WCRC_Solicitation_2.7.2017_Amendment_4.pdf

RFP-CMS-2016-8A-0008 Amendment 4 February 7, 2017 Workers’ Compensation Review Contractor

TABLE OF CONTENTS

SECTION B – SUPPLIES OR SERVICES AND PRICES/COST

B.1 DESCRIPTION OF SERVICES

B.2 TYPE OF CONTRACT/PRICE/PAYMENT

B.3 SCHEDULE OF SERVICES

B.4 WITHHOLDING OF CONTRACT PAYMENTS

SECTION C – DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1 STATEMENT OF WORK

SECTION D – PACKAGING AND MARKING

D.1 PACKAGING AND MARKING

SECTION E – INSPECTION AND ACCEPTANCE

E.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

E.2 APROVALS BY THE CONTRACTING OFFICER’S REPRESENTATIVE (COR)

SECTION F – DELIVERIES OR PERFORMANCE

F.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

F.2 PERIOD OF PERFORMANCE (JAN 2014)

F.3 DELIVERABLES

F.4 PLACE OF PEROFRMANCE

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 ACCOUNTING AND APPROPRIATION DATA

G.2 DISSEMINATION, PUBLICATION & DISTRIBUTION OF INFORMATION

G.3 GOVERNMENT REPRESENTATIVES AND RESPONSIBILITIES (JUL 2016)

G.4 PROPERTY ADMINISTRATION

G.5 PAYMENTS-INVOICES-FIRM FIXED PRICE CONTRACTS (OCT 2015)

G.6 CORRESPONDENCE PROCEDURES

G.7 DATA TO BE DELIVERED

G.8 USE OF GOVERNMENT DATA (REPORTS/FILES/COMPUTER TAPES OR DISCS)

G.9 CONTRACTOR PSAT PERFORMANCE EVALUATION(S) (OCT 2014)

G.10 CONTRACTOR WORK PERFORMED OUTSIDE THE UNITED STATES AND ITS

TERRITORIES (APR 2016)

SECTION H- SPECIAL CONTRACT REQUIREMENTS

H.1 BUSINESS ETHICS, CONFLICT OF INTEREST AND COMPLIANCE (DEC 2015)

H.2 APPROVAL OF CONTRACT ACQUIRED INFORMATION TECHNOLOGY (IT)

H.3 HIPAA BUSINESS ASSOCIATE CLAUSE (OCT 2014)

H.4 HHSAR 352.237-75 KEY PERSONNEL (DEC 2015)

H.5 CMS INFORMATION SECURITY (APR 2013)

H.6 OPEN GOVERNMENT PROACTIVE PRE-DISCLOSURE NOTIFICATION (OCT

2013)

H.7 CMS SECURITY CLAUSE

SECTION I – CONTRACT CLAUSES

I.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I.2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION

REGULATIONS (HHSAR) CLAUSES INCORPORATED BY REFERENCE

I.3 FAR 52.232-18 AVAILABILITY OF FUNDS (APR 1984)

I.4 FAR 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

I.5 FAR 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

I.6 FAR 52.219-17 - SECTION 8(a) AWARD (DEC 1996)

I.7 FAR 52.219-18 - NOTIFICATION OF COMPETITION LIMITED TO ELIGIBLE 8(a)

CONCERNS (JUNE 2003)

I.8 FAR 52.222-35 EQUAL OPPORTUNITY FOR VETERANS (OCT 2015)

I.9 FAR 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES

(JUL 2014)

I.10 FAR 52.222-42 STATEMENT OF EQUIVALENT RATES FOR FEDERAL HIRES

(MAY 2014)

I.11 HHSAR 352.239-74 ELECTRONIC INFORMATION AND TECHNOLOGY

ACCESSIBILITY (DEC 2015)

SECTION J – LIST OF ATTACHMENTS

J.1 WCRC SOW 2.2.2017 AMENDMENT 3

J.1.1 APPENDIX A WCCCS USER GUIDE AUGUST 2010

J.1.2 APPENDIX B WCRC DELIVERABLE SCHEDULE 2.2.2017 AMENDMENT 3

J.1.3 APPENDIX C WCRC WEEKLY STATUS REPORT TEMPLATE

J.1.4 APPENDIX D WCRC MONTHLY STATUS REPORT TEMPLATE

J.1.5 APPENDIX E WCMSA REFERENCE GUIDE VERSION 2.5

J.2 WCRC CLIN COST TEMPLATE AMENDMENT 3

J.3.1 PAST PERFORMANCE QUESTIONNAIRE CONTRACTOR REQUEST LEVEL

J.3.2 PAST PERFORMANCE QUESTIONNAIRE CO LETTER

J.3.3 PAST PERFORMANCE QUESTIONNAIRE INSTRUCTIONS AND RESPONSE

J.4 CONTRACTOR PERSONAL CONFLICT OF INTEREST FINANCIAL DISCLSOURE

TEMPLATE

J.5 CONTRACTOR BUSINESS ETHICS COI AND COMPLIANCE PROGRAM

REQUIREMENT

J.6 AMENDMENT 4 RFP QUESTIONS 2.7.2017

J.7 APPENDIX C TECH CH C 508 COMPLIANCE

SECTION K – REPRESENTATIONS, CERTIFICATIONS, AND OTHER

STATEMENTS OF OFFERORS OR QUOTERS

K.1 TO BE COMPLETED BY THE OFFEROR: [THE REPRENTATIONS AND

CERTIFICATIONS MUST BE EXECUTED BY AN INDIVIDUAL AUTHGORIZED

TO BIND THE OFFEROR]

K.2 FAR 52.203-2 CERTIFICATED OF INDEPENDENT PRICE DETERMINATION (APR

1985)

K.3 FAR 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (FEB 2016)

K.4 FAR 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB

1999)

K.5 FAR 52.222-25 AFFIRMATIVE ACTION COMPLIANCE (APR 1984)

