FCI Gilmer Solicitation.pdf

u.s. Department of Justice

Federal Bureau ofPrisons

Field Acquisition Office u.s. Armed Forces Reserve Complex Grand Prairie, Texas 75051

March 15,2012

Re: Request for Proposal (RFP) # RFPP01191200003, Comprehensive Medical Services, Federal Correctional Institution (FCI) Gilmer, Glenville, WV

Dear Offeror:

Accompanying this cover letter is a solicitation package prepared by the Federal Bureau of Prisons, Field Acquisition Office in Grand Prairie, Texas, for the acquisition of Comprehensive Medical Services for FCI Gilmer, located in Glenville, WV. The solicitation package includes the following:

Cover Letter (2 pages)

Table of Contents (1 page)

Solicitation (47 pages)

Attachments (40 pages)

Services to be provided include inpatient/outpatient facility services, inpatient/outpatient physiCian services, and on-site institution services. This package contains all the necessary information for submitting a proposal for evaluation.

In submitting proposals, offerors should consider all information provided herein. Please carefully follow all instructions located in the solicitation package concerning the content, format, and submission of proposals. Detailed information can be located in Section

5.2 of the solicitation.

All potential offerors are advised that this solicitation includes FAR 52.212-4, Contract Terms and Conditions-Commercial Items, which at paragraph (t) Central Contractor Registration (CCR) requires all contractors doing business with the Federal Government after September 30,2003, to be registered in the CCR database. Offerors should include their Data Universal Numbering System (DUNS) number in their offers. The Contracting Office will verify registration in the CCR database prior to award by entering the potential awardee's DUNS number into the CCR database. Failure to complete the registration procedures outlined in this clause may result in elimination from consideration for award.

Sealed offers shall be received on or before the deadline of May 14,2012, 2:00pm Central Time. Proposals shall be submitted to the following address:

Dennis A. Chinnici, Contract Specialist Federal Bureau of Prisons Field Acquisition Office U.S. Armed Forces Reserve Complex

346 Marine Forces Drive

Grand Prairie, Texas 75051

Mailed and hand-carried proposals must be delivered to the Contracting Officer or Contract Specialist at the address shown above no later than the time specified as the deadline for receipt of proposals. The official point of receipt for hand-carried proposals will be in the receptionist's area of the first floor at the address listed above. PLEASE DO NOT SUBMIT PROPOSALS TO ANY LOeATlON OTHER THAN THE ONE LISTED ABOVE. Proposals received after the deadline will processed pursuant to FAR 52.212-1 (f).

Please place any questions you may have in writing and fax them to (972) 352-4545 to my attention or email at dchinnici@bop.gov. We will consider all questions received and provide responses, where appropriate.

If you have any other questions, please feel free to call me at (972) 352-4651.

Dennis A. hinnici, Contract Specialist Federal Bureau of Prisons Field Acquisition Office

Enclosure mailto:dchinnici@bop.gov

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE 1 OF

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 RP # 0165-11 47

2. CONTRACT NO. 3. AWARDIEFFECTIVE 4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE

DATE DATE

RFPP01191200003 03/15/2012

a. NAME b. TELEPHONE NUMBER (No collect 8. OFFER DUE DATEl

7. FOR SOLICITATION

calls) LOCAL TIME

INFORMATION CALL: 05/14/2012

Dennis A. Chinnici 972-352-4651 2:00 PM, CT

9. ISSUED BY CODE 10. THIS ACQUISITION IS ~ UNRESTRICTED OR U SET ASIDE: % FOR:

Federal Bureau of Prisons o WOMEN-OWNED SMALL BUSINESS

SMALL BUSINESS (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

Field Acquisition Office i 0 HUBZONE SMALL SMALL BUSINESS PROGRAM NAICS:

U.S. Armed Forces Reserve Complex BUSINESS oECONOMICAlLY DISADVANTAGED 622110 346 Marine Forces Drive oSERVICE-DISABLED WOMEN..Q\M'>IED SMALL BUSINESS

VETERAN-OWNED (EDWOSB) SIZE STANDARD:

Grand Prairie, TX 75051 SMALL BUSINESS Os (A) $34,500,000

11. DELIVERY FOR FOB DESTINA 12. DISCOUNT TERMS 13b. RATING

TION UNLESS BLOCK IS 13a. THIS CONTRACT IS A

MARKED RATED ORDER UNDER

DPAS (15 CFR 700) 14. METHOD OF SOLICITATION

D SEE SCHEDULE ORFQ OIFB [gJRFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE I

Federal Bureau of Prisons Federal Bureau of Prisons FCI Gilmer, 201 FCI Lane, Glenville, VW 26351 FCI Gilmer, 201 FCI Lane, Glenville, VW 26351

17a. CONTRACTOR! CODE I I FACILITY 18a. PAYMENT WILL BE MADE BY CODE IOFFEROR CODE

Federal Bureau of Prisons FCI Gilmer PO Box 5000 Glenville, VW 26351

TELEPHONE NO. o 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 16a UNLESS BLOCK

OFFER BELOW IS CHECKED D SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Comprehensive Medical Services See Continuation Sheet(s)

(Use Reverse and/or Attach Additional Sheets as NecesS8/y)

