ATTACHMENT_2_PRICE_EVALUATION_Sample_Market_Segment_TOPRs.pdf

ATTACHMENT 2

PRICE EVALUATION

SAMPLE MARKET SEGMENT TOPRs

Inclusive in each of the following Sample Market Segment TOPRs:

Physician

MILDEP Ordering Memorandum with TOPR PWS (details sample requirement) Pricing Worksheet (Offerors proposed pricing) (Physician TOPR pricing sheet will be attached in FBO as

ATTACHMENT 2A)

Pricing Rationale Details (Offeror provides if proposing pricing outside of Government range)

Ancillary

MILDEP Ordering Memorandum with TOPR PWS (details sample requirement) Pricing Worksheet (Offerors proposed pricing) (Ancillary TOPR pricing sheet will be attached in FBO as

ATTACHMENT 2B)

Pricing Rationale Details (Offeror provides if proposing pricing outside of Government range)

Nursing

MILDEP Ordering Memorandum with TOPR PWS (details sample requirement) Pricing Worksheet (Offerors proposed pricing) (Nursing TOPR pricing sheet will be attached in FBO as

ATTACHMENT 2C)

Pricing Rationale Details (Offeror provides if proposing pricing outside of Government range)

Dental

MILDEP Ordering Memorandum with TOPR PWS (details sample requirement) Pricing Worksheet (Offerors proposed pricing) (Dental TOPR pricing sheet will be attached in FBO as

ATTACHMENT 2D)

Pricing Rationale Details (Offeror provides if proposing pricing outside of Government range)

SAMPLE MARKET SEGMENT TOPR: PHYSICIANS

MEMORANDUM FOR Market Segment Offeror

FROM: Defense Health Agency Contracting Office-Medical Q Services 4130 Stanley Rd.

Building 1000, Room 235 JBSA Fort Sam Houston, TX 78234

SUBJECT: Sample Market Segment Task Order Proposal Request (TOPR): Physician

1. The Defense Health Agency (DHA) is requesting a pricing proposal be submitted in response to this sample market segment TOPR in conjunction with instructions provided in this solicitation for the purposes of determining reasonable and realistic price.

2. Submission of a pricing proposal that is not identified on the Offeror’s self-scoring worksheet (Attachment

5) will not be evaluated for price.

3. Type of Physician: Pediatricians Period of performance: 1 October 2017 through 30 September 2018 Location: Walter Reed National Military Medical Center (WRNMMC) Bethesda.

4. The offeror’s proposed pricing for this sample market segment TOPR SHALL be entered on the Physician Pricing Worksheet found at Attachment 2A. Only provide the direct rate and unit price on the Physician Pricing Worksheet. The total task order price will be calculated automatically based on unit price x hours per HCW specialty & summed. The Government direct rate ranges and total task order price ranges are provided in paragraph 5 below.

5. The Government will evaluate the Health Care Worker (HCW) direct labor rate and total task order price to determine a realistic and reasonable price for this sample market segment TOPR.

a. Based on an Independent Government Cost Estimate (IGCE), and other market research, the Government has determined the following range of direct rates to be realistic range of rates for the services requested:

Pediatrician Physician Direct Rate Range (per Hour): $83.78 to $132.06

b. Based on an IGCE, and other market research, the Government has determined the following total task order price range to be reasonable for the services requested:

Pediatrician Physician Total Task Order Price Range: $1,082,188.80 to $1,705,804.80

6. If the offeror proposes direct rates or total task order pricing outside of the Government range shown in paragraph 5 above, the offeror will provide their rationale detailing the difference on the Price Rationale Details page below.

7. Prices provided in response to sample market segment TOPRs are for source selection evaluation purposes only. Sample market segment prices will not be tied to any Contract Line Item Number (CLIN) on the Indefinite Delivery/Indefinite Quantity (IDIQ) contracts.

8. The following provision applies: 52.222-46 -- Evaluation of Compensation for Professional Employees.

IN ADDITION TO THE BASIC PERFORMANCE WORK STATEMENT, THE FOLLOW APPLIES:

PEDIATRICIAN PERFORMANCE WORK STATEMENT

1.2. Description of Services:

The services required on this Task Order are under the following special program: N/A

1.5. General Information:

This Task Order is issued under the following arrangement:

X Personal Services: The following labor categories are under a personal services arrangement on this TO:

Pediatrician Physician – 4 FTE

☐Non-Personal Services: The following labor categories are under a non-personal services arrangement on this TO: None

1.5.4. Quality Assurance: The Government will evaluate the Contractor’s performance under this task order IAW a separate Quality Assurance Surveillance Plan (QASP). This Government-only plan is primarily focused on what the Government will do to ensure that the Contractor has performed IAW contract performance standards. The Task Order QASP provides a systematic method to evaluate performance to include how the performance standards will be applied, the frequency of surveillance, and the acceptable quality levels for each of the metrics identified in Technical Exhibit 1, Performance Requirements Summary. The QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the TO while the Government is responsible for quality assurance actions.

1.5.5. Contracting Officer’s Representative (COR): The following individual is designated as the COR for this TO-

Name of COR: Jennifer Felt COR Email Address: Jennifer.n.felt2.civ@mail.mil.

COR Telephone Number: 210-221-6231

1.5.6. Recognized Holidays: The only Contract HCWs who may be required to work holidays on federally recognized holidays are: None

1.5.7.1. Hours of Performance: WRNMMC is a medical center providing services 24 hours per day, 365 days per year (366 for leap year). The pediatric Clinic may have specific hours such as 0730 to 1630 Monday through Friday.

1.5.7.2. Scheduling: The schedule or scheduling process is as follows: COR will provide the work schedule by the 15h of each month for the following month.

