Released version 60RRBH23R0011 Disability Medical Exams 2023.pdf

Document Number: 60RRBH23R0011 PROCESSED Page 1 of 67

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER PAGE 1 OF

5. SOLICITATION NUMBER

60RRBH23R0011

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

06/22/2023

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls) 8. OFFER DUE DATE / LOCAL

TIME

08/03/2023

10:00 CT

CODE9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

X

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED 0 Days: 0.00 %

0 Days: 0.00 % 0 Days: 0.00 % 0 Days: 0.00 %

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER DPAS

(15 CFR 700)

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

025CODE15. DELIVER TO

U.S. RAILROAD RETIREMENT BOARD

DISABILITY BENEFITS

844 NORTH RUSH ST., 11TH FL.

CHICAGO, IL 60611

CODE 03916. ADMINISTERED BY

U.S.RAILROAD RETIREMENT BOARD

ACQUISITION MANAGEMENT

844 N. RUSH ST., 9TH FL.

CHICAGO, IL 60611

FACILITY

CODE

CODE

Telephone No.

17a. CONTRACTOR/

OFFEROR

039CODE18a. PAYMENT WILL BE MADE BY

U.S. RAILROAD RETIREMENT BOARD

FISCAL OPERATIONS

844 N RUSH ST., 5TH FLOOR

CHICAGO, IL 60611

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

OFFER SEE ADDENDUM

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

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

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

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Lines

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE X ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) Stephen Schenk

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 02/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

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19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: _________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PARTIAL FINAL

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

COMPLETE PARTIAL FINAL

36. PAYMENT 37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

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

STANDARD FORM 1449 (REV. 02/2012) BACK

Document Number: 60RRBH23R0011 PROCESSED Page 3 of 67

Table of Contents

Section Description Page Number

I Introduction Overview

II Schedule of Supplies and Services Schedule of Supplies and Services

III Statement of Work Statement of Work

IV General Terms and Conditions 52.252-1 Solicitation Provisions Incorporated by Reference (Feb 1998) 52.203-2 Certificate Of Independent Price Determination (Apr 1985) 52.203-11 Certification And Disclosure Regarding Payments To Influence Certain Federal Transactions (Sept 2007) 52.211-11 Liquidated Damages-Supplies, Services, or Research and Development (Sept 2000) 52.212-3 Offeror Representations and Certifications-Commercial Products and Commercial Services (Dec 2022) 52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders- Commercial Products and Commercial Services (Mar 2023) 52.216-1 Type of Contract (Apr 1984) 52.216-18 Ordering (Aug 2020) 52.216-19 Order Limitations (Oct 1995) 52.216-22 Indefinite Quantity (Oct 1995) 52.217-8 Option to Extend Services (Nov 1999) 52.217-9 Option to Extend the Term of the Contract (Mar 2000) 52.219-9 Small Business Subcontracting Plan (Oct 2022) 52.224-1 Privacy Act Notification (Apr 1984) 52.224-2 Privacy Act (Apr 1984) 52.232-11 Extras (Apr 1984) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.233-2 Service of Protest (Sept 2006) 52.237-3 Continuity of Services (Jan 1991) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997) 52.242-15 Stop-Work Order (Aug 1989) 52.246-25 Limitation of Liability-Services (Feb 1997) RRB.A.01 A. General RRB Provision-1.Technical Direction RRB.A.03 A. General RRB Provision-3.Billing RRB.A.07 A. General RRB Provision-7.The Role of Government Personnel and Responsibility for Contract Administration RRB.B.01 B. Security Provisions-1.Security Information RRB.B.02 B. Security Provisions-1. Privacy Or Security Safeguards (AUG 1996) FAR 52.239-1 (with RRB Fill-ins)

V Proposal Submission Instructions Section V - Proposal Submission Instrctions

VI Evaluation and Award Section VI - Evaluation and Award

VII List of Attachments Attachments and Exhibits

Document Number: 60RRBH23R0011 PROCESSED Page 4 of 67

Section I - Introduction

Overview

A. Agency Information

The U.S. Railroad Retirement Board (“RRB”) is an independent federal agency that administers a retirement and survivor benefit program for railroad employees and their families. The RRB was established by the Railroad Retirement Acts of 1937 and 1974. Its benefit program was the forerunner of the more familiar Social Security System. The Railroad Retirement System is unique inasmuch as it is the only federally administered benefit program covering a single private industry. The RRB also administers the Railroad Unemployment Insurance Act, which provides unemployment and sickness benefits to railroad employees. The RRB’s headquarters is located in Chicago, Illinois. The RRB has a national network of 53 field offices.

