CMS Performance Work Statement CCC 1.pdf

PERFORMANCE WORK STATEMENT

I. Background

The Federal Bureau of Prisons (BOP) was established in 1930 to provide more progressive and humane 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 208,685 Federal offenders. The Federal prison system is a nationwide system of prisons and detention 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 controlled 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 offenders in becoming law-abiding citizens.

As an agency under the Executive Branch of the United States Government, the BOP receives an annual appropriation of funds to accomplish its assigned mission. The public trust demands that this annual 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 medical, dental, and mental health services to Federal inmates by BOP staff. W hen 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 Metropolitan Correctional Center (hereinafter referred to as MCC) located in Chicago, Illinois, intends to make a single award to a responsible entity for the provision of Comprehensive Medical Services as set forth in this solicitation/contract. The MCC is an administrative facility designed to house Federal offenders of all security levels, including both male and female offenders. The MCC is a Multi-Care Level

Institutions which consist primarily of Care Level I and II inmates.

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 MCC.

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 MCC. 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 (i.e., medical claims) for services rendered under the resulting contract and for the adjudication of those invoices (i.e., 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 received 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 imposed as authorized by

Federal Acquisition Regulations (FAR) 9.506.

III. Statement of Output

W ithin this Performance W ork Statement (PW S), 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 specified in

Section A.18.3.2. 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 submit comprehensive proposals committing to provide all output 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 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 1a and 1b.)

Output #2: Provide physician 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 2c.)

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 physician, 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 services rendered during the performance of this contract. The contractor’s performance will be measured by the

Government utilizing the outcome measure indicators provided in Attachment X.

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 MCC’s approval. Once the QCP is approved by the MCC, the contractor shall utilize the QCP to guide and rigorously document the implementation of the required management and quality control actions to achieve the specified output.

V. Specific Requirements

Output #1: Provide inpatient and outpatient facility 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.

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 services.

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 MCC's preference to obtain the services of facilities that are accredited by The Joint Commission.

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 intends to utilize a facility which is accredited or certified by any other recognized professional accrediting 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 proximity of facility providers to the MCC, that it is capable of providing to achieve Output #1.

Output #2: Provide physician 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.

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

Community-Based Services

Physician 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 Contractor shall provide the services of professional medical staff who have appropriate educational qualification, experience, licensure, and board certification (where required) to achieve Output #2. This output specifically excludes the provision of radiological interpretations of BOP-provided films, images, 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 completion of internships and/or residences as appropriate.

W henever 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 federal prisoner, the escorting correctional staff, and the general public. The medical urgency of any referral must receive consideration in the scheduling and delivery of physician services.

For prescriptions to be filled by the MCC pharmacy, contract physicians shall only prescribe pharmaceutical drugs that are listed in the approved BOP Formulary. The BOP Formulary can be accessed at www.bop.gov/news//PDFs/formulary.pdf. Requests for exemptions shall be submitted to the

Contracting 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 prohibited.

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

Institution-Based Services

As an additional tool to satisfy Output #2, physician services may be performed within the confines of the

MCC. If the resulting contract does not provide for telemedicine consultation or all of the on-site clinics listed, the MCC reserves the right to pursue such contracts. The MCC 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 MCC determines to be reasonable and appropriate.

http://www.bop.gov/news/PDFs/formulary.pdf.

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

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

Physicians performing institution-based services shall be licensed to practice medicine in the State of

(insert). Physicians performing these services shall apply for clinical privileges at the MCC. All clinical privileges shall be appropriate to the qualifications of the provider and the resources of the facility 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 physician’s continued affiliation with the Contractor or any subcontractor. Continuation of privileges at the MCC shall be at the sole discretion of the MCC. Non-physician providers shall maintain active licenses from the State of Illinois, as applicable.

The following specialty clinics/sessions may be conducted at the MCC, contingent upon an acceptable offer. The BOP reserves the right to award some, all, or none of the following on-site clinics:

Cardiology Infectious Disease Psychiatry Orthopedic Surgeon

Dermatology Neurology Urology

ENT OB/Gynecology Dietician

Gastroenterology Ophthalmology Optometry

General Surgery Oral Surgery Physical Therapy

In the event it becomes necessary for the Government to cancel a scheduled visit, the MCC will provide the contract provider with 48-hour written or verbal notice prior to canceling a visit. However, certain circumstances beyond the control of the MCC (e.g., fog or other Acts of God, institution disturbances, etc.)

may dictate the cancellation of a scheduled visit with less than 48 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 privileging requirements of this contract.