K.6 FAR 52.227-15 REPRESENTATION OF LIMITED RIGHTS DATA RESTRICTED

COMPUTER SOFTWARE (DEC 2007)

K.7 FAR 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT

2015)

K.8 FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL

2013)

K.9 FAR 52.219-1 SMALL BUSINESS PROGRAM REPRESENTATIONS (OCT 2014)

K.10 FAR 52.215-6 PLACE OF PERFORMANCE (OCT 1997)

SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES O OFFERORS OR

QUOTERS

L.1 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

L.2 NAICS CODE AND SMALL BUSINESS STANDARD

L.3 FAR 52.215-1 INSTRUCTIONS TO OFFERORS – COMPETITIVE ACQUISITION

(JAN 2017)

L.4 FAR 52.216-1 TYPE OF CONTRACT (APR 1984)

L.5 FAR 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.6 HHSAR 352.239-73 ELECTRONIC INFORMATION AND TECHNOLOGY

ACCESSIBILITY NOTICE (DEC 2015)

L.7 FEDERAL ACQUISITION REGULATION (FAR) CLAUSES – CONTRACT AWARD

L.8 COMMUNICATIONS PRIOR TO CONTRACT AWARD

L.9 GENERAL INSTRUCITONS

L.10 PROPOSAL ORGANIZATION

L.11 VOLUME I: TECHNICAL PROPOSAL INSTRUCTIONS

L.12 VOLUME II: BUSINESS PROPOSAL INSTRUCTIONS

L.13 VOLUME III: BUSINESS ETHICS, CONFLICT OF INTEREST AND COMPLIANCE

INSTRUCTIONS

L.14 PROPOSAL ASSUMPTIONS

L.15 ORAL PRESENTATION INSTRUCTIONS

SECTION M – EVALUATION FACTORS FOR AWARD

M.1 FAR 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

M.2 GENERAL PROCEDURES FOR AWARD OF CONRACTS

M.3 EVALUATION OF VOLUME I: TECHNICAL PROPOSAL

M.4 EVALUATION OF VOLUME II: BUSINESS PROPOSAL

M.5 EVALUATION OF VOLUME III: BUSINESS ETHICS, CONFLICT OF INTEREST

AND COMPLIANCE

M.6 EVALUATION OF ORAL PRESENTATIONS

PART I – THE SCHEDULE

SECTION B – SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 DESCRIPTION OF SERVICES

The purpose of the Workers’ Compensation Review Contractor (WCRC) contract is to obtain services from an 8(a) certified Small Business to in accordance with CMS guidelines, evaluate workers’ compensation Medicare set-aside arrangement (WCMSA) proposals and project the future medical costs, including prescription drugs, related to the workers’ compensation (WC) injury, illness, or disease that would be otherwise reimbursable by Medicare.

B.2 TYPE OF CONTRACT/PRICE/PAYMENT

Payment and billing under this fixed price contract shall be based upon the contract line item numbers

(CLIN) and sub-contract line item numbers (SLIN) in the table below. Accordingly, each invoice shall specify the SLIN being billed in addition to the number of units (if applicable) being billed and the unit price. Travel cost billed shall be supported with receipts.

B.3 SCHEDULE OF SERVICES

The current Firm Fixed Price (FFP) of this contract is $ TBD; the potential price inclusive of all options is

$ TBD.

The pricing as indicated below is a FFP per unit.

CLIN 0001 Transition Period (July 1, 2017 – September 30, 2017) Total FFP

CLIN 0001 Transition Activities

SLIN 0001AA Month #1 of Transition*

SLIN 0001AB Month #2 of Transition*

SLIN 0001AC Month #3 of Transition*

CLIN 0002 Base Year (October 1, 2017 – June 30, 2018) Quantity

(# of Proposal Submissions)

Unit Price (Per Recomm)

Total FFP

CLIN 0002 Price Per WCMSA Recommendation

SLIN 0002AA WCMSA Recommendations - MIP 14,400**

SLIN 0002AB WCMSA Recommendations - Part D

SLIN 0002AC Optional WCMSA Recomm Additional Quantity - MIP 5,000

SLIN 0002AD Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0002AE Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0002AF Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0002AG Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0002AH Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0002AI Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0002AJ Optional WCMSA Recomm Additional Quantity - Part D

Total

CLIN 0003 Option Year 1 (July 1, 2018 – June 30, 2019)

(# of Proposal Submissions)

Unit Price (Per Recomm)

CLIN 0003 Price Per WCMSA Recommendation

SLIN 0003AA WCMSA Recommendations - MIP 19,200**

SLIN 0003AB WCMSA Recommendations - Part D

SLIN 0003AC Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0003AD Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0003AE Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0003AF Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0003AG Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0003AH Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0003AI Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0003AJ Optional WCMSA Recomm Additional Quantity - Part D

Optional NGHP Price Per LMSA Recommendation

SLIN 0003AK Optional LMSA & NFMSA Recomm - MIP 1,000

SLIN 0003AL Optional LMSA & NFMSA Recomm- Part D

SLIN 0003AM Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0003AN Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0003AO Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0003AP Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0003AQ Optional LMSA & NFMSA Recomm Additional Quantity - MIP 10,000

SLIN 0003AR Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0003AS Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0003AT Optional LMSA & NFMSA Recomm Additional Quantity- Part D

CLIN 0004 Option Year 2 (July 1, 2019 – June 30, 2020)

(# of Proposal Submissions)

Unit Price (Per Recomm)

CLIN 0004 Price Per WCMSA Recommendation

SLIN 0004AA WCMSA Recommendations - MIP

SLIN 0004AB WCMSA Recommendations - Part D

SLIN 0004AC Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0004AD Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0004AE Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0004AF Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0004AG Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0004AH Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0004AI Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0004AJ Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0004AK Optional LMSA & NFMSA Recomm - MIP 3,000