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

[8] 27•. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA [8J ARE D ARE NOT ATTACHED

D 27b. CONTRACTIPURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-515 ATTACHED. ADDENDA DARE D ARE NOT ATTACHED

D 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ___ D 29. AWARD OF CONTRACT: REF. OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED . YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

30a. SIGNATURE OF OFFERORICONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30e. DATE SIGNED30b. NAME AND TITLE OF SIGNER (Type or print) 31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

Dennis A. Chinnici (FAO)

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV. 512011)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

RFPP01191200003 Page 2 of 47

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

D RECEIVED D INSPECTED 0 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 321. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

CORRECT FOR

36. PAYMENT

DCOMPLETE DPARTIAL DFINAL

37. CHECK NUMBER

D PARTIAL D FINAL

38. SIR ACCOUNT NO. ~9. SIR VOUCHER NUMBER 40. PAID BY

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

42b. RECEIVED AT (Location)

42c. DATE REC'D (YYIMMlOO) I42d. TOTAL CONTAINERS

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

STANDARD FORM 1449 (REV. 10/2010) BACK

RFPP01191200003 Page 3 of 47

Table of Contents

Description Page Number

Solicitation/Contract Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. I

Commodity or Services Schedule

2-1 a Contract PricingfSDB Participation

2-2 Performance Work Statement. .................................................... , 8

Contract Clauses

. Evaluation of Contractor Performance Utilizing CPARS (April 2011)

52.24-403-70 Notice of Contractor Personnel Security Requirements (OCT 2005)

52.27-103-72 DOJ CONTRACTOR RESIDENCY REQUIREMENT BUREAU OF PRISONS (JUNE

2004)

52.216-18 Ordering (Oct 1995)

52.216-19 Order Limitations (Oct 1995)

52.216-21 Requirements (Oct 1995)

52.217-8 Option to Extend Services (Nov 1999)

52.217-9 Option to Extend the Term of the Contract (Mar 2000)

52.218-0000 CONTINUING CONTRACT PERFORMANCE DURING A PANDEMIC INFLUENZA

OR OTHER NATIONAL EMERGENCY (MAY 2008)

52.232-19 Availability Of Funds For The Next Fiscal Year (Apr 1984)

52.237-7 Indemnification and Medical Liability Insurance (Jan 1997)

2852.201-70 Contracting Officer's Technical Representative (COTR) (JAN 1985)

2852.223-70 Unsafe Conditions Due to the Presence of Hazardous Material (June 1996). , List ofAttachments

4-1 SPECIAL CONTRACT CONDITIONS

Solicitation Provisions

52.212-2 Evaluation - Commercial Items (Jan 1999)

--52.212-3 Offeror Representations and Certifications-Commerical Items (FEB 2012)

52.209-7 Information Regarding Responsibility Matters (Jan 2011)

52.216-1 Type of Contract (Apr 1984)

52.233-2 Service of Protest (Sept 2006)

5-1 TAILORING

5-2 SUBMISSIONIEVALUATION OF PROPOSALS

5-3 SUBCONTRACT CERTIFICATION

~FPPO1191200003 Page40f 47

Section 2 • Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 Comprehensive Medical Services for FCI Gilmer, located In Glenville, WV. See Section 2-1, Schedule of Items, and Section 2-2, Perfonnance WorK Statement.

Base Year: Effective Date of Award (EDOA) through twelve months

1.000000 SV $ 1$

0002 Comprehensive Medical Services for FCI Gilmer, located in Glenville, WV. See Section 2-1, Schedule of Items, and Section 2-2, Perfonnance WorK Statement.

Option Year 1: 13 months through 24 months from EDOA

1.000000 SV $ $

0003 Comprehensive Medical Services for FCI Gilmer, located in Glenville, WV. See Section 2-1, Schedule of Items, and Section

1.000000 SV $ $

2-2, Perfonnance Work Statement.

Option Year 2: 25 months through 36 months from EDOA

0004 Comprehensive Medical Services for FCI Gilmer, located in Glenville, WV. See Section 2·1, Schedule of Items, and Section 2·2, Performance Work Statement.

Option Year 3: 37 months through 48 months from EDOA

1.000000 SV $ $

0005 Comprehensive Medical Services for FCI Gilmer, located in Glenville, WV. See Section 2·1, Schedule of Items, and Section 2-2, Perfonnance Work Statement.

Option Year 4: 49 months through 60 months from EDOA

1.000000 SV $ Is

2-1 a Contract Pricing/SDB Participation

BLOCKS 19 THROUGH 24 - CONTRACT PRICING/SDB PARTICIPATION

Overview

Services are required to be provided in accordance with the Performance Work Statement included in this solicitation/contract. Offer ors are required to submit, as a part of their business proposal, a completed copy of the Schedule of Items and the Target for Participa tion ofSmall Disadvantaged Business Concerns (pages 6 through 8).

Pricing Methodology

Except for Optometry services, price proposals will be calculated from benchmarks utilizing Medicare reimbursement methodologies.

