ID07160027_DODMERB_PWS_DRAFT_6.9.2016.pdf

General Services Administration Federal Acquisition Service (FAS)

Greater Southwest Region

Task Order Number

ID07160027

Department of Defense Medical Examination Review Board (DoDMERB)

Medical Services Contract

Performance Work Statement (PWS)

– SECTION B –

SUPPLIES OR SERVICES AND PRICE/COST

B.1 In an effort to receive the highest quality solution at the lowest possible price, the Government requests all available discounts on all services offered by the contractor for this requirement.

B.2 The contractor will provide prompt payment terms in their proposal.

B.3 The contractor will provide pricing details for each period of performance; i.e. unit price per CLIN, total for each CLIN and a total for each performance period. The contractor will also provide a summary of the total of all performance periods for a grand proposal total.

B.4 This is a commercial, performance based, Firm Fixed Price (FFP) contract issued in accordance with Federal Acquisition Regulation (FAR) Parts 12 and 15.

B.5 Contractors must use the tables below when submitting their price proposals. The pricing tables below represent the reasonable total estimated quantities; the CPT Codes listed below are not an inclusive list, but rather a sample of the most commonly requested examinations. This estimate is not a representation that the estimated quantity will be required or ordered, or that conditions affecting requirements will be stable or normal.

Table 1 - BASE PERIOD

CPT

Codes Description Qty U/I Price per Unit

IME Completed Medical Examination Report 26500

EA

IME Partial Optometric Medical Examination Report (Partial Physical Exam)

1200 EA

IME Partial Clinical Medical

950 EA

IME/AMI Failure to Appear 450 EA IME/AMI Reassignment 1800 EA

CPT

Codes

70220 X-ray - Obtain radiologic exam of sinuses, complete 30 EA

70450 X-ray - Computed Tomography (CT) scan, head or brain;

without contrast material

30 EA

70486 X-ray - Obtain computerized axial tomography, sinuses 30 EA

70551 X-ray - Obtain a magnetic resonance imaging, brain 30 EA

71020 X-ray, chest, two views - frontal & lateral 30 EA

71250 X-ray, CT thorax 30 EA 71550 X-ray - MRI thorax 30 EA 72040 X-ray of spine, cervical 30 EA

72069 X-ray spine, thoracolumbar, standing (scoliosis) 250 EA

72070 X-ray exam, spine, thoracic, two views 55 EA

72100 X-ray exam, spine, lumbosacral, four views 55 EA

72125 X-ray - CT of cervical spine 30 EA 72128 X-ray - CT of thoracic spine 30 EA 72131 X-ray - CT of lumbar spine 30 EA

72141 X-ray - MRI of spinal canal and contents, cervical 30 EA

72146 X-ray - MRI of spinal canal and contents, thoracic 30 EA

72148 X-ray - Magnetic Resonance Imaging (MRI) of spinal canal and contents, lumbar

72220 X-ray of sacrum and coccyx 30 EA 73000 X-ray of clavicle, complete 30 EA

73030 X-ray exam, shoulder, two views 200 EA

73050 X-ray of acromioclavicular joints 30 EA

73060 X-ray of humerus 30 EA 73080 X-ray of elbow, complete 30 EA 73090 X-ray of forearm 30 EA 73110 X-ray exam, wrist, three views 150 EA 73120 X-ray of hand 30 EA 73140 X-ray of finger(s) 30 EA

73510 X-ray of hip - unilateral, complete 30 EA

73520 X-ray of hips, bilateral 30 EA 73550 X-ray of femur (thigh) 30 EA

73560 X-ray of knee, anteroposterior and lateral views 30 EA

73590 X-ray of tibia and fibula 30 EA 73610 X-ray of ankle, complete 30 EA 73630 X-ray of foot, complete 30 EA 73700 X-ray - CT of lower extremity 30 EA

73721 X-ray - MRI without contrast material of lower extremity 30 EA

74150 X-ray - Obtain a CT scan -abdomen; without contrast material

74400 X-ray - Intravenous urography (pyelography) 30 EA

76536

X-ray - Echography, B-scan and/or real time soft tissues of head/neck (thyroid, parathyroid, parotid)

76705 X-ray - Echography, abdominal, B-scan and/or real time 30 EA

76770 X-ray - Echography, retroperitoneal, B-scan and/or real time

76775 Obtain an echography, retroperitoneal; limited of r/o hydronephrosis. (list specific study and reason)

76856 X-ray - Echography, pelvic 30 EA

76870 X-ray - Echography, scrotum and contents 30 EA

80048 Lab test - Basic metabolic panel 30 EA 80061 Lab test - Lipid panel 30 EA 80074 Lab test - Acute Hepatitis Panel 30 EA 80076 Lab test - Hepatic function panel 30 EA

81001 Lab test - Urinalysis with microscopy 200 EA

81003 Lab test - Urinalysis without

81015 Lab test - Urinalysis, microscopy only 1,500 EA

81675 Please obtain a urine calcium/creatinine ratio (creatinine), via routine urine collection

81679 calcium/creatinine ratio (calcium), via routine urine collection

82570 Please obtain a UP/C ratio (creatinine), via routine urine

82575 Lab test - Creatinine clearance 30 EA

82947 Please obtain a fasting glucose blood test 30 EA

83020 Lab test - Hemoglobin electrophoresis 30 EA

83036 Hemoglobin HbA1c (HPLC) 30 EA

84156

(protein), via routine urine

84436 Lab test - Thyroxin, total 30 EA

84443 Lab test - Thyroid stimulating hormone (TSH) 30 EA

85027 Lab test - Blood count, hemogram and platelet count, automated

200 EA

86003 Lab test - Allergen specific lgE;

quantitative or semicuantitative 50 EA

86480 Please obtain a QuantiFERON - TB Gold (QFT-Gold) blood test 50 EA

90801

Office consultation with a mental health provider certified in drug/alcohol counseling or addiction medicine

90801 Psychiatric diagnostic interview examination 30 EA

92002

Optometric/Ophthalmogical consultation that does not require a dilated examination.