1.5.7.3. Recording HCW Time: Changes to the recording of HCW time identified in the contract PWS are as follows: None

1.5.7.4.3. Substitute HCWs: If the Contractor substitutes permanent HCWs for a temporary period of time, the substitute shall meet the same qualification standards and health requirements as stated in the contract. Additional qualification and standards are as follows: None

1.5.7.5. Closures: During a planned closure of the facility due to training, holiday or unplanned closure due to unusual and compelling circumstances (e.g., natural disasters, military emergencies, severe weather), the Contractor will be compensated only for the actual hours the HCW provided services

1.5.8. Place of Performance: The work to be performed under this contract will be at WRNMMC. HCWs shall receive notification two weeks prior to any reassignment.

1.5.9. Mission Essential: The following labor categories are designated as mission essential:

Pediatrician Physician

1.6.1. Quality Control Plan (QCP): The Contractor shall have a planned and systematic QCP that outlines the quality control process covering every aspect of the Contractor’s operation under this TO. The Contractor shall submit a Task Order QCP to the TOKO within 30 calendar days of contract award. The TOKO will approve the QCP in writing. The Contractor shall submit changes to an approved QCP to the TOKO for approval throughout the life of the contract.

1.6.3. Periodic Progress Meetings: Contractor will be required to attend periodic progress meetings at no additional cost to the Government.

1.6.4.2. Representative Status Change: The Contractor shall notify the TOKO in writing of changes in the status (i.e., termination or replacement) of designated Contractor representative within 5 business days of the change.

1.6.6. Contractor Travel: Reimbursement will not be provided for travel within a 40-mile radius of the place of performance. HCW travel requirements are as follows: N/A

1.6.7. Relocation Costs: The Government will not pay the Contractor to relocate HCWs.

1.6.9 Orientation: Orientation will be paid at the billable rate.

1.6.9.2. Computer Skill Competency: Each HCW shall demonstrate competency as required in the contract.

1.6.10. MTF Training: Additional training requirements are as follows: None

1.6.12. MTF Standards: Specific policies, procedures, and instructions/regulations for the place of performance are as follows: WRNMMC, policies, procedures and instructions/regulations.

1.6.20.3. Occupational Health: The HCW shall be required to obtain documentation of required physical testing or a report of a physical examination.

1.6.20.5. Tuberculosis Screening: The additional immunization/screening requirements for the risk of exposure to tuberculosis (TB) are as follows: None

1.6.25 Competency-Based HCW Interviews: Prior to HCW placement, the Government will contact the HCW to determine if the HCW is meets the requirements set in the contract and/or task order.

3. Government Furnished Items and Services:

3.1. General: The following additions are made to the Government furnished items and services for this TO: None

4. Contractor Furnished Items and Responsibilities:

4.1. Rubber Stamp: The Contractor will be required to ensure privileged HCWs providing services on this contract have a rubber stamp.

4.2. General: The following Contractor furnished items and services are required for this TO: None

5.1. Task 1 – Recruit (Recruit/Retain): The duties for each qualified HCW are as follows: As outlined in Exhibit 5 of the contract.

5.2. Task 2 – Qualify (Qualifying/Credentialing). In addition to the qualifications listed in the contract, the following additional or supplemental qualifications are required for HCWs on this TO: None

5.2.3. Certifications: In addition to the qualifications listed in the contract, HCWs shall maintain the following additional certifications: None

5.2.4. HCW Education Requirements: In addition to the qualifications listed in the contract, HCWs shall meet the following additional education and experience requirements: None

5.2.6. Qualifying/Credentialing Packages: The Contractor shall provide a complete package, Clinical Quality Management. The packages needed for this TO are as follows:

5.2.6.2. X Qualifying Package: The Contractor shall provide a complete, current, and accurate qualifying package:

Pediatrician Physician

5.2.6.3. Credentialing Package for Non-Privileged HCWs: None

5.2.6.4. Credentialing Package for Privileged HCWs: The Contractor shall provide a complete, current, and accurate credentialing package for Pediatrician Physician within 45 days of placement.

5.2.6.4.1. Clinical Competency: Each HCW requesting clinical privileges shall be required to demonstrate clinical competency within the past two years in the required clinical discipline as specified in this PWS.

5.2.6.4.3. Drug Enforcement Agency (DEA) Registration: Requirements for DEA registration numbers are required for: NA

5.2.6.4.4. Board Certification: Requirements in addition to or supplementing Attachment 5 for board certification are as follows: None

5.2.9. Security Investigative Requirements: The Contractor shall ensure HCWs comply with the following security requirements not already identified in the contract PWS: None

5.2.9.1. HCWs shall be subject to the following additional security investigative processes, to appointments with Unit Security Managers: None

5.2.9.4. HCWs shall be subject to the following security processes for fingerprints: None

5.2.9.5. The HCW shall complete an XSF-85 Questionnaire for National Security Positions (or equivalent OPM investigative product)

5.3.1. Initial Placement: The Contractor shall ensure HCWs begin performance as follows:

60 days after date of award.

5.4.3.2. Malpractice Insurance for Non-Personal Services: The Contractor and all subcontractors shall ☐shall not ☐ meet the requirements of FAR Clause 52.237‑7, Indemnification and Medical Liability Insurance, for its HCWs, in the following amounts for the entire performance period of the TO: NA

5.4.4. Schedule Management: The TO will establish the work schedule and billable hours for each HCW. The Contractor shall maintain a process to monitor work and billable hours on the TO. When directed by the Government, the HCW shall remain on duty to complete patient treatment where lack of continuity of care would otherwise jeopardize patient health. This provision is not intended to apply to the time required to complete routine tasks (e.g., completion of paperwork or routine administrative tasks at the end of a shift) which are to be completed as part of the normal work schedule.

