Complete_Solicitation_-FCI_Oxford.pdf

U.S. Department of Justice

Federal Bureau of Prisons Administrative Division

Field Acquisition Office Grand Prairie, Texas 75051

May 21, 2015

Re:

Dear Off eror:

Request for Proposal (RFP) # RFPP04101500001 Comprehensive Medical Services Federal Correctional Institution (FCI) Oxford, Grand Marsh, WI

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 Oxford, located in Grand Marsh, WI. The solicitation package includes the following:

Cover Letter Table of Contents Solicitation Attachments

Services to be provided include inpatient/outpatient facility services and inpatient/outpatient physician 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.

Page 1of2

Offers shall be received on or before the deadline referenced on Block 8 of the Standard Form 1449. Proposals shall be submitted to the following address:

Federal Bureau of Prisons Field Acquisition Office U.S. Armed Forces Reserve Complex 346 Marine Forces Drive Grand Prairie, Texas 75051 Attention: Dennis A. Chinnici, Contracting Officer

Mailed and hand-carried offers must be delivered to the Contracting Officer 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 offers will be at the first floor mail room of the address listed above.

PLEASE DO NOT SUBMIT PROPOSALS TO ANY LOCATION OTHER THAN THE ONE

LISTED ABOVE. Proposals received after the deadline will processed pursuant to FAR 52.212-1 (f).

Please submit any questions you may have via email, to dchinnici@bop.gov. I 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. Chinnici, Contracting Officer Federal Bureau of Prisons Field Acquisition Office

Enclosure

Page 2 of2

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

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 42

2. CONTRACT NO. 3. AWARD/EFFECTIVE 4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE

DATE DATE

RFPP04101500001 05/21/2015

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

7. FOR SOLICITATION

calls) LOCAL TIME

INFORMATION CALL: 06/19/2015

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

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

Federal Bureau of Prisons D SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS ---

D (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

Field Acquisition Office D HUBZONE SMALL SMALL BUSINESS PROGRAM NAICS:

U.S. Armed Forces Reserve Complex BUSINESS

0EDWOSB 622110

346 Marine Forces Drive D SERVICE-DISABLED

VETERAN-OWNED SIZE STANDARD:

Grand Prairie, TX 75051 SMALL BUSINESS n 8 (A) $38.5 million 11 . DELIVERY FOR FOB DESTINA- 12. DISCOUNT TERMS 13b. RATING

TION UNLESS BLOCK IS 0 13a. THIS CONTRACT IS A

MARKED RATED ORDER UNDER

DPAS (15 CFR 700) 14. METHOD OF SOLICITATION

D SEE SCHEDULE 0RFQ 01FB [gjRFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE I

Federal Bureau of Prisons, FCI Oxford Federal Bureau of Prisons, FCI Oxford

County Road "G" & Elk Ave, Grand Marsh, WI 53936 County Road "G" & Elk Ave, Grand Marsh, WI 53936

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

OFFEROR CODE

Federal Bureau of Prisons, FCI Oxford PO Box 500 Oxford, WI 53952

TELEPHONE NO.

D 17b. CHECK IF REMITIANCE IS DIFFERENT AND PUT SUCH ADDRESS IN 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a 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 Sheets(s)

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

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

[g] 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1 , 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

D 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52 .212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

[g] ARE DARE NOT ATTACHED

DARE DARE 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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

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

30b. NAME AND TITLE OF SIGNER (Type or print)

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

STANDARD FORM 1449 (REV. 212012)

Prescribed by GSA - FAR (48 CFR) 53.212

Table of Contents

Description Page Number

Solicitation/Contract Form

2 Commodity or Services Schedule 2-1 Contract Pricing 2-2 Performance Work Statement

3 Contract Clauses

4 List of Attachments ..................................................................... ·

4-1 SPECIAL CONTRACT CONDITIONS

5 Solicitation Provisions

5-1 TAILORING

5-2 SUBMISSION/EVALUATION OF PROPOSALS

5-3 SUBCONTRACT CERTIFICATION

Page 2of42

Section 2 - Commodity or Services Schedule

Schedule of Supplies/Services Continuation Sheet

Item No Suoolies/Services Comprehensive Medical Services for FCI Oxford, located in Oxford, WI. See Section 2-1, Schedule of

0001 Items, and Section 2-2, Performance Work Statement.

Base Year: Effective Date of Award (EDOA) through 12 months Comprehensive Medical Services for FCI Oxford, located in Oxford, WI. See Section 2-1 , Schedule of