For each category of service to be provided, offerors will be allowed to propose a variance from the benchmark Medicare rate in the form of a discount from or a premium to Medicare rates established by the Centers for Medicare and Medicaid services. The rates es tablished in the resulting contract shall not be construed as participation in the Medicare program; contract rates will merely be equated to Medicare rates of reimbursement without reductions for deductibles, copayments, or co-insurance. When appropriate, outlier payments calculated in accordance with Medicare reimbursement methodologies shall be made in recognition of ex tremely costly stays. The outlier payment shall be calculated based upon the defined benchmark and will consist of the operating portion only. This structuring of the pricing methodology is not intended to be restrictive of any offeror; offerors need only to propose that percentage discount from or premium to the Medicare benchmark rate which will reflect the desired level of payment for the cat egory of services rendered. If during contract performance, it is determined that a necessary contract deliverable is not covered by Medicare reimbursement methodologies, a separate rate shall be negotiated for such deliverable(s).

RFPP01191200003 Page 5 of 47

Medicare Part A. The Medicare benchmark to be utilized for all services covered by Medicare Part A shall be the most current Basic DRG payment (i.e., Operating Federal Rate) established for Rural Areas in the state of West Virginia. The Basic DRG calculation shall not include any provider-specific adjustments allowed under actual Medicare participation. Offerors may propose a discount from or a premium to Basic DRG rates. (Refer to Attachment I of this solicitation)

Medicare Part B Physician and Non-Physician Services. The Medicare benchmark to be utilized for all physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for Payment Locality 16 for the state ofWest Virginia. The benchmark charges shall be those established for participating providers. Offerors may propose a dis count from or a premium to the benchmark charges.

Medicare Part B Facility Services (including hospital outpatient services and ambulatory surgical centers). The Medicare benchmark to be utilized for all facility services covered by Medicare Part B shall be the most current APC and ASC rates calculated for Rural Areas in the State of West Virginia. Offerors may propose a discount from or a premium to the benchmark charges.

Estimated Quantities

Estimated quantities for the base year and all option periods are detailed below. The estimated quantities provided are not a represent ation to the offeror/contractor that the estimated quantities will be required or ordered or that conditions affecting requirements will be stable or normaL

Inpatient and Outpatient Facility and Physician Services

Base Year - Effective Date ofAward (EDOA) through 12 months

Inpatient Days: Estimated 500 Days

Outpatient Visits: Estimated 450 Visits

Option Year 1 - 13 through 24 Months from EDOA

Inpatient Days: Estimated 500 Days

Outpatient Visits: Estimated 450 Visits

Option Year 2" 25 through 36 Months from EDOA

Inpatient Days: Estimated 500 Days

Outpatient Visits: Estimated 450 Visits

Option Year 3" 37 through 48 Months from EDOA

Inpatient Days: Estimated 500 Days

Outpatient Visits: Estimated 450 Visits

Option Year 4 - 49 through 60 Months from EDOA

Inpatient Days: Estimated 500 Days

Outpatient Visits: Estimated 450 Visits

Outpatient Institution Services

Optometrist services shall be paid based upon the provision of defined sessions.

RFPP01191200003 Page 6 of 47

Optometrist: Session Duration - 6 hours

Session Quantity - 36 per contract year

Schedule ofItemsffarget for Participation of Small Disadvantaged Business Concerns

Offerors shall complete the following Schedule of Items and Target for Participation of Small Disadvantaged Business Concerns. All proposed pricing and participation targets will be evaluated in accordance with FAR 52.212-2, "Evaluation--Commercial Items" and "Evaluation of Proposals" (Section 5-2) of this solicitation.

All offerors are hereby advised that the successful offeror's unit pricing (to include discount percentage from or premium percentage to the benchmark Medicare rate and unit pricing for session-priced items) for the base year and all option years is public information, in accordance with Federal Acquisition Regulations (FAR) 15.503(b){I){iv). Accordingly, all successful unit pricing will be released to unsuccessful offerors with the notification of award as well as to the general public when requested. Any party who objects to the release of their own unit pricing information, should they be awarded a contract in response to this solicitation, should not submit a proposal in response to this solicitation.

Schedule of Items

BASE YEAR

Effective Date of Award through 12 months

la. Inpatient Facility Services: Discount or + Premium to Medicare Part A

1 b. Outpatient Facility Services: Discount or + Premium to Medicare Part B

2a. Inpatient Physician Services: Discount or + Premium to Medicare Part B

2b. Outpatient Physician Services: Discount or + Premium to Medicare Part B

2c. Outpatient Institution Services:

I. Optometrist $ ____per six-hour session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-1+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

OPTION YEAR 1

13 through 24 months from EDOA lao Inpatient Facility Services: Discount or + Premium to Medicare Part A

lb. Outpatient Facility Services: Discount or + Premium to Medicare Part B

2a. Inpatient Physician Services: Discount or + Premium to Medicare Part B

2b. Outpatient Physician Services: Discount or + Premium to Medicare Part B

RFPP01191200003 Page 7 of 47

2c. Outpatient Institution Services:

1. Optometrist $ _____ per six-hour session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

OPTION YEAR 2

25 through 36 months from EDOA

1a. Inpatient Facility Services: Discount or + Premium to Medicare Part A

1b. Outpatient Facility Services: Discount or + Premium to Medicare Part B

2a. Inpatient Physician Services: Discount or + Premium to Medicare Part B

2b. Outpatient Physician Services: Discount or + Premium to Medicare Part B

2c. Outpatient Institution Services:

1. Optometrist $ _____ per six-hour session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

OPTION YEAR 3

37 through 48 months from EDOA

1a. Inpatient Facility Services: Discount or + Premium to Medicare Part A

1b. Outpatient Facility Services: Discount or + Premium to Medicare Part B

2a. Inpatient Physician Services: Discount or + Premium to Medicare Part B

2b. Outpatient Physician Services: Discount or + Premium to Medicare Part B

2c. Outpatient Institution Services:

1. Optometrist $ ____ per six-hour session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

OPTION YEAR 4

49 through 60 months from EDOA

.'RFPP01191200003 Page 8 of 47 lao Inpatient Facility Services: Discount or + Premium to Medicare Part A

I b. Outpatient Facility Services: Discount or + Premium to Medicare Part B

2a. Inpatient Physician Services: Discount or +--,Premium to Medicare Part B

2b. Outpatient Physician Services: Discount or + Premium to Medicare Part B

2c, Outpatient Institution Services:

l. Optometrist $ ____ per six-hour session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENT AGE. IF NO VARIANCE, ENTER "0".

Target for Participation of Small Disadvantaged Business (SDB) Concerns

Offerors shall provide a participation target for utilization of small disadvantaged business (SDB) concerns (including joint ventures, teaming arrangements, and subcontracts) performing within North American Industry Classification System Sector 62, Health Care and Social Assistance. The SDB participation target identified by the offeror will be incorporated into any resulting contract.

Participation Target ______ percent

The above participation target will be achieved through performance by:

] the Contractor, including joint venture partners and team members (target: ___percent)

] subcontractors (target: percent)

Offerors are advised that, in accordance with FAR clause 52.219-25 entitled Small Disadvantaged Business Participation Program -Disadvantaged Status and Reporting, in order to qualify for disadvantaged status under this clause, SDB concerns must be identified as such in the database maintained by the Small Business Administration (Pro-Net) or by contacting the SBA's Office of Small Disad vantaged Business Certification and Eligibility.

2-2 Performance Work Statement

PERFORMANCE WORK STATEMENT

I. Background

The Federal Bureau of Prisons (BOP) was established in 1930 to provide more progressive and hu mane care for Federal inmates, to professionalize the prison service, and to ensure consistent and centralized administration. Today, the BOP is responsible for the custody and care of approximately 217,000 Federal offenders. The Federal prison system is a nationwide system of prisons and deten tion facilities for the incarceration of inmates who have been sentenced to imprisonment for Federal crimes and the detention of individuals awaiting trial in Federal court. The defined mission of the BOP is as follows:

It is the mission of the Federal Bureau of Prisons to protect society by confining offenders in the con

RFPP01191200003 Page 9 of47 trolled environments of prisons and community-based facilities that are safe, humane, cost-efficient, and appropriately secure, and that provide work and other self-improvement opportunities to assist of fenders in becoming law-abiding citizens.

As an agency under the Executive Branch of the United States Government, the BOP receives an an nual appropriation of funds to accomplish its assigned mission. The public trust demands that this an nual appropriation be prudently managed. Thus, dollars spent to maintain the health of the inmate population must reflect the agency's best efforts to obtain cost-effective health care consistent with community standards.

In meeting the health care needs of a growing inmate population, the BOP provides essential medic al, dental, and mental health services to Federal inmates by BOP staff. When a medical need arises which cannot be provided within prison walls by BOP, staff, referrals are then made to community based providers. It is the goal of this solicitation to establish a contractual agreement that will provide necessary physician and facility services for both inpatient admissions and outpatient encounters.

The BOP intends to make a single award to a responsible entity for the provision of Comprehensive Medical Services for the Federal Correctional Institution (hereinafter referred to as FCI) in Glenville, West Virginia, as set forth in this solicitation/contract. The FCI currently houses male inmates. The FCI is presently identified as a Care Level II BOP facility. Care Level II is an intermediate classifica tion on the four-level scale where Care Levell represents the healthiest inmates and Care Level IV represents inmates with serious health issues. Criteria for categorizing an inmate in the Care Level II category is included as Attachment 2. Despite this description of general health of the inmate popula tion, needs for inmate healthcare may arise at any time, in any specialty, and any level of complexity.

Classification and designation of inmates is the sole responsibility of the BOP and may be changed at any time without consideration to the contractor.

The FCI is located at 201 FCI Lane, Glenville, West Virginia. In evaluating offers, the Government will evaluate the proximity of the proposed community-based providers, in addition to other factors, and give preference to those providers located nearest the FC!. Although a mileage restriction has not been placed on this acquisition, the Government reserves the right to determine that the proposed driving distances/conditions to community-based providers pose an unacceptable cost or security risk and to find such offers unacceptable.

II. Organizational Conflict of Interest

The objective of this solicitation is to satisfy the BOP's requirement for the provision of health care to the inmates of the FC!. A potential organizational conflict of interest may arise if the awardee is an entity which also holds or partiCipates in a separate contract/agreement with the BOP as a medical claims adjudicator. A possible conflict of interest may exist if the awardee has dual responsibilities for the submission of proper invoices (Le., medical claims) for services rendered under the resulting con tract and for the adjudication of those invoices (Le., medical claims) under a separate contract/ agreement with the BOP.