5.4.4.1. Schedule Management for Personal Services: The work schedule for each labor category is as follows:

Pediatrician Physician: Monday to Friday 0730-1630

5.4.4.1 Call-Back Hours: HCWs will not be required to report in-person to the MTF during on-call hours if needed.

The number if call-back hours and timeframe is as follows:

5.4.4.2. Schedule Management for Non-Personal Services: Hours of service and roster submission requirements are as follows: N/A

5.4.4.3. Duty Hours:

Duty hours shall be performed during normal operating hours, Monday through Friday 0730-1630, and shall not exceed 40 hours in a work week. Typical work shifts consist of eight (8) hour days and a one (1) hour unpaid lunch.

5.4.4.4. On-Call Hours: On-call requirements for each labor category are as follows: N/A

5.4.4.5. Overage Hours: Overage hours for each labor category are as follows: N/A

5.5.3. Scope of Work: HCWs will be able to bill the Government for participation in administrative functions (i.e., orientation, quality improvement programs, clinical/administrative data collection, meetings, and training). Specific tasks associated with administrative duties beyond the tasks outlined in the contract PWS include: None

5.5.5. Billing for Services: The Contractor will only be paid for the actual hours the HCW provides services with the following exception for personal services HCWs: N/A

5.6.1. Task 6 – Reports. The minimum level of metrics maintained at the Task Order level include HCW overall fill rate, on-time fill percentage, turnover rate, and replenish rate. Acceptable Quality Levels (AQLs) on these metrics are set in Technical Exhibit 1, PRS in this TO. The minimum level of metrics will be calculated as follows:

5.6.1.1. Overall Fill Rate: The overall fill rate is the percentage of the total amount of required FTE-weighted days (i.e., purchased) filled in a reporting period. The overall fill rate is calculated by dividing the sum of FTE-weighted days HCWs fill a position in a reporting period by the total number of required FTE-weighted days in the same reporting period.

5.6.1.2. On-Time Fill Percentage: Percentage of FTEs filled by the required start date during the reporting period.

The on-time fill percentage is calculated by dividing the number of initial and replacement FTEs assigned with a required start date in a reporting period filled on time by the total number of initial and replacement FTEs assigned with a required start date in the same reporting period.

5.6.1.3. Turnover Rate: The number of FTEs that turned over during a reporting period. The turnover rate is calculated by dividing the number of assigned FTEs turned over in a reporting period (for any reason) by the total number of assigned FTEs in the same reporting period. Turnovers occurring less than 30 calendar days before the end of the TO will not be counted as a turnover for this metric.

5.6.1.4. Replenish Rate: The replenish rate is a measure of how well assigned positions remain filled in a reporting period. The replenish rate is calculated by dividing the sum of FTE-weighted assigned HCW days in a reporting period by the sum of FTE-weighted days available subsequent to initial HCW assignment start dates in the same reporting period.

5.6.1.5. Additional Metrics: Additional metrics on this Task Order ☐ are X are not identified in Technical Exhibit

1, PRS.

6.4.4 Health Insurance Portability and Accountability Act (HIPAA): Additional or supplemental instructions unique to HIPAA for this TO are as follows:

PERFORMANCE REQUIREMENTS SUMMARY (PRS)

The following performance outcome acceptable quality levels (AQLs) for minimum quality levels of service are required on this TO:

Performance Objective Reference Performance Objective

Method of Surveillance

AQL

Overall Fill Rate 5.1: Recruit HCWs

Percentage of days FTEs are assigned to a position in a reporting period

Government management oversight;

discrepancy reports

95 %

On-Time Fill Percentage

5.3: Place HCWs Percentage of FTEs filled by the required start date in the TO during the reporting period

Government management oversight;

discrepancy reports

95 %

Turnover Rate 5.3.2: Replace HCWs

The number of FTEs that turned over during a reporting period

Government management oversight;

discrepancy reports

20 %

Replenish Rate

5.2: HCW

Qualifications

The measure of how well assigned positions remain filled in a reporting period

Government management oversight;

95 %

DELIVERABLES SCHEDULE

Deliverable Frequency # of Copies Medium/Format Submit To

Key Personnel List NLT 5 business days of TO award

1 Electronic copy (MS Word) via email

TOKO

Initial Placement of HCWs:

Qualifying Documentation (i.e., qualifying package;

credentialing package)

NLT 15 days for qualifying and 30 days for credentialing packages before the required start date

Electronic copy (MS Word) via email to TOKO; submission on-line CCQAS

TOKO

Replacement of HCWs:

Qualifying documentation (i.e., qualifying package;

credentialing package)

NLT 15 days after vacancy occurs for non-credentialed HCWs; NLT 15 days after vacancy for credentialed HCWs

Electronic copy (MS Word) via email to TOKO; submission on-line CCQAS

TOKO

Quality Control Plan Within 30 days of TO award

Electronic copy (MS Word) via email

TOKO

Security Investigative Package

NLT 45 days before the required start date of the HCW

1 Electronic submission TOKO

N/A N/A N/A N/A N/A

Pricing Rationale Details Physician Market Segment

If the offeror proposes unit pricing or direct rates outside of the Government range shown in paragraph 5 of this Sample Market Segment TOPR above, the offeror will provide rationale detailing the difference below:

1. Rationale for Difference in Total Task Order Pricing:

2. Justification for Total Task Order Pricing:

3. Rationale for Difference in Direct Labor Rate:

4. Justification for Difference in Direct Labor Rate:

SAMPLE MARKET SEGMENT TOPR: ANCILLARY

FROM: Defense Health Agency (COD-SA) 4130 Stanley Rd.