0002 Items, and Section 2-2, Performance Work Statement.

Option Year I : 13 months through 24 months from

EDOA

Comprehensive Medical Services for FCI Oxford, located in Oxford, WI. See Section 2-1 , Schedule of

0003 Items, and Section 2-2, Performance Work Statement.

Option Year 2: 25 months through 36 months from

EDOA

Comprehensive Medical Services for FCI Oxford, located in Oxford, WI. See Section 2-1, Schedule of

0004 Items, and Section 2-2, Performance Work Statement.

Option Year 3: 37 months through 48 months from

EDOA

Comprehensive Medical Services for FCI Oxford, located in Oxford, WI. See Section 2-1 , Schedule of

0005 Items, and Section 2-2, Performance Work Statement.

Option Year 4: 49 months through 60 months from

EDOA

2-1 Contract Pricing

BLOCKS 19 THROUGH 24 - CONTRACT PRICING

Overview

Services are required to be provided in accordance with the Performance Work Statement included in this solicitation/contract. Offerors are required to submit, as a part of their business proposal , a completed copy of the Schedule of Items (pages 4 through 6).

Pricing Methodology

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 established 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

Page 3of42 deductibles, copayments, or co-insurance. When appropriate, outlier payments calculated in accordance with Medicare reimbursement methodologies shall be made in recognition of extremely 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 category 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).

Medicare Part A. The Medicare benchmark to be utilized for all services covered by Medicare Part A shall be the most current Basic MS-DRG payment (i.e., Operating Federal Rate) established for CBSA 52, for Rural Areas of Wisconsin. The Basic MS-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 MS-DRG rates . (Refer to Attachment 1 of this solicitation)

Medicare Part B Physician and Non-Physician Services. The Medicare benchmark to be utilized for all physician and non-physician services covered by Medicare Part B shall be those rates established in the most current Medicare Part B Fee Schedule for Payment Locality 0 for the State of Wisconsin. The benchmark charges shall be those established for participating providers. Offerors may propose a discount 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 CBSA 52 for Rural Areas of Wisconsin. 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 representation 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

The following quantities are individual estimates for each performance period, (i.e. the base year and each option year), and are anticipated to remain consistent throughout each performance period:

Inpatient Days:

Outpatient Visits:

Schedule of Items

Estimated 36 Days Estimated 192 Visits

Offerors shall complete the following Schedule of Items. 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) for the base year and all option years is public information, in accordance with Federal Acquisition Regulations (FAR) 15.503(b)(l)(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

Page 4of42

NOTE: FOR EACH OF THE FOLLOWING PERFORMANCE PERIODS; IF OFFERING AV ARIAN CE

FROM THE BENCHMARK MEDICARE RA TE, INSERT APPLICABLE "-/+" PERCENT AGE. IF NO

VARIANCE, ENTER "O".

BASE YEAR

Effective Date of Award (EDOA) through 12 months

I a. 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

OPTION YEAR I

13 through 24 months from EDOA

la. 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

OPTION YEAR 2

25 through 36 months from EDOA

I a. 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

OPTION YEAR 3

37 through 48 months from EDOA ·

I a. 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

Page 5of42

OPTION YEAR 4

49 through 60 months from EDOA

1 a. 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

2-2 Performance Work Statement

PERFORMANCE WORK STATEMENT (PWS)

I. Background

The Federal Bureau of Prisons (BOP) was established in I 930 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 219,000 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.

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. 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 professional and facility services for both inpatient admissions and outpatient encounters.

The Federal Correctional Institution Oxford (hereinafter referred to as FCI) located in Oxford, Wisconsin, 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 FCI currently houses male inmates and is presently identified as a Care Level I facility .

This is an administrative classification which provides for the designation of a generally healthy inmate population to the FCI .

Criteria for categorizing an inmate in the Care Level I category are included as Attachment 2. Despite this description of the general health of the inmate population, however, needs for inmate healthcare may arise at varying levels of complexity.

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 FCI. 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

Page 6of42 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 FCI. 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 medical claims for services rendered under the resulting contract and for the adjudication of those 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

Within this 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 specified in Section 5-2. Therefore, the Government may award any or all line items, may withhold award of any or all line items, or may award to an offeror who proposes less than the full complement of services contained in this solicitation. Accordingly, output items I 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 # I:

Output #2:

Output #3:

Output #4:

Output #5:

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 la and I b.)