Offers received from any firm which holds or partiCipates in a separate contract/agreement for BOP medical claims adjudication services must address any potential organizational conflict of interest that may arise and must provide a detailed explanation of how such conflicts will be avoided. Offers re ceived 'from any firm which holds or partiCipates in a separate contract/agreement for BOP medical claims adjudication services which fail to adequately address/resolve potential conflicts of interest will be rejected without further consideration. This limitation on the eligibility of offerors has been im

RFPP01191200003 Page 10 of 47 posed as authorized by Federal Acquisition Regulations (FAR) 9.506.

III. Statement of Output

Within this Performance Work Statement (PWS). necessary services are described in terms of output rather than specific task assignments. The BOP desires to make an award to the offeror who can provide the best value, considering the diversity of available services and price, among other criteria speci'fied in Section 5-2. Therefore, the Government may award any or all line items, may withhold award of any or all line times, or may award to an offeror who proposes less than the full complement of services contained in this solicitation. Accordingly, output items 1 and 2 are optional deliverables while output items 3, 4, and 5 are applicable to all services provided. Offerors are encouraged to sub mit comprehensive proposals committing to provide all outputs listed in the solicitation. Offerors who propose less comprehensive approaches will be evaluated accordingly.

Output #1: Provide inpatient and outpatient facility services which conform to community stand ards and all local, state and Federal laws and regulations applicable to the delivery of health care to members of the general public. (Cross-reference pricing categories 1 a and 1 b)

Output #2: Provide profeSSional services which conform to community standards and all local, state and Federal laws and regulations applicable to the delivery of health care to members of the general public. (Cross-reference pricing categories 2a, 2b and 2c1)

Output #3: Submit properly priced invoices for services rendered.

Output #4: Manage medical record information in a manner which promotes continuity of care while observing restrictions on the release of information.

Output #5: Maintain open avenues of communication, facilitating the exchange of information between the contract provider, contract facility, and the Government regarding the contract services.

IV. Compliance with Contract Requirements

The Contractor's efforts under this contract shall be monitored to ensure that the required output is achieved. The Government reserves the right to inspect and evaluate in a reasonable manner all ser vices rendered during the performance of this contract. The contractor's performance will be meas ured by the Government utilizing the outcome measure indicators provided in Attachment III.

The Contractor is responsible for all management and quality control actions necessary to meet the quality standards set forth by this contract. Prior to commencing performance, the Contractor shall develop and submit a quality control plan (QCP) for the FCl's approval. Once the QCP is approved by the FCI, the contractor shall utilize the QCP to guide and rigorously document the implementation of the required management and quality control actions to achieve the speci'fied output.

V. Specific Requirements

Output #1: Provide inpatient and outpatient faCility services which conform to community

" 'I"

RFPP01191200003 Page 11 of47 standards and all local, state and Federal laws and regulations applicable to the delivery of health care to members of the general public.

Output #1 is an optional deliverable. However, if the offeror proposes to provide these services, the following minimum requirements apply.

If proposed, the contractor shall provide facility services on an as-needed basis in a manner which adheres to community standards of quality and cost-effective medical care. The services required to satisfy Output #1 may include inpatient facility and outpatient facility, including emergency room ser vices. Inpatient visits for non-emergency services shall require private room accommodations with available space for up to three armed or unarmed guards per inmate.

It is the FCI's preference to obtain the services of facilities that are accredited by The Joint Commis sion. Offerors utilizing facilities which maintain accreditation by The Joint Commission shall submit a copy of the current accreditation certificate as part of the offeror's technical proposal. If an offeror in tends to utilize a facility which is accredited or certified by any other recognized professional accredit ing body, the offeror shall submit documentation validating this accreditation or certification as a part of its proposal.

The offeror's technical proposal shall discuss in detail the diversity of services, as well as the proxim ity of facility providers to the FCI, that it is capable of providing to achieve Output #1.

Output #2: Provide professional services which conform to community standards and all local, state, and Federal laws and regulations applicable to the delivery of health care to mem bers of the general public.

Output #2 is an optional deliverable. However, if the offeror proposes to provide these services, the following minimum requirements shall apply.

Community-Based Services

Professional services resulting from a BOP referral are necessary to be performed in a community based setting (e.g., hospital facility, surgical center, physician's office, etc.). If proposed, the Con tractor shall provide the services of professional medical staff who have appropriate educational qual ification, experience, licensure, and board certification (where required) to achieve Output #2. This output specifically excludes the provision of radiological interpretations of BOP-provided films, im ages, or other media.

If requested by the Contracting Officer, the Contractor shall be required to document primary source verification of the credentials for each provider including: current license from the appropriate State Board of Medical Examiners, education from professional schools or universities, evidence of comple tion of internships and/or residencies as appropriate.

Whenever possible, appointments for specialty care should be available within 14 calendar days from the date of referral to the specialty provider. This practice promotes the safety and security of the fed eral prisoner, the escorting correctional staff, and the general public. The medical urgency of any re ferral must receive consideration in the scheduling and delivery of professional services.