B. Objective

The RRB seeks the services of a licensed physicians, psychologists, psychiatrist, and medical facilities (as described in the Statement of Work, Section III.E.) who shall provide consultative examinations and/or ancillary tests for disability benefits primarily adjudicated by the the Disability Benefits Division (DBD). However, additional divisions (Reconsideration) and Bureaus (Hearings and Appeals) may also request services.

C. Background

1. The disability program, administered by the Railroad Retirement Board (RRB), is mandated by the Railroad Retirement Act (RRA). DBD is responsible for making agency decisions related to disability-based benefits under the RRA and the Social Security Act (SSA).

2. When the disability decision is rendered by the RRB that decision is based on the regulations as cited in the current edition of Title 20, Code of Federal Regulations, Part 220.

3. This solicitation outlines a program whereby ordered consultative examinations will be furnished by a contractor who shall establish and maintain systems and procedures necessary to provide consistent quality, timely response and adequate control. Cost control, accuracy and utilization of electronic data interchange (EDI), including but not limited to a paperless payment system and a paperless upload/download system for receipt of deliverables , are the benefits of such a contract.

4. DBD is involved in requesting and reimbursing claims related and professional services required in connection with the disability program. A number of guides are available and utilized in the claim evaluation including the RRA, SSA, and CFRs.

5. By its nature, the disability claim workload is difficult to predict. RRB offers the following information to aid interested parties in making projections:

a. In Fiscal Year 2022, there were about 20,000 persons on RRB’s rolls, receiving benefits because of disability.

New applications from employees, widow(er)s and children for disability-based benefits under the Railroad Retirement Act currently average about 2,150 per year.

b. In Fiscal Year 2022, RRB requested approximately 1600 medical examinations and ancillary tests. Based on experience and current workloads, RRB expects to request, but does not guarantee, medical examinations or tests for approximately 1800 cases per year to be rendered on disability claims. Disability claims are most commonly related to, musculoskeletal, mental or neurological impairments. Very often, claims are based on a combination of impairments.

6. Approximately 25% (403 cases) of exams may be required for mental impairments.

a. Approximately 27% (435 cases) of exams may be required for orthopedic impairments.

b. Approximately 17% (272) of exams may be an internal exam with orthopedic impairment.

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Associated Lines:

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Section II - Schedule of Supplies and Services

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

0001 Medical- Other

Firm Fixed Price

PSC: Q999

0.000000 EACH

Period of Performance: 10/01/2023 - 09/30/2024

Description:

Initial contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/ test in Attachment B for the initial year of services.

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

0002 Medical- Other

Firm Fixed Price

PSC: Q999

0.000000 EACH

Period of Performance: 10/01/2024 - 09/30/2025

Description:

First option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the first option year of services.

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

0003 Medical- Other

Firm Fixed Price

PSC: Q999

0.000000 EACH

Period of Performance: 10/01/2025 - 09/30/2026

Description:

Second option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the second option year of services.

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

0004 Medical- Other

Firm Fixed Price

PSC: Q999

0.000000 EACH

Period of Performance: 10/01/2026 - 09/30/2027

Description:

Third option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the third option year of services.

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Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

0005 Medical- Other

Firm Fixed Price

PSC: Q999

0.000000 EACH

Period of Performance: 10/01/2027 - 09/30/2028

Description:

Fourth option year contract term for the medical examination services. Offerors shall enter a firm fixed price per examination/test for each examination/test in Attachment B for the fourth option year of services.

Schedule of Supplies and Services

A. Offerors must provide a fully loaded, firm-fixed monthly price, in CLINs 0001 through 0005 for the provision of services specified in Section III of this RFP, for the Base Period and (4) Option Periods. The RRB describes “fully loaded” as the price inclusive of direct wage, fringe benefits, all overheads, general and administrative (G&A) cost, profit and fees. Offerors shall also complete the fill-ins below for Sections II. B and C.

Offerors must complete all pricing CLINs indicated in the above Schedule of Supplies and Services.

If the offeror has any government-wide acquisiton contract (GWAC), please enter your GWAC number or link to the contract.

B. Price quotation is valid through ____/____/2023. (180 days from the date of offer, unless otherwise stated).

C. Contractor Information for Order Administration:

1. Authorized representatives:

Business Technical Name:_________________________________________________________ Phone #:_______________________________________________________ Fax #: _________________________________________________________ E-Mail:_________________________________________________________

2. System for Award Management (SAM) registration completed*: Yes [ ] No [ ]

* Offeror must be properly registered, including business size annotation, in the System for Award Management (SAM) to be eligible for award of a Federal contract or order. (See www.sam.gov).

