FCI Sheridan Comprehensive Medical -Corr.pdf

U.S. Department of Justice

Federal Bureau of Prisons

Administration Division

Field Acquisition Office Grand Prairie, Texas 75051

December 15, 2010

Re: Request for Proposal RFPP06110900001-Comprehensive Medical Services

Federal Detention Center (FDC) SeaTac, WA

Dear Offeror:

This cover letter precedes 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 the

Federal Detention Center located in SeaTac, Washington. Services to be provided include inpatient/outpatient facility and physician services and outpatient institution services. This package contains the following:

Table of Contents (1 pages)

Solicitation (49 Pages)

Attachments (32 Pages)

The package contains a total of 82 pages and has all necessary information for submitting a proposal for evaluation.

When submitting a proposal, 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.

Sealed offers shall be received on or before the deadline of February 21, 2011, at 2:00 p.m. Central Time.

Proposals shall be submitted to the following address:

Teresa Kennon

Field Acquisition Office

U.S. Armed Forces Reserve Complex

346 Marine Forces Drive

Grand Prairie, TX 75051

Mailed or hand-carried proposals must be delivered to the 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 the first floor reception area. PLEASE DO NOT SUBMIT

PROPOSALS TO ANY LOCATION OTHER THAN THE ONE LISTED ABOVE. Proposals received after the deadline will be 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 tkennon@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) 352-4512.

Sincerely, //s//

Teresa Kennon, Contracting Officer

Field Acquisition Office

Enclosure

RFPP06110900001

Table of Contents Section Description

1 Solicitation/Contract Form

2 Commodity or Services Schedule

2.1 Contract Pricing/SDB Participation …………………………………………………………………………………………5

2.2 Performance Work Statement

Contract Clauses A.1 ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions (June 2010)

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) 52.218-0000 Continuing Contract Performance During a Pandemic Influenza or Other National Emergency (May 2008) 2852.223-70 Unsafe Conditions Due to the Presence of Hazardous Material (June 1996) 2852.201-70 Contracting Officer’s Technical Representative (COTR)(Jan 1985) 52.209-8 Updates of Information Regarding Responsibility Matters (DEVIATION) (Oct 2010) …………………………………………………………………………………………………………….21 52.216-18 Ordering (Oct 1995)…………………………………………………………………………………………….. 21 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) 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984) 52.237-7 Indemnification and Medical Liability Insurance (Jan 1997) 52.252-6 Authorized Deviations in Clauses……………………………………………………………………………24 52.212-5 Contract Terms and Conditions Required to Implement Statues or Executive Orders- -Commercial Items (Oct 2010)

4 List of Attachments

4-1 Special Contract Conditions Solicitation Provisions A.2 ADDENDUM TO FAR 52.212-1, Instructions to Offerors - - Commercial Items (Jun 2008)

5.1 Tailoring

5.2 Submission of Proposals

5.3 SUBCONTRACTING CERTIFICATION

52.209-7 Information Regarding Responsibility Matters (Apr 2010) 52.216-1 Type of Contract (Apr 1984) 52.233-2 Service of Protest (Sep 2006)

2852.233-70 Protests Filed Directly with the Department of Justice (Jan 1998) 52.27-103-71 Faith-Based and Community-Based Organization (Aug 2005) 52.212-2 Evaluation - Commercial Items (Jan 1999) 52.212-3 Offeror Representations and Certifications (Oct 2010)

Section 2 – Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Comprehensive Medical Services for the FDC located in SeaTac, WA. See Sections 2-1 Schedule of Items and 2-2 Performance Work Statement

Base Year: Date of Award (DOA) through 12 months from DOA

Comprehensive Medical Services for the FDC located in SeaTac, WA. See Sections 2-1 Schedule of Items and 2-2, Performance Work Statement

Option Year 1: 13 months through 24 months from DOA

Comprehensive Medical Services for the FDC located in SeaTac, WA. See Sections 2-1 Schedule of Items and 2-2 Performance Work Statement

Option Year 2: 25 months through 36 months from DOA

Comprehensive Medical Services for the FDC located in SeaTac, WA. See Sections 2-1 Schedule of Items and 2-2 Performance Work Statement

Option Year 3: 37 months through 48 months from DOA

Comprehensive Medical Services for the FDC located in SeaTac, WA. See Sections 2-1 Schedule of Items and 2-2 Performance Work Statement

Option Year 4: 49 months through 60 months from DOA

1.000000

SV

2-1 CONTRACT PRICING/SDB PARTICIPATION

BLOCK 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.

Offerors are required to submit, as a part of their business proposal, a completed copy of Schedule of Items and Target for

Participation of Small Disadvantaged Business Concerns.