'-""",$I"

RFPP01191200003 Page 12 of 47

For prescriptions to be filled by the FCI pharmacy, contract providers shall only prescribe pharma ceutical drugs that are listed in the approved BOP Formulary. The BOP Formulary can be accessed at www.bop.gov/newsIlPDFs/formulary.pdf. Requests for exemptions shall be submitted to the Con tracting Officer's Technical Representative (COTR), who shall obtain the required approvals. As part of the Discharge Instructions, the issuance of sample medication to any Federal inmate shall be pro hibited.

The offeror's technical proposal shall discuss in detail the diversity of services, as well as the proxim ity of physician providers to the FCI, that it is capable of providing to achieve Output #2.

Institution-Based Services

As an additional tool to satisfy Output #2, specialty services may be performed within the confines of the FC!. If the resulting contract does not provide for telemedicine consultation or all of the on-site clinics listed, the FCI reserves the right to pursue such contracts. The FCI also reserves the right to determine the manner of an inmate's referral, i.e., via on-site clinic, via community-based referral, via telemedicine consult, or any other method the FCI determines to be reasonable and appropriate.

If the contractor performs on-site specialty clinics at the FCI, the following minimum requirements shall apply. Contract services shall be provided on-site within the Health Services Unit of the FC!.

Consultations shall be limited to the chief complaint on the BOP consultation form. Services shall in clude diagnosis and treatment of medical conditions with appropriate referral, if necessary, to a spe cialist at the contract medical facility. Scheduling of clinics shall be subject to the mutual agreement of the FCI and the contract provider. Scheduling of inmates for on-site clinics shall be performed by the FCI.

Providers performing institution based services shall be licensed to practice medicine in the state of West Virginia. Providers performing these services shall apply for clinical privileges at the FCI. All clinical privileges shall be appropriate to the qualifications of the provider and the resources of the fa cility where care is provided. Any clinical privileges granted due to the award of this contract shall be contingent upon the continuation of this contract and upon the provider's continued affiliation with the Contractor or any subcontractor. Continuation of privileges at the FCI shall be at the sole discretion of the FC!.

The following speCialty clinic may be conducted at the Fel, contingent upon an acceptable offer. The BOP reserves the right to award or not award the following on-site clinic:

Optometrist

In the event it becomes necessary for the Government to cancel a scheduled visit, the FCI will provide the contract provider with 24-hour written or verbal notice prior to canceling a visit. However, certain circumstances beyond the control of the FCI (e.g., fog or other Acts of God, institution disturb ances, etc.) may dictate the cancellation of a scheduled visit with less than 24 hours written or verbal notice. In the event it becomes necessary for the contract provider to cancel a scheduled visit, the Contractor may provide qualified replacement professional staff or may reschedule a mutually agreed-upon replacement session. Prior to utilizing replacement staff, the Contractor must obtain preliminary clearance from the Contracting Officer or COTR, in accordance with the security and priv ileging requirements of this contract.

www.bop.gov/newsIlPDFs/formulary.pdf

RFPP01191200003 Page 13 of 47

All contract personnel providing services within the confines of the FCI shall have a complete back ground investigation conducted in accordance with BOP Program Statement 3000.03, "Human Re source Management Manual." See also "Contract Security/Investigative Requirements" contained within Section 4-1 of this solicitation/contract. All contract providers and other applicable staff who will enter the FCI to perform services on a recurring basis shall be required to attend a four-hour institu tion orientation course held at the FCI or a mutually acceptable site. A "refresher" orientation must be completed annually. The Contractor's costs for contract staff to attend this training shall be the re sponsibility of the Contractor. The Contracting Officer or COTR will be responsible for scheduling training for all applicable contract staff.

Output #3: Submit properly priced invoices for services rendered.

Overview- Upon completion of a treatment encounter, the contractor shall prepare and submit proper invoices for services rendered under this contract. For the purpose of this contract, a specific defini tion for what documentation constitutes an invoice is provided below. A proper invoice shall include the information specified in FAR clause 52.212-4, Contract Terms and Conditions - Commercial Items, paragraph (g). Services shall be invoiced in accordance with the terms and conditions of the contract, including the payment rate structures specified in the contract.

Invoice I Medical Claims Adjudication. The FCI will employ a process of invoice/medical claims adjudication to ensure, at a minimum, that the services billed by the contractor were properly author ized and ordered by the FCI, are appropriately coded in compliance with Medicare coding policies (where applicable), are properly priced in accordance with the terms and conditions of the contract, and do not represent duplicate billings for payments already made. In addition, the FCI may utilize the services of a third-party medical claims adjudicator to review invoices submitted by the contractor under this contract. When requested by the FCI, the contractor shall comply with all reasonable re quests for additional invoice/medical claim/medical record documentation. All invoice payments shall be made by the FCI and any disagreements regarding the paid amount of any invoice shall be re solved directly with the FCI.

Invoice Definitions.