SLIN 0004AL Optional LMSA & NFMSA Recomm- Part D

SLIN 0004AM Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0004AN Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0004AO Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0004AP Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0004AQ Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0004AR Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0004AS Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0004AT Optional LMSA & NFMSA Recomm Additional Quantity- Part D

CLIN 0005 Option Year 3 (July 1, 2020 – June 30, 2021)

(# of Proposal Submissions)

Unit Price (Per Recomm)

CLIN 0005 Price Per WCMSA Recommendation

SLIN 0005AA WCMSA Recommendations - MIP

SLIN 0005AB WCMSA Recommendations - Part D

SLIN 0005AC Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0005AD Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0005AE Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0005AF Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0005AG Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0005AH Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0005AI Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0005AJ Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0005AK Optional LMSA & NFMSA Recomm - MIP

SLIN 0005AL Optional LMSA & NFMSA Recomm- Part D

SLIN 0005AM Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0005AN Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0005AO Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0005AP Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0005AQ Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0005AR Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0005AS Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0005AT Optional LMSA & NFMSA Recomm Additional Quantity- Part D

CLIN 0006 Option Year 4 (July 1, 2021 – June 30, 2022)

(# of Proposal Submissions)

Unit Price (Per Recomm)

CLIN 0006 Price Per WCMSA Recommendation

SLIN 0006AA WCMSA Recommendations - MIP

SLIN 0006AB WCMSA Recommendations - Part D

SLIN 0006AC Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0006AD Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0006AE Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0006AF Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0006AG Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0006AH Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0006AI Optional WCMSA Recomm Additional Quantity - MIP

SLIN 0006AJ Optional WCMSA Recomm Additional Quantity - Part D

SLIN 0006AK Optional LMSA & NFMSA Recomm - MIP 9,000

SLIN 0006AL Optional LMSA & NFMSA Recomm- Part D

SLIN 0006AM Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0006AN Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0006AO Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0006AP Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0006AQ Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0006AR Optional LMSA & NFMSA Recomm Additional Quantity- Part D

SLIN 0006AS Optional LMSA & NFMSA Recomm Additional Quantity - MIP

SLIN 0006AT Optional LMSA & NFMSA Recomm Additional Quantity- Part D

*Fixed Price will be paid in 3 increments, 20% for Month #1, 30% for Month #2, and 50% for Month #3.

**Minimum Quantity Guaranteed

Contractor shall be paid the Fixed Unit Price for delivery of each MSA Recommendation. The unit price shall be split using the following ratios, based upon two separate funding sources, 67% Medicare

Integrity Program (MIP) Funds and 33% Part D Funds. This ratio shall be applied to not only the

WCMSA work but the Optional LMSA & NFMSA work as well.

The contract will include a guaranteed minimum quantity of proposal submissions. Submission shall be defined as all new cases submitted, cases returning from development, or from re-review. Therefore, offerors have assurance as to the minimum quantities they can review and potentially invoice for. The contract includes optional contract line item numbers or sub-contract line item numbers (CLIN/SLIN) for additional quantities.

The guaranteed minimum means this is the minimum quantity of proposals available for the contractor to review and recommend an MSA.

If the number of proposals available to review does not meet the guaranteed minimum, the contractor will be paid the unit price for the remaining quantity, from the available quantity up to the minimum quantity guarantee. Only SLINs marked as having a guaranteed minimum quantity will be subject to this condition.

CLINs/SLINs for Optional Quantities. The contractor will be paid for recommendations submitted and deemed acceptable by the Government.

B.4 WITHHOLDING OF CONTRACT PAYMENTS

Notwithstanding any other payment provisions of this contract, failure of the Contractor to submit required reports when due or failure to perform or deliver required work, supplies, or services, will result in the withholding of payments under this contract unless such failure arises out of causes beyond the control, and without the fault or negligence of the Contractor as defined by the clause entitled "Excusable

Delays" or "Default", as applicable. The Government shall promptly notify the Contractor of its intention to withhold payment of any invoice or voucher submitted.

(END OF SECTION B)

SECTION C – DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

C.1 STATEMENT OF WORK

Independently and not as an agent of the Government, the Contractor shall furnish all the necessary services, qualified personnel, material, equipment, facilities, and supplies, not otherwise provided by the

Government as needed to perform the requirements set forth in the Statement of Work, Attachment J.1.

The SOW is entitled “Workers’ Compensation Review Contractor.”

(END OF SECTION C)

SECTION D – PACKAGING AND MARKING

D.1 PACKAGING AND MARKING

All deliverables required under this contract shall be packaged, marked and shipped in accordance with

Government specifications. The Contractor shall guarantee that all required materials shall be delivered in immediate usable and acceptable condition, as per the Schedule of Deliverables provided in Attachment

J.1.2.

(END OF SECTION D)

SECTION E – INSPECTION AND ACCEPTANCE

E.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

Number Title Date

52.246-4 Inspection of Services- Fixed-Price August 1996

E.2 APPROVALS BY THE CONTRACTING OFFICER’S REPRESENTATIVE (COR)

All services or supplies to be delivered to the COR will be deemed to have been accepted 30 calendar days after date of delivery, except as otherwise specified in this contract, if written approval or disapproval has not been given within such period. The COR's approval or revision to the services or supplies delivered shall be within the general scope of work stated in this contract.

(END OF SECTION E)

SECTION F – DELIVERIES OR PERFORMANCE

F.1 FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

Number Title Date

52.242-15 Stop Work Order Aug 1989

52.242-17 Government Delay of Work Apr 1984

F.2 PERIOD OF PERFORMANCE (JAN 2014)

The period of performance of this contract is TBD through TBD.