Associated Lines:

PERIOD OF PERFORMANCE

ITEM START END

0001 10/01/2023 09/30/2024

0002 10/01/2024 09/30/2025

0003 10/01/2025 09/30/2026

0004 10/01/2026 09/30/2027

0005 10/01/2027 09/30/2028

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Section III - Statement of Work

Statement of Work

A. Background

Under the current contract, the contractor provides consultative medical examinations and ancillary tests for claimants and annuitants of RRA and SSA benefits throughout the country (rural and metropolitan areas). Both physical and psychological examinations and tests are completed in-person within 60 miles of the examinees address. Some psychological exams are completed via video teleconferencing technology (VTT) in accordance with 20 CFR 220.57.

1. The disability program, administered by the Railroad Retirement Board (RRB), is mandated by the Railroad Retirement Act (RRA). Disability Benefits Division (DBD) is responsible for making agency decisions related to disability-based benefits under the RRA and the Social Security Act (SSA). When the disability decision is rendered by the RRB that decision is based on the RRB's regulations as codified in Title 20, Code of Federal Regulations, Part 220. This nationwide program consists of:

a. Initial determinations of disability, which may result in monthly annuity payments;

b. “Disability freeze” determinations, which may result in, among other things, early Medicare coverage;

c. Continuing disability review (CDR) activity, which determines continuing entitlement to disability benefits; and

d. An appeals process, which affords any applicant who disagrees with a disability determination rendered by the RRB an opportunity for administrative review.

2. DBD is comprised of two determination sections (including clerical staff who perform functions for all parts of the office), where medical and vocational expertise is combined to provide claim decisions. Initial medical and vocational evidence development related to disability claims is the joint responsibility of the RRB’s Field Service and Headquarters staff. The development includes accumulation of all pertinent existing medical records (hospital, clinic, etc.), which may be forwarded to the exam or ancillary test provider for review/consideration in examination. The final exam/ancillary test report will be reviewed by RRB staff in making the final determinations.

3. Consultative examinations and/or ancillary tests are used as supportive evidence in making a determination of disability under Federal guidelines for either a current or former railroad employee or his/her widow(er) or child. Disability entitlement under the RRA may exist based on total disability, with medical and vocational factors considered, for railroad employees, their widows, or their children who suffer onset of disability prior to the age of 22. In addition, entitlement is possible if an employee who meets certain age and/or service requirements is unable to perform their regular railroad occupation. Disability entitlement under the SSA may exist based on total disability with medical and vocational factors considered.

4. The primary emphasis in disability claims processing is not on treatment, but rather on identifying the functional limitations that may interfere with the claimant's ability to work. Therefore, the consultative examination and report must be in sufficient detail to permit the claims examiner and/or evaluating physician who do not see or examine the applicant to determine the severity and duration of the impairment. This determination is made within set of guidelines that require that objective medical findings be documented in a detailed manner and with the use of specific testing procedures. These manners and procedures are governed by regulations (20 CFR, Part 220 and 20 CFR Part 404). Alternative testing methods and procedures must not be used in the disability determination. For example, in the pulmonary function test, the flow volume loop for calculating the forced expiratory volume (FEVI) and forced vital capacity (FVC) are not acceptable.

5. The types of examinations and tests the RRB will order depend upon the evidence needed for the disability determination.

The RRB will order only the specific examinations or ancillary tests needed. If an ancillary test such as an X-ray, blood study, or EKG will furnish the additional evidence needed for the disability determination, RRB may decide to order such test rather than a more comprehensive medical examination.

B. Operational Activities

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1. Examination Scheduling and Performance Requirements

a. The Contractor shall follow the examination formats and test protocols set forth in (Exhibit 2 - Revised Consultative Examination Protocols and Exhibit 3 - Revised Ancilliary Test) and shall assure that all required examinations and ancillary tests are performed in accordance with sound medical practice and as specified in this solicitation/contract.

b. The Contractor shall schedule and perform examinations and ancillary tests upon receipt of an order.

(i) For cases designated as routine, the Contractor shall contact the claimant/representative by phone call or text if cellphone (or via mail if the claimant cannot be reached by phone) within 7 calendar days after receipt of an order to begin the scheduling process. The examination date shall be no later than 18 calendar days after the claimant has been contacted.

Once the mutually-agreed upon appointment has been set up, the Contractor shall, within 24 hours, release a notice to the claimant including all specifics of the appointment, such as date, time, location, special instructions including but not limited to request to reschedule if the person is within 90 days of a surgical procedure (pre or post), reason(s) for appointment, types of examinations and/or ancillary tests, etc. A report must be received by the RRB headquarters no later than 10 calendar days after the examination or test is completed, for a total processing time not to exceed 35 days.