All contract personnel providing services within the confines of the MCC shall have a complete background investigation conducted in accordance with BOP Program Statement 3000.03, "Human

Resource Management Manual." See also "Contract Security/Investigative Requirements" contained within Section A.16 of this solicitation/contract. All contract physicians and other applicable staff who will enter the MCC to perform services on a recurring basis shall be required to attend a four-hour institution orientation course held at the MCC 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 responsibility 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 definition 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/Medical Claims Adjudication. The MCC will employ a process of invoice/medical claims adjudication to ensure, at a minimum, that the services billed by the contractor were properly authorized and ordered by the MCC, 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 MCC may utilize the services of a third-party medical claims adjudicator to review invoices submitted by the contractor under this contract.

W hen requested by the MCC, the contractor shall comply with all reasonable requests for additional invoice/medical claim/medical record documentation. All invoice payments shall be made by the MCC and any disagreements regarding the paid amount of any invoice shall be resolved directly with the MCC.

Invoice Definitions.

Line Items 1a - Inpatient Facility Services, 1b - Outpatient Facility Services, 2a - Inpatient Physician

Services, 2b - Outpatient Physician Services, and 2c1 - Outpatient Institution Services - Other

Physicians: At the outset of this contract, an invoice for services rendered under Line Items 1a, 1b, 2a, 2b, and 2c1 shall be a paper version of an invoice containing 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 MCC, an invoice for services rendered under Line Items 1a, 1b, 2a, 2b, and 2c1 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 National 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 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. Claims detailed in the invoice shall be listed first in descending order by the YREGDOC number, second in alphabetic order by the inmate’s last name, and third by ascending date of service (i.e., earliest to latest) when more than one claim is present for the same inmate within the same invoice.

Line Item 2c2 - Outpatient Institution Services - Optometrist: An invoice for services rendered under

Line Item 2c2 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 the 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. W ithin ten calendar days after notification that a third party medical claims adjudication service will be utilized by the

MCC, the contractor shall provide the BOP's medical claims adjudicator with a complete list of provider information, 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 X. Provider information supplied to the BOP’s medical claims adjudicator should be appropriately marked to identify the data as proprietary information so that it may be adequately protected by the BOP and its contracted medical claims adjudicator.

Provider information shall be submitted directly to the BOP’s medical claims adjudicator. As individual providers are added to the contractor's network, the contractor shall provide the information listed in Attachment X 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 utilize only 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 X). The contractor shall participate in the claims adjudication process described herein as a “Business Associate” of the BOP. As a Business

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 MCC, the

Contractor shall electronically transmit the information found on each individual invoiced claim via ANSI

837 format only, to the BOP’s medical claims adjudicator. After the Contractor’s electronic transmission to the BOP’s medical claims adjudicator, the Contractor shall promptly submit a paper copy of the invoice to the MCC. 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 claim to the

BOP’s medical claims adjudicator is provided in Attachment X, along with other pertinent details.

Procedures for Filing Corrected Claims.

Facility Services. If it becomes necessary to file a corrected claim for facility services, the

Contractor shall electronically transmit the information found on each individual corrected claim via ANSI 837 format only, to the BOP’s medical claims adjudicator. After the Contractor’s electronic 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 MCC.

Physician/Professional Services. If it becomes necessary to file a corrected claim for physician/professional services, the Contractor shall submit the corrected claim in hard copy (i.e., paper) format to the BOP’s medical claims adjudicator. 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 MCC.

Payment by the MCC. The MCC will pay all invoices directly to the Contractor. If the invoiced amount of a claim exceeds the adjudicated amount of that claim, the MCC will take an administrative deduction from the invoice. The MCC 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 claim, the contractor will provide written notification to the MCC of the disagreement along with the reasons why the Contractor believes the claim was paid incorrectly. The MCC will interface between the Contractor and the medical claims adjudicator to bring resolution to any disagreements. If it is determined that a claim was paid incorrectly by the MCC, interest on the underpayment will be paid when required by the Prompt Payment Act.

Timeliness of Invoices.

Invoices shall be received at the designated point of receipt within 90 calendar days after an inmate’s discharge or outpatient encounter or other service provided under this contract. Invoices 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. Invoices 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. Invoices submitted after December 31 of the year after the year services were rendered will be rejected and will not be paid.

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 outstanding 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 FDC of outstanding fiscal year obligations, supported by adequate documentation. This estimate and supporting 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 records and evaluation and treatment reports prepared and maintained by the contract facility and/or contract physicians. Inmate medical records will be subject to review by the MCC for validation of payment 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 request(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 MCC in order to enhance inmate recovery as well as continuity of care. At the completion of treatment, the Contractor shall provide the MCC with documented discharge instructions, as provided by the attending physician. 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.