Elements in a DoDMERB eye exam would qualify for this code - new patient intermediate exam

100 EA

92004 comprehensive consultation requiring a dilated fundus exam

- new patient complex exam

92015 exam - manifest refraction (new or repeat)

1,500 EA

92025 Obtain a corneal topography exam with a written interpretation and the original color topography results

92060

Optometric/Ophthalmogical -senorimotor evaluation;

comprehensive strabismus evaluation with multiple measurements of ocular deviation to include a report

50 EA

92083 exam - extended visual field examination with automated perimetry

92506 Office - Consult - Evaluation by speech therapist/speech pathologist

92552 Audiogram - Pure tone audiometry (threshold); air only 250 EA

92557 Obtain a comprehensive audiometry threshold evaluation and speech recognition

92567 Obtain a tympanometry 30 EA

93000 Electrocardiogram, 12-lead, with interpretation & report 30 EA

93015 Cardiovascular stress test 35 EA 93230 24-hour Holter monitor study 30 EA

93303 Obtain transthoracic echocardiography for congenital anomalies

93306 Obtain echocardiogram and color flow doppler for evaluation of XXX 60 EA

93307

X-ray - Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording;

complete

93325 X-ray - Echocardiogram - Doppler color flow velocity mapping

40 EA

93350 Obtain transthoracic echocardiography, real-time with image documentation (2D), rest/stress

94010 Spirometry, with or without maximal voluntary ventilation

(PFT)

94060 Spirometry, before and after bronchodilator (aerosol) 50 EA

94070 Bronchoprovocation pulmonary function test 30 EA

94620 Obtain exercise spirometry study 50 EA

94621 Obtain exercise spirometry study (Complex) 50 EA

95010 Skin allergy testing 50 EA

95015 Obtain skin allergy testing (intracutaneous/intradermal tests) for XXX

95070 Inhalation bronchial challenge testing 50 EA

95075 Obtain ingestion challenge test for:

XXX 30 EA

95816 Electroencephalogram (EEG) 30 EA 96100 Psychological testing 30 EA

96117 Neuropsychological testing battery 30 EA

99172

Optometric/Ophthalmogical -visual function screening -visual acuity measurements, red lens test, cover test, near point of convergence, horizontal & vertical phorias, depth perception and color vision to include PIP, Vivid Red-Green, or FALANT

150 EA

99242 AMI Medical Consultation (CPT 99242) Report 1,500 EA

99243 AMI Medical Consultation (CPT 99243) Report 500 EA

99244 AMI Medical Consultation (CPT 99244) Report 500 EA

99245 AMI Medical Consultation (CPT 99245) Report 500 EA

J7674 Methacholine chloride as inhalation solution 50 EA

Table 2 - OPTION YEAR ONE (1)

Codes Description Qty U/I Price per Unit

IME Completed Medical Examination Report 27500

IME Partial Optometric Medical Examination Report (Partial Physical Exam)

1300 EA

1000 EA

IME/AMI Failure to Appear 500 EA IME/AMI Reassignment 1850 EA

(CT) scan, head or brain;

71020 X-ray, chest, two views -frontal & lateral 30 EA

72040 X-ray of spine, cervical 30 EA

72070 X-ray exam, spine, thoracic, two views 55 EA

72100 X-ray exam, spine, lumbosacral, four views 55 EA

72131 X-ray - CT of lumbar spine 30 EA

Imaging (MRI) of spinal canal

73030 X-ray exam, shoulder, two views 200 EA

73050 X-ray of acromioclavicular joints 30 EA

73060 X-ray of humerus 30 EA 73080 X-ray of elbow, complete 30 EA 73090 X-ray of forearm 30 EA 73110 X-ray exam, wrist, three views 150 EA 73120 X-ray of hand 30 EA 73140 X-ray of finger(s) 30 EA

73510 X-ray of hip - unilateral, complete 30 EA

73520 X-ray of hips, bilateral 30 EA 73550 X-ray of femur (thigh) 30 EA

73630 X-ray of foot, complete 30 EA 73700 X-ray - CT of lower extremity 30 EA abdomen; without contrast and/or real time soft tissues of head/neck (thyroid, parathyroid, 76705 X-ray - Echography, abdominal, B-scan and/or real 30 EA time

X-ray - Echography, retroperitoneal, B-scan and/or retroperitoneal; limited of r/o hydronephrosis. (list specific study

80074 Lab test - Acute Hepatitis Panel 30 EA

80076 Lab test - Hepatic function panel 30 EA calcium/creatinine ratio (creatinine), via routine urine calcium/creatinine ratio (calcium), (creatinine), via routine urine blood test 30 EA

(protein), via routine urine hemogram and platelet count, 86480 Please obtain a QuantiFERON - TB Gold (QFT-Gold) blood test 50 EA

90801

Office consultation with a mental health provider certified in drug/alcohol counseling or consultation that does not require a dilated examination.

Elements in a DoDMERB eye exam would qualify for this code - new patient intermediate comprehensive consultation requiring a dilated fundus exam exam - manifest refraction (new with a written interpretation and the original color topography results senorimotor evaluation;

comprehensive strabismus evaluation with multiple measurements of ocular exam - extended visual field examination with automated speech therapist/speech audiometry threshold evaluation

93303 Obtain transthoracic echocardiography for congenital

93306 Obtain echocardiogram and color flow doppler for evaluation of

XXX

60 EA

93307

X-ray - Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording;

Doppler color flow velocity echocardiography, real-time with image documentation (2D), maximal voluntary ventilation

(Complex) 50 EA

95010 Skin allergy testing 50 EA

95015 Obtain skin allergy testing (intracutaneous/intradermal tests)

95075 Obtain ingestion challenge test for:

XXX 30 EA

95816 Electroencephalogram (EEG) 30 EA 96100 Psychological testing 30 EA

96117 Neuropsychological testing battery 30 EA

99172

Optometric/Ophthalmogical -visual function screening -visual acuity measurements, red lens test, cover test, near point of convergence, horizontal & vertical phorias, depth perception and color vision to include PIP, Vivid Red-Green, J7674 Methacholine chloride as inhalation solution 50 EA