(ii) The Contractor shall process urgent cases in an expeditious manner when requested by authorized RRB personnel. In the event of such a request, the contractor shall contact the claimant/representative by phone call or text if cellphone (or via mail if the claimant cannot be reached by phone) within 5 calendar days after receipt of an order to begin the scheduling process. The examination shall be scheduled to occur within 10 calendar days for all exam and test types. Once the mutually-agreed upon appointment has been set up, the Contractor shall, within 24 hours, release a notice to the claimant including all specifics of the appointment, such as date, time, location, special instructions, reason(s) for appointment, types of examinations and/or ancillary tests, etc. A report must be received by the RRB headquarters no later than 10 calendar days after the examination or test is completed, for a total processing time not to exceed 25 calendar days.

(iii) The Contractor shall provide a reminder call to the claimant/representative between 48 and 72 hours prior to the scheduled appointments for all cases.

c. The Contractor shall complete orders in a timely manner.

(i) For cases designated as routine, the contractor’s processing time from receipt of the order to the receipt at the RRB of an acceptable written examination report shall be no more than 35 calendar days for 80% of all orders, and no more than 45 calendar days from the receipt of the order for the remaining 20%.

(ii) For cases designated as urgent, the contractor’s processing time from receipt of the order to the receipt at the RRB of an acceptable written examination report shall be no more than 25 calendar days.

(iii) The mean processing time average for all reports shall not exceed 35 calendar days. (See Attachment A - FY22 Ordered Urgent Routine Exams - Tests for the number of examinations and tests ordered in Fiscal Year 2022).

(iv) The contract delivery schedule shall be waived and the contract timeliness standards shall be deemed inapplicable in the event that:

1.1 One of the following circumstances caused an otherwise timely and acceptable medical examination report to be submitted late

(i) Claimant requests that the location of a scheduled appointment be changed,

(ii) RRB requests that the location of a scheduled appointment be changed,

(iii) Claimant requests that the date of a scheduled appointment be changed,

(iv) RRB requests that the date of a scheduled appointment be changed, Document Number: 60RRBH23R0011 PROCESSED Page 10 of 67

(v) The Contractor is unable, through no fault of its own, to contact the claimant in a timely manner i.e. invalid contact information and;

2.1 The Contractor identifies the specific reason (i-v, above) for late submission of the report and conveys that information, in a manner mutually agreed to by the RRB and the Contractor, to the RRB at the time of report submission. The RRB shall have final authority in determining whether the contract required timelines performance shall be waived.

(d) The Contractor shall complete orders with geographical considerations and customer convenience.

(i) Exam orders are requested in both metropolitan and rural communities. The Contractor's medical offices or sites must be located to provide maximum geographic coverage, minimizing inconvenience to the claimant. The Contractor must make every effort, including the recruitment of additional providers, if necessary, to assure that claimants need travel no more than 60 highway miles from their place of residence in order to attend an appointment. In the event scheduling is not possible within 60 highway miles, the Contractor must get agreement from claimant prior to scheduling exams further than 60 miles.

(ii) Whenever feasible, ancillary tests shall be scheduled for the same day as the examination and at the same site, thereby reducing inconvenience to the claimant.

(iii) The RRB and the claimant shall have the right to object to and refuse any scheduled examination with the Contractor's designated physician or psychologist per 20 CFR 220.58. If the RRB finds there is a good reason for the objection, the RRB will schedule the examination with another Contractor-provided physician or psychologist.

(e) The Contractor must keep RRB informed of contacts and processes for each exam (see Section III.D.3:Reporting Requirements).

(i) The Contractor must, at the time of scheduling, furnish the RRB headquarters with an electronic copy of the notice released to the claimant in accordance with Section III.B.1.b(i) and (ii) above.

(ii) If additional consultative examinations or ancillary tests other than those requested by RRB authorized personnel become necessary during the testing, authorization for these additional services must be obtained from RRB headquarters personnnel by telephone. Such contacts must go through the Contractor's liaison official (Program Manager. See Section III.D.2(c) for definition of "contractor's liaison official"). Whenever feasible, this authorization shall be obtained while the claimant is still at the examining site.

The original order shall be modified by RRB personnel to reflect and confirm the authorization for additional service. Telephone numbers of RRB personnel will be provided to the Contractor before the commencement of contract performance. Personnel in the DBD , the Reconsideration Section, and the Bureau of Hearings and Appeals are generally available from 10:00 a.m. to 2:30 p.m. Central Time each working day. Some personnel in these offices may also be available from 6:00 a.m. to 10:00 a.m. and 2:30 p.m. to 6:30 p.m.

(iii). Any examination or test-related instructions/notifications (i.e. post op/exacerbation reminders, appointment access, etc.) sent to the claimant in advance of the examination or test shall be sent by the Contractor. The specific format for these notifications/letters must be approved by the RRB prior to contract implementation.