Line Items 1 a - Inpatient Facility Services, 1 b - Outpatient Facility Services, 2a - Inpatient Phys ician Services, 2b - Outpatient Physician Services. At the outset of this contract, an invoice for services rendered under Line Items 1 a, 1b, 2a, and 2b shall be a paper version of an invoice contain ing not more than 50 individual medical claims. Each invoice shall be supported with paper copies of Universal Billing (UB) 92 forms or Centers for Medicare and Medicaid Services (CMS) 1500 forms, as applicable, for each medical claim included in the invoice.

Following written notification to the contractor by the Contracting Officer that a third-party medical claims adjudication service will be utilized by the FCI, an invoice for services rendered under Line Items 1 a, 'I b, 2a, and 2b shall be a paper invoice detailing not more than 50 individual medical claims which have been electronically transmitted to the BOP's medical claims adjudicator via American Na tional Standards Institute (ANSI) 837 format that also conforms to Medicare and Health Insurance Portability and Accountability Act of 1996 (HIPAA) electronic billing standards. For each medical claim included on the invoice, the contractor shall reference, at a minimum, the following information:

YREGDOC number, inmate name and register number, date of service, provider of service, billed code, and contract amount billed. Medical claims detailed in the invoice shall be listed first in des cending order by the YREGDOC number, second in alphabetic order by the inmate's last name, and third by ascending date of service (Le., earliest to latest) when more than one medical claim is

''"RFPP01191200003 Page 14 of 47 present for the same inmate within the same invoice.

The Contractor shall not submit a medical claim for processing that the Contractor knows or has reason to be lieve contains inaccurate, incomplete, or misleading information. Medical claims which contain inacccurate, in complete, or misleading information shall be held by the Contractor and not submitted until such time as all lines are deemed to be accurate and complete. At that time, the Contractor may proceed with submitting the medical claim for processing and invoicing the FCr for all services represented by that medical claim.

Line Item 2c1, Outpatient Institution Services - Optometrist: An invoice for services rendered under line Item 2c1 shall be a paper invoice detailing the date(s) sessions were provided, the number of sessions provided, the unit pricing applied, and the extended total amount due.

The BOP will not use services of a third party medical claims adjudicator for verification of these services.

Provider Information

Submission of Provider Data to the BOP's Medical Claims Adjudicator- Within ten calendar days after notification that a third-party medical claims adjudication service will be utilized by the FCI, the contractor shall provide the BOP's medical claims adjudicator with a complete list of provider informa tion, which will enable the claims adjudicator to accurately identify the correct payable amount for any provider performing services under the Contract. Specific informational requirements are provided in Attachment #4. Provider information supplied to the BOP's medical claims adjudicator should be ap propriately marked to identify the data as proprietary information so that it may be adequately protec ted by the BOP and it's contracted medical claims adjudicator. Provider information shall be submit ted directly to the BOP's medical claims adjudicator. As individual providers are added to the con tractor's network, the contractor shall provide the information listed in Attachment #4 to the medical claims adjudicator no less than three business days prior to filing claims electronically for services rendered by such new providers.

National Provider Identifier (NPI) Numbers- The contractor shall only utilize providers who have a current National Provider Identifier (NPI) number.

Electronic Trading Partner Agreement - The BOP will execute the Electronic Trading Partner Agreement with the medical claims adjudicator (Attachment #5). The contractor shall participate in the claims adjudication process described herein as a "Business Associate" of the BOP. As a Busi ness Associate, the contractor agrees to abide by all terms of the Trading Partner Agreement as it pertains to Business Associates.

Technical Data for Submission of Claims - Prior to the submission of an invoice to the FCI, the Contractor shall electronically transmit the information found on each individual invoiced medical claim via ANSI 837 format only, to the BOP's medical claims adjudicator. After the Contractor's elec tronic transmission to the BOP's medical claims adjudicator, the Contractor shall promptly submit a paper copy of the invoice to the FC!. The Contractor will also post the ANSI 837 file in an FTP site set up and maintained by the BOP's medical claims adjudicator. The only exceptions to the electronic filing requirement shall be corrected claims for professional services. Address information for the submission of a paper medical claim to the BOP's medical claims adjudicator is provided in Attach ment #6, along with other pertinent details.

RFPPO1191200003 Page 15 of 47

Procedures for Filing Corrected Claims.

Facility Services- If it becomes necessary to file a corrected medical claim for facility services, the Contractor shall electronically transmit the information found on each individual corrected medical claim via ANSI 837 format only, to the BOP's medical claims adjudicator. After the Contractor's elec tronic transmission to the BOP's medical claims adjudicator, the Contractor shall promptly submit a paper copy of the invoice or credit memo, as applicable, to the FCI. Invoices for corrected medical claim shall be clearly marked as such and shall be separate from routine invoices. Invoices or credit memos for corrected medical claim shall detail information pertaining to the original medical claim submission, including any amount(s) previously paid, and shall bill only for the corrected medical claim submission or reflect the credit amount due for the corrected medical claim submission.

Physician/Professional Services- If it becomes necessary to file a corrected medical claim for phys ician/professional services, the Contractor shall submit the corrected medical claim in hard copy (Le., paper) format to the BOP's medical claims adjudicator. The word "CORRECTED" shall be promin ently displayed on the paper medical claim. After the Contractor's submission to the BOP's medical claims adjudicator, the contractor shall promptly submit a paper copy of the invoice or credit memo, as applicable, to the FCI. Invoices for corrected medical claims shall be clearly marked as such and shall be separate from routine invoices. Invoices or credit memos for corrected medical claims shall detail informatiol1 pertaining to the original medical claim submission, including any amount(s) previ ously paid, and shall bill only for the corrected medical claim submission, or reflect the credit amount due for the corrected medical claims submission.