Building 1000, Room 235

SUBJECT: Sample Market Segment Task Order Proposal Request (TOPR): Ancillary sample market segment TOPR in conjunction with instructions provided in this solicitation for the purposes

2. Submission of a pricing proposal that is not identified on the Offeror’s self-scoring worksheet (Attachment

3. Type of Ancillary Service: Pharmacy Technicians Physical Therapists Physical Therapy Assistants Medical Laboratory Technicians

Location: Brooke Army Medical Center (BAMC), Joint Base San Antonio

4. The offeror’s proposed pricing for this sample market segment TOPR SHALL be entered on the Ancillary Pricing Worksheet found at Attachment 2B. Only provide the direct rate and unit price on the Ancillary Pricing Worksheet. The total task order price will be calculated automatically based on unit price x hours

5. The Government will evaluate the Health Care Worker (HCW) direct labor rate and total task order price to determine a reasonable and realistic price for this sample market segment TOPR.

services requested:

Pharmacy Technician Direct Rate Range: $16.23 - $21.84 Physical Therapist Direct Rate Range: $35.70 - $45.04 Physical Therapy Assistant Direct Rate Range: $26.24 -$29.31 Medical Laboratory Technician Direct Rate Range: $16.80 - $27.73

Ancillary Total Task Order Price Range: $3,995,712.00 - $5,591,961.60

6. If the offeror proposes direct rates or total task order pricing outside of the Government range shown in paragraph 5 above, the offeror will provide their rationale detailing the difference on the Price Rationale

7. Prices provided in response to sample market segment TOPRs are for source selection evaluation purposes

8. The following Department of Labor Wage Determination applies:

WD 2015-2522 REV3 Dated 18-Feb-2016

9. The following clauses are incorporated by reference:

52.222-41 Service Contract Labor Standards 52.222-43 Fair Labor Standards Act and Service Contract Labor Standards – Price Adjustment

IN ADDITION TO THE BASIC PERFORMANCE WORK STATEMENT, THE FOLLOW APPLIES:

ANCILLARY PERFORMANCE WORK STATEMENT

1.2. Description of Services:

The services required on this Task Order are under the following special program: N/A

1.5. General Information:

This Task Order is issued under the following arrangement:

X Personal Services: The following labor categories are under a personal services arrangement on this TO:

Pharmacy Technicians: 14 FTEs Physical Therapists: 9 FTEs Physical Therapy Assistants: 14 FTEs Medical Laboratory Technicians: 22 FTEs

Non-Personal Services: The following labor categories are under a non-personal services arrangement on this TO:

None

1.5.4. Quality Assurance: The Government will evaluate the Contractor’s performance under this task order IAW a separate Quality Assurance Surveillance Plan (QASP). This Government-only plan is primarily focused on what the Government will do to ensure that the Contractor has performed IAW contract performance standards. The Task Order QASP provides a systematic method to evaluate performance to include how the performance standards will be applied, the frequency of surveillance, and the acceptable quality levels for each of the metrics identified in Exhibit 1, Performance Requirements Summary. The QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the TO while the Government is responsible for quality assurance actions.

1.5.5. Contracting Officer’s Representative (COR): The following individual is designated as the COR for this TO:

Name of COR: Jennifer Felt.

COR Email Address: Jennifer.n.felt2.civ@mail.mil.

COR Telephone Number: 210-221-6231

1.5.6. Recognized Holidays: The only Contract HCWs who may be required to work holidays on federally recognized holidays are: None

1.5.7.1. Hours of Performance: SAMMC is a medical center providing services 24 hours per day, 365 days per year (366 for leap year). Specific clinics and ancillary services may have specific hours such as 0730 to 1630 Monday through Friday.

1.5.7.2. Scheduling: The schedule or scheduling process is as follows: COR will provide the work schedule by the 15h of each month for the following month.

1.5.7.3. Recording HCW Time: Changes to the recording of HCW time identified in the contract PWS are as follows: None

1.5.7.4.3. Substitute HCWs: If the Contractor substitutes permanent HCWs for a temporary period of time, the substitute shall meet the same qualification standards and health requirements as stated in the contract. Additional qualification and standards are as follows: None

1.5.7.5. Closures: During a planned closure of the facility due to training, holiday or unplanned closure due to unusual and compelling circumstances (e.g., natural disasters, military emergencies, severe weather), the Contractor will be compensated only for the actual hours the HCW provided services

1.5.8. Place of Performance: The work to be performed under this contract will be at BAMC. HCWs shall receive notification two weeks prior to the reassignment.

1.5.9. Mission Essential: The following labor categories are designated as mission essential:

Pharmacy Technicians Physical Therapists Physical Therapy Assistants Medical Laboratory Technicians

1.6.1. Quality Control Plan (QCP): The Contractor shall have a planned and systematic QCP that outlines the quality control process covering every aspect of the Contractor’s operation under this TO. The Contractor shall submit a Task Order QCP to the TOKO within 30 calendar days of contract award. The TOKO will approve the QCP in writing. The Contractor shall submit changes to an approved QCP to the TOKO for approval throughout the life of the contract.

1.6.3. Periodic Progress Meetings: Contractor will be required to attend periodic progress meetings at no additional cost to the Government.

1.6.4.2. Representative Status Change: The Contractor shall notify the TOKO in writing of changes in the status (i.e., termination or replacement) of designated Contractor representative within 5 business days of the change.

