Quantities were originally estimated based on historical numbers from the Services, and an additional 30% was added to those historical numbers.

On performance requirement summary, would you consider to decrease the acceptable quality level to 90%? A 100% compliance is practically not possible and not reasonable.

Licensing, credentials, privileging to remain at 100% compliance.

Do you have the numbers / data on the STAT studies that are performed between 8PM EST -

8AM EST?

No. A breakdown by priority is not available at this time. However, there will be some number of studies that will need done during this time.

How many US are done without doppler versus with doppler?

Composition of ultrasound examinations is similar to that seen in community practice.

MRI Total spine - Is this considered as one study or 3 studies (Cervical, Thoracic, Lumbosacral spine)?

3.

In section 1.51. (page 112) of the solicitation, what kind of nuclear services or studies are included? Can the agency confirm if this includes SPECT or PET imaging? Does this include body and/or cardiac imaging?

Doesn’t include PET. Includes body/cardiac. Most common procedures are biliary scintigraphy, cardiac imaging, perfusion/ventilation scans, and bone scans.

If SPEC imaging is required, can the agency confirm how they are transmitted? Will the government be outputting DICOM?

For required SPECT imaging, DICOM will be used.

Can the agency confirm what information will need to be provided to the MTF Privileging Authority prior to starting contract work? Is there preliminary work Contractors can do on background checks and security training prior to award to expedite this process?

Contractor must ask an MTF privileging authority for this information and won’t know this until the TO request for proposal is sent.

In section 1.10.1 Quality Control, can the agency confirm the expected components of the quality control plan? The government expects a QC plan that includes description of:

a. Process to collect and a methodology to report the quality metrics to include turn-around-time, critical test reporting, and critical result reporting IAW PWS requirements.

b. Process to satisfy The Joint Commission (TJC) for focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE) IAW PWS requirements

c. Process to provide timely and accurate telephonic and Non-Routine Communication for CRITICAL Test and CRITICAL Results IAW the PWS.

d. Process to provide timely, accurate, and complete Final Reports for STAT and Routine Studies, IAW PWS requirements.

e. Process to comply with the consultation requirements IAW the PWS.

f. Process to comply with cybersecurity requirements IAW the PWS.

What EHR is the agency using currently? Is the Contractor expected to use the existing system or provide their own?

Some MTFs use CHCS and some MTFs use MHS GENESIS. MHS GENESIS is a Federal government version of Cerner Millenium. CHCS is being phased out as MTFs transition to MHS GENESIS. This transition should be completed by 2024.

In Section 1.6.1.2.1, page 112, can the agency clarify when the Phase-In process starts?

The phase-in period will start on the effective date on SF 1449. For planning purpose, that will be on/about 1 April 2021.

In Section 1.11.3.7, page 116, can the agency clarify what volume of business will originate from within the continental US, and which state(s) this will include?

See answer to similar question above.

Can the agency confirm what form billing expected to take (e.g. itemized or global)?

Billing will occur for each individual task order.

Will HCSA 1500 forms be required? What level of itemization will be required?

No. IAW PWS, billing will occur through WAWF.

Do invoices need to have each study by patient name/identifier, or use mass billing?

This will be determined for each task order.

If the contract starts in April 2021, when does Phase-In happen? Can the agency confirm the expected award date and transition period?

There is no transition period. The contractor will have 180 days to get services ready to perform work on the first task order. The task orders will specify whether a transition or phase-in period is required. It will depend on whether the MTF has an incumbent currently providing teleradiology services.

The instructions to offerors section on page 104 of the solicitation does not detail sections or page allotment for a technical approach to the project. Can the agency confirm if a technical response is required for this opportunity, what content it should include, and the page limitation Offerors need to adhere to?

By proposing on this effort, the offeror accedes to all stated performance requirements and outcomes in the PWS and solicitation. There is no technical response needed as the PWS provides the desired outcomes and requirements to be met and adhered to.

In section 1.6.1.2.1 it says: “The Contractor shall have key personnel available during the 180 calendar day phase in period, to complete personnel recruitment, hiring, and MTF credentialing/privileging requirements, to include Government review and approval; complete connectivity requirements such as B2B actions; and complete training and security requirements.

Section 6.6.1 indicates that the security requirements include an ATO. Is a single ATO available across all services branches? We assume that the government will respond quickly to all RMF submissions and that we will not be held responsible for obtaining an ATO within the 180 days if the government is unable to respond quickly.

The Contractor must meet all timelines in para 6.11.1.

In 1.11.3.5, you state the “The Contractor performing the official interpretation shall be responsible for the quality of the images being reviewed and understand the elements of Quality Control (QC) of digital image management systems.” We interpret this to mean that the contractor shall report all quality issues to the DoD, as they will have no control over the equipment or the people performing the exams. Is this accurate?

Partially. Agree that the MTF is responsible for quality of the examination, but feedback from contractor on examination quality is expected, especially if negative patterns are identified. Also, the contractor is expected to discuss with the performing technologist by telephone if an immediate remedy is needed or if requested by the technologist or ordering provider.

In section 1.11.3.8, you request, “The Contractor shall ensure each radiologist obtains clinical privileges from the MTF Privileging Authority prior to beginning work. The Contractor shall follow the clinical privileging processes and requirements outlined in each TO.” Does each MTF have their own Privileging Authority, so that each radiologist would require credentialing at each MTF for which they will be providing services?

See previous answers to this question. Only one privileging action is required for each contractor radiologist.

In section 1.44.3 discusses the T3 investigation. Do we understand correctly that the contractor is also responsible for government charges to conduct the investigations? If so, where can we find the current estimated cost to complete these investigation? Both individual clearance applicants and the government contractors that are supporting cleared personnel do not incur cost for a background investigation. The federal government, through appropriated funds, pays costs of background investigations.

To be clear, the TOs are given a year at a time. We would propose monthly billing as progress payments. The contract includes 252.232-7015 and 252.232.7016. Are these the clauses that support monthly billing?

As the ordering against this IDIQ will be decentralized, these clauses are included to allow flexibility and options at the ordering office level.

Also, what is accepted for proof of the quantity of reports? A single report will be provided for each CPT defined exam. Is the return of the report considered proof? Are on-line reports considered proof? How long is the contracting officer allowed to take to confirm that the invoice is correct?

As part of the Monthly Progress Report, the offeror will provide a spreadsheet that lists all the examinations they reported that month including NPI of the interpreting radiologist, DMIS ID of the supported site, accession numbers, and CPT codes for each examination

Would the government consider tiered pricing? Many of the costs, such as infrastructure and security clearance (RMF), are fixed. However, it is hard to amortize them over an unknown quantity.

Is the government covering any of the costs for RMF or personnel security clearances?

CONTRACTOR RESPONSIBILITIES:

Clinical Personnel Required: The Contractor shall provide contract physician (s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

Do we just need to provide list with the physician name and their address? Please clarify what information is needed for physicians.

Paragraph 1.11.3 outlines the different information requirements for physicians (radiologists).