Table 3 - OPTION YEAR TWO (2)

Codes Description Qty U/I Price per Unit

IME Completed Medical Examination Report 28800

IME Partial Optometric Medical Examination Report (Partial Physical Exam)

1350 EA

1100 EA

IME/AMI Failure to Appear 600 EA IME/AMI Reassignment 1900 EA

(CT) scan, head or brain;

71020 X-ray, chest, two views -frontal & lateral 30 EA

72040 X-ray of spine, cervical 30 EA

72070 X-ray exam, spine, thoracic, two views 55 EA

72100 X-ray exam, spine, lumbosacral, four views 55 EA

72131 X-ray - CT of lumbar spine 30 EA

Imaging (MRI) of spinal canal

73030 X-ray exam, shoulder, two views 200 EA

73050 X-ray of acromioclavicular joints 30 EA

73060 X-ray of humerus 30 EA 73080 X-ray of elbow, complete 30 EA 73090 X-ray of forearm 30 EA 73110 X-ray exam, wrist, three views 150 EA 73120 X-ray of hand 30 EA 73140 X-ray of finger(s) 30 EA

73510 X-ray of hip - unilateral, complete 30 EA

73520 X-ray of hips, bilateral 30 EA 73550 X-ray of femur (thigh) 30 EA

73630 X-ray of foot, complete 30 EA 73700 X-ray - CT of lower extremity 30 EA abdomen; without contrast and/or real time soft tissues of head/neck (thyroid, parathyroid, 76705 abdominal, B-scan and/or real retroperitoneal, B-scan and/or retroperitoneal; limited of r/o hydronephrosis. (list specific study

80074 Lab test - Acute Hepatitis Panel 30 EA

80076 Lab test - Hepatic function panel 30 EA calcium/creatinine ratio (creatinine), via routine urine calcium/creatinine ratio (calcium), (creatinine), via routine urine blood test 30 EA

(protein), via routine urine hemogram and platelet count, 86480 Please obtain a QuantiFERON - TB Gold (QFT-Gold) blood test 50 EA

90801

Office consultation with a mental health provider certified in drug/alcohol counseling or consultation that does not require a dilated examination.

Elements in a DoDMERB eye exam would qualify for this code - new patient intermediate comprehensive consultation requiring a dilated fundus exam exam - manifest refraction (new with a written interpretation and the original color topography results senorimotor evaluation;

comprehensive strabismus evaluation with multiple measurements of ocular exam - extended visual field examination with automated

Office - Consult - Evaluation by speech therapist/speech audiometry threshold evaluation

93303 Obtain transthoracic echocardiography for congenital

93306 Obtain echocardiogram and color flow doppler for evaluation of

60 EA

93307

X-ray - Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording;

Doppler color flow velocity echocardiography, real-time with image documentation (2D), maximal voluntary ventilation

(Complex) 50 EA

95010 Skin allergy testing 50 EA

95015 Obtain skin allergy testing (intracutaneous/intradermal tests)

95075 Obtain ingestion challenge test for:

XXX 30 EA

95816 Electroencephalogram (EEG) 30 EA 96100 Psychological testing 30 EA

96117 Neuropsychological testing battery 30 EA

99172

Optometric/Ophthalmogical -visual function screening -visual acuity measurements, red lens test, cover test, near point of convergence, horizontal & vertical phorias, depth perception and color vision to include PIP, Vivid Red-Green, J7674 Methacholine chloride as inhalation solution 50 EA

Table 4 - OPTION YEAR THREE (3)

Codes Description Qty U/I Price per Unit

IME Completed Medical Examination Report 29000

70220 X-ray - Obtain radiologic exam of sinuses, complete 30 EA

(CT) scan, head or brain; without contrast material

70486 X-ray - Obtain computerized axial tomography, sinuses 30 EA

72040 X-ray of spine, cervical 30 EA

72131 X-ray - CT of lumbar spine 30 EA

Imaging (MRI) of spinal canal and contents, lumbar

73030 X-ray exam, shoulder, two views 200 EA 73050 X-ray of acromioclavicular joints 30 EA 73060 X-ray of humerus 30 EA 73080 X-ray of elbow, complete 30 EA 73090 X-ray of forearm 30 EA 73110 X-ray exam, wrist, three views 150 EA 73120 X-ray of hand 30 EA 73140 X-ray of finger(s) 30 EA 73510 X-ray of hip - unilateral, complete 30 EA 73520 X-ray of hips, bilateral 30 EA 73550 X-ray of femur (thigh) 30 EA

73560 X-ray of knee, anteroposterior and lateral views 30 EA

73630 X-ray of foot, complete 30 EA 73700 X-ray - CT of lower extremity 30 EA abdomen; without contrast and/or real time soft tissues of head/neck (thyroid, parathyroid, retroperitoneal, B-scan and/or real retroperitoneal; limited of r/o hydronephrosis. (list specific study

76870 X-ray - Echography, scrotum and contents 30 EA

80074 Lab test - Acute Hepatitis Panel 30 EA 80076 Lab test - Hepatic function panel 30 EA

81015 Lab test - Urinalysis, microscopy only 1,500 EA calcium/creatinine ratio (creatinine), calcium/creatinine ratio (calcium), via routine urine collection

(creatinine), via routine urine

82947 Please obtain a fasting glucose blood test 30 EA

84156 Please obtain a UP/C ratio (protein), via routine urine collection 30 EA

84436 Lab test - Thyroxin, total 30 EA

85027 Lab test - Blood count, hemogram and platelet count, automated 200 EA

90801

Office consultation with a mental health provider certified in drug/alcohol counseling or consultation that does not require a dilated examination. Elements in a DoDMERB eye exam would qualify for this code - new patient intermediate exam comprehensive consultation requiring a dilated fundus exam -new patient complex exam