1.6.6. Contractor Travel: Reimbursement will not be provided for travel within a 40-mile radius of the place of performance. HCW travel requirements are as follows: N/A

1.6.7. Relocation Costs: The Government will not pay the Contractor to relocate HCWs.

1.6.9 Orientation: Orientation will be paid at the billable rate.

1.6.9.2. Computer Skill Competency: Each HCW shall demonstrate competency as required in the contract.

1.6.10. MTF Training: Additional training requirements are as follows: None

1.6.12. MTF Standards: Specific policies, procedures, and instructions/regulations for the place of performance are as follows: BAMC, policies, procedures and instructions/regulations.

1.6.20.3. Occupational Health: The HCW shall be required to obtain documentation of required physical testing or a report of a physical examination.

1.6.20.5. Tuberculosis Screening: The additional immunization/screening requirements for the risk of exposure to tuberculosis (TB) are as follows: None

1.6.25 Competency-Based HCW Interviews: Prior to HCW placement, the Government will not contact the HCW to determine if the HCW is meets the requirements set in the contract and/or task order.

3. Government Furnished Items and Services:

3.1. General: The following additions are made to the Government furnished items and services for this TO: None

4. Contractor Furnished Items and Responsibilities:

4.1. Rubber Stamp: The Contractor will be required to ensure privileged HCWs providing services on this contract have a rubber stamp.

4.2. General: The following Contractor furnished items and services are required for this TO: None

5.1. Task 1 – Recruit (Recruit/Retain): The duties for each qualified HCW are as follows: As outlined in Exhibit 5.

5.2. Task 2 – Qualify (Qualifying/Credentialing). In addition to the qualifications listed in the contract, the following additional or supplemental qualifications are required for HCWs on this TO: None

5.2.3. Certifications: In addition to the qualifications listed in the contract, HCWs shall maintain the following additional certifications: None

5.2.4. HCW Education Requirements: In addition to the qualifications listed in the contract, HCWs shall meet the following additional education and experience requirements: None

5.2.6. Qualifying/Credentialing Packages: The Contractor shall provide a complete package IAW Army Regulation 40-68, Clinical Quality Management. The packages needed for this TO are as follows:

5.2.6.2. Qualifying Package: The Contractor shall provide a complete, current, and accurate qualifying package:

None

5.2.6.3. Credentialing Package for Non-Privileged HCWs: The Contractor shall provide a complete, current, and accurate credentialing package for Pharmacy Technicians, Physical Therapy Assistants, Medical Laboratory Technicians, within 30 days of placement.

5.2.6.4. Credentialing Package for Privileged HCWs: The Contractor shall provide a complete, current, and accurate credentialing package for Physical Therapists within 30 days of placement.

5.2.6.4.1. Clinical Competency: Each HCW requesting clinical privileges shall be required to demonstrate clinical competency within the past two years in the required clinical discipline as specified in this PWS.

5.2.6.4.3. Drug Enforcement Agency (DEA) Registration: Requirements for DEA registration numbers are required for: NA

5.2.6.4.4. Board Certification: Requirements in addition to or supplementing Attachment 5 for board certification are as follows: None

5.2.9. Security Investigative Requirements: The Contractor shall ensure HCWs comply with the following security requirements not already identified in the contract PWS: None

5.2.9.1. HCWs shall be subject to the following additional security investigative processes, to appointments with Unit Security Managers: None

5.2.9.4. HCWs shall be subject to the following security processes for fingerprints: None

5.2.9.5. The HCW shall complete either a ☐X SF-85 or a ☐SF-86 Questionnaire for National Security Positions (or equivalent OPM investigative product)

5.3.1. Initial Placement: The Contractor shall ensure HCWs begin performance as follows:

45 Days after date of award.

5.4.3.2. Malpractice Insurance for Non-Personal Services: The Contractor and all subcontractors shall ☐shall not ☐ meet the requirements of FAR Clause 52.237‑7, Indemnification and Medical Liability Insurance, for its HCWs, in the following amounts for the entire performance period of the TO as further identified in Attachment B, Malpractice Insurance Certification Form in the proposal: NA

5.4.4. Schedule Management: The TO will establish the work schedule and billable hours for each HCW. The Contractor shall maintain a process to monitor work and billable hours on the TO. When directed by the Government, the HCW shall remain on duty to complete patient treatment where lack of continuity of care would otherwise jeopardize patient health. This provision is not intended to apply to the time required to complete routine tasks (e.g., completion of paperwork or routine administrative tasks at the end of a shift) which are to be completed as part of the normal work schedule.

5.4.4.1. Schedule Management for Personal Services: The work schedule for each labor category is as follows:

Pharmacy Technicians: Monday to Friday 0730-1630 Physical Therapists: Monday to Friday 0730-1630 Physical Therapy Assistants: Monday to Friday 0730-1630 Medical Laboratory Technicians: Monday to Friday 0730-1630

5.4.4.1 Call-Back Hours: HCWs will not be required to report in-person to the MTF during on-call hours if needed. The number if call-back hours and timeframe is as follows:

5.4.4.2. Schedule Management for Non-Personal Services: Hours of service and roster submission requirements are as follows: N/A

5.4.4.3. Duty Hours:

Duty hours shall be performed during normal operating hours, Monday through Friday 0730-1630, and shall not exceed 40 hours in a work week. Typical work shifts consist of eight (8) hour days and a one (1) hour unpaid lunch.