(iv) If the claimant fails to appear for an examination (“no shows”),the Contractor must notify RRB headquarters when it is determined that the claimant was a “no show.” The reason for the missed appointment shall be stated, if known. The Contractor shall not reschedule a “no show” without RRB headquarters approval. The Contractor shall not be reimbursed in the event a claimant fails to appear for an examination or test.

f. The Contractor must not use the same doctor who had conducted a previous examination for a new consultative examination at the reconsideration or an appeal level. The RRB will furnish the name(s) of the doctor(s) involved in these cases to avoid rescheduling with the same provider.

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g. The Contractor shall perform repeat examinations and/or ancillary tests without additional charges when the RRB determines that upon review the initial examinations and ancillary tests do not comply with the guidelines shown in Exhibit 2 (Revised Consultative Examination Protocols and Exhibit 3 - Revised Ancilliary Test) which is consistent with 20 CFR 404, Appendix 1 to Subpart P. Any repeated examination or ancillary test shall be accomplished within the original timeframes and in accordance with the procedures set forth in this contract. The RRB shall have sole authority in determining adequacy of examinations and/or ancillary tests.

h. The Contractor must ensure that his/her staff will extend proper courtesy to the claimant in order to maintain good public relations including timely responses to inquiries.

i. The Contractor shall not charge the claimant for any services contracted by the RRB and shall assure that any subcontractors such as providers or billing services will not bill the claimant for any services. The RRB shall not be responsible for payment for any unauthorized services performed by any subcontractor.

j. Examination Duration - In scheduling full consultative examinations, sufficient time shall be allowed to permit the examining physician to take a case history and perform the examination (including any needed tests) See 20 CFR §220.61 (a)..Specific examinations shall be performed within the following timeframes.

(i) A complete and through internal medical examination including medical history is expected to take a minimum of 30 minutes, excluding ancillary testing time (blood drawing, X-rays, etc.).

(ii) A complete and through psychological exam including medical history is expected to take a minimum of 60 minutes.

(iii) A complete and thorough musculoskeletal or neurological examination including medical-history is expected to take a minimum of 30 minutes.

2. Examination Report Requirements

The following information shall be included in every examination report regardless of specific examinations ordered and shall be typed on official letterhead. (Ref: 20 CFR §220.61 and 220.120.)

a. The claimant's name and address.

b. The claimant's social security number or railroad retirement claim number, if different. This shall be shown on each page of the report.

c. Date examination performed.

d. The major or chief complaints alleged by the claimant as reason for not working.

e. Current medication by name of drug, dose and frequency.

f. A family and social history including a list of any familial diseases; environmental exposure and information regarding the claimant's personal habits with respect to smoking, drug and alcohol consumption. A statement regarding the patient's reliability shall be included.

g. A review of the affected system(s).

(1) Refer to the section in (Exhibit 2 - Revised Consultative Examination Protocols) that corresponds to the examination ordered as well as the chief complaints for specific information required. Claimants with multiple impairments must be evaluated with the protocol that addresses each of the alleged impairments. For example, a physician examining a claimant with an alleged cardiovascular impairment and a respiratory impairment must follow the instructions for an internal medicine examination as well as the instructions for a cardiovascular examination and a respiratory examination. In most cases, a general internal medicine examination will be ordered for claimants with multiple impairments.

However, if one of the multiple impairments is musculoskeletal in nature, a specialized internal medicine examination with orthopedic emphasis may be ordered, rather than a separate general internal medicine exami¬nation and a separate orthopedic examination. Examples of a routine exam is available

Document Number: 60RRBH23R0011 PROCESSED Page 12 of 67 online and included within the protocols. Abnormalities include deformities or non-normal range performance that may or may not suggest additional follow-up must be detailed.

(2) Any “positive” and “negative” detailed findings based on the examination and ancillary tests and from the background information (if provided) must be included. An omission of a specific finding will not be interpreted as a “negative” or normal finding.

(3) Quantifiable assessments must be given. Subjective terms such as “frequent” or “significant” are not acceptable. Measurable objective findings shall be documented with actual measurements or a quantified assessment. For example, the range of motion information provided in an orthopedic or a musculoskeletal examination of the claimant's affected joint(s) is quantified in degrees. Percentages of normal range of motion or movement measured by inches are not acceptable. Examples of a routine exam is available online and hyperlinked within the protocols. Questions regarding exam sufficiency shall be directed to the contract’s liaison or other authorized RRB personnel.

h. Each major or chief complaint shall be discussed in detail under the “History of Present Illness.” The discussion of these complaints must present a detailed longitudinal description of the pertinent past history of the disease stated in addition to the detailed description of the individual's statement of the current complaints. It is important to present, in as much detail as is obtained from the individual, significant occurrences, including changes in the status of those complaints over time, hospitalizations with dates and names of hospitals, findings, test results and treatment during the hospitalization as understood by the individual, and the ongoing treatment. It is particularly important to provide a detailed description of the individual's current complaints, explaining those factors that increase the problem or impairment and those which may provide relief, and the individual's description of how the impairment limits the ability to function.