Optometric/Ophthalmogical exam

- manifest refraction (new or repeat) with a written interpretation and the senorimotor evaluation;

comprehensive strabismus evaluation with multiple measurements of ocular deviation to include a report

Optometric/Ophthalmogical exam

- extended visual field examination with automated speech therapist/speech

Obtain a comprehensive audiometry threshold evaluation and speech recognition

93000 Electrocardiogram, 12-lead, with interpretation & report 30 EA

93303 Obtain transthoracic echocardiography for congenital

93307

X-ray - Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording;

93325 X-ray - Echocardiogram - Doppler color flow velocity mapping 40 EA echocardiography, real-time with image documentation (2D), rest/stress maximal voluntary ventilation

(Complex) 50 EA

95010 Skin allergy testing 50 EA

95015 Obtain skin allergy testing (intracutaneous/intradermal tests) for

95070 Inhalation bronchial challenge testing 50 EA

95075 Obtain ingestion challenge test for:

XXX 30 EA

95816 Electroencephalogram (EEG) 30 EA 96100 Psychological testing 30 EA

96117 Neuropsychological testing battery 30 EA

99172

Optometric/Ophthalmogical -visual function screening - visual acuity measurements, red lens test, cover test, near point of convergence, horizontal & vertical phorias, depth perception and color vision to include PIP, Vivid Red-Green, or FALANT

99242 AMI Medical Consultation (CPT 99242) Report 1,500 EA

99243 AMI Medical Consultation (CPT 99243) Report 500 EA

99244 AMI Medical Consultation (CPT 99244) Report 500 EA

99245 AMI Medical Consultation (CPT 99245) Report 500 EA

Table 5 - OPTION YEAR FOUR (4)

Codes Description Qty U/I Price per Unit

IME Completed Medical Examination Report 30000

(CT) scan, head or brain; without contrast material

72040 X-ray of spine, cervical 30 EA

72131 X-ray - CT of lumbar spine 30 EA

Imaging (MRI) of spinal canal

73030 X-ray exam, shoulder, two views 200 EA 73050 X-ray of acromioclavicular joints 30 EA 73060 X-ray of humerus 30 EA 73080 X-ray of elbow, complete 30 EA 73090 X-ray of forearm 30 EA 73110 X-ray exam, wrist, three views 150 EA 73120 X-ray of hand 30 EA 73140 X-ray of finger(s) 30 EA

73510 X-ray of hip - unilateral, complete 30 EA

73520 X-ray of hips, bilateral 30 EA 73550 X-ray of femur (thigh) 30 EA

73630 X-ray of foot, complete 30 EA 73700 X-ray - CT of lower extremity 30 EA abdomen; without contrast and/or real time soft tissues of head/neck (thyroid, parathyroid, retroperitoneal, B-scan and/or retroperitoneal; limited of r/o hydronephrosis. (list specific study

76870 X-ray - Echography, scrotum and contents 30 EA

80074 Lab test - Acute Hepatitis Panel 30 EA 80076 Lab test - Hepatic function panel 30 EA

81015 Lab test - Urinalysis, microscopy only 1,500 EA calcium/creatinine ratio (creatinine), calcium/creatinine ratio (calcium), (creatinine), via routine urine

82947 Please obtain a fasting glucose blood test 30 EA

84156 Please obtain a UP/C ratio (protein), via routine urine collection 30 EA

84436 Lab test - Thyroxin, total 30 EA hemogram and platelet count, 90801

Office consultation with a mental health provider certified in drug/alcohol counseling or consultation that does not require a dilated examination. Elements in a DoDMERB eye exam would qualify for this code - new patient intermediate exam comprehensive consultation requiring a dilated fundus exam -new patient complex exam exam - manifest refraction (new with a written interpretation and the senorimotor evaluation;

comprehensive strabismus evaluation with multiple measurements of ocular deviation to include a report exam - extended visual field examination with automated speech therapist/speech

Obtain a comprehensive audiometry threshold evaluation and speech recognition

93000 Electrocardiogram, 12-lead, with interpretation & report 30 EA

93303 Obtain transthoracic echocardiography for congenital

93307

X-ray - Echocardiography, transthoracic, real-time with image documentation (2D) with or without M-mode recording;

Doppler color flow velocity echocardiography, real-time with image documentation (2D), maximal voluntary ventilation

(Complex) 50 EA

95010 Skin allergy testing 50 EA

95015 Obtain skin allergy testing (intracutaneous/intradermal tests) for

95075 Obtain ingestion challenge test for:

XXX 30 EA

95816 Electroencephalogram (EEG) 30 EA 96100 Psychological testing 30 EA

96117 Neuropsychological testing battery 30 EA

99172

Optometric/Ophthalmogical -visual function screening - visual acuity measurements, red lens test, cover test, near point of convergence, horizontal & vertical phorias, depth perception and color vision to include PIP, Vivid Red-Green, or FALANT

99242 AMI Medical Consultation (CPT 99242) Report 1,500 EA

99243 AMI Medical Consultation (CPT 99243) Report 500 EA

99244 AMI Medical Consultation (CPT 99244) Report 500 EA

99245 AMI Medical Consultation (CPT 99245) Report 500 EA

B.7 Other Direct Costs (ODCs) – There are no ODCs anticipated for this contract.

B.8 Travel - Travel is not anticipated for this contract.

SECTION C –

DESCRIPTION / SPECIFICATIONS/ SCOPE OF WORK

C.1 BACKGROUND

The mission of DoDMERB involves the medical evaluation of applicants to various Department of Defense (DoD) accession and DoD commissioning programs. Contracting services are required to provide a subcontracted network of medical providers and connectivity between DoDMERB, Applicants, the Prime Contractor and the various Medical Network Providers.

The Initial Medical Examinations (IME) and the Additional Medical Information (AMI) accomplished under the provisions of this contract are for the purpose of certifying civilian and military individuals who have applied for appointments to any of the five Service Academies, or applications to the Reserve Officers Training Corps (ROTC) Programs, or the Uniformed Services University of Health Sciences (USUHS) and other programs, as required. The information gained through this medical examination shall be utilized by DoDMERB, military and contracted services medical officials to determine applicants’ qualification status.