This contract includes the following Option Periods:

TBD through TBD

CLIN 0001 Period of Performance

SLIN 0001AA Transition TBD

SLIN 0001AB Transition TBD

SLIN 0001AC Transition TBD

CLIN 0002 Period of Performance

SLIN 0002AA Base Year TBD

SLIN 0002AB Base Year TBD

SLIN 0002AC Base Year TBD

SLIN 0002AD Base Year TBD

SLIN 0002AE Base Year TBD

SLIN 0002AF Base Year TBD

SLIN 0002AG Base Year TBD

SLIN 0002AH Base Year TBD

SLIN 0002AI Base Year TBD

SLIN 0002AJ Base Year TBD

CLIN 0003 Period of Performance

SLIN 0003AA Option Year 1 TBD

SLIN 0003AB Option Year 1 TBD

SLIN 0003AC Option Year 1 TBD

SLIN 0003AD Option Year 1 TBD

SLIN 0003AE Option Year 1 TBD

SLIN 0003AF Option Year 1 TBD

SLIN 0003AG Option Year 1 TBD

SLIN 0003AH Option Year 1 TBD

SLIN 0003AI Option Year 1 TBD

SLIN 0003AJ Option Year 1 TBD

SLIN 0003AK Option Year 1 TBD

SLIN 0003AL Option Year 1 TBD

SLIN 0003AM Option Year 1 TBD

SLIN 0003AN Option Year 1 TBD

SLIN 0003AO Option Year 1 TBD

SLIN 0003AP Option Year 1 TBD

SLIN 0003AQ Option Year 1 TBD

SLIN 0003AR Option Year 1 TBD

SLIN 0003AS Option Year 1 TBD

SLIN 0003AT Option Year 1 TBD

CLIN 0004 Period of Performance

SLIN 0004AA Option Year 2 TBD

SLIN 0004AB Option Year 2 TBD

SLIN 0004AC Option Year 2 TBD

SLIN 0004AD Option Year 2 TBD

SLIN 0004AE Option Year 2 TBD

SLIN 0004AF Option Year 2 TBD

SLIN 0004AG Option Year 2 TBD

SLIN 0004AH Option Year 2 TBD

SLIN 0004AI Option Year 2 TBD

SLIN 0004AJ Option Year 2 TBD

SLIN 0004AK Option Year 2 TBD

SLIN 0004AL Option Year 2 TBD

SLIN 0004AM Option Year 2 TBD

SLIN 0004AN Option Year 2 TBD

SLIN 0004AO Option Year 2 TBD

SLIN 0004AP Option Year 2 TBD

SLIN 0004AQ Option Year 2 TBD

SLIN 0004AR Option Year 2 TBD

SLIN 0004AS Option Year 2 TBD

SLIN 0004AT Option Year 2 TBD

CLIN 0005 Period of Performance

SLIN 0005AA Option Year 3 TBD

SLIN 0005AB Option Year 3 TBD

SLIN 0005AC Option Year 3 TBD

SLIN 0005AD Option Year 3 TBD

SLIN 0005AE Option Year 3 TBD

SLIN 0005AF Option Year 3 TBD

SLIN 0005AG Option Year 3 TBD

SLIN 0005AH Option Year 3 TBD

SLIN 0005AI Option Year 3 TBD

SLIN 0005AJ Option Year 3 TBD

SLIN 0005AK Option Year 3 TBD

SLIN 0005AL Option Year 3 TBD

SLIN 0005AM Option Year 3 TBD

SLIN 0005AN Option Year 3 TBD

SLIN 0005AO Option Year 3 TBD

SLIN 0005AP Option Year 3 TBD

SLIN 0005AQ Option Year 3 TBD

SLIN 0005AR Option Year 3 TBD

SLIN 0005AS Option Year 3 TBD

SLIN 0005AT Option Year 3 TBD

CLIN 0006 Period of Performance

SLIN 0006AA Option Year 4 TBD

SLIN 0006AB Option Year 4 TBD

SLIN 0006AC Option Year 4 TBD

SLIN 0006AD Option Year 4 TBD

SLIN 0006AE Option Year 4 TBD

SLIN 0006AF Option Year 4 TBD

SLIN 0006AG Option Year 4 TBD

SLIN 0006AH Option Year 4 TBD

SLIN 0006AI Option Year 4 TBD

SLIN 0006AJ Option Year 4 TBD

SLIN 0006AK Option Year 4 TBD

SLIN 0006AL Option Year 4 TBD

SLIN 0006AM Option Year 4 TBD

SLIN 0006AN Option Year 4 TBD

SLIN 0006AO Option Year 4 TBD

SLIN 0006AP Option Year 4 TBD

SLIN 0006AQ Option Year 4 TBD

SLIN 0006AR Option Year 4 TBD

SLIN 0006AS Option Year 4 TBD

SLIN 0006AT Option Year 4 TBD

F.3 DELIVERABLES

(a) A list of deliverables is provided under Section J, Attachment J.1.2, and Schedule of

Deliverables, attached hereto and made part of this contract.

(b) All deliverables required under this contract shall be packaged, marked and shipped in accordance with U.S. Government specifications. The Contractor shall guarantee that all required materials shall be delivered in immediate usable and acceptable condition.

(c) The Contractor shall submit all required deliverables and reports in accordance with the attached schedule. Reports submitted under the contract shall reference and cite the contract number and identify CMS as the sponsoring agency.

(d) Satisfactory performance under the contract shall be deemed to occur upon delivery and acceptance by the Contracting Officer, or the duly authorized representative, of the following items in accordance with the schedule, Attachment J.1.2, (reports submitted under the contract shall reference and cite the contract number and identify CMS as the sponsoring agency):

Note: Additional deliverables may be assigned as part of the product planning process.

Individual products may be released on a flow basis, as necessary by the direction of the

COR.

All electronic files shall be submitted in a format that is compatible with Microsoft Office PC-based software. As this requirement is subject to change, the contractor shall be able to adapt to any new CMS standard in order to submit deliverables. Unless specifically denoted as

“workday(s),” all timeframes are in calendar days, calendar weeks, calendar months, etc. after the effective date of the contract.

F.4 PLACE OF PERFORMANCE

All performance shall take place at the Contractor’s site.