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, and 2b.)

Submit properly-priced invoices for services rendered.

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

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 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 3.

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 FCI'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

Page 7of42 to achieve the specified output.

V. Specific Requirements

Output #I: 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 #I is an optional deliverable. However, if the offeror proposes to provide these services, the following minimum requirements apply. Throughout the performance of this contract, the Contractor shall not utilize any provider that appears in the List of Excluded Individuals/Entities (LEIE) maintained by the U.S. Department of Health & Human Services.

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 #I 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 FCI '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 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 members of the general public.

Output #2 is an optional deliverable. However, ifthe offeror proposes to provide these services, the following minimum requirements shall apply. Throughout the performance of this contract, the Contractor shall not utilize any provider that appears in the List of Excluded Individuals/Entities (LEIE) maintained by the U.S. Department of Health & Human Services.

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 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.

Jfrequested 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.

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 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 professional services.

For prescriptions to be filled by the FCI pharmacy, contract providers shall only prescribe pharmaceutical drugs that

Page 8of42 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 Representative (COR), 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 professional providers to the FCI, that it is capable of providing to achieve Output #2.

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 FCI 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 FCI, are appropriately coded in compliance with Medicare coding polrcies (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 ofa third-party medical claims adjudicator to review medical claims submitted by the Contractor under this contract. When requested by the FCI, the Contractor shall comply with all reasonable requests 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 resolved directly with the FCI.

Invoice Definitions.

Line Items la - Inpatient Facility Services, lb - Outpatient Facility Services, 2a - Inpatient Physician Services, and 2b - Outpatient Physician Services:

At the outset of this contract, an invoice for services rendered under Line Items 1 a, 1 b, 2a, and 2b 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) 04 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 la, 1 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 National Standards Institute (ANSI) 837 format that also conforms to Medicare and Health Insurance Portability and Accountability Act of 1996 (HlPAA) 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 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 medical claim is present for the same inmate within the same invoice.

If the Contractor' s proposal encompasses the provision of oral surgery and/or dental procedures, only those medical claims which represent adjunctive dental care will be submitted by the Contractor to the medical claims adjudication contractor for processing. Oral surgery and/or dental procedures which are not considered to be adjunctive dental care will be submitted to the FCI for verification.

The Contractor shall not submit a medical claim for processing that the Contractor knows nor has reason to believe contains inaccurate, incomplete, or misleading information. Medical claims which contain inaccurate, incomplete, Page 9of42 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 FCI for all services represented by that medical claim.

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 information, which will enable the medical 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 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 4 to the medical claims adjudicator no less than three business days prior to filing medical 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 5). The Contractor shall participate in the medical 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 Medical 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 electronic transmission to the BOP' s medical claims adjudicator, the Contractor shall promptly submit a paper copy of the invoice to the FCI. 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 medical claims for professional services. Address information for the submission of a paper medical claim to the BOP's medical claims adjudicator is provided in Attachment 6, along with other pertinent details.

Procedures for Filing Corrected Medical 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 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 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 information pertaining to the original medical claim submission (including any amount(s) previously paid and the associated invoice numbers) 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 physician/professional services, the Contractor shall submit the corrected medical claim in hard copy (i.e., paper) format to the BOP's medical claims adjudicator. The word "CORRECTED" shall be prominently 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 information pertaining to the original medical claim submission (including any amount(s) previously paid and the associated invoice numbers) and shall bill only for the corrected medical claim submission or reflect the credit amount due for the corrected medical claim 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 administrative 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 supporting documentation for 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 required 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 outpatient encounter or other service provided under this contract. Medical claims which are submitted/invoiced 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/invoiced within the acceptable time period, but are found to contain errors or require further justification, will be rejected and shall be resubmitted/reinvoiced by the Contractor within 30 calendar days from the date of rejection. Upon resubmission, invoices for corrected medical claims shall bear the new date of submission.

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 FCI 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 I 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 providers. Inmate medical records will be subject to review by the FCI 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 ofan inmate's medical records by the inmate or a third party shall be directed to the COR 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 inpatient admissions, a faxed report documenting treatment plans will be submitted to the FCI Medical Records Department no later than 8 am 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 COR. 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 COR 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 COR upon receipt but not later than I 0 calendar days past discharge.