i. The physician obtaining the history and performing the physical examination must provide diagnostic and prognostic conclusions based on the claimant's medical history, the physical examination and any laboratory tests obtained in conjunction with the physical examination. All abnormalities shall be explained or commented on if a definite explanation cannot be provided.

j. The physician who performs a physical examination shall provide a diagnosis and prognosis. A statement as to what the claimant can still do despite his or her impairment(s). This statement must describe the consultative physician's or psychologist's opinion concerning the claimant's ability, despite his or her impairment(s), to do basic work activities such as sitting, standing, lifting, carrying, handling objects, hearing, speaking, and traveling:

and, in cases of mental impairment(s), the consultative physician's or psychologist's opinion as to the claimant's ability to reason or make occupational, personal, or social adjustments (see 20 CFR 220.61(c)(6). This statement must be substantiated by the objective findings of the examination and shall not be based on subjective factors such as the claimant's allegations.

k. The physician/psychologist who performs the psychiatric or psychological examination shall also provide a statement as to what the claimant can still do despite his or her impairment.

C. Ordering Procedures

The orders for consultative examinations and/or ancillary tests will be initiated by authorized RRB . Authorized RRB includes claims examiners, leads, analysts and management from the Disability Benefits Division (DBD), claim specialists from the Reconsideration Section, hearings officers from the Bureau of Hearings and Appeals, and Claims Representatives from RRB field offices.

1. The orders for consultative examinations and ancillary tests shall be conveyed from the RRB to the Contractor electronically through RRB’s current financial system, Financial Management Integrated System (FMIS). It provides automated transactions and processes to obligate funding for ordered consultative opinions, records the acceptance of the completed medical opinion and generates a daily payment (direct deposit) to the contractor. Since the daily payment will usually be made up of multiple medical opinion payments, the system generates a report for each daily payment identifying the medical opinions paid for. The contractor will be given security access to retrieve the report from a secure server at RRB via FTP (File Transfer Protocol).

2. The Contractor shall deliver complete medical reports which include detailed exam notes, checklist, worksheet etc., narrative report, and forms completed by the claimant.

3. Orders for examinations and/or ancillary tests will include the following information:

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a. Date of request.

b. Order Number – Administrative number assigned to each order.

c. Name of the authorized RRB personnel.

d. Name of the unit to receive the examination/test reports.

e. Name and date of birth of the person to be examined, the latest address of record and phone number (if available).

f. Identification number. This will include the claim number plus a two-character alpha suffix for RRB's internal use. The claim number is usually the social security number in the case of an employee, but it may be different in the case of a widow(er) or a child who is entitled on the employee's earnings record.

g. Name of railroad employee, if different from the person named in "e" above.

h. RRB field office that services the area where the claimant lives.

i. Special considerations such as but not limited to:

(i) Urgent handling required.

(ii) Physical/mental impairments, impaired speech, poor hearing, etc., that may affect the scheduling.

(iii) Other limitations, such as illiteracy or difficulty with English. If there is a language barrier, the primary language will then be specified.

(iv) Name, address and phone number of representative payee (if applicable).

(v) Identification as a reconsideration or appeal case. To ensure impartiality, the original examining doctor MUST NOT BE USED FOR REEXAMINATION. The name of this doctor will be provided.

(vi) Any other limitations that shall be considered by the contractor when scheduling an appointment.

j. The chief complaint(s) as described by the claimant.

k. The consultative examinations and/or ancillary tests needed. Currently, we use a three-digit examination number to identify examinations and tests. (See Attachment B - Unit Pricing Schedule Exam - Tests Estimated Orders)

l. Reason code. This is a numeric code used to identify the Reason for the examination and the beneficiary type.

(See Exhibit 1 for the listing of these codes).

m. The name of the claimant’s treating physician(s), if known. The consultative examination shall not be done by the claimant’s treating physician(s).

n. When a psychiatric or neurological examination is ordered, the authorized RRB personnel will furnish a copy of available medical evidence that must then be forwarded to the physician performing the consultative examination for review and to aid in the medical evaluation.

D. Administrative Requirements

1. Medical Staff Qualifications

a. The Contractor will provide physicians knowledgeable of medical standards for each exam performed. In addition, knowledge of regulations, policies and guidelines related to disability-based benefits under the Railroad Retirement Act (RRA) and Social Security Act (SSA) as those Acts are currently stated and as they may change during the lifetime of this contract.

Document Number: 60RRBH23R0011 PROCESSED Page 14 of 67 b.All physicians performing services under this contract shall be currently licensed in the State in which contractual services are rendered and shall have training and experience necessary to perform the type of examination or test required. The physician or psychologist may use support staff to help perform the examination.