(END OF SECTION F)

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 ACCOUNTING AND APPROPRIATION DATA

CLIN Req. No. Can No. Appropriation

No.

Object Class Amount

TBD TBD TBD TBD TBD $TBD

TOTAL

$TBD

G.2 DISSEMINATION, PUBLICATION & DISTRIBUTION OF INFORMATION

(a) Data and information either provided to the Contractor, or to any subcontractor or generated by activities under this contract or derived from research or studies supported by this contract, shall be used only for the purposes of the contract. It shall not be duplicated, used or disclosed for any purpose other than the fulfillment of the requirements set forth in this contract. This restriction does not limit the contractor's right to use data or information obtained from a non-restrictive source. Any questions concerning "privileged information" shall be referred to the

Contracting Officer.

(b) Some data or information may require special consideration with regard to the timing of its disclosure so that preliminary findings which could create erroneous conclusions are not stipulated. Also, some data or information, which relate to policy matters under consideration by the Government, may also require special consideration with regard to the timing of its disclosure so that the open and vigorous debate, within the government, of possible policy options is not damaged.

(c) Any questions about use or release of the data or information or handling of material under this contract shall be referred to the Contracting Officer who must render a written determination.

The Contracting Officer's determinations will reflect the results of internal coordination with appropriate program and legal officials.

(d) Written advance notice of at least forty-five (45) days shall be provided to the Contracting

Officer of the Contractor's desire to release findings of studies or research or data or information described above. If the Contractor disagrees with the Contracting Officer's determination, and if this disagreement cannot be settled by the Contractor and the Contracting Officer in a mutually satisfactory manner, then the issue will be settled pursuant to the "Disputes" clause.

(e) Any presentation of any report, statistical or analytical material based on information obtained from this contract shall be subject to review by the COR before dissemination, publication, or distribution. Presentation includes, but is not limited to, papers, articles, professional publications, speeches, testimony or interviews with public print or broadcast media.

This does not apply to information that is requested pursuant to the Federal Freedom of

Information Act.

(f) The COR review shall cover accuracy, content, manner of presentation of the information, and also the protection of the privacy of individuals. If the review finds that the Privacy Act is or may be violated, the release/use of the presentation shall be denied until the offending material is removed or until the Contracting Officer makes a formal determination, in writing, that the privacy of individuals is not being violated.

(g) If the review shows that the accuracy, content, or manner of presentation is not correct or is inappropriate in the light of the purpose of the project, the COR shall immediately inform the

Contractor, in writing, of the nature of the problem. If the Contractor disagrees, the COR may insist that the presentation contain, in a manner of equal importance, materials, which show the government's problem with the presentation.

(h) The Contractor agrees to acknowledge support by CMS whenever reports of projects funded, in whole or in part, by this contract are published in any medium. The Contractor shall include in any publication resulting from work under this contract, an acknowledgment substantially, as follows:

"The analyses upon which this publication is based were performed under Contract Number

TBD, entitled, Workers’ Compensation Review; sponsored by the Centers for Medicare &

Medicaid Services, Department of Health & Human Services."

Any deviation from the above legend shall be approved, in writing, by the Contracting Officer.

G.3 GOVERNMENT REPRESENTATIVES AND RESPONSIBILITIES (JUL 2016)

Following are the Government Representatives and their respective roles and responsibilities on this contract:

a. Contracting Officer

As defined in Federal Acquisition Regulation (FAR) 2.101, Definitions, and in accordance with FAR 1.602-1, Authority, “Contracting officers have authority to enter into, administer, and/or terminate contracts and make related determinations and findings.” There is no other authorized representative or any other Administrative Contracting Officer assigned to this contract to carry out a Contracting Officer’s duties, except for technical direction assigned to the Contracting Officer’s Representative, if applicable.

The Contracting Officer is:

Centers for Medicare & Medicaid Services

Office of Acquisition & Grants Management

Medicare Administrative Contracts Group

Division of Western Medicare Administrative Contracts

ATTN: Debra Stidham

7500 Security Blvd.

Mail-stop: B2-14-21

Baltimore, MD 21244-1850

Phone: 410-786-5129

Email Address: debra.stidham@cms.hhs.gov

b. Contract Specialist

Notwithstanding any of the other provisions of this Contract, the Contract Specialist will assist the Contracting Officer with his/her responsibilities as defined in the FAR.

The Contract Specialist is:

mailto:debra.stidham@cms.hhs.gov

Office of Acquisition & Grants Management

Medicare Administrative Contracts Group

Division of Western Medicare Administrative Contracts

ATTN: Stephen Stoyer

7500 Security Blvd.

Mail-stop: B2-14-21

Phone: 410-786-9803

Email Address: stephen.stoyer@cms.hhs.gov

c. Contracting Officer’s Representative

The Contracting Officer’s Representative (COR), as defined in FAR 2.101, Definitions, is:

Office of Acquisition & Grants Management

Office of Financial Management

Division of Medicare Secondary Payer Operations

ATTN: John Jenkins

7500 Security Blvd.

Mail-stop: C3-16-14

Phone: 410-786-3373

Email Address: john.jenkins@cms.hhs.gov

In accordance with FAR 1.602-2(d), Responsibilities, the COR’s delegated responsibilities are identified in the Contracting Officer’s appointment memorandum, a copy of which will be furnished to the contractor.

Technical direction must be within the general scope of the work stated in the contract. The term "technical direction" is defined to include, without limitation, the following:

(1) Directions to the Contractor which direct the contract effort, shift work emphasis between work areas or tasks, require pursuit of certain lines of inquiry, fill in details or otherwise serve to accomplish the contractual technical requirements as identified in the Statement of Work or Performance Work Statement; or

(2) Provision of information to the Contractor, which assists in the interpretation of drawings, specifications, or technical portions of the work description.