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

Page 11of42 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 FCJ 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 COR within a 24-hour time period or the next normal working day. All FCI 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 FCI medical staff.

A contract provider may discuss with the inmate patient only the diagnosis and possible treatment options directly related to the written consultation provided by the FCI. The contract provider should not guarantee any future treatment to the inmate or discuss future appointment dates. All consultant recommendations should be sent to the FCI for review by the Primary Care Provider Team and/or Clinical Director (CD). The BOP PCPT and/or CD is under no obligation to follow consultant recommendations. All patient care information and/or treatment plans will be reviewed by the PCPT/CD and the final disposition will be relayed to the inmate in accordance with BOP policies and procedures. In the event further care is approved, the Contractor will be notified by the FCI. The Contractor shall not perform any treatment/procedures unrelated to the reason for consultation without receiving prior authorization from the FCI.

VI. Enhancements to the Basic Contract Requirements

Offerors are encouraged to propose enhancements to the basic contract requirements which will facilitate the FCI's ability to conform to the BOP' s stated mission. Offerings which assist the FCI 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 2-1 .

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 FCI is specifically interested in receiving offers of enhancements in the following areas:

Acceptance of referrals by FCI physicians to reduce FCI expenditures in the area of Evaluation and Management Services (e.g., referrals for colonoscopies)

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. Inmates Who Release from BOP Custody

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. When 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 Work Statement)

Section 3 - Contract Clauses

Clauses By Reference

52.252-2 CLAUSES IN CORPORA TED 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. Also, the full text of a clause mav be accessed electronicallv at this/these address( es): www.acauisition.!!ov/browsefar Clause Title 52.232-18 Availabilitv OfFunds (Apr 1984) 52 .212-4 Contract Terms and Conditions-Commercial Items (May 2015)

A. I ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions--Commercial ltems (Dec 2014)

The terms and conditions for the following clauses are hereby incorporated into this solicitation and resulting contract as an addendum to FAR clause 52.212-4.

Clauses by Full Text

52.216-18 Ordering (Oct 1995)

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from the first day of the effective contract period through the last day of the effective contract period.

(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.

(c) If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.

(End of clause)

52.216-19 Order Limitations (Oct 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $50.00, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor-- (!) Any order for a single item in excess of the estimated quantities within the current performance period as identified in Section 2-1;

(2) Any order for a combination of items in excess of the estimated quantities within the current performance period as identified in Section 2-1 ; or

(3) A series of orders from the same ordering office within 30 days that together call for quantities exceeding the limitation in paragraph (b )( 1) or (2) of this section.

( c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor ifthat requirement exceeds the maximum-order limitations in paragraph (b) of this section.

(d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 7 days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons . Upon receiving this notice, the Government may acquire the supplies or services from another source.

(End of clause)

52.216-21 Requirements (Oct 1995)

(a) This is a requirements contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies or services specified in the Schedule are estimates only and are not purchased

Page 13of42 by this contract. Except as this contract may otherwi~e provide, ifthe Government' s requirements do not result in orders in the quantities described as "estimated" or "maximum" in the Schedule, that fact shall not constitute the basis for an equitable price adjustment.

(b) Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. Subject to any limitations in the Order Limitations clause or elsewhere in this contract, the Contractor shall furnish to the Government all supplies or services specified in the Schedule and called for by orders issued in accordance with the Ordering clause. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations.

(c) Except as this contract otherwise provides, the Government shall order from the Contractor all the supplies or services specified in the Schedule that are required to be purchased by the Government activity or activities specified in the Schedule.

( d) The Government is not required to purchase from the Contractor requirements in excess of any limit on total orders under this contract.

( e) If the Government urgently requires delivery of any quantity of an item before the earliest date that delivery may be specified under this contract, and ifthe Contractor will not accept an order providing for the accelerated delivery, the Government may acquire the urgently required goods or services from another source.

(t) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after the last day of the effective contract period.

(End of clause)

52.217-8 Option to Extend Services (Nov 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within the current performance period.

(End of clause)

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

(a) The Government may extend the term of this contract by written notice to the Contractor within the current performance period; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

( c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 5 years, but excludes the exercise of any option under the clause 52.217-8, Option to Extend Services, which is incorporated into this contract in full text.

(End of clause)

52.232-19 Availability Of Funds For The Next Fiscal Year (Apr 1984) Funds are not presently available for performance under this contract beyond September 30 of the base year or any option year exercised.