5.4.4.4. On-Call Hours: On-call requirements for each labor category are as follows: N/A

5.4.4.5. Overage Hours: Overage hours for each labor category are as follows: N/A

5.5.3. Scope of Work: HCWs will be able to bill the Government for participation in administrative functions (i.e., orientation, quality improvement programs, clinical/administrative data collection, meetings, and training). Specific tasks associated with administrative duties beyond the tasks outlined in the contract PWS include:

5.5.5. Billing for Services: The Contractor will only be paid for the actual hours the HCW provides services with the following exception for personal services HCWs: N/A

5.6.1. Task 6 – Reports. The minimum level of metrics maintained at the Task Order level include HCW overall fill rate, on-time fill percentage, turnover rate, and replenish rate. Acceptable Quality Levels (AQLs) on these metrics are set in Exhibit 1, PRS in this TO. The minimum level of metrics will be calculated as follows:

5.6.1.1. Overall Fill Rate: The overall fill rate is the percentage of the total amount of required FTE-weighted days (i.e., purchased) filled in a reporting period. The overall fill rate is calculated by dividing the sum of FTE-weighted days HCWs fill a position in a reporting period by the total number of required FTE-weighted days in the same reporting period.

5.6.1.2. On-Time Fill Percentage: Percentage of FTEs filled by the required start date during the reporting period.

The on-time fill percentage is calculated by dividing the number of initial and replacement FTEs assigned with a required start date in a reporting period filled on time by the total number of initial and replacement FTEs assigned with a required start date in the same reporting period.

5.6.1.3. Turnover Rate: The number of FTEs that turned over during a reporting period. The turnover rate is calculated by dividing the number of assigned FTEs turned over in a reporting period (for any reason) by the total number of assigned FTEs in the same reporting period. Turnovers occurring less than 30 calendar days before the end of the TO will not be counted as a turnover for this metric.

5.6.1.4. Replenish Rate: The replenish rate is a measure of how well assigned positions remain filled in a reporting period. The replenish rate is calculated by dividing the sum of FTE-weighted assigned HCW days in a reporting period by the sum of FTE-weighted days available subsequent to initial HCW assignment start dates in the same reporting period.

5.6.1.5. Additional Metrics: Additional metrics on this Task Order ☐ are ☐X are not identified in Exhibit 1, PRS.

6.4.4 Health Insurance Portability and Accountability Act (HIPAA): Additional or supplemental instructions unique to HIPAA for this TO are as follows: NA

The following performance outcome acceptable quality levels (AQLs) for minimum quality levels of service are

Performance Objective Reference Performance Objective

Method of Surveillance

AQL

Overall Fill Rate 5.1: Recruit HCWs

Percentage of days FTEs are assigned to a position in a reporting period

Government management oversight;

discrepancy reports

95 %

On-Time Fill Percentage

5.3: Place HCWs

Percentage of FTEs filled by the required start date in the TO during the reporting period

Government management oversight;

discrepancy reports

95 %

Turnover Rate 5.3.2: Replace HCWs

The number of FTEs that turned over during a reporting period

Government management oversight;

discrepancy reports

20 %

Replenish Rate 5.2: HCW Qualifications

The measure of how well assigned positions remain filled in a reporting period

Government management oversight;

95 %

NLT 5 business days of TO award

1 Electronic copy (MS Word) via email

TOKO

Initial Placement of HCWs:

Qualifying Documentation (i.e., qualifying package;

credentialing package)

NLT 15 days for qualifying and 30 days for credentialing packages before the required start date

Electronic copy (MS Word) via email to TOKO; submission on-line CCQAS

TOKO

Replacement of HCWs:

Qualifying documentation (i.e., qualifying package;

credentialing package)

NLT 15 days after vacancy occurs for non-credentialed HCWs; NLT 15 days after vacancy for credentialed HCWs

Electronic copy (MS Word) via email to TOKO; submission on-line CCQAS

TOKO

Quality Control Plan Within 30 days of TO award

Electronic copy (MS Word) via email

TOKO

Security Investigative Package

NLT 45 days before the required start date of the HCW

1 Electronic submission TOKO

N/A N/A N/A N/A N/A

Ancillary Market Segment

If the offeror proposes unit pricing or direct rates outside of the Government range shown in paragraph 5 of this

SAMPLE MARKET SEGMENT TOPR: NURSING

4130 Stanley Rd.

Building 1000, Room 235

SUBJECT: Sample Market Segment Task Order Proposal Request (TOPR): Nursing sample market segment TOPR in conjunction with instructions provided in this solicitation for the purposes

2. Submission of a pricing proposal that is not identified on the Offeror’s self-scoring worksheet (Attachment

3. Type of Nursing Service:

Registered Nurse, Case Manager Registered Nurse Family Practice Registered Nurse Emergency Medicine Certified Nurse Midwife

Location: David Grant Medical Center (DGMC), Travis AFB, CA

4. The offeror’s proposed pricing for this sample market segment TOPR SHALL be entered on the Nursing Pricing Worksheet found at Attachment 2C. Only provide the direct rate and unit price on the Nursing Pricing Worksheet. The total task order price will be calculated automatically based on unit price x hours

5. The Government will evaluate the Health Care Worker (HCW) direct labor rate and total task order price to

Registered Nurse, Case Manager: $35.72 - $45.89 Registered Nurse Family Practice: $35.72 - $43.22 Registered Nurse Emergency Medicine: $35.72 - $44.39 Certified Nurse Midwife: $48.98 - $66.85

Total Nursing Task Order Price Range: $504,172.80 - $646,982.40

6. If the offeror proposes direct rates or total task order pricing outside of the Government range shown in paragraph 5 above, the offeror will provide their rationale detailing the difference on the Price Rationale

7. Prices provided in response to sample market segment TOPRs are for source selection evaluation purposes

WD 2005-2070 REV18 Dated 29-Dec-2015

IN ADDITION TO THE BASIC PERFORMANCE WORK STATEMENT, THE FOLLOW APPLIES:

NURSING PERFORMANCE WORK STATEMENT

1.2. Description of Services:

The services required on this Task Order are under the following special program: N/A

1.5. General Information:

This Task Order is issued under the following arrangement:

Personal Services: The following labor categories are under a personal services arrangement on this TO: Nursing Services

Registered Nurse, Case Manager – 1 FTE Registered Nurse Family Practice – 1 FTE Registered Nurse Emergency Medicine - 1 FTE Certified Nurse Midwife – 1 FTE

1.5.4. Quality Assurance: The Government will evaluate the Contractor’s performance under this task order IAW a separate Quality Assurance Surveillance Plan (QASP). This Government-only plan is primarily focused on what the Government will do to ensure that the Contractor has performed IAW contract performance standards. The Task Order QASP provides a systematic method to evaluate performance to include how the performance standards will be applied, the frequency of surveillance, and the acceptable quality levels for each of the metrics identified in Exhibit 1, Performance Requirements Summary. The QASP is created with the premise that the Contractor is responsible for management and quality control actions to meet the terms of the TO while the Government is responsible for quality assurance actions.