However, examinations must be performed by a physician or psychologist. Examinations performed by other non-physicians, including but not limited to physician assistants, are not acceptable. Any such support staff must meet appropriate licensing or certification requirements of the State in which he/she practices. Psychologists may be a Ph.D., M.D., or have at least a Master’s degree in clinical psychology.

c. The Contractor shall use medical technicians for ancillary tests who are licensed or certified, if applicable, and have appropriate experience and training in performing specified tests.

d. The Contractor shall ensure that all its medical providers' facilities meet State and local codes for licensing, insurance, safety and sanitary purposes.

e. The Contractor shall maintain and make available upon request by the RRB's Contracting Officer’s Technical Representative (COR) a list of all medical staff that displays name, title, specialty function, and languages spoken. Curriculum vitae on all medical staff and appropriate copies of medical licenses, specialty ratings and certifications must also be available annually and for periodic spot checks by the RRB's COR.

f. No physician performing services under this contract shall have served as a witness in a lawsuit either against or for a railroad employer, or be an employee of a railroad, of the RRB, or subcontractor of an RRB contractor for disability related examinations services. In addition, no physician shall perform services under this contract for any case where they have provided medical or RFC assessments as a treating or consulting physician per 20CFR

220.63 . Conflict of interest as described in 20 CFR 220.63 includes, but not limited to personal or financial relationships with RRB employee or patient. This does not preclude the provider from submitting medial evidence based on prior treatment or examination of the claimant.

g. The Contractor shall not employ, under this contract, the services of any individual or entity who is excluded, suspended, or otherwise barred from participating in Medicare, Medicaid or any other Federal or Federally-assisted program; who has been convicted, under Federal or State law, in connection with the delivery of health care services, of fraud, theft, embezzlement, breach of fiduciary responsibility or financial abuse; who has been convicted under Federal or State law of unlawful manufacture, distribution, prescription, or dispensing of a controlled substance; whose license to provide health care services is revoked or suspended by any State licensing authority for reasons bearing on professional competence, professional conduct, or financial integrity; who has surrendered such a license while formal disciplinary proceedings involving professional conduct were pending;

or who has had a civil monetary assessment or penalty imposed on such individual or entity for any activity described in this section or as a result of formal disciplinary proceedings per 20 CFR 220.64.

2. Contractor Management

a. The Contractor shall deliver complete medical reports which include detailed exam notes, checklist, worksheet etc., narrative report, and forms completed by the claimant to the RRB headquarters daily using secure electronic transmission accessible by all RRB designated officials and Contractor contacts that comply with all applicable federal laws, rules and regulations.

b. The Contractor shall implement an RRB accessible real-time system that tracks the status of each medical exam ordered under this contract. Each exam ought to meet the requirements of the protocols and standard medical practices.

c. The Contractor shall designate a contract performance liaison person (Program Manager/PM) and backup to coordinate activities, resolve day-to-day problems, and answer questions from RRB personnel. In addition, the contractor shall identify administrative staff that will be involved in the implementation and on-going administration of this contract. Staff changes after award must be coordinated with the RRB. All staff must be organized and trained staff to provide all required functions under this contract. Trained includes being knowledgeable of regulations, policies and guidelines related to disability-based benefits under the Railroad Retirement Act (RRA) and Social Security Act (SSA) as those Acts are currently stated and as they may change during the lifetime of this contract.

d. The Contractor shall revise systems and procedures in response to changes in laws and regulations as described and communicated to the Contractor by the RRB. Such laws and regulations must be implemented within the

Document Number: 60RRBH23R0011 PROCESSED Page 15 of 67 designated timeframes proposed by RRB. If contractor is unable to meet deadlines, it must be communicated before established deadline.

e. The contractor ought to continuously review the quality of exam reports submitted for sufficiency, detail, and compliance to the protocols and standard medical practices. Quality reviews include customer (claimant examined) experience and feedback. The Contractor shall provide monthly and quarterly reports related to quality and timeliness of exams.

f. The Contractor shall provide certain basic management information to the RRB on all cumulative exam report data set. Such information shall include, but not be limited to the following:

(i) RRB Claim Number.

(ii) Claimant’s Name.

(iii) Exam requestor and date requested.

(iv) Reason for exam.

(v) Reasons for delays or exclusions from contract timeliness standards.

(vi) Indicate type of exam ordered by name and number (ex. 013 psych).

(vii) Indicate Exam/Facility Provider.

(viii) Indicate if exam was ordered routine or urgent.

(ix) Processing Dates such as order request date.

(x) Dates, times and methods of all contact with claimant.

(xi) Date notice released to claimant for examination.

(xii) Examination date.

(xiv) Date contractor receives report.

(xv) Date report sent to RRB.