C.2 SCOPE

The objective of this contract is to provide a network of Medical Providers and Optometric Providers within the U.S. and U.S. territories to complete an IME and to complete or gather AMI. Medical evaluations are divided into IMEs and AMIs. An IME consists of an optometric examination, hands-on medical examination, an audiometric screening, and potentially laboratory tests. A request for AMI represents information (consults and/or tests) that may be needed in addition to the information that was gathered during the IME. Not every IME will require AMI, as many applicants are healthy enough to receive a determination without AMI. AMI requirements will be determined by DoDMERB after review of the IME.

IMEs shall be conducted or supervised by qualified and licensed Medical Doctors (MD) or Doctor of Osteopathy (DO). IMEs may be conducted by licensed Physician Assistants (PA) or Nurse Practitioners (NP) under the direct supervision of a licensed MD or DO. All examinations completed by a PA or NP shall be validated and countersigned by the supervising MD or DO. Optometric Examinations shall be conducted by Ophthalmologists, or Optometrists.

AMI shall be conducted by qualified and licensed MDs or DOs, Ophthalmologists, Optometrists or potentially ancillary medical personal. For specialty consultations the physician will be Board Certified and have active credentials at a healthcare facility. Medical tests shall be performed by ancillary medical personnel certified/registered in their field. Eye examinations shall be conducted by Ophthalmologists or Optometrists unless specifically stated otherwise in the AMI requested by DoDMERB.

C.3 DEFINITIONS

AFROTC: Air Force Reserve Officer Training Corps

AGENCY: Refers to a specific US Service Academy, Reserve Officer Training Corps (ROTC) organization, and other programs as required (e.g. Army ROTC or Uniformed Services University of the Health Sciences {USUHS}).

AGENCY OFFICE: The Military Service office which processes all applications and nominations for appointment.

AMI: Additional Medical Information in the form of consults or tests, etc. A term used to describe a DoDMERB requirement - additional medical tests, information, evaluations, or consultations.

APPLICANT: An individual (military or civilian) who has applied for admission to one of the US Service Academies, ROTC Programs, USUHS and other programs as required.

CHASE: To contact applicant with respect to completing requirements.

COLLEGE SCHOLARSHIP PROGRAM: Individuals who are presently enrolled in a university and are applying for a 1, 2, or 3-year scholarship through AROTC, AFROTC, or NROTC.

COMPLETE INITIAL MEDICAL EXAMINATION (IME): A complete IME is made up of the medical, audiometric and optometric evaluations. All are completed by the Network Provider, quality controlled by the Contractor, forwarded to DoDMERB via electronic means, and acknowledged by DoDMERB as acceptable. Basically an IME is considered a complete IME, when it is not rejected by DoDMERB for quality control issues (all boxes filled in, positive responses of the applicant were thoroughly addressed by the Network Provider, forms signed, etc.).

CONTRACTING OFFICER REPRESENTATIVE (COR): The Government's representative is responsible for quality assurance surveillance of contractor performance. The Chief of Operations, DoDMERB will appoint to this position and will be delegated by the Contracting Officer.

CYCLE YEAR: (Same as selection cycle. The cycle year is a reflection of the academic (school) admission year of the Service Academies. It generally runs from 1 July of one year to 30 June the next year.

DOES NOT MEET MEDICAL STANDARDS (DNMMS): A certification which indicates an applicant has been found not to meet DoD medical standards. An applicant who DNMMS has an opportunity to receive a waiver from the military agency the applicant applied to.

DoDMERB: The Department of Defense Medical Examination Review Board.

DOWN DAY: means a day that AF or DoDMERB leadership designates as a minimal manning day or liberal leave day.

EXAMINING FACILITY: The physical location where the IME or AMI is accomplished.

INITIAL MEDICAL EXAMINATION (IME): A group of completed forms (electronic) that reflects the findings of the examination. At a minimum, an IME includes DD Form 2351 (Report of Medical Examination) and DD Form 2492 (Report of Medical History), appropriate questionnaires if applicable and possibly a separate optometric form created by the Contractor and approved by DoDMERB, prior to implementation.

LIAISON OFFICER: An individual in the civilian community who is a member of the Reserve Forces (i.e. Army, Navy, etc.) and is responsible for providing guidance to applicants.

MANAGEMENT RECORD: Those records, excluding IME or AMI records, used to perform and document the performance of this contract.

NETWORK PROVIDER: The physician, physician's assistant, nurse practitioner, optometrist or specialist who accomplishes the IME or AMI

PARTIAL IME: A Partial IME is when only one or two of the components of a Complete Initial Medical Examination are completed by the applicant - either the medical, audiometric or the optometric. The completion of all three components of an IME is applicant driven. The partial IME is forwarded to the contractor (by the network provider) for quality control and is held in abeyance by the contractor (in accordance with the PWS). If the applicant does not complete the outstanding portion(s) of the examination within the required time period as stated in the PWS, the contractor then forwards the Partial IME to DoDMERB. The Contractor bills the examination as a “Partial IME” (either Partial Optometric IME or Partial Medical IME).

PERFORMANCE WORK STATEMENT (PWS): means a statement of work for performance-based acquisitions that describes the required results in clear, specific, and objective terms with measurable outcomes.

QUALITY CONTROL (QC): The process by which the Contractor reviews the quality of all factors involved in the IME and AMI.

REVIEWER: A DoDMERB employee responsible for the evaluation and certification of an applicant examination.

SCHOLARSHIP RECIPIENT: An individual who has been offered a 1, 2, 3, or 4 year ROTC scholarship by a ROTC Scholarship Program.

SELECTION CYCLE: 1 July through 30 June is generally the annual period in which applicants for appointments to the US Service Academies, ROTC Scholarships, and Uniformed Services University of the Health Sciences are considered for appointments.