The COR does not have the authority to:

1. Make changes to contract terms and conditions;

2. Direct the contractor to perform work or make deliveries not specifically required under the contract;

mailto:stephen.stoyer@cms.hhs.gov mailto:john.jenkins@cms.hhs.gov

3. Waive or relax the Government’s rights with regard to the Contractor’s compliance with the specifications, price, delivery or any other terms or conditions of the contract;

4. Make any commitments or approve any actions that would create any financial obligation on the part of the Government; or

5. Issue direction that constitutes a “change” as defined in:

FAR 52.243-1, Changes – Fixed Price;

FAR 52.243-2, Changes – Cost Reimbursement;

FAR 52.243-3, Changes – Time and Material and Labor Hour;

FAR 52.243-4, Changes; or, FAR 52.243-5, Changes and Changed Conditions.

All technical direction shall be issued in writing by the COR or, if issued verbally, shall be confirmed in writing by the COR within five (5) business days after issuance. The

Contractor shall proceed promptly with the performance of technical direction duly issued by the COR within the scope of his/her authority.

If, in the opinion of the Contractor, any instruction or direction issued by a Government representative constitutes a change to the contract or constitutes a “Change Order” as defined in FAR 2.101, Definitions, the Contractor shall follow the instructions identified in

FAR 52.243-7 Notification of Changes.

G.4 PROPERTY ADMINISTRATION

A. The Contractor is responsible for an annual physical inventory accounting for all government property under this contract. The inventory must be conducted by September 30th and the

Form 565 Report of Accountable Personal Property submitted by October 31st of each year.

B. The inventory report shall include all items acquired, furnished, rented or leased under the contract. Employees who conduct the inventories should not be the same individuals who maintain the property records. Following the physical inventory, the Contractor shall prepare an inventory report and submit the report to the CMS Property Administrator at the address on the following page:

Centers for Medicare & Medicaid Services

OOM, Administrative Services Group

Division of Property and Space Management

Attn: Tyrone Harris, Sr.

7500 Security Boulevard, M/S SLL-13-12

Baltimore, Maryland 21244-1850

(410) 786-2923

C. Commercially leased software is subject to these reporting requirements.

D. The Contractor shall submit a consolidated report of all accountable government property under this contract, including subcontractor inventory information.

E. The final inventory report shall indicate that all items required for continued contract performance are acceptable and free from contamination. Property that is no longer usable or required shall be reported and disposition requested. The final inventory report shall be submitted upon the date of contract expiration.

G.5 PAYMENTS - INVOICES - Firm Fixed Price Contracts (OCT 2015)

a. GENERAL: The Contractor shall submit to the Government an invoice for payment in accordance with the instructions below.

b. METHOD OF PAYMENT: CMS shall only make an electronic payment of invoices in accordance with FAR 52.232-33, Payments by Electronic Funds Transfer – System for

Award Management. In order to receive payments, the contractor shall register in the

System for Award Management (SAM) database, in accordance with FAR 52.204-7, System for Award Management.

ADDRESS CHANGES: The contractor shall notify CMS’ Division of Accounting

Operations of all banking and address changes in SAM via the following email address:

CCRChanges@cms.hhs.gov.

c. CONTENT OF INVOICE - Invoices shall include, at a minimum:

Contractor’s name and address;

Contractor’s Tax Identification Number (TIN);

Contractor’s DUNS Number;

Invoice date;

Invoice Number to include the designation of the Contract Payment Category Type as follows:

Contract Payment Category Type IA (All Small Businesses No $ Limit)

Contract and Order Number, as applicable;

Contract line item number and/or Subcontract line item number;

Description, quantity, unit of measure, unit price and extended price of the items actually delivered or services rendered;

Shipping and payment terms;

Terms of any discount for prompt payment offered;

Other substantiating documentation or information as required by the contract;

Name, title, phone number and complete mailing address of responsible official to whom payment is to be sent;

Name, title, phone number of person to notified in the event of a defective invoice; and, Period of performance or delivery date of goods or services provided.

d. MAILINGS: Invoices shall be submitted as follows:

1. ELECTRONIC MAIL: The contractor shall submit an electronic copy of the invoice to both of the following individuals:

Contract Specialist – TBD xxxx.xxxxx@CMS.HHS.Gov; and

COR – TBD xxxx.xxxxx@CMS.HHS.Gov.

2. REGULAR MAIL: An original hard copy shall be submitted to the address below:

mailto:CCRChanges@cms.hhs.gov mailto:xxxx.xxxxx@CMS.HHS.Gov mailto:xxxx.xxxxx@CMS.HHS.Gov

Department of Health & Human Services

OFM/Division of Accounting Operations

P.O. Box 7520

Baltimore, MD 21207-0520

3. OVERNIGHT MAIL: If the contractor chooses to use an overnight mail carrier, the original hard copy of the invoice shall be submitted to the address below:

Department of Health & Human Services

OFM/Division of Accounting Operations

7500 Security Boulevard/Mailstop: C3-11-03

e. PAYMENTS: The Government shall make payment of all invoices in accordance with

FAR 52.232-1 Payments, and

FAR 52.212-4 Contract Terms and Conditions – Commercial Items (If applicable)

Upon acceptance by the Contracting Officer’s Representative (COR) in accordance with the applicable FAR Inspection and Acceptance clause and the Contracting Officer’s approval, as appropriate.

Reimbursement for invoices submitted under this contract shall be made not later than thirty (30) calendar days after receipt of an acceptable invoice from the Contractor requested at the paying office designated above. Any discrepancies determined as a result of the audit could delay the processing of the invoice and may result in the invoice being returned to the Contractor for corrections.

f. INTEREST ON OVERDUE PAYMENT

The Prompt Payment Act, Public Law 97-177 (96 Stat.85.31 U.S.C. 1801) is applicable to payments under this contract and requires the payment of interest on payments made more than 30 calendar days after receipt of an invoice by the Division of Accounting

Operations.