Payment by the FCI- The FCI will pay all invoices directly to the Contractor. If the invoiced amount of a medical claim exceeds the adjudicated amount of that medical claim, the FCI will take an admin istrative deduction from the invoice. The FCI will provide written notification to the Contractor when an administrative deduction is taken from an invoice payment.

If the Contractor is in disagreement with the paid amount of a medical claim, the contractor will provide written notification to the FCI of the disagreement along with the reasons why the Contractor believes the medical claim was paid incorrectly. The FCI will interface between the Contractor and the medical claims adjudicator to bring resolution to any disagreements. If it is determined that a medical claim was paid incorrectly by the FCI, interest on the underpayment will be paid when re quired by the Prompt Payment Act.

Timeliness of Medical Claims-

Medical claims shall be submitted/invoiced within 90 calendar days after an inmate's discharge or out patient encounter or other service provided under this contract. Medical claims which are submitted beyond the 90-day requirement shall constitute a performance deficiency under this output and shall be documented in the contractor's performance evaluations. Medical claims which are submitted within the acceptable time period, but are found to contain errors or require further justification, will be rejected and shall be resubmitted by the contractor within 30 calendar days from the date of rejection.

No later than November 1 of each year, the contractor shall stimulate the billing process by reviewing its records, including those of subcontracted providers, to determine an estimated amount of out standing charges for services provided through September 30 of that year. Based upon information generated through this review process, the contractor shall provide a written estimate to the FCI of outstanding fiscal year obligations, supported by adequate documentation. This estimate and sup

RFPP01191200003 Page 160f47 porting documentation shall be provided to the Contracting Officer no later than December 1 of each year. The contractor shall put forth its best efforts to ensure the accuracy of the annual estimate provided to the Government.

Output #4: Manage medical record information in a manner which promotes continuity of care while observing 'restrictions on the release of information.

Upon request, authorized BOP staff shall have access to and obtain copies of all inmate medical re cords and evaluation and treatment reports prepared and maintained by the contract facility and/or contract providers. Inmate medical records will be subject to review by the FCI for validation of pay ment and verification of services rendered. Release of information shall only be made in accordance with community standards, Joint Commission regulations, and the Privacy Act of 1974. Any re quest(s) for copies of an inmate's medical records by the inmate or a third party shall be directed to the COTR for processing.

NotWithstanding the above restrictions on the release of information, medical record information shall be provided to the FCI in order to enhance inmate recovery as well as continuity of care. For inpa tient admissions, a faxed report documenting treatment plans will be submitted to the FCI Medical Records Department no later than 8:00 a.m. each day. This form with the requested information will be provided to the contractor by the FCI. At the completion of treatment, the Contractor shall provide the FCI with documented discharge instructions, as provided by the attending physician. Copies of all lab, x-ray, ekg, progress notes and emergency room working notes shall also accompany the patient or be faxed immediately to the COTR. A written report by the attending physician which documents the circumstances of the inpatient treatment, outpatient procedure, or other conSUltation shall be provided to the COTR within ten business days of the inpatient discharge, outpatient procedure, or other consultation. All lab and consultations pending at time of discharge shall be faxed to the COTR upon receipt but not later than ten calendar days past discharge.

Output #5: Maintain open avenues of communication, facilitating the exchange of informa tion between the contract physician, contract faCility, and the Government regarding the con tract services.

The Contractor shall provide a Point of Contact (POC) who shall be responsible for facilitating the Contractor's delivery of health services under this contract. The POC shall have sufficient clinical knowledge to enable preliminary technical consultation, with referral to a specialist if necessary. The Contractor shall designate this individual in writing to the Contracting Officer prior to the start-date of the contract. Alternate POC's may be deSignated; however, the Contractor must identify those times when an alternate shall be the primary POC (i.e., after-hours and weekend referrals).

There shall be an open line of communication between the Contractor, its representatives, and the FCI to ensure that only those services ordered by the institution are provided, unless required for in tervention in a life-threatening emergency. In the event of a life-threatening emergency, the Contract or shall contact the COTR within a 24-hour time period or the next normal working day. All FCI refer rals shall be the sole responsibility and decision of the Government. No inmate may be transferred to another medical facility, with exception of emergency cases, without advanced approval by author ized FCI medical staff.

VI. Enhancements to the Basic Contract ReqUirements

RFPP01191200003 Page 17 of 47

Offerors are encouraged to propose enhancements to the basic contract requirements which will facil itate the Fel's ability to conform to the BOP's stated mission. Due to security concerns inherent in transporting an inmate into the community for medical care, it is the Fel's preference to treat inmates within the confines of a secure perimeter whenever possible. Offerings which assist the Fel in mitig ating security concerns are considered beneficial to the Government and will be evaluated for merit.

Enhancements are not additional line items. Pricill9 for offered enhancements must be absorbed in the line item…