SERVICES DELIVERY SUMMARY (SDS) or ACCEPTABLE QUALITY LEVELS (AQL) means the minimum level of acceptable performance that the contractor must meet and still be considered a satisfactory performer.

TIMELY: means by the Government’s deadline or, if no formal deadline is set, within five business days.

C.4 ACRONYMS

ACRONYM DEFINITIONS

ACO Administering Contracting Office AF Air Force AFROTC Air Force Reserve Officer Training Corp AFB Air Force Base AFJI Air Force Joint Instruction AFMS Air Force Medical Service AFMSA Air Force Medical Support Agency AFROTC Air Force Reserve Officer Training Corp AIS Automated Information Systems AO Action Officer AQL Acceptable Quality Levels AROTC Army Reserve Officer Training Corps CAC Common Access Card CFR Code of Federal Regulations CO Contracting Officer CONUS Continental United States COR Contracting Officer’s Representative

CPAR Contractor Performance Assessment Report CR Client Representative DoD Department of Defense DoDD Department of Defense Directive DoDI Department of Defense Instruction DoDMERB Department of Defense Medical Examination Review Board DOT Department of Transportation DFARS Defense Federal Acquisition Regulation Supplement FAR Federal Acquisition Regulation FOIA Freedom of Information Act FTE Full-Time Equivalent GFI Government Furnished Information GSA General Services Administration GSAM General Services Administration Acquisition Manual HAF Headquarters Air Force HIPAA Health Insurance Portability and Accountability Act of 1996 IT Information Technology MAJCOM Major Command MHS Military Health Systems MTF Military Treatment Facility NACI National Agency Check and Inquiries NATO North Atlantic Treaty Organization NDA Non-Disclosure Agreement NROTC Navy Reserve Officer Training Corps OCI Organizational Conflict of Interest OCONUS Outside Continental United States OSD Office of the Secretary of Defense OPM Office of Personnel and Management PA Privacy Act PII Personal Identifiable Information PM Program Manager POC Point of Contact PoP Period of Performance PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Program QC Quality Control QCP Quality Control Plan

OPSEC Operational Security SDS Service Delivery Summary SI Sensitive Information USAF United States Air Force USAFA United States Air Force Academy USCGA United States Coast Guard Academy USMA United States Military Academy USMMA United States Merchant Marine Academy USNA United States Naval Academy USUHS Uniformed Services University of Health Services

C.5 Summary of Requirements

5.1 Reserved

5.2 IME Providers. The contractor shall develop and provide professional medical services including personnel, supervision, equipment, materials and other items necessary to accomplish IMEs (medical, audiometric, and optometric). Unless specifically identified herein these three components shall be referred to as “IMEs”.

5.3 AMI Providers. The contractor shall develop and provide professional medical services including personnel, supervision, equipment, materials and other items necessary to accomplish complete AMI (consultations and tests) in accordance with this contract, unless specifically identified herein these two components shall be referred to as “AMIs”.

C.6 Reserved

C.7 Operational Requirements

7.1 Training

7.1.1 Train Providers. The required IME and the AMI consultations required under this contract are extensive and equivalent to the executive physical examination in the civilian community. The contractor shall provide clinical, administrative processing and quality control training to their network providers. The number of personnel required to be trained at each Examining Facility shall be determined by the contractor and shall be at the contractor's expense.

7.1.2 Training Contractor Management Personnel. To ensure continuity between all stakeholders in performance/delivery of services, the contractor shall provide and maintain a list of management personnel who are qualified to execute these services. The contractor shall provide the list of management personnel to the CO and COR in a timely manner when changes occur.

7.1.2.1Ensure all management personnel receive a minimum of two calendar-days training in the overall DoDMERB activities.

7.1.2.2The training shall be coordinated with and conducted by the Director of Operations, DoDMERB or Director of Administration, DoDMERB or a designated appointee; shall be conducted at DoDMERB located at the United States Air Force Academy (USAFA) Building 8034, 8034 Edgerton Drive, Colorado Springs, CO; and shall be conducted no less than 30 calendar days of taking the management position assignment. Travel and accommodations for this training shall be at the contractor’s expense.

7.2 Software Application Platform. The contractor shall provide and maintain a secure website program that allows for:

7.2.1 ROTC Detachments to “add” applicants to a database. Additionally, DoDMERB can electronically add applicants to the contractor’s database.

7.2.1.1Once added and electronically approved by DoDMERB, the applicants may then go into the vendor’s database to begin their portion of the process.

7.2.2 All applicants to complete their medical forms on-line.

7.2.2.1The required forms include the DD Form 2351, DD Form 2492, and associated questionnaires.

7.2.2.1.1The applicants’ demographics must be electronically data filled onto the DD Form 2351.

7.2.2.1.2The applicants’ demographics must be electronically data filled onto the DD Form 2492 and their medical history questions and responses must be data filled on line.

7.2.2.1.2.1The system must allow for thirty (30) additional questionnaires to be electronically completed, signed and dated based on positive responses to particular questions of the DD Form 2492.

7.2.2.1.3The DD Form 2492 must have the capability for the applicants to digitally sign and date the form.

7.2.2.2The application must allow the applicant to data enter, securely save and print all required forms, as outlined in appendix C and D.

7.2.2.3These forms must be available prior to the applicants’ medical and optometric appointments.

7.2.3Electronic transfer of the completed IMEs into the DoDMERB system.

7.2.4Electronic transfer of the completed AMIs into the DoDMERB system.

7.2.4.1All AMIs have individualized identifiable codes.

7.2.5Electronically receive the authorization for IME and AMI from DoDMERB.

7.2.6On line scheduling of both IME and AMI providing addresses and phone numbers to the applicants.

7.3Procedural Variations. Any proposed procedural variations by the contractor, after contract start date, shall be submitted in writing to the CO and the COR for review and consideration. The CO will return the proposed procedural variation to the contractor with 15 days of receipt with a determination of the request.

7.4DoD Mission Category. The services performed under this contract per DoDI 8580.1 are categorized as “Mission Essential” and Mission Assurance Category (MAC) III. Performance of service during a crisis declared by the Secretary of Defense or overseas combatant commander will be executed as instructed by the Contracting Officer.