1.5.5. Contracting Officer’s Representative (COR): The following individual is designated as the COR for this TO:

Name of COR: Jennifer Felt.

COR Email Address: Jennifer.n.felt2.civ@mail.mil.

COR Telephone Number: 210-221-6231

1.5.6. Recognized Holidays: Contract HCWs that support inpatients wards will be required to work on federally recognized holidays dependent upon department needs. HCWs supporting clinics with hours of operations Monday through Friday, 7:30 to 4:30 will not be required to work on federally recognized holidays.

Recognized federal holidays are: New Year’s Day, Dr. Martin Luther King, Jr. Birthday, Presidents day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day, and Christmas Day

HCWs required to work recognized federal holidays are: Registered Nurse Emergency Medicine, Registered Nurse Emergency Room, Registered Nurse General Surgery Ward, and Registered Nurse Operating Room.

1.5.7.1. Hours of Performance: The performance hours of the MTF are as follows:

HCWs support inpatient department hours of performance will be 24/7. HCWs supporting outpatient clinics performance hours will be Monday through Friday, 7:30 AM PST to 4:30 PM PST.

1.5.7.2. Scheduling: The schedule or scheduling process is as follows: Clinic personnel will assist in patient scheduling. Complete administrative control of the patient shall remain with the Government.

1.5.7.3. Recording HCW Time: Changes to the recording of HCW time identified in the contract PWS are as follows: None

1.5.7.4.3. Substitute HCWs: If the Contractor substitutes permanent HCWs for a temporary period of time, the substitute shall meet the same qualification standards and health requirements as stated in the contract. Additional qualification and standards are as follows: None

1.5.7.5. Closures: During a planned closure of the facility due to training, holiday or unplanned closure due to unusual and compelling circumstances (e.g., natural disasters, military emergencies, severe weather), the Contractor will only be paid for the actual hours the HCW provided services. The Government will notify the Contractor in the same manner as the Government notifies DoD civilian personnel.

1.5.8. Place of Performance: The work to be performed under this contract will be at the David Grant Air Force Medical Center, 101 Bodin Circle, Travis AFB, CA. HCWs shall receive notification two weeks prior to the reassignment.

1.5.9. Mission Essential: The following labor categories are designated as mission essential:

Registered Nurse Emergency Medicine

1.6.1. Quality Control Plan (QCP): The Contractor shall have a planned and systematic QCP that outlines the quality control process covering every aspect of the Contractor’s operation under this TO. The Contractor shall submit a Task Order QCP to the TOKO within fifteen (15) calendar days of contract award. The TOKO will approve the QCP in writing. The Contractor shall submit changes to an approved QCP to the TOKO for approval throughout the life of the contract.

1.6.3. Periodic Progress Meetings: Contractor will not be required to attend periodic progress meetings at no additional cost to the Government.

1.6.4.2. Representative Status Change: The Contractor shall notify the TOKO in writing of changes in the status (i.e., termination or replacement) of designated Contractor representative within three (3) business days of the change.

1.6.6. Contractor Travel: Reimbursement will not be provided for travel within a 40-mile radius of the place of performance. HCW travel requirements are as follows: N/A

1.6.7. Relocation Costs: The Government will not pay the Contractor to relocate HCWs.

1.6.9. Orientation: Orientation will be paid at the billable rate.

1.6.9.2. Computer Skill Competency: Each HCW shall demonstrate competency as required in the contract and as follows: have working knowledge of latest versions of office automation software and recognize potential enhancements or limitations of new software/applications utilized by industry. Examples of working knowledge are (but not limited to):

• In Microsoft Excel – ability to create new and modify existing formulas and ability to format cells and graphs. Arithmetic skills are required.

• In Microsoft Word – ability to create, edit and format text, tables and graphics using various font, paragraph and styles; ability to use and edit shapes, quick parts and indexing; and ability to track, accept and delete changes. English grammar skills are required.

• In Microsoft PowerPoint – ability to create new and modify existing briefs, charts and graphs; ability to format text, bulleted lists, and insert objects. Visual presentation skills are required.

1.6.10. MTF Training: Additional training requirements are as follows: None

1.6.12. MTF Standards: Specific policies, procedures, and instructions/regulations for the place of performance are as follows: None

1.6.20.3. Occupational Health: The HCW shall be required to obtain documentation of required physical testing or a report of a physical examination.

1.6.20.5. Tuberculosis Screening: The additional immunization/screening requirements for the risk of exposure to tuberculosis (TB) are as follows: None

1.6.25 Competency-Based HCW Interviews: Prior to HCW placement, the Government will contact the HCW to determine if the HCW meets the requirements set in the contract and/or task order.

3. Government Furnished Items and Services:

3.1. General: The Contractor shall ensure accurate control and accountability of all GFP/GFI. The following GFP/GFI will be provided to the Contractor, on-site.