(xvi) Reasons for delays or exclusions from contract timeliness standards.

(xvii) Indicate if exam was ordered routine or urgent.

(ix) Number of days at each step i. to viii. including since order received (initial contact date, time, number of attempts, method of contact, reminder notice information, exam date, report delivered date).

g. All reports provided shall be sortable, including by month and fiscal year. The reporting period for routine reports shall begin on the first day of each month. All reports shall be furnished and delivered to the Contracting Officer’s Representative (COR) within two workdays after the end of the reporting period. Secure Electronic Data Interchange technology must be employed to transmit reporting data to the RRB.

h. Reports shall be provided both on a monthly and ad hoc basis.

1.1 The following reports shall be provided on a monthly basis. RRB claim number and sorting capabilities shall organize each report. Note: all reports below must include data in Section D.2.f above.

a. Deliverables reflect cases where an examination order has been issued by the RRB but the Contractor has not scheduled an exam. Note: This report must include documentation regarding initial contacts with the claimant.

b. Scheduled - reflect those cases where the Contractor has scheduled the examination but it has not yet been conducted.

c. Reports Pending reflect those cases where the examination has been conducted but the report has not yet been submitted to the RRB. Note: This report shall include date of examination, any dates demonstrating follow-up with the provider and provider’s response.

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d. Reports Submitted reflect those cases where the examination report has been submitted to the RRB. Note: This report shall include date of examination, any follow-ups with provider to obtain report, and date delivered to RRB.

e. Untimely Reports reflect all exams ordered routine or urgent that are not completed by the due dates. Note: This report shall include exams not meeting the timeframe allotted and reason why.

f. No Show Report-reflect all cases where the examination order has been issued by the RRB, the Contractor scheduled, but the claimant did not show for the exam. Notification shall include the RRB claim number including the alpha suffix, the claimant's name, the examination code for the examination/ ancillary tests missed, and the reason for the “no-show,” if known. The specific notification process must be approved by the RRB prior to contract implementation.

g. Reject/Clarification reflect all cases where RRB has issued an exam order, the Contractor completed a report, but RRB returned the report for clarification or change. This report shall include date of order, date of examination, any internal control dates/comments for clarification, and date contractor received RRB reject.

h. Consolidated Report reflecting items D.2.f (x) through (ix) shown above.

2.1 The following report shall be provided twice a month on the 1st and 15th of each month. Note if the day falls on a weekend or holiday, the next business day is acceptable. Each report shall be organized by RRB claim number and have sorting capabilities. Note: all reports below must include data in Section III.D(f).

a. Unpaid Invoice reflect all exams conducted, reports delivered and awaiting payment more than 20 days. Note, the report must include RRB Claim Number, Claimant’s Name, Exams requested, exams delivery date.

b. Unable to Contact reflect exam orders where claimant was unresponsive after the 7 days and RRB has not responded to assistance request.

c. Delayed Reports reflect all exams ordered routine or urgent that are completed but pending exam report greater than 10 days from the date of exam. Note: This report shall include follow-up attempts to resolve the exam and any reason why for the delayed exam reports.

3.1 Generally, RRB will give 2 days’ notice for ad hoc reports. In addition to RRB making requests, the Office of Inspector General (OIG) may also request data and or information. The Contractor must respond to both RRB and OIG within 2 days as to report status at a minimum if report not immediately available. Such reports must include data in Section III.D(f). Examples include but not limited to the following:

a. Distance Travelled reflect distance claimants have travelled to attend exams. If attended multiple exams, each shall be listed. Such reports will include but not be limited to the RRB claim number, claimant’s name, claimant’s address, facility name, facility address, the examination/test date, and the distance between the claimant’s residence and the facility.

b. Providers Identified reflect frequency of medical exam providers used by exam types for designated time period.

c. Similar Exam Orders reflect exams ordered and/or delivered for the same claimant (i.e.

orthopedic and orthopedic specialist for a designated time period). Note, this report shall be by claimant SSN and include date ordered and types of exams ordered.

d. Average Exam Time reflect the time claimant spent in an exam, starting with the time being seen by the provider.

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e. At the end of the fiscal year, only the orders not delivered shall be carried over to the next fiscal year's reports where they will be carried, along with all new activity, for the entire fiscal year.

E. Program Safeguard Requirements

To maintain the integrity of the programs administered by RRB based on the contractor’s services rendered, the contractor must maintain a quality control and assurance plans.

1. Quality Control Plan – The Contractor shall maintain an ongoing quality control plan to ensure that the requirements of this contract are satisfied. The plan shall include methods for identifying, resolving and preventing deficiencies in the quality and timeliness of services performed under this contract to ensure the level of performance meets the contract’s requirements.

2. Quality Assurance Plan – The RRB…