7.5Provider Locations. IME centers shall be established by the contractor in locations designated by the Government under Section F.6.1 of this solicitation. AMI centers shall be established by the contractor in locations designated by the Government under Section F.6.2 of this solicitation.

7.5.1Location Proximity. It is in the Government’s best interest for sites of the IMEs are as closely located as possible, when not co-located. Historically the co-location of the medical and audiometric portions of the IMEs have proven very beneficial to the applicant and the government.

7.5.2State, City and ZIP Codes

7.5.2.1IME centers are identified by their ZIP code for the purposes of scheduling. Section F.6.1 specifies by ZIP code (first three digits) for the IME locations

7.5.2.2AMI centers are identified by state and city for the purposes of scheduling. Section F.6.2 specifies the state and city for AMI locations.

7.5.3DoDMERB Amending IME and AMI Centers. Due to unforeseen events, situational dependent criteria such as base closures, downsizing Military Medical Treatment Facilities (MTFs), security issues, increased/decreased volume of applicants, and individual facility performance, the Government reserves the right to request additional IME and AMI centers be established or discontinued, as required. After notification by the Contracting Officer, the contractor shall have 30 calendar days to provide evidence of compliance.

7.5.4Contractor Amending IME and AMI Centers. The contractor may terminate IME centers and AMI centers provided there is not an impact of service for that area/region as determined by DoDMERB and upon approval by the Contracting Officer. The contractor shall provide a written request to the Contracting Officer of proposed deletions to the established centers and/or additions no later than 10 business days prior to execution. The Government reserves the right to disapprove the proposed request.

7.5.5Site Inspections. The Government reserves the right to conduct on-site inspections of all IME and AMI centers. The purpose of such inspections will be to determine the suitability of the examining centers in terms of geographic location, accessibility to the main city thoroughfares, and safety concerns.

7.5.5.1In the event the Government desires to accomplish an inspection, the Contractor shall be so advised 5 calendar days in advance of the proposed inspection date and will be provided the name of the individual who will accomplish the inspection.

7.5.5.2IME and AMI centers located in depressed or high crime rate areas are considered cause for termination of select sites. If an inspection (on-site or other) determines the IME and AMI centers as being unsuitable because of location, safety, staffing, or accessibility, the Contracting Officer will notify the contractor within 15 calendar days after the inspection. The Contractor shall have 15 calendar days to provide information satisfactory to DoDMERB that the location has adequate safeguards and/or cause for its continued usage.

7.5.5.3DoDMERB maintains sole right of determination of suitability. If a facility is determined unsuitable per DoDMERB, the Contracting Officer will provide a copy of the final determination report to the contractor within 30 days of DoDMERB’s written notification.

7.5.5.4In such case as a center is determined unsuitable by DoDMERB, the Contractor has 30 calendar days to establish a new IME or AMI center for that ZIP code area

7.6SCHEDULING INITIAL MEDICAL EXAMINATIONS (IME) AND ADDITIONAL

MEDICAL INFORMATION (AMI)

7.6.1 Scheduling

7.6.1.1 IME. The scheduling system shall permit applicants to personally arrange for the IME appointment via the Contractor’s network providers. The Contractor shall make available an appointment (through the network providers) to the applicant within 15 calendar days of being contacted by the applicant (unless the applicant is unable to conform to that period). If the applicant is unable to comply with any of those appointments and the Contractor has demonstrated compliance with the solicitation, the Contractor will not be penalized. The contractor shall make available a matched facility within one business day of data transmission receipt. No other method is authorized, unless unusual and unforeseen circumstances evolve. Data transfer format standards for IME shall be as determined by DoDMERB, and format can be changed, at no cost to the government, with 30-day written notice from DoDMERB.

7.6.1.2 AMI. The scheduling system shall permit applicants to personally arrange for the AMI (consult and/or test) appointment via the Contractor’s network providers. The Contractor shall make available an appropriate appointment (through the network providers) to the applicant within 30 calendar days of the Contractor being contacted by the applicant (unless the applicant is unable to conform to that period). If the applicant is unable to comply with any of those appointments and the Contractor has demonstrated compliance with the solicitation, the Contractor will not be penalized. Data transfer format standards for AMI shall be as determined by DoDMERB, and format can be changed, at no cost to the government, with 30-day written notice from DoDMERB.

7.6.2Rescheduling. Applicants shall be permitted to reschedule any appointment one time. Upon receiving a second rescheduling request for any one appointment from the applicant, the Contractor shall instruct the applicant to contact DoDMERB for additional rescheduling consideration/authorization.

7.6.3Failures to Appear. Following an applicant’s failure to appear for any scheduled appointment, the applicant shall be permitted by the Contractor to reschedule a total of only one IME appointment and only one AMI appointment without DoDMERB authorization. Upon receiving a second failure to appear for any appointment (under any circumstances) and the applicant requests rescheduling, the Contractor shall instruct the applicant to contact DoDMERB for additional rescheduling consideration and authorization.

7.6.3.1 The contractor shall report an applicant as a ‘Failure to Appear’ when an applicant fails to appear at a scheduled appointment without properly notifying the examination center on or prior to the previous business day.

7.6.3.2 An applicant shall be afforded one (1) “Failure to Appear” appointment that is reimbursable to the Contractor for an IME. An applicant shall be afforded one (1) “Failure to Appear” appointment that is reimbursable to the Contractor for AMI.

7.6.4Partial IMEs. A Partial IME generally occurs when the applicant only completes one element of the IME, but fails to complete any remaining portions of the IME (e.g. applicant completes optometric portion of exam but chooses not to complete medical portion of exam). Payment for partial IMEs is acceptable. After 30 days of any completed portion of the IME, the contractor may submit its invoice for billing as a “Partial Examination”. The completed portion of the partial examination shall be submitted to DoDMERB prior to payment of the partial examination.