Pricing Methodology

Except for session-priced items, 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 deductibles or copayments. 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 DRG payment (i.e., Operating Federal Rate) established for CBSA 42644, Seattle - Bellevue - Everett, WA. 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 Services 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 2, for Seattle, WA. 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 42644, Seattle - Bellevue - Everett, WA. Offerors may propose a discount from or a premium to the benchmark charges.

Estimated Quantities

Estimated quantities for the base year and all option years 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

Base Year - Date of Award (DOA) through twelve (12) months from DOA

Inpatient Days: Estimated 250 Days

Outpatient Visits: Estimated 500 Visits

Option Year 1 - Thirteen (13) months through twenty-four (24) months from DOA

Option Year 2 - Twenty-five (25) months through thirty-six (36) months from DOA

Option Year 3 - Thirty-seven (37) months through forty-eight (48) months from DOA

Option Year 4 - Forty-nine (49) months through sixty (60) months from DOA

Outpatient Institution Services

Estimated quantities shall remain constant for the base year and all option years. For Medicare-based services, duration of visits is listed for informational purposes only, as contracted rates will be based upon the Medicare allowable per procedure performed. Optometry services shall be paid based upon the provision of defined sessions.

Optometrist Session Duration - 4 Hours

Session Quantity - 24 per contract year (Estimated)

Psychiatrist Visit Duration - 6 Hours (Approximate)

Visit Quantity - 48 per contract year (Estimated)

NOTE: Session - priced items which exceed the established session or are less than a full session shall be prorated to the nearest quarter hour.

Schedule of Items/Target 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.

SCHEDULE OF ITEMS

BASE YEAR

Date of Award (DOA) through 12 months from DOA

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. Other Physicians: -______ Discount or +______ Premium to Medicare Part B

2. Optometrist: $______ Per Session

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

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

OPTION YEAR 1

13 through 24 months from DOA

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

OPTION YEAR 2

25 through 36 months from DOA

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

OPTION YEAR 3

37 through 48 months from DOA

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

OPTION YEAR 4

49 through 60 months from DOA

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

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 Disadvantaged Business Certification and Eligibility.

2-2 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 210,000 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. 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. 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 Federal Detention Center Sea-Tac (hereinafter referred to as FDC) located in SeaTac, Washington, 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 FDC is an administrative facility currently housing male and female inmates.

Care Level Information - Care Level II: -The FDC 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 inmate 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 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.

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 FDC. 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 FDC.

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

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 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 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 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 FDC's approval. Once the QCP is approved by the FDC, 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 FDC'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 FDC, 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.

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 physician services.

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

If the contractor performs on-site specialty clinics at the FDC, the following minimum requirements shall apply. Contract services shall be provided on-site within the Health Services Unit of the FDC. 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 FDC and the contract physician. Scheduling of inmates for on-site clinics shall be performed by the

FDC.

Physicians performing institution-based services shall be licensed to practice medicine in the State of Washington. Physicians performing these services shall apply for clinical privileges at the FDC. 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 FDC shall be at the sole discretion of the FDC.

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

Optometrist

Psychiatrist

In the event it becomes necessary for the Government to cancel a scheduled visit, the FDC 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 FDC

(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 FDC 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 4-1 of this solicitation/contract. All contract physicians and other applicable staff who will enter the FDC to perform services on a recurring basis shall be required to attend a four-hour institution orientation course held at the FDC 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 FDC 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 FDC, 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 FDC 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 FDC, the contractor shall comply with all reasonable requests for additional invoice/medical claim/medical record documentation. All invoice payments shall be made by the FDC and any disagreements regarding the paid amount of any invoice shall be resolved directly with the FDC.

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 FDC, 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.

The contract shall not submit a claim for processing that the contractor knows or has reason to believe contains inaccurate, incomplete, or misleading information. Claims which contain inaccurate, incomplete or misleading information shall be held until such time as all lines are deemed to be accurate and complete by the contractor. At that time, the contractor may proceed with submitting the claim for processing and invoicing the FDC for all services represented by that claim.

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. Within ten calendar days after notification that a third-party medical claims adjudication, service will be utilized by the FDC, 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 #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 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 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 FDC, 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 FDC. 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 #6, 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

FDC.

Invoices for corrected claims shall be clearly marked as such and shall be separate from routine invoices. Invoices or credit memos for corrected claims shall detail information pertaining to the original claim submission (including any amount(s) previously paid and the associated invoice numbers) and shall bill only for the corrected claim submission or reflect the credit amount due for the corrected claim submission.