Determinations of interest due will be made in accordance with the provisions of the

Prompt Payment Act and Office of Management and Budget Circular A-125.

G.6 CORRESPONDENCE PROCEDURES

To promote timely and effective administration, correspondence (except for invoices), submitted under this contact shall be subject to the following procedures:

(a) Technical Correspondence - Technical correspondence (as used herein, this term excludes correspondence which proposes or otherwise involves waivers, deviations or modifications to the requirements, terms or conditions of this contract) shall be addressed to the Contracting Officer’s

Representative (COR) with an informational copy of the basic correspondence to the Contracting

Officer.

(b) Other Correspondence - All other correspondence shall be addressed to the Contracting

Officer with an informational copy of the basic correspondence to the COR.

(c) Subject Lines - All correspondence shall contain a subject line, commencing with the contract number and assigning consecutive numbers (serial numbers to permit accountability), as illustrated below:

EXAMPLE: Contract No. - 500-00-XXXX

Sequence # - XX (YEAR) - XXXX

Subject - Request for Subcontract Consent

G.7 DATA TO BE DELIVERED

Any working papers, interim reports, data given by the Government or first produced by the Contractor under the contract or collected or otherwise obtained by the Contractor under the contract, or results obtained or developed by the Contractor (subcontractor or consultants) pursuant to the fulfillment of this contract are to be delivered, documented, and formatted as directed by the Contracting Officer.

In addition, information and/or data, which are held by the Contractor related to the operation of their business and/or institution and which are obtained without the use of Federal funds, shall be considered

"PROPRIETARY DATA" and are not "subject data" to be delivered under this contract.

G.8 USE OF GOVERNMENT DATA (REPORTS/FILES/COMPUTER TAPES OR DISCS)

Any data given to the contractor by the Government shall be used only for the performance of the contract unless the Contracting Officer specifically permits another use, in writing. Should the Contracting

Officer permit the contractor the use of Government-supplied data for a purpose other than solely for performance of this contract and if such use could result in a commercially viable product, the

Contracting Officer and the contractor must negotiate a financial benefit to the Government. This benefit should most often be in the form of a reduction in the price of the contract; however, the Contracting

Officer may negotiate any other benefits he/she determines are adequate compensation for the use of these data.

Upon the request of the Contracting Officer or the expiration date of this contract, whichever shall come first, the contractor shall, upon instructions from the Contracting Officer, return or destroy all data given to the contractor by the Government. However, the Contracting Officer may direct that the data be retained by the contractor for a specific period of time, which period shall be subject to agreement by the contractor. Whether the data are returned, retained, or destroyed shall be the decision of the Contracting

Officer with the exception that the contractor may refuse to retain the data. The contractor shall retain no data, copies of data, or parts thereof, in any form, when the Contracting Officer directs that the data be returned or destroyed. If the data are to be destroyed, the contractor shall directly furnish evidence of such destruction in a form the Contracting Officer shall determine is adequate.

G.9 CONTRACTOR PAST PERFORMANCE EVALUATION(S) (OCT 2014)

a. General:

In accordance with Federal Acquisition Regulation (FAR) 42.15, Contractor Performance

Information, past performance evaluations shall be prepared at least annually and at the time the work under a contract or order is completed. Additional interim performance evaluations may be prepared at Contracting Officer discretion, as necessary.

CMS will utilize the Contractor Performance Assessment Reporting System (CPARS), the

Government wide evaluation reporting tool for all past performance reports on contracts and orders, as appropriate. CPARS is a secure Internet website located at https://www.cpars.gov.

b. CPARS Process:

1. CPARS Training: Contractors may obtain CPARS training material and register for on-line training https://www.cpars.gov.

2. Post-Award Contract Registration: CMS is responsible for registering the contract in

CPARS within 30 calendar days of contract award. The Contractor shall:

i. Designate at least one (1) point of contact that will be responsible for serving as the

Contractor’s Representative (CR). Additional CRs may also be identified; and,

ii. Provide the CMS Contract Specialist with the name(s) and email address(es) of the

CPARS point(s) of contact.

Once CMS registers the contract in CPARS, the CR(s) will receive an automated CPARS email message that contains User IDs and instructions for creating a password for future past performance evaluation processing.

3. Interim, Annual and Final Past Performance Evaluation Reports:

a. Issuing the Evaluation: Once the CMS Assessing Official (AO) issues an evaluation to the Contractor in CPARS, the CR(s) will receive an email instructing them to login to CPARS to review the evaluation.

b. Contractor Comments: The CR has the option to provide comments on the evaluation, indicate if they concur or do not concur with the evaluation, sign, and then return the evaluation to the AO. The CR has a total of 60 days following the AO’s evaluation signature date to submit comments. If the CR submits comments within the first 14 days following the AO’s signature date and the AO closes the evaluation, the evaluation will become available in Past Performance Information Retrieval

System - Report Card (PPIRS-RC) within 1 day.

On day 15 following the AO’s evaluation signature date, the evaluation will become available in PPIRS-RC with or without CR comments and whether or not it has been closed by the AO. If no CR comments have been sent and the evaluation has not been closed, it will be marked as “Pending” in PPIRS-RC.

If the CR sends comments at any time prior to 61 days following the AO’s evaluation signature date, those comments will be reflected in PPIRS-RC within 1 day. On day https://www.cpars.gov/ https://www.cpars.gov/

61 following the AO’s evaluation signature date, the CR will be “locked out” of the evaluation and may no longer send comments.

G.10 Contractor Work Performed Outside the United States and its Territories (APR

2016)

To comply with requirements of Homeland Security Presidential Directive -12 (HSPD-12) and

Personal Identity Verification (PIV) of Federal Employees and Contractors, CMS must achieve appropriate security assurance for multiple CMS information systems by efficiently verifying the claimed identity of individuals working on the contract. The Contractor and its subcontractor(s) shall not perform any activities under this contract, including the transmission of data or other information, outside of the United States (U.S.) and its Territories without the prior written approval of the Contracting Officer. If work must be performed outside the U.S., the Contractor shall submit a request to the Contracting Officer, in writing, at least 45 calendar days prior to the work beginning.