7.6.5Reassignments. The contractor shall allow for applicant reassignments between their initially scheduled centers to a subsequent center. This is usually a result of applicants leaving the scheduled area for a period of time, necessitating a reassignment to another center location (e.g. student departs campus and returns home for summer break). The Government will be responsible for a minimal administration and handling cost. An applicant is authorized a total of two reassignments (IME and AMI combined) through the contractor. Thereafter, the contractor shall advise the applicant to contact DoDMERB for consideration/authorization.

7.7APPLICANT RECORDS AND PERSONAL IDENTIFIABLE INFORMATION (PII)

7.7.1Release of PII. The contractor shall not release medical records/medical record information to any entity other than DoDMERB. Requests for medical records, or portions thereof, shall be forwarded to DoDMERB.

7.7.2Safeguarding of Privacy Act (PA) Information. The contractor shall establish standards designed to protect unauthorized or unintentional access, disclosure, modification, or destruction of patient information.

7.7.3Authorized Employees. Contractor shall restrict access to personal information to authorized employees and authorized subcontractors only who have signed access authorization documents.

Contractor shall submit photocopy or digital signed copies of authorized employees and authorized subcontractors to DoDMERB Contracting Officer or Contracting Officer Representative when requested by DoDMERB.

7.7.4Compliance documentation shall include that authorized personnel are trained and will comply with the following: Safeguarding procedures; Health Insurance Portability and Accountability Act (HIPAA) rules, regulations, and requirements as set forth in the Code of Federal Regulations at 45 CFR Part 164 (Title 45 - Public Welfare, Subtitle A--Department of Health and Human Services, Part 164, Security And Privacy); and DoD Health Information Privacy Regulation 6025.18-R.

7.8INITIAL MEDICAL EXAMINATIONS AND ADDITIONAL MEDICAL INFORMATION -

GENERAL

7.8.1General

7.8.1.1 Prior to submission to DoDMERB, the IMEs will be quality controlled by the Contractor for completeness and accuracy. For incomplete/inaccurate IMEs the Contractor shall return documents to the Network Provider and document to DODMERB those IMEs were received, but incomplete, and returned to the Network Provider for correction/completion. IMEs will be submitted to DoDMERB within 15 calendar days of the date of the last examination (medical, audiometric or optometric). In the event an applicant does not complete all portions of the IME the Contractor will process IAW the “Partial IME” section of this solicitation.

7.8.1.2 Prior to submission to DoDMERB, the AMI will be quality controlled by the Contractor for completeness and accuracy. For incomplete/inaccurate AMI the Contractor shall return documents to the Network Provider and document to DODMERB that AMI were received, but incomplete, and returned to the Network Provider for correction/completion. AMI will be submitted to DoDMERB within 15 calendar days of the date of the examination. In the event an applicant does not complete all portions of the AMI the Contractor will process IAW the “Partial AMI” section of this solicitation.

(Matt seeks further clarification or rewrite here)

7.8.1.3 Special Cases. In the case of circumstances outside of the control of the Contractor (e.g.

hurricanes, blizzards), DoDMERB shall be notified telephonically and/or through e-mail for resolution on a one-by-one basis.

7.8.1.4 Processing Standards Failures. Failure of the Contractor to maintain timeliness in execution of IMEs and AMIs submitted to DoDMERB shall be recorded in Contractor Performance Assessment Record (CPAR). The standard shall allow for no more than 10 rejections per calendar month for IMEs, and no more than 10 rejections per calendar month for AMIs.

7.8.1.5 Incomplete IMEs and AMI. If the Network Provider fails to complete an IME or AMI, the Contractor shall, in a timely manner, arrange for the completion of items omitted at no cost to the Government or applicants.

7.8.1.6 Rejected IMEs and AMIs. Results that are considered rejected shall, in a timely manner, be re-tested in a timely manner by the Contractor at no cost to the Government or applicant(s). The Government’s decision(s) related to the adequacy/inadequacy of technical data contained within an IME or AMI report/document shall be final.

7.8.1.7 Reprocessing Standards Failures. IMEs and AMI Examinations returned to Contractor for reasons of incomplete/inadequate shall be completed or satisfied within 15 calendar days of delivery to the Contractor. DoDMERB may allow exceptions to this timeline if the applicant is unable or unwilling to comply.

7.8.18 Inconsistency and Failures to Meet Standards. Failures and rejections may be reflected in CPAR at the Government’s discretion. Consistent with and subject to governing regulations of the Federal Acquisitions Regulations the Government may cancel contracts at the convenience of government.

7.8.2Initial Medical Examination

7.8.2.1 Scope of IME. The contractor shall provide a complete and comprehensive examination to include a “hands-on” clinical examination, pure tone threshold audiometric tests, and a complete eye examination as described in Appendix E.

7.8.2.2 Medical Findings. The IME shall address and record findings related to all positive responses listed in the applicant’s medical history which the applicant shall fill out as DoD Form 2492 (e.g., history of extremity injury, surgery, note the range of motion, strength, atrophy, any deformities, etc.

of the affected area; if a history of rash/dermatitis, then note the presence or absence of findings)

(Appendix D). Both positive and specific negative findings shall be commented on by the Network Provider.

7.8.2.3 One on One. The clinical or “hands-on” IME will be conducted on a one-on-one basis.

Further, an appropriate gender chaperone will be present if applicant requested.

7.8.2.4 IME Reporting Method. Examinations shall be completed utilizing the DD Form 2351 and DD Form 2492 and applicable questionnaires (Appendix C and Appendix D). The Contractor may create for DoDMERB consideration and approval, at no cost to the government, a separate paper Optometric form or electronic Optometric Form for submission of optometric findings during the IME (Appendix E).

7.8.2.5 Provider Examination Instructions. The contractor shall prepare a brochure (Not Separately Priced) for the examining centers that outlines the DoDMERB Initial Medical Examination and requirements. This brochure shall specify the examination and administrative procedures the contractor requires the Network Providers to follow. Through the Contracting Officer, DoDMERB will approve the brochure prior to implementation.