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. The word “CORRECTED” shall be prominently displayed on the paper 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 FDC. Invoices for corrected claims shall be clearly marked as such and shall be separate from routine invoices. Invoices or credit memos for corrected claims shall detail information pertaining to the original claim submission (including any amount(s) previously paid and the associated invoice numbers) and shall bill only for the corrected claim submission or reflect the credit amount due for the corrected claim submission.

Payment by the FDC. The FDC will pay all invoices directly to the Contractor. If the invoiced amount of a claim exceeds the adjudicated amount of that claim, the FDC will take an administrative deduction from the invoice. The

FDC 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 FDC of the disagreement along with the reasons why the Contractor believes the claim was paid incorrectly. The

FDC 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 FDC, interest on the underpayment will be paid when required by the Prompt Payment Act.

Timeliness of Invoices/Claims

Claims for services shall be submitted/invoiced within 90 calendar days after an inmate’s discharge or outpatient encounter or other service provided under this contract. 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.

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 claims shall bear the new date of submission. Invoiced claims which do not comply with Medicare rules on time limits for filing claims 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 FDC 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 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 FDC in order to enhance inmate recovery as well as continuity of care. At the completion of treatment, the Contractor shall provide the FDC 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 FDC 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 FDC 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 FDC medical staff.

VI. Enhancements to the Basic Contract Requirements

Offerors are encouraged to propose enhancements to the basic contract requirements which will facilitate the FDC'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 FDC's preference to treat inmates within the confines of a secure perimeter whenever possible. Offerings which assist the FDC 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 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. 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 to provide release transportation for the inmate.

Section 3 – Contract Clauses

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text.

Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed

Electronically at this/these address(es): http://www.acquisition.gov/far

Clause Title

52.203-12 Limitation on Payments To Influence Certain Federal Transaction (OCT 2010)

52.204-4 Printed or Copied Double-Sided on Recycled Paper (Aug 2000)

52.204-9 Personal Identity Verification of Contract Personnel (Sept 2007)

52.209-6 Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment (SEPT 2006)

52.212-4 Contract Terms and Conditions - Commercial Items (June 2010)

52.223-5 Pollution Prevention and Right-to-Know Information (Aug 2003)

52.224-1 Privacy Act Notification (Apr 1984)

52.224-2 Privacy Act (Apr 1984)

52.228-5 Insurance – Work on a Government Installation (Jan 1997)

52.232-18 Availability of Funds (Apr 1984)

52.237-2 Protection of Government Buildings, Equipment, and Vegetation (Apr 1984)

52.253-1 Computer Generated Forms (Jan 1991)

A.1 ADDENDUM TO FAR 52.212-4, Contract Terms and Conditions - - Commercial Items (June 2010)

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

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

Compliance with Homeland Security Presidential Directive-12 (HSPD-12) and Federal Information Processing Standard

Publication 201 (FIPS 201) entitled "Personal Identification Verification (PIV) for Federal Employees and Contractors,"

Phase I.1. Long-Term Contractor Personnel:

In order to be compliant with HSPD-12/PIV I, the following investigative requirements must be met for each new long-term contractor employee whose background investigation (BI) process begins on or after October 27, 2005:

a. Contractor Personnel must present two forms of identification in original form prior to badge issuance (acceptable documents are listed in Form I-9, OMB No. 1615-0047, "Employment Eligibility Verification," and at least one document must be a valid State or Federal government-issued picture ID);

b. Contractor Personnel must appear in person at least once before a DOJ official who is responsible for checking the identification documents. This identity proofing must be completed sometime during the clearance process but prior to badge issuance and must be documented by the DOJ official;

c. Contractor Personnel must undergo a BI commensurate with the designated risk level associated with the duties of each position. Outlined below are the minimum BI requirements for each risk level:

High Risk - Background Investigation (5 year scope)

Moderate Risk - Limited Background Investigation (LBI) or Minimum Background Investigation (MBI)

Low Risk - National Agency Check with Inquiries (NACI) investigation

d. The pre-appointment BI waiver requirements for all position sensitivity levels are a:

1) Favorable review of the security questionnaire form;

2) Favorable fingerprint results;

3) Favorable credit report, if required;

4) Waiver request memorandum, including both the Office of Personnel Management schedule date and position sensitivity/risk level; and

5) Favorable review of the National Agency Check (NAC) portion of the applicable BI that is determined by position sensitivity/risk level.

A badge may be issued following approval of the above waiver requirements.

If the NAC is not received within five days of OPM's scheduling date, the badge can be issued based on a favorable review of the Security Questionnaire and the Federal Bureau of Investigation Criminal History Check (i.e., fingerprint check results).

e. Badge re-validation will occur once the investigation is completed and favorably adjudicated.