The following additions are made to the Government furnished items and services for this TO: None

4. Contractor Furnished Items and Responsibilities:

4.1. Rubber Stamp: The Contractor will not be required to ensure privileged HCWs providing services on this contract have a rubber stamp.

4.2. General: The following Contractor furnished items and services are required for this TO: None

5.1. Task 1 – Recruit (Recruit/Retain): The duties for each qualified HCW are as follows:

5.2. Task 2 – Qualify (Qualifying/Credentialing). In addition to the qualifications listed in the contract, the following additional or supplemental qualifications are required for HCWs on this TO: None

5.2.3. Certifications: In addition to the qualifications listed in the contract, HCWs shall maintain the following additional certifications: None

5.2.4. HCW Education Requirements: In addition to the qualifications listed in the contract, HCWs shall meet the following additional education and experience requirements: None

5.2.6. Qualifying/Credentialing Packages: The Contractor shall provide a complete package IAW AFI 44-119. The packages needed for this TO are as follows:

5.2.6.2. Qualifying Package: The Contractor shall provide a complete, current, and accurate qualifying packages for Certified Nurse Midwife, Registered Nurse Emergency Medicine, Registered Nurse Family Practice, and Registered Nurse Case Manager within 45 days before HCW placement.

5.2.6.3. Credentialing Package for Non-Privileged HCWs: The Contractor shall provide a complete, current, and accurate credentialing packages for Certified Nurse Midwife, Clinical Nurse Specialist Adult Psychiatric – Mental Health, Registered Nurse Emergency Medicine, Registered Nurse Family Practice, Registered Nurse General Surgery, Registered Nurse Operating Room, and Registered Nurse Case Manager within 45 days before HCW placement.

5.2.6.4. Credentialing Package for Privileged HCWs: N/A

5.2.6.4.1. Clinical Competency: Each HCW requesting clinical privileges shall be required to demonstrate clinical competency within the past two years in the required clinical discipline as specified in this PWS.

5.2.6.4.3. Drug Enforcement Agency (DEA) Registration: N/A

5.2.6.4.4. Board Certification: N/A

5.2.9. Security Investigative Requirements: The Contractor shall ensure HCWs comply with the following security requirements not already identified in the contract PWS:

5.2.9.1. HCWs shall be subject to the following additional security investigative processes, to appointments with Unit Security Managers: None

5.2.9.4. HCWs shall be subject to the following security processes for fingerprints: None

5.2.9.5. The HCW shall complete an SF-85P Questionnaire for National Security Positions (or equivalent OPM investigative product).

5.3.1. Initial Placement: The Contractor shall ensure HCWs begin performance as follows:

60 days after date of contract award

5.4.3.2. Malpractice Insurance for Non-Personal Services: The Contractor and all subcontractors shall not meet the requirements of FAR Clause 52.237‑7, Indemnification and Medical Liability Insurance, for its HCWs, in the following amounts for the entire performance period of the TO as further identified in Attachment B, Malpractice Insurance Certification Form in the proposal:

5.4.4. Schedule Management: The TO will establish the work schedule and billable hours for each HCW. The Contractor shall maintain a process to monitor work and billable hours on the TO. When directed by the Government, the HCW shall remain on duty to complete patient treatment where lack of continuity of care would otherwise jeopardize patient health. This provision is not intended to apply to the time required to complete routine tasks (e.g., completion of paperwork or routine administrative tasks at the end of a shift) which are to be completed as part of the normal work schedule.

5.4.4.1. Schedule Management for Personal Services: The work schedule for each labor category is as follows:

Certified Nurse Midwife – Monday – Friday, 7:30AM PST – 4:30 PM PST Registered Nurse Case Manager - Monday – Friday, 7:30AM PST – 4:30 PM PST Registered Nurse Family Practice - Monday – Friday, 7:30AM PST – 4:30 PM PST

The following HCW are required to work in an inpatient setting. The department or clinic will require services to be provided over a 24 hour period. The Government designated scheduler will provide schedules 2 weeks, in advance, IAW the term and conditions of the contract.

Registered Nurse Emergency Medicine – 24/7

**Work schedules are subject to change based on the direction from the COR or Government designated scheduler.

5.4.4.1 Call-Back Hours: HCWs will not be required to report in-person to the MTF during on-call hours if needed.

5.4.4.2. Schedule Management for Non-Personal Services: Hours of service and roster submission requirements are as follows: N/A

5.4.4.3. Duty Hours:

Duty hours for outpatient clinics shall be performed during normal operating hours, Monday through Friday, and shall not exceed 40 hours in a work week. Typical work shifts consist of eight (8) hour days and a one (1) hour unpaid lunch.

Duty hours for inpatient departments shall be performed during normal operating hours. Inpatient departments operate 24 hours a day 7 days a week 365 days a year. Typical work shifts include eight (8) and twelve (12) hour shifts. HCW shall not be scheduled to work more than 40 hours a week.

5.4.4.4. On-Call Hours: On-call requirements for each labor category are as follows: N/A

5.4.4.5. Overage Hours: Overage hours for each labor category are as follows: N/A

5.5.3. Scope of Work: HCWs will be able to bill the Government for participation in administrative functions (i.e., orientation, quality improvement programs, clinical/administrative data collection, meetings, and training). Specific tasks associated with administrative duties beyond the tasks outlined in the contract PWS include: None

5.5.5. Billing for Services: The Contractor will only be paid for the actual hours the HCW provides services with the following exception for personal services HCWs: None

5.6.1. Task 6 – Reports. The minimum level of metrics maintained at the Task Order level include HCW overall fill rate, on-time fill percentage, turnover rate, and replenish rate. Acceptable Quality Levels (AQLs) on these metrics are set in Exhibit 1, PRS in this TO.