Output #5: Maintain open avenues of communication, facilitating the exchange of information between the contract physician, contract facility, and the Government regarding the contract 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 MCC to ensure that only those services ordered by the institution are provided, unless required for intervention in a life-threatening emergency. In the event of a life-threatening emergency, the Contractor shall contact the COTR within a 24-hour time period or the next normal working day. All MCC referrals 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 authorized MCC medical staff.

VI. Enhancements to the Basic Contract Requirements

Offerors are encouraged to propose enhancements to the basic contract requirements which will facilitate the MCC’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 MCC’s preference to treat inmates within the confines of a secure perimeter whenever possible. Offerings which assist the MCC in mitigating security concerns are considered beneficial to the Government and will be evaluated for merit.

Enhancements are not additional line items. Pricing for offered enhancements must be absorbed in the line item structure established within Section A.2. Offerings of enhancements that are separately-priced line items will not be considered or accepted. The Government reserves the right to reject any offered enhancements that are determined not to be in the best interest of the Government.

The offeror’s technical proposal shall discuss in detail any such enhancements proposed, including relevant terms and a detailed discussion of the merits of offered enhancements.

VII. Infants Born to Inmates and Inmates Who Release from BOP Custody

The BOP has the authority to pay for immediate postnatal care of a child born to a female inmate when the BOP finds itself responsible for the cost by default (no other resource can be compelled to pay). The

BOP may assume financial responsibility for the medical expenses of a child for the first three (3) days after a routine vaginal birth or up to seven (7) days for a Caesarean section. This financial responsibility may be extended for a limited time for extenuating circumstances on a case-by-case basis. The

Contractor shall bill the BOP according to established contract rates. In the event the infant’s medical needs exceed the BOP’s authority for financial responsibility, the Contractor shall coordinate the application for financial assistance (e.g., Medicaid) for the infant. Once the BOP’s obligations as set forth in this paragraph are concluded, no further payment will be made on behalf of the inmate’s infant child.

Offerors are advised that the BOP retains responsibility only for inmates in the custody of the BOP. The

BOP’s responsibilities, including fiscal responsibilities, end with the inmate’s release from custody. Once released from custody, the former inmate will become personally liable for any further medical treatment received. W hen an inmate’s term of commitment expires while the inmate is in inpatient status in a contracted facility, the BOP will use its best effort to notify the contractor in advance of the inmate’s projected release date. In preparation of a pending release from BOP custody, the contractor shall provide planning assistance to an inmate who requires continuing or follow-up medical care that extends beyond his or her projected release date.

Should an inmate’s release date come while in inpatient status in a contracted hospital, the inmate’s place of conviction and/or legal residence is outside the local area, and there are no other entities assuming custodial responsibility for the inmate, the BOP will accept financial responsibility for the inmate’s medical care until the BOP can satisfy its obligation provide release transportation for the inmate.

(End of Performance W ork Statement)

Care Levels Defined:

Care Level I: The MCC is presently identified as a Care Level I BOP facility. This is an administrative classification which provides for the designation of a generally healthy inmate population to the MCC.

Criteria for categorizing an inmate in the Care Level I category is included as Attachment I. Despite this description of the general health of the inmate population, however, 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.

Care Level II: The MCC is presently identified as a Care Level II BOP facility. Care Level II is an intermediate classification on the four-level scale where Care Level I 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 I. Despite this description of the general health of the inmate population, however, 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.

Care Level III: The MCC is presently identified as a Care Level III BOP facility. Care Level III is an intermediate classification on the four-level scale where Care Level I represents the healthiest inmates and Care Level IV represents inmates with serious health issues. Criteria for categorizing an inmate in the

Care Level III category is included as Attachment I. Despite this description of the general health of the inmate population, however, 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.

Care Level IV: The MCC is presently identified as a Care Level IV BOP facility. This is an administrative classification which provides for the designation of an inmate population which generally suffers from serious health issues. Criteria for categorizing an inmate in the Care Level IV category is included as

Attachment I. Despite this description of the general health of the inmate population, however, 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.

Female Institutions: W ithin the BOP’s care level classification system, the FPC does not have a specific care level assignment. Inmates assigned to the FPC will normally be classified in one of Care Levels I, II, or III. Care Level I represents a generally healthy inmate population; Care Levels II and III are intermediate classifications on the four-level scale where Care Level I represents the healthiest inmates and Care Level IV represents with serious health issues. Criteria for categorizing an inmate in a care level category is included as Attachment I. Despite this description of the general health of the inmate population, however, 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.