The Contracting Officer will consider the following factors in making a decision whether to authorize the performance of work outside the U.S. and its Territories:

1. Statement of Work requirements, which are being requested to be completed outside the U.S.

and its Territories;

2. Total projected dollar value of the work to be performed outside the U.S.;

3. The desired country/location where the work will be performed;

4. FAR Part 25, Foreign Acquisitions, and all other laws and regulations applicable to the performance of work outside the United States;

5. Whether the contractor and/or its subcontractor(s) have plans in place to adequately protect and secure CMS data, as well as abide by all applicable laws and regulations when work is performed outside of the U.S. and its Territories. Plans shall include -

a. Adequate contract terms regarding system security;

b. Adequate contract terms regarding the confidentiality and privacy requirements for information and data protection;

c. Adequate contract terms that are otherwise relevant, including the requirements of the

Statement of Work;

d. The Contractor’s corporate compliance plan and internal policies and procedures designed to prevent and detect violations of applicable law, regulations, rules and ethical standards by employees, agents and others; and,

6. Whether the approval would be in best interests of the United States.

The Contractor’s request for authorization to perform work outside the U.S. shall demonstrate that the performance of the work outside the U.S. satisfies all of the above factors. Contracting

Officer approval to perform work outside the U.S. may require additional Statement of Work requirements, additional contract terms and conditions and/or Federal Acquisition Regulation

(FAR) clauses to be incorporated into the contract.

(END OF SECTION G)

SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 BUSINESS ETHICS, CONFLICT OF INTEREST AND COMPLIANCE

(DEC 2015)

a. General: It is imperative that the Contractor and the services provided under this contract be free, to the greatest extent possible, of all Organizational and Personal

Conflicts of Interest. In this clause, all references to Organizational and/or Personal

Conflicts of Interests will be referred to individually or collectively, as the text justifies, as Conflicts of Interest (COI). Except as provided below, the Contracting Officer shall not maintain a contract with a Contractor that the Contracting Officer determines has, or has the potential for, an unresolved COI. However, in accordance with FAR 9.503

Waiver, the Contracting Officer may contract with a Contractor that has an unresolved

COI if the Contracting Officer determines that it is in the best interest of the Government to do so.

b. Definitions:

Actual COI– means that the COI is currently in existence as determined by the Offeror’s or Contractor’s Compliance Officer and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Affiliates – As defined in FAR 2.101 means associated business concerns or individual(s) if, directly or indirectly either one controls or can control the other; or a third party controls or can control both.

For purposes of this contract, affiliate control or influence may include, but is not limited to:

(a) Interlocking management or ownership (e.g., individuals serving in similar capacities in several companies);

(b) Identity of interests among family members such as spouse/domestic partner and/or any dependent of the respondent;

(c) Shared facilities and equipment;

(d) Common use of employees; or

(e) A business concern organized just prior to, or immediately following, the release of a solicitation or request for information, which has the same or similar management, ownership, or principal employees as the offeror or Contractor.

Any business, whether or not it is organized for profit or located in the United States or its outlying areas, or person may be found to be an affiliate. Control may be affirmative or negative and it is immaterial whether it is exercised so long as the power to control exists.

Apparent (Perceived) COI – means that the COI on first observation appears to be an actual or potential COI, but may or may not be after analysis. Even if the apparent COI is determined to be non-existent, this perception may still require further explanation.

Avoidance – means Government action taken in one acquisition that is intended to prevent a COI in that acquisition or in a future action. Methods of avoiding COIs include, but are not limited to:

Drafting the statement of work (SOW) to exclude tasks that require Contractors to utilize subjective judgment; or

Obtaining advice from more than one source on any issue on which there are concerns about an COI so that there is no area in which the Government is relying solely on the advice of any one of the sources; or

Excluding an Offeror from participation in a contract award.

Financial Interests/Relationships – means a healthcare related direct or indirect ownership or investment interest (including an option or non-vested interest) in any entity that exists through equity, debt, or other means and includes any indirect ownership or investment interest no matter how many levels removed from a direct interest.

A financial interest/relationship may arise from the following non-exclusive examples:

(a) Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

(b) Current or known future arrangements or requirements for which you are defined as an interested party, including, but not limited to, an entity that may create one or more of the three forms of COI;

(c) Consulting relationships, including commercial and professional consulting and service arrangements, scientific and technical advisory board memberships, or serving as an expert witness in litigation;

(d) Services provided in exchange for honorariums including travel expense reimbursements;

(e) Research funding or other forms of research support;

(f) Healthcare related investment in the form of stock or bond ownership, including healthcare sector investment only mutual funds;

(g) Healthcare business ownership or partnership interests;

(h) Patents, copyrights, and other intellectual property interests;

(i) Seeking or negotiating for prospective employment or business; or

(j) Gifts, including travel.

Mitigation– means action taken by the Contractor to reduce the COI risk to a level acceptable to CMS on a present contract.

Neutralization – means excluding or restricting a Contractor from offering, as a prime or subcontractor, on future contracts while allowing the Contractor to perform on the instant contract. This method protects the Government’s interests in cases where the

Contractor’s work on the instant contract could be biased or impaired by virtue of its expectation of future work, or when the Contractor would have an unfair advantage in competing for award of the future work.

Organizational Conflict of Interest – In accordance with FAR 2.101 Definitions, means that because of other activities or relationships with other persons, a person is unable, or potentially unable, to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is, or might be, otherwise impaired, or a person has an unfair competitive advantage.

For purposes of this contract, the conflict of interest definition includes direct or indirect relationships including, but not limited to, the Contractor and…